Friday, January 25, 2008

Emergency Department Crowding Dangerous

Emergency Waits Get Dangerously Long in U.S.

WASHINGTON (Reuters) Jan 15, 2008 - Patients seeking urgent care in U.S. emergency rooms are waiting longer than in the 1990s, U.S. researchers reported on Tuesday.

They found a quarter of MI patients waited 50 minutes or more before seeing a doctor in 2004. Waits for all types of emergency department visits became 36% longer between 1997 and 2004, the team at Harvard Medical School reported.

Especially unsettling, people who had seen a triage nurse and been designated as needing immediate attention waited 40% longer -- from an average of 10 minutes in 1997 to an average 14 minutes in 2004, the researchers report in the journal Health Affairs.

Heart attack patients waited eight minutes in 1997 but 20 minutes in 2004, Dr. Andrew Wilper and colleagues found.

Dr. Wilper's team used U.S. Census survey and National Center for Health Statistics data for their study, which covered more than 92,000 emergency department visits.

They used other surveys to calculate that the number of emergency room visits rose from 93.4 million in 1994 to 110.2 million in 2004.

During the same time, 12% fewer hospitals operated emergency rooms, according to the American Hospital Association.

"EDs close because, in our current payment system, emergency patients are money-losers for hospitals," Dr. Wilper said in a statement.

Harvard's Dr. David Himmelstein, who worked on the study, also lobbies for some kind of national health care system. "One contributor to ED crowding is Americans' poor access to primary and preventive care, which could address medical issues before they become emergencies," Dr. Himmelstein said in a statement.

The American College of Emergency Physicians said the findings were not surprising.

"Emergency physicians have said for years that crowding and long wait times are hurting our patients -- insured and uninsured equally," ACEP president Dr. Linda Lawrence said in a statement.

"Ever-lengthening waits are a frightening trend because any delays in care can make the difference between life and death for some patients. The number of emergency patients is increasing while the number of hospital beds continues to drop. It is a recipe for disaster."

See Keith's Letter written in 2001.


Thursday, January 24, 2008

Culture of Death

Was Henry Hyde debating the Partial-Birth Abortion Act or discussing the treatment of Haitians? "Partially-born" human beings and the Haitian people seem to have much in common.

"This is not a debate about religious doctine or even about public policy options.
It is a debate about our understanding of human dignity, what it means to be a member of the human family, even though tiny, powerless and unwanted. We are knee deep in a culture of death...Look, in this advanced democracy, in the year 2000, is it our crowning achievement that we have learned to treat people as things? Our moment in history is marked by a mortal conflict between a culture of life and a culture of death. God put us in the world to do noble things, to love and to cherish our fellow human beings, not to destroy them. Today we must choose sides.

---Henry Hyde during House floor debate on the Partial-Birth Abortion Ban Act, 2000.

Friday, January 18, 2008

The Tormented

"We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented."

--Elie Wiesel

Haitians Equal Courage

Jhiny is 13 years old and was born with heart disease.

Jhiny, her mom, and brothers and sisters (all eight of them) live in a tiny one room cinder block house in Port-au-Prince.

They have no stove, running water, or toilet. They have occasional electricity when the State of Haiti turns it on.

Jhiny has gone to school for seven years with her sick heart. She is an excellent student.

Jhiny speaks and writes French and Haitian Creole.

Jhiny came to the United States without any family members or friends. She speaks very little English.

Jhiny is polite and industrious. Her host family in the United States love her.

Last night Jhiny spoke with confidence about her date today with the Bard-Parker knife.

Early this morning she crawled onto an operating table and went to sleep. Alone.

Her heart was fixed this morning by a very good pediatric heart surgeon and an experienced cardiac team of nurses and perfusionists.

Jhiny is off the bypass pump as I post.

Jhiny is courageous.

Jhiny is Haitian.

(Jhiny is in the blue dress holding her little sister.)

Sunday, January 13, 2008

Should Saint Francis Medical Center Remain Catholic? Part VIII

Directive Number 6 of the Ethical and Religious Directives for Catholic Health Care Services:

"A Catholic health care organization should be a responsible steward of the health care resources available to it. Collaboration with other health care providers, in ways that do not compromise Catholic social and moral teaching, can be an effective means of such stewardship."

Therefore, why wasn't Directive Number 6 followed by Bishop Jenky and Monsignor Rohlfs, the OSF Sisters, and OSF-SFMC administration?

When the Diocese lost their nerve regarding "social responsibility" for sick and dying Haitian Hearts children, why did the Diocese not "collaborate" with other children's hospitals around the U.S. and Canada and elsewhere, to help us find the kids medical care? Why did OSF not "collaborate" with other medical centers? It would have been very easy to do.

Just because OSF in Peoria wouldn't help these children any longer, did not give the Diocese an out. The Diocese (Bishop Jenky and Monsignor Rohlfs) should have publically stated that Haitian Hearts and the Diocese would collaborate with other medical centers even if OSF did not want to participate. And they could have thanked OSF for what they had done for Haitian children and said that it was time to move on.

But this was just too hard for the Diocese to do. They did not want to embarrass OSF in any way. The Diocese stated in the media that all parties worked in good faith which was obviously not correct. When Monsignor Rohlfs threatened me and stated that the Diocese would come out in the media against me if I filed a petition for a Tribunal Court, this was not good faith on his part. And when Bishop Jenky told me that I needed to come to confession to him for "killing 18 Haitian children" if I pursued the Tribunal Court, this did not seem to be in good faith either.

And Catholics wonder how the church sex abuse scandal happened over the past 50 years??

Finally, Directive Number 9 states:

"Employees of a Catholic health care institution must respect and uphold the religious mission of the institution and adhere to these Directives. They should mantain professional standards and promote the institution's commitment to human dignity and the common good."

OSF has fallen short of this Directive also and our Catholic Diocese is a big part of the problem.

Friday, January 11, 2008

Should Saint Francis Medical Center Remain Catholic? Part VII

Over the years I have had face-to-face discussions and sent and received e mails from Joe Piccione. Joe is OSF's Corporate ethicist.

Joe was not a champion of the Haitian Hearts children referred to in this web log. His fear was obvious. He was afraid to buck OSF even though the Ethical and Religious Directives mandated his action.

As mentioned earlier, Joe was hired in the mid-1990's to find a way for OSF to dispense birth control pills without making it appear that OSF was dispensing birth control pills. Joe worked with the Catholic Diocese of Peoria and developed loopholes which allow physicians that are employed by OSF to prescribe oral contraceptives when they are not working for OSF. Apparently they are not working for OSF when they are writing the prescriptions for oral contraceptives. After the prescription is written, they are OSF employees again. Yes, this is difficult to understand, but was done so OSF could stay competitive in the medical market...according to Joe.

In the 2001 revisions of the Directives it states considerable moral distance is needed to be established and maintained between the Catholic entity and the provision of prohibited services. Where is the "moral distance" when OSF and the Diocese were instigating and arranging the changes that would allow their providers (doctors) to be involved in "wrongdoing"?

Directive 52 states: "Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church's teaching on responsible parenthood and in methods of natural family planning."

However, Joe and OSF and the Diocese were able to skirt around Directive 52. The Directives were not established so lawyer/ethicists could find ways to break the spirit of the law.

OSF recently lost their only Natural Family Planning (NFP) doctor. Even though there is a NFP department, too little OSF funds have been dedicated to this department and Joe and others haven't pushed hard enough. NFP is not covered under OSF HealthPlans even though numerous oral contraceptives are covered. (Interestingly, I do not believe OSF HealthPlans which includes contraceptives is offered OSF employees. Why?)

Joe also told me that scandal is an act against charity. He was skirting around this word also. The Directives state that the technical theological definition of scandal from the Cathechism of the Catholic Church is: "Scandal is an attitude or behavior which leads another to do evil".

According to the teachings of the Catholic Church, oral contraceptives when used for contraceptive purposes, is evil. So when Joe, OSF, and the Diocese created loopholes for others to do evil, is this not scandalous?

In fact, Directive Number 71 states: "The possibility of scandal must be considered when applying the principles governing cooperation. Cooperation (with evil-doers), which in all other respects is morally licit, may need to be refused because of the scandal that might be caused." (There are different types of "cooperation" that ethicists use to sanction certain actions...)

I believe that Joe, OSF, and the Catholic Diocese of Peoria have created scandal; in other words, helped lead people to do the wrong thing. And with regards to Haitian Hearts patients, these kids have been refused care at OSF-SFMC. This is scandal too.

Should Saint Francis Medical Center remain Catholic?

Wednesday, January 9, 2008

Should Saint Francis Medical Center Remain Catholic? Part VI

Ethical and Religious Directives Number 2 calls for "a spirit of mutual respect among caregivers" as the basis of compassionate health care is noteworthy. It indicates, first, that effective care in the spirit of Christ requires a coordinated team effort. The manner in which health care personnel treat one another is of utmost importance in creating a compassionate caregiving community.

In Peoria's Medical Mafia I documented the lack of "mutual respect" at Saint Francis Medical Center exhibited by the statements and actions of Keith Steffen, Chris Lofgren, David Gorenz, and Sue Wozniak. The Peoria public and some of the OSF communtiy would have a hard time believing what the Carroll family knows too well. (See Conversations with Keith , Conversations with Sister Canisia , and Conversations with Chris.)

Directives 5 and 9 state that adherence to the Directives is required in a Catholic institution as a condition for medical privileges and employment. The people listed above have no worries about their actions because the checks and balances at OSF and the Diocese are not working as they should to educate OSF's administration and assure that they follow the Directives.

Compassionate care for patients naturally suffers when OSF administration shows lack of respect for its employees.

Tuesday, January 8, 2008

Should Saint Francis Medical Center Remain Catholic? Part V

The Bishop's Synod of 1971 summed up the reason for the church's intense concern for matters of social justice:

"Action on behalf of justice and participation in the transformation of the world fully appear to be a constitutive dimension of the preaching of the Gospel, or, in other words, of the church's mission for the redemption of the human race, and its liberation from every oppressive situation."

The Ethical and Religious Directives for Catholic Health Care Services (Directives) place great emphasis on social justice. The Directives have set forth several principles:

1. Sacredness of Life: Catholic health care is dedicated to promoting human dignity and the sacredness of life, from the moment of conception until death. Derived from this principle is the right to life and the right to protect it through adequate health care. In the bishops' view, this first principle is not a religious principle; that is, it is not derived primarily and fundamentally from the teaching of Christ, though it is certainly in accord with that teaching. The principle is based on human experience and human reason.

2. The Option for the Poor: The second principle, to have "an option for the poor", is derived primarily from the teaching and tradition of the church. Indeed the Directives refer to caring for the poor as "a biblical mandate".

How is OSF-SFMC following the Directives when they:

1. Refuse to accept Haitian Hearts patients that were operated at OSF in the past and need repeat surgery, even when full funding or partial funding is offered for their care? Where is responsible stewardship exercised while Haitian children are dying during OSF's 500 million dollar campus renovation in Peoria?

2. Delayed surgery of at least one Haitian child that was in Peoria awaiting surgery?

3. Attempted to divert funds dedicated for Haitian children to OSF-Children's Hospital of Illinois?

Where is "social justice" here?

Where is the Catholic Diocese of Peoria? When Monsignor Rohlfs was notified that I felt Haitian surgery was delayed on a Haitian baby that suffered a cardiac arrest with his host family in the Peoria area, Monsignor Rohlfs looked unconcerned and asked me to "let me know if it happens again..."

Should Saint Francis Medical Center remain Catholic?

Monday, January 7, 2008

Should Saint Francis Medical Center Remain Catholic?--Part IV

In the last 15 years the Catholic Diocese of Peoria has been faced with circumstances that have been truly difficult for them.

OSF-SFMC pushed the Diocese hard to allow oral contraceptives to be written by OSF physicians under the guise of "limited private practice". This was presented by OSF Corporate Ethicist Joseph Piccione and others from OSF. Monsignor Steven Rohlfs and Bishop John Myers were involved in making the decison.

What does "limited private practice" mean? Under this plan agreed upon by the Diocese and OSF, an OSF physician can write oral contraceptives when he/she suddenly is no longer an employee of OSF while he writes the prescription on his own prescription pad. This supposedly puts a "firewall" between the oral contraceptive and OSF. This plan is hard to believe by most people that hear about it for the first time, but functions in OSF facilites throughout the Midwest. Keeping OSF financially sound drove the plan in the 1990's when Mr. Piccione was hired by OSF.

When the Diocese and OSF go to such extremes regarding an issue so sacred and important to the Catholic Church (oral contraceptives), I do not believe it is difficult for OSF or the Diocese to ignore dying Haitian children.

The Ethical and Religious Directives intent is not to find ways around Humane Vitae or the teachings of the bible regarding the poor.

The Collection of Selected Readings referenced below states the following:

"If a Catholic health care facility were to fail to adhere to the Directives, it might lose its identification as Catholic. That is, if the Directives are not observed, affiliation with the Catholic Church in a particular diocese could be withdrawn by the diocesan bishop. Because some Catholic health care facilities are actually owned by a diocese or a religious congregation, the loss of Catholic identification could also result in the closing of the facility. In other cases, when the facility is owned by a board of trustees, the trustees might decide to continue to manage the facility even though it would no longer be affiliated with the Catholic Church."

(From Ethical and Religious Directives for Catholic Health Care Services: Seeking Understanding--A Collection of Selected Readings. The Catholic Health Association.)

Should Saint Francis Medical Center Remain Catholic?--Part III

The preamble to the Ethical and Religious Directives states:

The Directives “are concerned primarily with institutionally based Catholic health care services. They address the sponsors, trustees, administrators, chaplains, physicians, health care personnel, and patients or residents of these institutions and services.”

Therefore the Board of Directors at OSF, administrators at Saint Francis Medical Center (SFMC), chaplains at SFMC, and the ethicists at SFMC and OSF Corporate, and the OSF legal team, are all being called upon to follow the norms in the Directives.

Individuals at OSF included in the above would include Doug Marshall who is OSF’s attorney. Mr. Marshall has written that OSF-SFMC will not accept Haitian Hearts patients. Keith Steffen is OSF-SFMC CEO and Paul Kramer, Executive Director of Children’s Hospital of Illinois, acted in ways that were not supportive of sick Haitian children. Mr. Kramer delayed surgery in Peoria and also called the American Consulate in Haiti. OSF ethicists Joseph Piccione and Gerald McShane sent mixed messages or no messages supporting Haitian children in need of heart surgery.

As the source referenced below states, if the above named individuals to not want to follow the norms of the Directives, they are free to disaffiliate from the Catholic institution if they think their consciences would be violated.

The Catholic bishops state:

“The dialogue between medical science and Christian faith has for its primary purpose the common good of all human persons.”

In Peoria’s situation, the Directives have not been promulgated by Bishop Daniel Jenky. With this weakness, OSF-SFMC has been allowed to ignore certain aspects of the good will and good actions that the Directives implore be done by Catholic health care facilities.

(From Ethical and Religious Directives for Catholic Health Care Services:Seeking Understanding--A Collection of Selected Readings. The Catholic Health Association.)

Friday, January 4, 2008

Should Saint Francis Medical Center Remain Catholic?--Part II

The Order of Saint Francis (OSF) advertises their Mission statements in the secular press and repeats these statements at many retreats and orientations given their thousands of employees.

Jesus is the one sent by God who came to reestablish God’s reign among all peoples. In Luke’s account of the Gospel, Jesus outlined what being God’s Mission in the world required of him by applying the words of the prophet Isaiah to himself: “The spirit of the Lord has anointed me and has sent me to proclaim good news to the poor, release to the captives, recovery of sight to the blind, liberty to the oppressed, to announce the year of the Lord’s favor.” (Lk 4:18-19).

Everything that Jesus did, that is, his ministry, was done as a means of making the substance of this declaration reality. Although his actions focused often on the physical needs of person, the effect of his activities in response to these needs had an impact and importance beyond mere intervention in the physical realm.

When Jesus cured the woman suffering from hemorrhage, for example, he did more than restore an individual to physical health. Through his interaction with the woman and the manner in which he healed her, Jesus declared to the community that had cast her out because of her affliction that the reign of God is inclusive of all persons without distinction.

Haitian patients are very similar to this biblical woman. Haitians have been marginalized by the world and suffer in every way possible. If Saint Francis Medical Center (SFMC) in Peoria were helping them, rather than ignoring them, SFMC would reveal that their mission was the same as Jesus. Those that have been excluded would be included. The ministry of Catholic health care facilities is charged to treat the marginalized and those that are bleeding.

The Ethical and Religious Directives seek to proclaim in contemporary terms those attitudes and behaviors that are most consistent with furthering God’s reign of love and justice (e.g., regard for the dignity of the person and the inviolability of innocent human life…)

Should Saint Francis Medical Center remain Catholic?

(From Ethical and Religious Directives for Catholic Health Care Services: Seeking Understanding— A Collection of Selected Readings— The Catholic Health Association of the United States)

Should Saint Francis Medical Center Remain Catholic?

Should Saint Francis Medical Center (SFMC) remain Catholic? What distinguishes Saint Francis as a Catholic medical center?

I went to mass yesterday at the OSF chapel on Jan 1. I think the OSF chapel is one of the most beautiful churches in Peoria.

But is SFMC truly acting like a Catholic medical center? Is it following the Ethical and Religious Directives for Catholic Health Care Services?

OSF is not caring for Haitian Hearts patients and they are dying.

The Ethical and Religious Directives for Catholic Health Care Services is the current official statement of ethical directives for the provision of health care in Catholic facilities in the United States.

The Directives were approved by the United States Conference of Catholic Bishops (USCCB) and the USCCB recommended their implementation by diocesan bishops. The Directives were written with the collaboration among the U.S. Catholic bishops, Catholic health care leaders, theologians and ethicists, and the Holy See (the Pope).

The Directives are a set of principles that inform the provision of health services under Catholic sponsorship. They are conclusions drawn from a faith-inspired vision of the human person and the experience gained from providing holistic health care.

We need to remember that the goal of the Directives is to promote consistency between what is done under the auspices of Catholic sponsorship and church teaching on moral matters as these relate to the provision of health services.

Taking care of the poor is emphasized by the Directives. SFMC has rejected Haitian children and young adults that were operated at OSF in the past and now need repeat surgery.

It seems very clear what the Directives would say about caring for Haitian Hearts patients? Would the Directives advise Saint Francis Medical Center to remain a Catholic health care facility?