Cambio Healthcare Solutions wants to look good to the politicians, lower costs at any price. They have given up on revenue enhancement and fixing the broken billing department. They are focusing instead on more cost cutting: squeezing budgets, running off more staff, and not paying bills. Who knew you could run a hospital on IOU’s?
Cambio’s brain trust is going department-by-department chopping fat and waste. Physical therapy lost its wheel chair budget, respiratory therapy its equipment budget (those ventilators are a real excess). We fully expect that they’ll just fire all the discharge planners and replace them with new technology: the hospital ejecto-bed (which will propel patients off the roof and back into the streets of Oakland).
Actually, the consultant’s high-risk management schemes have begun melting down. Cambio Healthcare Solutions thinks unions are icky, so they have replaced many permanent staff with travelers and temps. They outsourced about half the nurses in the emergency department and the critical care areas.
Whenever a highly qualified specialist nurse tries to get hired on at the medical center, their resume gets lost. “You can teach the traveler from Virginia how to give chemotherapy. She has ten years of experience in labor and delivery it can’t be that different.”
So aside from frightening patient care scenarios this passion for outsourcing has now created a financial crisis. You see temp agencies are ruthless negotiators and when they supply a huge percentage of your staff, they can pretty much name their price. That’s just what the agency that supplies one third of the medical center’s respiratory therapists did. The raised the hourly rate from $ 38 to $54 dollars an hour. Oops, there goes your cost savings.
Cambio showed them, they cancelled the contract. Starting Saturday they’re gone, no more travelers. So now they will be paying the regular staff tons of overtime. Actually the department maybe able to run with less respiratory therapists if the ventilators get repossessed, that will really cut the work down.
Any day now, the nursing outsourcers (who provide half of the critical care nurses) will decide to gouge the medical center and raise their rates; this will catapult the medical center back into big debt. Cambio’s betting they can ride on temps, IOUs and service cuts until their contract is up. They run a lean mean healthcare machine and they’re running the medical center right into the ground.
Friday, March 04, 2005
Thursday, March 03, 2005
Measure A Giveaway
The Oakland Tribune is keeping an eye on the cash. The Sups are going to give millions to Saint Rose Hospital to cover the cost of treating the uninsured. Oh, poor private hospital.
Look, I'm all for supporting hospitals who reach out to the poor and the uninsured, but Saint Rose is not known for its soft touch with needy. Hospitals who get these funds should have to demonstrate that they don't discriminate or dump patients.
If an accident victim gets discharged from Saint Rose with an unfixed broken hip, and they still need an orthopedic surgery at Highland, why should our tax dollars go to the hospital that gave the poor patient expensive advice and Vicodin.
I'm guessing there's no strings attached to this public funds giveaway and Saint Rose doesn't plan to use the funds to develop substance abuse program for all the meth addicts who live within commuting distance of their hospital.
Oh, well at least the Tribune's on the job, to read Karen Holzmeister's piece click here:
http://www.insidebayarea.com/searchresults/ci_2592564
Look, I'm all for supporting hospitals who reach out to the poor and the uninsured, but Saint Rose is not known for its soft touch with needy. Hospitals who get these funds should have to demonstrate that they don't discriminate or dump patients.
If an accident victim gets discharged from Saint Rose with an unfixed broken hip, and they still need an orthopedic surgery at Highland, why should our tax dollars go to the hospital that gave the poor patient expensive advice and Vicodin.
I'm guessing there's no strings attached to this public funds giveaway and Saint Rose doesn't plan to use the funds to develop substance abuse program for all the meth addicts who live within commuting distance of their hospital.
Oh, well at least the Tribune's on the job, to read Karen Holzmeister's piece click here:
http://www.insidebayarea.com/searchresults/ci_2592564
Thursday, February 17, 2005
Highland’s Good at Bad
We did it. We passed the inspection with only minimal findings. No one could find the elusive consulting team, Cambio Healthcare Solutions, the only proof we have of their continued existence is the massive revenue drain from their billing and the occasional memo. Still the inspectors actually noticed that private hospitals “dump” into the county system. Shocking, absolutely shocking. Who knew that they even cared, next time they come we’ll give them a list of dumped patients.
See dumping, or as one CEO I knew called it, “referral of underinsured patients to the appropriate public provider” is what keeps profits up and statistics pretty at private hospitals. People think you have to be poor, or a drug user, or perhaps illegal to get dumped, sure basic prejudice and discrimination counts, but the bottom line is really how costly is the disease. Cancer, now that’s an expensive disease and lupus there’s a disease that just keeps on costing. So county hospitals don’t just get the very poor, they get the very sick. When you’re real sick it’s easy to forget those extra forms and payments, and poof, insurance is gone. Bye bye, so long, you get referred to “the appropriate public healthcare provider.”
So who needs a public hospital, the really sick. The cancer business is booming at the medical center, as are all the medical clinics for people with diabetes, high blood pressure, heart disease and kidney disease. Medical center doctors can’t get rid of hard problems; they have no choice but to try to help patients to manage even the most difficult diseases. That’s why many of the best doctors in the Bay Area work at the medical center. They are really good at managing really bad health problems.
See dumping, or as one CEO I knew called it, “referral of underinsured patients to the appropriate public provider” is what keeps profits up and statistics pretty at private hospitals. People think you have to be poor, or a drug user, or perhaps illegal to get dumped, sure basic prejudice and discrimination counts, but the bottom line is really how costly is the disease. Cancer, now that’s an expensive disease and lupus there’s a disease that just keeps on costing. So county hospitals don’t just get the very poor, they get the very sick. When you’re real sick it’s easy to forget those extra forms and payments, and poof, insurance is gone. Bye bye, so long, you get referred to “the appropriate public healthcare provider.”
So who needs a public hospital, the really sick. The cancer business is booming at the medical center, as are all the medical clinics for people with diabetes, high blood pressure, heart disease and kidney disease. Medical center doctors can’t get rid of hard problems; they have no choice but to try to help patients to manage even the most difficult diseases. That’s why many of the best doctors in the Bay Area work at the medical center. They are really good at managing really bad health problems.
Parenting For Politicians
Our meditating, miso-drinking, dog-loving mayor wants to beef up his image. Jerry Brown wants to go back to Sacramento as Attorney General, California’s top cop. Unfortunately the “strong mayor” doesn’t look strong; he looks tired and bored, so he has to take tough stands. Political consultants and the Oakland Tribune have re-invented Jerry as the “Crime Stopper.” As part of the PR push to pump up the Mayor’s image, he rolled out the “curfew” plan for parolees.
Mayor Brown noticed that people come out of our prisons and they aren’t “rehabilitated,” in fact they are very likely to get involved in more trouble. So Jerry decided that the same unsuccessful approach that is being applied within prisons would work in Oakland, take away their freedom. The curfew keeps parolees locked in their homes from 10:00 pm to 6:00 am, it’s sort of a “time out “ “you’re grounded” approach to urban youth and crime.
Oakland has something of a crisis of critical thinking when it comes to politicians. They all want to look tough, so most went along with this bad plan. “ They just have to take some responsibility” that’s the rationale one council staffer gave me. Here’s the problem, most kids in “the system” have little or no family support, they get punished, thrown out, and beaten based on the same rationale, “you have to take some responsibility.” Any thoughtful parent will tell you “ time out” or “ curfew” is for the parents so they can calm down and figure out how to help and guide their child. Punishment in the absence of parenting does not make responsible adults.
Two adolescent boys lived in the neighborhood around my work. They lived in a run down house with their adoptive mother. Their mom died of cancer with little support and the boys struggling to care for her. The home health nurse tried to get some help for the boys but there was none. At about 14 and 15 years old they were left in the house (they didn’t own it because they weren’t officially adopted). They got lost and sad and the house became more and more run down. The kids got sick and hurt and into more and more trouble. They got evicted, the house was boarded up, and the kids had nowhere to go. They wandered the neighborhood, it was the only home they ever had. They were in and out of jail and I suppose they are in prison now. They are nice kids. We completely failed them.
Oakland youth know we’re afraid of them and that we don’t like them. They expect to be locked up, harassed, and treated like criminals, even those who aren’t. We get kids at Highland Hospital all the time who are working hard and “taking responsibility,” they get shot paralyzed, hurt or killed. The Oakland police department doesn’t investigate their cases; they barely take reports. Our kids get crippled and government moves forward as if nothing happened. It breaks their hearts and their spirits to loose so much and be treated so badly.
Stay at home, “you have to take some responsibility”. See if you don’t have adults to teach you what that means its just more punishment, it will fail for the same reasons that the prisons fail. Oakland parents talk about keeping their children alive and out of jail into adulthood. They worry about the crime, and the police. Oakland’s politicians feel safer with our youth locked up or locked in. Careful parents don’t just protect their children; they prepare them to live in the world and to make it a better place. I explain to my children that Mayor Brown and many of the City Council Representatives are racist, stupid and mean, but that most of the people who live in Oakland are not.
Mayor Brown noticed that people come out of our prisons and they aren’t “rehabilitated,” in fact they are very likely to get involved in more trouble. So Jerry decided that the same unsuccessful approach that is being applied within prisons would work in Oakland, take away their freedom. The curfew keeps parolees locked in their homes from 10:00 pm to 6:00 am, it’s sort of a “time out “ “you’re grounded” approach to urban youth and crime.
Oakland has something of a crisis of critical thinking when it comes to politicians. They all want to look tough, so most went along with this bad plan. “ They just have to take some responsibility” that’s the rationale one council staffer gave me. Here’s the problem, most kids in “the system” have little or no family support, they get punished, thrown out, and beaten based on the same rationale, “you have to take some responsibility.” Any thoughtful parent will tell you “ time out” or “ curfew” is for the parents so they can calm down and figure out how to help and guide their child. Punishment in the absence of parenting does not make responsible adults.
Two adolescent boys lived in the neighborhood around my work. They lived in a run down house with their adoptive mother. Their mom died of cancer with little support and the boys struggling to care for her. The home health nurse tried to get some help for the boys but there was none. At about 14 and 15 years old they were left in the house (they didn’t own it because they weren’t officially adopted). They got lost and sad and the house became more and more run down. The kids got sick and hurt and into more and more trouble. They got evicted, the house was boarded up, and the kids had nowhere to go. They wandered the neighborhood, it was the only home they ever had. They were in and out of jail and I suppose they are in prison now. They are nice kids. We completely failed them.
Oakland youth know we’re afraid of them and that we don’t like them. They expect to be locked up, harassed, and treated like criminals, even those who aren’t. We get kids at Highland Hospital all the time who are working hard and “taking responsibility,” they get shot paralyzed, hurt or killed. The Oakland police department doesn’t investigate their cases; they barely take reports. Our kids get crippled and government moves forward as if nothing happened. It breaks their hearts and their spirits to loose so much and be treated so badly.
Stay at home, “you have to take some responsibility”. See if you don’t have adults to teach you what that means its just more punishment, it will fail for the same reasons that the prisons fail. Oakland parents talk about keeping their children alive and out of jail into adulthood. They worry about the crime, and the police. Oakland’s politicians feel safer with our youth locked up or locked in. Careful parents don’t just protect their children; they prepare them to live in the world and to make it a better place. I explain to my children that Mayor Brown and many of the City Council Representatives are racist, stupid and mean, but that most of the people who live in Oakland are not.
Monday, February 07, 2005
Preparing for Failure, Fighting for Survival
The nurse crouches over to examine the bleeding patient in the crowded emergency room. The loudspeaker cracks, and an authoritative and threatening voice comes on, “all nurses who have not completed their charting will be hunted down.” A bead of sweat forms on the nurse’s head and the patient says, “Gee that’s sounds draconian.”
For those new to the Dirt, in good financial times county supervisors leave the public hospital alone, neglect has been the prevalent approach of the county supervisors to the medical center. In tougher financial times the supervisors consistently “bad mouth” the institution, berating it for providing expensive medical services to the indigent and failing to reap a profit (this is the mission of the hospital and the legal responsibility of the county).
So when the most recent financial crunch hit, the sups supported a tax to provide financial support for the hospital (Measure A) and when the tax passed they developed a pay back plan, so the hospital, could actually give money back to the county. Now no competent hospital management team would sign off on this plan so the politicians hired, consultants, Cambio Healthcare Solutions. They have managed to run off and retired many skilled employees, they upgraded executive titles and salaries and they have gotten the hospital in deep doo doo with ”regulatory bodies.”
Anyone who works in healthcare knows the fear and dread that inspections from regulatory bodies inspire. So how does a high-end top draw consulting giant like Cambio Healthcare Solutions approach the impending invasion of inspectors? Well consultants don’t make their money in smooth running well-oiled healthcare delivery machines, chaos and crisis is what drives their business. A well-planned failure, now that would necessitate more consultants, there would be cost cuts, blame to assign, reports to write and layoffs to implement. It’s a consultant’s wet dream.
A strategic belly flop, well Cambio laid the groundwork over the last year by running off nursing staff and replacing them with temps and travelers. Many of the nurses who will be attempting to comply with Medicare and Medi-Cal regulations are visiting from Canada. They don’t even have Medicare in Cananda, in Canada nurses treat patients not the medical chart.
Managers keep introducing more and more new forms to nurses who have more and more patients. Nurses can’t fill out the tons new forms, which have been introduced in the last two weeks if they don’t have nursing assistants to help them with patient care. While nurses get crushed under unbearable patients loads, hoards of managers run around auditing charts and threatening nurses.
The terms “patients” or “quality care” have not come up in the numerous mandatory meetings, which mangers attend in preparation for the coming inspection. Why last week a hoard of mangers was seen slaving feverously over the chart of a patient who had died weeks before. It is the strong sentiment of many Highland clinicians that quality documentation is most effectively achieved through quality patient care and that sane staffing would allow them to better achieve both.
One caregiver said trying to provide quality care and appropriate documentation in the current atmosphere of hysteria and blame was like trying to fry an egg in the back of Winnebago heading down Highway One with a drunk at the wheel. While Cambio Healthcare Solutions does all they can to fail the upcoming inspection, medical center employees have risen to the challenge, they plan to beat the odds and pass.
For those new to the Dirt, in good financial times county supervisors leave the public hospital alone, neglect has been the prevalent approach of the county supervisors to the medical center. In tougher financial times the supervisors consistently “bad mouth” the institution, berating it for providing expensive medical services to the indigent and failing to reap a profit (this is the mission of the hospital and the legal responsibility of the county).
So when the most recent financial crunch hit, the sups supported a tax to provide financial support for the hospital (Measure A) and when the tax passed they developed a pay back plan, so the hospital, could actually give money back to the county. Now no competent hospital management team would sign off on this plan so the politicians hired, consultants, Cambio Healthcare Solutions. They have managed to run off and retired many skilled employees, they upgraded executive titles and salaries and they have gotten the hospital in deep doo doo with ”regulatory bodies.”
Anyone who works in healthcare knows the fear and dread that inspections from regulatory bodies inspire. So how does a high-end top draw consulting giant like Cambio Healthcare Solutions approach the impending invasion of inspectors? Well consultants don’t make their money in smooth running well-oiled healthcare delivery machines, chaos and crisis is what drives their business. A well-planned failure, now that would necessitate more consultants, there would be cost cuts, blame to assign, reports to write and layoffs to implement. It’s a consultant’s wet dream.
A strategic belly flop, well Cambio laid the groundwork over the last year by running off nursing staff and replacing them with temps and travelers. Many of the nurses who will be attempting to comply with Medicare and Medi-Cal regulations are visiting from Canada. They don’t even have Medicare in Cananda, in Canada nurses treat patients not the medical chart.
Managers keep introducing more and more new forms to nurses who have more and more patients. Nurses can’t fill out the tons new forms, which have been introduced in the last two weeks if they don’t have nursing assistants to help them with patient care. While nurses get crushed under unbearable patients loads, hoards of managers run around auditing charts and threatening nurses.
The terms “patients” or “quality care” have not come up in the numerous mandatory meetings, which mangers attend in preparation for the coming inspection. Why last week a hoard of mangers was seen slaving feverously over the chart of a patient who had died weeks before. It is the strong sentiment of many Highland clinicians that quality documentation is most effectively achieved through quality patient care and that sane staffing would allow them to better achieve both.
One caregiver said trying to provide quality care and appropriate documentation in the current atmosphere of hysteria and blame was like trying to fry an egg in the back of Winnebago heading down Highway One with a drunk at the wheel. While Cambio Healthcare Solutions does all they can to fail the upcoming inspection, medical center employees have risen to the challenge, they plan to beat the odds and pass.
Oaklandrising.com
Oakland lacks a newspaper interested in real investigative journalism, this crisis of critical thinking has resulted in little or no public discussion of issues. The absence of any scrutiny has resulted in a bumper crop of incompetent, unethical, inept and absent politicians. Flagrant mismanagement of public institutions and resources has become the norm; the Alameda County Medical Center is well managed compared to the Peralta College System or the Oakland Schools.
The decay of integrity and the basic competence of elected officials in Oakland has started to attract some very talented reporters to Oakland. They see career making scandals. My current favorites are: Douglas Allan Taylor, the Berkeley Daily Planet, Chris Thompson, Will Harper and Kara Platoni all of whom write for the East Bay Express.
Douglas Allan Taylor is an Oaklander, a parent and the most thoughtful and intelligent voice we have right now. His most recent piece is posted in http:www.Oaklandrising.com
The decay of integrity and the basic competence of elected officials in Oakland has started to attract some very talented reporters to Oakland. They see career making scandals. My current favorites are: Douglas Allan Taylor, the Berkeley Daily Planet, Chris Thompson, Will Harper and Kara Platoni all of whom write for the East Bay Express.
Douglas Allan Taylor is an Oaklander, a parent and the most thoughtful and intelligent voice we have right now. His most recent piece is posted in http:www.Oaklandrising.com
Tuesday, January 25, 2005
Slumber Party At Mayor Brown’s Pad
Well, mayor Brown plans to pair up with Tom Orloff (the DA who couldn’t convict the crooked cops) to attack parolee’s civil liberties. The dynamic duo, the absent and the incompetent will work together to implement the ill advised (a mandatory bedtime for parolees: a 10:00 pm curfew). You see Jerry really wants to look tough on crime, he’s running for Attorney General, so he’s trying to beef up his image. He’ll be long gone when the American Civil Liberties Union starts suing the Oakland into oblivion over this curfew business.
Besides, Jerry’s a big idea man; he can’t be bothered with testy details. So what if parolees become homeless, it happens all the time, do they just have to report to a designated freeway overpass or parking lot; or are they in violation of their parole? Is homelessness now an automatic parole violation? Is this “curfew” just a tool to send hundreds of homeless parolees to prison?
What about those parolees that don’t come from stable loving homes, a cold hard truth? Say junior comes home and mom’s locked him out, do junior and mom go to jail? Let’s say little miss gets put on curfew, and someone in the stable home attacks her at 11:15 pm. Can she sue the city and county for forcing her to stay in an unsafe environment? Here’s one Jerry should know something about, say a dude with a history of disputes with his female partners, gets into an altercation one late night with his wife in their home. The attacker then uses the “curfew defense” insisting that had he not been on curfew, he would have done what they taught him in anger management and left the environment.
So do I oppose the “curfew” approach to curbing crime? No, the idea is not without merit it just needs some modification to reflect the realities of life in Oakland. You see the curfew only works if we can guarantee a safe and stable home environment for parolees. I think this is just the job for Jerry; he can bring all the parolees over to his loft for slumber parties, anger management groups and seminars on animal rights and leash laws. Jerry can start “We the Parolees” and take, real hands-on approach to fighting crime.
Besides, Jerry’s a big idea man; he can’t be bothered with testy details. So what if parolees become homeless, it happens all the time, do they just have to report to a designated freeway overpass or parking lot; or are they in violation of their parole? Is homelessness now an automatic parole violation? Is this “curfew” just a tool to send hundreds of homeless parolees to prison?
What about those parolees that don’t come from stable loving homes, a cold hard truth? Say junior comes home and mom’s locked him out, do junior and mom go to jail? Let’s say little miss gets put on curfew, and someone in the stable home attacks her at 11:15 pm. Can she sue the city and county for forcing her to stay in an unsafe environment? Here’s one Jerry should know something about, say a dude with a history of disputes with his female partners, gets into an altercation one late night with his wife in their home. The attacker then uses the “curfew defense” insisting that had he not been on curfew, he would have done what they taught him in anger management and left the environment.
So do I oppose the “curfew” approach to curbing crime? No, the idea is not without merit it just needs some modification to reflect the realities of life in Oakland. You see the curfew only works if we can guarantee a safe and stable home environment for parolees. I think this is just the job for Jerry; he can bring all the parolees over to his loft for slumber parties, anger management groups and seminars on animal rights and leash laws. Jerry can start “We the Parolees” and take, real hands-on approach to fighting crime.
Vote Health Letter to Hospital Authority
The Medical Center needs a permanent, experienced public hospital management team to establish a strategic vision for ACMC and to lead its restructuring effort. Cambio's part-time management team has not and cannot fulfill this role because they have no long term commitment to the success of the institution or to county residents who depend on ACMC for its life-saving services.
We are concerned that the Board of Trustees did not begin its search for a permanent CEO last year. Now that you contracted with Russell Reynolds Associates, we ask your board to:
· Expedite its efforts to hire a permanent CEO, and
· Allow the new CEO to hire the executive team of COO, CFO and HR Director.
We also ask that the Board of Trustees conduct a performance evaluation of Cambio and its management team, and make this review public. One year into Cambio's tenure at the Medical Center, the Trustees have yet to hold Cambio accountable for delivering on its promises. Some of these failures are reflected in the most recent financial report:
1. Registry use "hit new highs" of $1.7 million in December, and runs $2 million
over budget in just six months, a 30% variance;
2. Discharged Not Final Billed has risen for the past three months;
3. Medi-Cal is under-budget by over $12.5 million, while CMSP is over-budget by
$3 million;
4. Despite an investment of $300,000 into a "marketing campaign,"
obstetrical deliveries continue to decline.
We believe the quality of care at ACMC has suffered under Cambio’s leadership. The most egregious example of Cambio’s failures involves ACMC’s growing reliance on temporary nurses. The situation is particularly dangerous at John George, and in Highland's ER, ICU and TCU. Cambio's team of consultants and managers has only exacerbated a difficult situation. According to the HR Department, there were 117 RN vacancies in November, but ACMC conducted only five interviews that month. The Medical Center hired five RNs, but eight quit. In a letter to the Trustee's HR Committee, SEIU Local 616 wrote that Cambio has failed to act on its own recommendations regarding nurse recruitment and retention, contained in its May, 2004 Nursing Assessment.
The Medical Center's staff and patients, and county residents who fund this institution deserve better. Vote Health has confidence that you will act expeditiously to hire a permanent CEO and to hold Cambio accountable for its performance.
Sincerely yours,
Kay Eisenhower
Kay Eisenhower, Chair
Vote Health http://www.votehealth.net
We are concerned that the Board of Trustees did not begin its search for a permanent CEO last year. Now that you contracted with Russell Reynolds Associates, we ask your board to:
· Expedite its efforts to hire a permanent CEO, and
· Allow the new CEO to hire the executive team of COO, CFO and HR Director.
We also ask that the Board of Trustees conduct a performance evaluation of Cambio and its management team, and make this review public. One year into Cambio's tenure at the Medical Center, the Trustees have yet to hold Cambio accountable for delivering on its promises. Some of these failures are reflected in the most recent financial report:
1. Registry use "hit new highs" of $1.7 million in December, and runs $2 million
over budget in just six months, a 30% variance;
2. Discharged Not Final Billed has risen for the past three months;
3. Medi-Cal is under-budget by over $12.5 million, while CMSP is over-budget by
$3 million;
4. Despite an investment of $300,000 into a "marketing campaign,"
obstetrical deliveries continue to decline.
We believe the quality of care at ACMC has suffered under Cambio’s leadership. The most egregious example of Cambio’s failures involves ACMC’s growing reliance on temporary nurses. The situation is particularly dangerous at John George, and in Highland's ER, ICU and TCU. Cambio's team of consultants and managers has only exacerbated a difficult situation. According to the HR Department, there were 117 RN vacancies in November, but ACMC conducted only five interviews that month. The Medical Center hired five RNs, but eight quit. In a letter to the Trustee's HR Committee, SEIU Local 616 wrote that Cambio has failed to act on its own recommendations regarding nurse recruitment and retention, contained in its May, 2004 Nursing Assessment.
The Medical Center's staff and patients, and county residents who fund this institution deserve better. Vote Health has confidence that you will act expeditiously to hire a permanent CEO and to hold Cambio accountable for its performance.
Sincerely yours,
Kay Eisenhower
Kay Eisenhower, Chair
Vote Health http://www.votehealth.net
Wednesday, January 19, 2005
Harm Reduction or in Plain English Damage Control
Bare with me folks I’m running on empty. My daughter, Emma (imagine a three-year-old 40 pound Afropolurican with very good lungs) has made a serious attempt on her parent’s lives. She’s waking up three to four times a night screaming, usually with a fashion request like “I need my party shoes.”
So damage control or Harm Reduction is first and foremost in my cloudy mind. The thing about public hospitals is that they’re public. Only sound county policies can fix the medical center, fix Oakland and fix people. That’s the job, the endgame, and the bottom line. That’s where the solutions start, with sick people. Our experts look at budgets, at billing, at politicians, at contracts and studies. No one has spoken to the patients and they especially haven’t talked to the “problem patients” or “frequent flyers.”
You ask any ten homeless people in Oakland what they need, they’ll usually tell you two things: first they will tell you how sick they feel and second they will tell you they are trying to get Disability. By this they mean Social Security Income and Medi-Cal the health benefit that comes with it. You see in Alameda County we have bureaucracies on top of bureaucracies all not managing the poor and sick’s basic problems: healthcare coverage and disability benefits.
Alameda County non-profits, public services, community clinics and private healthcare providers all compete for funding. It’s every agency for itself; they don’t cooperate to get poor disabled people benefits. The very sick and poor (hence very expensive clients) just get bounced around between agencies. County agencies don’t coordinate care and advocate for patients, they compete for Dave Kears’ favor by cutting costs and position themselves for funding. In fact the prison system spends its time knocking people off benefits and then dropping them back into Oakland without a job, an income or a healthcare benefit.
It’s hard to get over that terminal cancer when you have to stand on the corner and sell the Street Sheet Newspaper to get money for yourself and your two young children. Sure you’re dying and certainly you deserve the social security income you paid into for twenty years but in Alameda County we preach the "personal responsibility approach" to getting disability benefits. Yeah, drag your sick self down to the Social Security office and fill out the forms, than fight with all the public agencies that have your medical records to try to make them give them to Social Security. In the mean time live on the street and “hey, if it doesn’t work, it’s not our fault, you have to take some responsibility.“
The good people at The Positive Resource Center, in San Francisco, keep the data on these things and it turns out 90% of claims submitted without an advocate get denied and 30% submitted with an advocate get denied. So clearly the personal responsibility policy is based more on prejudice than on data. See, many people who use county services use drugs, or did use drugs, or have been to prison or have mental illness and the county doesn’t really want to help them. Sure we have a few non-profits, who help the super-sick or special groups, but we have no coordinated plan and worse, we lack a philosophy of compassion and service, and the political leadership to address the problems of our most needy.
So in my little neighborhood in Oakland, the Dimond, we have five to ten people with all sorts of mental and physical illnesses living in parking lots and on the street. We have a clearly schizophrenic woman in urine-soaked clothes, who is sometimes too frightened to stand in line for food. We have a serial defecator who deposits little surprises in shopkeepers doorways, we have a woman with an amputation, and an assortment of men with physical, mental health and substance abuse problems. A local business owner called the county, concerned about the health and welfare of these obvious mentally or physically ill people and was told call the Oakland Police Department.
So, Harm Reduction, it’s a global philosophical approach to dealing with public health problems. It’s a pragmatic approach to substance abuse and high-risk behaviors. The idea is limit the damage. If the public health problem is AIDS, focus on stopping the spread of AIDS; not stopping sex (sex is fun and cheap and therefore very hard to stop). Try to prevent violence, instead of only investing in punishment. It’s a more pragmatic and less Puritanical approach to public health. Besides sticking drug offenders in jail has done little or nothing to slow public health problems.
So as a practical matter what does this mean. Well, in San Francisco, that great city by the Bay. It means all county agencies or agencies funded by the county must work together to get the social security benefits for eligible clients. They can’t dump them on other agencies or send clients chasing down bureaucratic black holes. That’s right, San Francisco plans to put in place performance measures and standards, they’re not just addressing the problem they’re managing the solution. This means merchants, neighbors and police don’t have to watch sick people suffering on their streets, and it means state and federal funds are used to pay for health and income benefits, this saves the county money and keeps public services like hospitals financially viable.
Postscript: Any advice on how to keep Emma "Slave-to-Fashion" Fisher off the catwalk in the wee hours of the night would be deeply appreciated.
So damage control or Harm Reduction is first and foremost in my cloudy mind. The thing about public hospitals is that they’re public. Only sound county policies can fix the medical center, fix Oakland and fix people. That’s the job, the endgame, and the bottom line. That’s where the solutions start, with sick people. Our experts look at budgets, at billing, at politicians, at contracts and studies. No one has spoken to the patients and they especially haven’t talked to the “problem patients” or “frequent flyers.”
You ask any ten homeless people in Oakland what they need, they’ll usually tell you two things: first they will tell you how sick they feel and second they will tell you they are trying to get Disability. By this they mean Social Security Income and Medi-Cal the health benefit that comes with it. You see in Alameda County we have bureaucracies on top of bureaucracies all not managing the poor and sick’s basic problems: healthcare coverage and disability benefits.
Alameda County non-profits, public services, community clinics and private healthcare providers all compete for funding. It’s every agency for itself; they don’t cooperate to get poor disabled people benefits. The very sick and poor (hence very expensive clients) just get bounced around between agencies. County agencies don’t coordinate care and advocate for patients, they compete for Dave Kears’ favor by cutting costs and position themselves for funding. In fact the prison system spends its time knocking people off benefits and then dropping them back into Oakland without a job, an income or a healthcare benefit.
It’s hard to get over that terminal cancer when you have to stand on the corner and sell the Street Sheet Newspaper to get money for yourself and your two young children. Sure you’re dying and certainly you deserve the social security income you paid into for twenty years but in Alameda County we preach the "personal responsibility approach" to getting disability benefits. Yeah, drag your sick self down to the Social Security office and fill out the forms, than fight with all the public agencies that have your medical records to try to make them give them to Social Security. In the mean time live on the street and “hey, if it doesn’t work, it’s not our fault, you have to take some responsibility.“
The good people at The Positive Resource Center, in San Francisco, keep the data on these things and it turns out 90% of claims submitted without an advocate get denied and 30% submitted with an advocate get denied. So clearly the personal responsibility policy is based more on prejudice than on data. See, many people who use county services use drugs, or did use drugs, or have been to prison or have mental illness and the county doesn’t really want to help them. Sure we have a few non-profits, who help the super-sick or special groups, but we have no coordinated plan and worse, we lack a philosophy of compassion and service, and the political leadership to address the problems of our most needy.
So in my little neighborhood in Oakland, the Dimond, we have five to ten people with all sorts of mental and physical illnesses living in parking lots and on the street. We have a clearly schizophrenic woman in urine-soaked clothes, who is sometimes too frightened to stand in line for food. We have a serial defecator who deposits little surprises in shopkeepers doorways, we have a woman with an amputation, and an assortment of men with physical, mental health and substance abuse problems. A local business owner called the county, concerned about the health and welfare of these obvious mentally or physically ill people and was told call the Oakland Police Department.
So, Harm Reduction, it’s a global philosophical approach to dealing with public health problems. It’s a pragmatic approach to substance abuse and high-risk behaviors. The idea is limit the damage. If the public health problem is AIDS, focus on stopping the spread of AIDS; not stopping sex (sex is fun and cheap and therefore very hard to stop). Try to prevent violence, instead of only investing in punishment. It’s a more pragmatic and less Puritanical approach to public health. Besides sticking drug offenders in jail has done little or nothing to slow public health problems.
So as a practical matter what does this mean. Well, in San Francisco, that great city by the Bay. It means all county agencies or agencies funded by the county must work together to get the social security benefits for eligible clients. They can’t dump them on other agencies or send clients chasing down bureaucratic black holes. That’s right, San Francisco plans to put in place performance measures and standards, they’re not just addressing the problem they’re managing the solution. This means merchants, neighbors and police don’t have to watch sick people suffering on their streets, and it means state and federal funds are used to pay for health and income benefits, this saves the county money and keeps public services like hospitals financially viable.
Postscript: Any advice on how to keep Emma "Slave-to-Fashion" Fisher off the catwalk in the wee hours of the night would be deeply appreciated.
My Favorite Non-Profit
The Positive Resource Center in San Francisco is a model of how powerful a non-profit can be. They do benefits and employment advocacy: they are thinkers, teachers, advocates and wonderful people. They fight to get benefits for the most underserved and deserving clients, and they share their expertise through classes and trainings. I learned most of what I know about benefits through their trainings.Their exceptional work makes the world a better place.
Check them out or just send them a check:
http://www.positiveresource.org/
Check them out or just send them a check:
http://www.positiveresource.org/
Go San Francisco!
San Francisco Department of Public Health Philosophy
Social Security Income benefits help disabled clients achieve their therapeutic goals by improving access to healthcare and by giving them the financial means to stabilize their living situation and better meet their nutritional needs
Department of Public Health Goal
Department of Public Health clients should be screened for Social Security Income eligibility. All clients deemed eligible for Social Security Income benefits will be assisted through the application process.
Excerpted from Positive Resource Training Materials 2004
Social Security Income benefits help disabled clients achieve their therapeutic goals by improving access to healthcare and by giving them the financial means to stabilize their living situation and better meet their nutritional needs
Department of Public Health Goal
Department of Public Health clients should be screened for Social Security Income eligibility. All clients deemed eligible for Social Security Income benefits will be assisted through the application process.
Excerpted from Positive Resource Training Materials 2004
Tuesday, January 04, 2005
So, You Wanna to Be Highland’s CEO
The new smash hit reality TV series brought to you by the same fun loving politicos who brought you the Raiders and the Alameda county football tax.
It’s sort of a cross between ER and In Living Color. The medical center has had over 10 CEO’s in the last 12 years and while most have done little or nothing to improve or maintain healthcare services in Alameda County this crew of villains, rogues, ne’er do wells and actually a few good people are an untapped geyser of entertainment value.
So the search is on, all applicants for the newly posted position of CEO of the medical center position will be asked to participate. Ken Cohen the best CEO the medical center has had will host the show (the county supervisors got rid of Ken because of his excess of competence and real aptitude for the job.)
All contestants will begin their journey to greatness on BART or AC transit, while you can get to a football game in reasonable time using public transit from most places in Oakland, it can take hours to get to the county hospital. Contestants are advised to start early and get a transfer.
Once at Highland, contestants (dressed in clothes donated by patients) will approach the ER triage desk with complaints of nausea, pain, long-term substance abuse, and paranoid ideation. Successful candidates will be admitted to the hospital and bonus points will be given to any candidates who get transferred to the locked psychiatric facility at John George.
Once admitted to the hospital all contestants will be required to eat only the diet prescribed by their doctor and provided by nutritional services. After completing the mandatory two-day stay at Hotel Highland, successful applicants will receive coaching and legal advice from previous CEO’s.
Mike Wall will be the show’s official golf coach. Ophelia Long will speak on the Grand Jury and how an indictment does not have to end your career in Alameda County. Mike Smart will speak on the art and science of mumbling and on the importance of a close friendship with Dave Kears. Dave Kears will discuss how to write legislation to specifically exclude oneself from conflict of interest accountability. Ken Cohen, Paul Hayes, and Dr. Mittelberger, the medical center’s most competent past leaders will discuss current problems, past failures, political pitfalls and bear traps. Efton Hall will give a very short speech on how to outsource your own job. Mike Burroughs and Susan Crutchfield will discuss the joys of consulting, traveling first class and how to choose a Hilton.
Survivors will come to the Highland Auditorium for a Jeopardy style QA (on issues of medical management and local politics) Ken Cohen will host.
Sample Questions
1. The neck bone is connected to the?
2. OK, here’s a tough one, which county supervisor owned blighted property within blocks of Highland Hospital?
3. What was the name of the county supervisor who would snore audibly or read the newspaper, while matters concerning the medical center were discussed?
The winner will be selected based on his overall score, the swimsuit and talent competition and audience applause.
All proceeds from, “So, you wanna be Highland’s CEO” will be donated to the Highland Foundation earmarked for actual healthcare (durable equipment, caregiver salaries and medications); none of the proceeds will be re-invested in PR, BS or consultants.
Answers to sample question: 1. Head bone 2. Supervisor Gail Steele 3. Supervisor Mary King
It’s sort of a cross between ER and In Living Color. The medical center has had over 10 CEO’s in the last 12 years and while most have done little or nothing to improve or maintain healthcare services in Alameda County this crew of villains, rogues, ne’er do wells and actually a few good people are an untapped geyser of entertainment value.
So the search is on, all applicants for the newly posted position of CEO of the medical center position will be asked to participate. Ken Cohen the best CEO the medical center has had will host the show (the county supervisors got rid of Ken because of his excess of competence and real aptitude for the job.)
All contestants will begin their journey to greatness on BART or AC transit, while you can get to a football game in reasonable time using public transit from most places in Oakland, it can take hours to get to the county hospital. Contestants are advised to start early and get a transfer.
Once at Highland, contestants (dressed in clothes donated by patients) will approach the ER triage desk with complaints of nausea, pain, long-term substance abuse, and paranoid ideation. Successful candidates will be admitted to the hospital and bonus points will be given to any candidates who get transferred to the locked psychiatric facility at John George.
Once admitted to the hospital all contestants will be required to eat only the diet prescribed by their doctor and provided by nutritional services. After completing the mandatory two-day stay at Hotel Highland, successful applicants will receive coaching and legal advice from previous CEO’s.
Mike Wall will be the show’s official golf coach. Ophelia Long will speak on the Grand Jury and how an indictment does not have to end your career in Alameda County. Mike Smart will speak on the art and science of mumbling and on the importance of a close friendship with Dave Kears. Dave Kears will discuss how to write legislation to specifically exclude oneself from conflict of interest accountability. Ken Cohen, Paul Hayes, and Dr. Mittelberger, the medical center’s most competent past leaders will discuss current problems, past failures, political pitfalls and bear traps. Efton Hall will give a very short speech on how to outsource your own job. Mike Burroughs and Susan Crutchfield will discuss the joys of consulting, traveling first class and how to choose a Hilton.
Survivors will come to the Highland Auditorium for a Jeopardy style QA (on issues of medical management and local politics) Ken Cohen will host.
Sample Questions
1. The neck bone is connected to the?
2. OK, here’s a tough one, which county supervisor owned blighted property within blocks of Highland Hospital?
3. What was the name of the county supervisor who would snore audibly or read the newspaper, while matters concerning the medical center were discussed?
The winner will be selected based on his overall score, the swimsuit and talent competition and audience applause.
All proceeds from, “So, you wanna be Highland’s CEO” will be donated to the Highland Foundation earmarked for actual healthcare (durable equipment, caregiver salaries and medications); none of the proceeds will be re-invested in PR, BS or consultants.
Answers to sample question: 1. Head bone 2. Supervisor Gail Steele 3. Supervisor Mary King
The Medi-Cal Massacre
Well, the Governator is going to kick some disabled behinds; he’s going to blow the sick and infirm right off their benefits. Political insiders say Arnold’s super budget is super mean. It attacks Health and Human Services and Medi-Cal with a fevered frenzy.
Arnold, Arnold, Arnold, you’re off script, out of character, your characters were always violent, but ultimately kind hearted and humanistic. Conan didn’t run around taking blood pressure medications away from old ladies. The terminator would never rob from the sick and give to the prisons. What has happened? You’re supposed to be the good guy.
To get all the gory details from the good people who follow these things, at Health Access, click here:
http://www.health-access.org/blogger.html
Arnold, Arnold, Arnold, you’re off script, out of character, your characters were always violent, but ultimately kind hearted and humanistic. Conan didn’t run around taking blood pressure medications away from old ladies. The terminator would never rob from the sick and give to the prisons. What has happened? You’re supposed to be the good guy.
To get all the gory details from the good people who follow these things, at Health Access, click here:
http://www.health-access.org/blogger.html
Monday, December 20, 2004
Angels in Oakland
Bureaucrats love numbers and the end of the year calls for the final count. So here’s some numbers for you 86, 109, 108, 84 and 80. Murders in Oakland for the last five years friends, children, husbands, wives and grandparents lost. Oakland actually has a neighborhood called “ghost town” of course city hall doesn’t recognize the name, it's bad PR. Oakland has become a city of ghosts, of angels and people whose lives have been forever changed by violence.
Our democratic machine has approached its people and their strife from a position of fear and ignorance. Liberal democrats wring their hands, “Why don’t the youth vote?” “Why are they so angry?” “What is wrong with them?” Then they vote for more prisons and close schools. I meet Oakland youth everyday who have personal experience with violence. They have ideas opinions and a very thoughtful perspective of the world and their place in it. They don’t vote or trust politicians because politicians have done nothing to win their respect or trust. They want to be heard, to be taught and to be loved and we do little or nothing to meet their simple needs.
Poor neighborhoods can’t get a beat cop in Oakland, but affluent enclaves like Montclair get two. Mayor Brown having done little or nothing for Oakland youth now plans to exploit their suffering to promote his own political career. Having played politics with our schools and our police services, leaving both much worse than he found them, Brown, a ruthless pollster, plans to run against crime and inner city youth for state attorney general. He will appeal to fear and a tired white liberal base, who remembers him as a governor, back when he cared and came to work.
Mayor what’s his name can’t help Oakland, leadership and hope in Oakland won’t come from has been politicians; it will come from our children. RIP, Rest in Peace, our children understand death and in a funny way life better than most forty year olds. These kids know the world in a hard dark way and face it with courage and hope. They love and remember lost friends, the people our politicians are so determined to forget. They know that to our leaders they are just troubling statistics, “ urban youth problems” not people. I had one young girl tell me, “ I feel like garbage, something that someone has thrown away and forgotten.”
Local democrats need to stop sucking up to developers, stop building ballparks and ice rinks, put down their spread sheets, walk out of their focus groups and go and meet our children. Every week these young people come through Highland Hospital their lives lost or forever changed by violence, not once in twelve years have I seen a politician come to talk to these kids or their families.
You can’t solve problems you don’t understand. Oakland’s political machine doesn’t care about our youth and our youth know it. We just voted money for violence prevention, let's see those politicians walk into the neighborhoods, the prisons and the hospitals, talk to our children then bring them back to city hall. Urban youth problems cannot be solved without buy in from urban youth. If you want to change the culture you have to understand it. RIP doesn’t just mean "Rest in Peace", it means Rich in Potential and if democrats continue to ignore these children, Rise in Protest.
Our democratic machine has approached its people and their strife from a position of fear and ignorance. Liberal democrats wring their hands, “Why don’t the youth vote?” “Why are they so angry?” “What is wrong with them?” Then they vote for more prisons and close schools. I meet Oakland youth everyday who have personal experience with violence. They have ideas opinions and a very thoughtful perspective of the world and their place in it. They don’t vote or trust politicians because politicians have done nothing to win their respect or trust. They want to be heard, to be taught and to be loved and we do little or nothing to meet their simple needs.
Poor neighborhoods can’t get a beat cop in Oakland, but affluent enclaves like Montclair get two. Mayor Brown having done little or nothing for Oakland youth now plans to exploit their suffering to promote his own political career. Having played politics with our schools and our police services, leaving both much worse than he found them, Brown, a ruthless pollster, plans to run against crime and inner city youth for state attorney general. He will appeal to fear and a tired white liberal base, who remembers him as a governor, back when he cared and came to work.
Mayor what’s his name can’t help Oakland, leadership and hope in Oakland won’t come from has been politicians; it will come from our children. RIP, Rest in Peace, our children understand death and in a funny way life better than most forty year olds. These kids know the world in a hard dark way and face it with courage and hope. They love and remember lost friends, the people our politicians are so determined to forget. They know that to our leaders they are just troubling statistics, “ urban youth problems” not people. I had one young girl tell me, “ I feel like garbage, something that someone has thrown away and forgotten.”
Local democrats need to stop sucking up to developers, stop building ballparks and ice rinks, put down their spread sheets, walk out of their focus groups and go and meet our children. Every week these young people come through Highland Hospital their lives lost or forever changed by violence, not once in twelve years have I seen a politician come to talk to these kids or their families.
You can’t solve problems you don’t understand. Oakland’s political machine doesn’t care about our youth and our youth know it. We just voted money for violence prevention, let's see those politicians walk into the neighborhoods, the prisons and the hospitals, talk to our children then bring them back to city hall. Urban youth problems cannot be solved without buy in from urban youth. If you want to change the culture you have to understand it. RIP doesn’t just mean "Rest in Peace", it means Rich in Potential and if democrats continue to ignore these children, Rise in Protest.
Dirtistics
Well, the Dirt’s a data driven blog so here are the numbers. I don’t want anyone saying I don’t know how to crunch a number or spread a sheet. Hits year to date 9,766. Average daily unique hits 24. Biggest day 129. Biggest fans consultants, they hit often and hard from Hiltons, hospitals and financial institutions all over the county. Dean Whitter, Deloitte and Touche read the Dirt; these hits definitely don’t come from my relatives, we don’t have any money to manage. Hospitals dig the Dirt: Kaiser, Children’s, UCSF, Highland, and more. Politicians read the Dirt: Alameda County, City and County of San Francisco, the City of Oakland and the California Assembly read the Dirt. Reporters read the blog and patients love the Dirt. Universities, unions and other hapless hospitals workers, under siege by consultants, all dig the Dirt.
The Dirt has more than 300 subscribers and has sent out close to 7,000 emails. An average of 47% of the emails sent are opened and an average of 32% of the readers click through to the blog. People even Google the Dirt “that dirty thang,” “the daily poop” or “low budget blog.” The Dirt gets lots of reads but no respect.
The Dirt has more than 300 subscribers and has sent out close to 7,000 emails. An average of 47% of the emails sent are opened and an average of 32% of the readers click through to the blog. People even Google the Dirt “that dirty thang,” “the daily poop” or “low budget blog.” The Dirt gets lots of reads but no respect.
Wednesday, December 15, 2004
Deconsultification
Well, it’s official according to the authority board the deconsultification process has begun. Deconsulting a public institution is sort of like desalinization, it’s a great idea that would save lives and feed the hungry but no one has quite worked out how to do it. The Dirt loves to be helpful, so how about a going away party? “Come on lets party, fiesta. All night long.” Send your “Adios Cambio Celebration” ideas to the Daily Dirt.
The Consultants Who Stole Christmas
“ While decorations are intended to create a festive atmosphere….Many decorative items can pose a potential fire hazard that could result in a disaster.” -excerpted official ACMC memo
If our leaders would come down on mismanagement half as hard as they came down on Christmas, the hospital would be in the black by now. Managers were also treated to sermon on politically correct and administratively approved language to describe the holidays. They’re taking the bull by the horns on this one. Caregivers speculate that the rash of holiday memos and directives is just Cambio’s not so subtle way of saying, “there will be no free Christmas dinner, we’re just too cheap.”
So aside from the recent morale boosters, what’s up? Well Highland nurses, many of whom already have other jobs, get more discouraged by the day. Senior management continues to heap more menial administrative tasks on the already overburdened clinicians. Nurses are now responsible for getting the History and Physical Exam form from the physician and faxing it to the pharmacy. Come on guys, everyone should be responsible for their own paperwork and getting it where it has to go. So starting last week nurses the hapless middle women of this misadventure began faxing all these forms to the pharmacy. The pharmacy ran out of fax paper and started calling back nursing stations to complain about the deluge of paper. This new plan would have been really bad for morale, but since on many nursing floors less than half the staff is permanent, the temps, travelers and registry could care less. They don’t worry about paperwork. Normal management wouldn’t try to run a McDonalds with less than half regular staff, but Cambio seems to think you can run an ICU this way. Oh, well.
Cambio’s keeping the budget lines down by not spending. You need 65 signatures to spend cash and at any given time 20 of those signatures are in Tennessee, Texas or just resting up at the Hilton. Parts don’t get bought, machines don’t get fixed and even the rare nurse who wants work at the medical center doesn’t get hired. Hey, I bet that budget’s looking better though.
If our leaders would come down on mismanagement half as hard as they came down on Christmas, the hospital would be in the black by now. Managers were also treated to sermon on politically correct and administratively approved language to describe the holidays. They’re taking the bull by the horns on this one. Caregivers speculate that the rash of holiday memos and directives is just Cambio’s not so subtle way of saying, “there will be no free Christmas dinner, we’re just too cheap.”
So aside from the recent morale boosters, what’s up? Well Highland nurses, many of whom already have other jobs, get more discouraged by the day. Senior management continues to heap more menial administrative tasks on the already overburdened clinicians. Nurses are now responsible for getting the History and Physical Exam form from the physician and faxing it to the pharmacy. Come on guys, everyone should be responsible for their own paperwork and getting it where it has to go. So starting last week nurses the hapless middle women of this misadventure began faxing all these forms to the pharmacy. The pharmacy ran out of fax paper and started calling back nursing stations to complain about the deluge of paper. This new plan would have been really bad for morale, but since on many nursing floors less than half the staff is permanent, the temps, travelers and registry could care less. They don’t worry about paperwork. Normal management wouldn’t try to run a McDonalds with less than half regular staff, but Cambio seems to think you can run an ICU this way. Oh, well.
Cambio’s keeping the budget lines down by not spending. You need 65 signatures to spend cash and at any given time 20 of those signatures are in Tennessee, Texas or just resting up at the Hilton. Parts don’t get bought, machines don’t get fixed and even the rare nurse who wants work at the medical center doesn’t get hired. Hey, I bet that budget’s looking better though.
Monday, December 06, 2004
Holiday Hospital
Well it’s that time of year again. Yeah, the shopping, the eating, the Christmas music and family fun that never ends. The overwhelming pressure to be full of joy and good cheer is enough to unmask even the most latent psychological problems. There’s no doubt about it the holidays can be hard on your health, but they’re good for our business.
Dietary indiscretion, isn’t that a great term? It sounds like you slept with a Ho Ho. Actually, dietary indiscretion fills lots of hospital beds, it’s the salt. Tips people right over the edge into heart failure. Trust me, I spent one holiday season in the Critical Care Unit fighting with my father-in-law over a bag of pork rinds.
Booze always fills a few beds. Alcohol, cars and testosterone: it’s that magic combination that keeps trauma centers full. Drinking is a time-honored strategy for coping with the family gathering.
Then there’s always the flu, the freeways and the family feuds. Doesn’t it feel good to be needed?
Dietary indiscretion, isn’t that a great term? It sounds like you slept with a Ho Ho. Actually, dietary indiscretion fills lots of hospital beds, it’s the salt. Tips people right over the edge into heart failure. Trust me, I spent one holiday season in the Critical Care Unit fighting with my father-in-law over a bag of pork rinds.
Booze always fills a few beds. Alcohol, cars and testosterone: it’s that magic combination that keeps trauma centers full. Drinking is a time-honored strategy for coping with the family gathering.
Then there’s always the flu, the freeways and the family feuds. Doesn’t it feel good to be needed?
The Unholy Alliance
Did you know Alameda county runs an HMO? That’s right folks, we can’t afford a hospital or clinics for the uninsured but we have adequate funds to run an insurance company to administer public healthcare dollars- it’s called the Alameda Alliance for Health.
The Alliance was established in 1996 to “administer” healthcare dollars mostly Medi-Cal. The Alliance was Dave Kears’ brainchild why run a hospital when you could build a bureaucracy- all the money none of the hassles. When the Alliance was established most of the profitable Medi-Cal clients, young women with children were immediately sucked out of the county hospital. The Alliance referred them to private hospitals. Many of the medical center’s financial problems date back to the creation of the Alameda Alliance.
How could Mr. Kears sell such a bad idea to our well-meaning but inept county supervisors? The same way George Bush is trying to sell out Social Security. Dave Kears said the Alliance offered clients, “choice.” Whenever Dave or George say, “choice” one should understand that they plan to dismantle some public service.
The Alliance was established in 1996 to “administer” healthcare dollars mostly Medi-Cal. The Alliance was Dave Kears’ brainchild why run a hospital when you could build a bureaucracy- all the money none of the hassles. When the Alliance was established most of the profitable Medi-Cal clients, young women with children were immediately sucked out of the county hospital. The Alliance referred them to private hospitals. Many of the medical center’s financial problems date back to the creation of the Alameda Alliance.
How could Mr. Kears sell such a bad idea to our well-meaning but inept county supervisors? The same way George Bush is trying to sell out Social Security. Dave Kears said the Alliance offered clients, “choice.” Whenever Dave or George say, “choice” one should understand that they plan to dismantle some public service.
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