Wednesday, June 30, 2010

What is Structural Violence? Look no Further than Peoria...

Photo by John Carroll

This is Jenny.

Jenny is being denied heart surgery by OSF-Saint Francis Medical Center in Peoria.

She e mailed the other day and is no longer able to work at her job in the bank in Port-au-Prince. And she wrote in her e mail that she is afraid that I will not be able to find a hospital in the States to accept her.

I am afraid too.

Jenny is slowly dying. She is so viable and so alive now. She deserves so much more.

See paragraph below regarding structural violence.

"Structural violence" is one way of describing social arrangements marked by racism and other social inequalities. In the influential view of sociologist Johan Galtung, structural violence is "the avoidable impairment of fundamental human needs", embedded in longstanding "ubiquitous social structures, normalized by stable institutions and regular experience." Because they seem so ordinary in our ways of understanding the world, such violent structures are almost invisible. Disparate access to resources, political power, education, and health care as well as unequal legal standing are just a few examples. Such arrangements do violence to society's losers; the arrangements are structural because they are embedded in the economic organization of our social world. Those responsible for maintaining such inequalities are not the chief victims of structural violence....

Paul Farmer Reader

Monday, June 28, 2010

Overcrowding for Dummies, by Dr. Peter Viccellio

This is a great link for ED overcrowding.

All hospital administrators in the world need to read this!

Saturday, June 26, 2010

Emergency Department Crowding Still an Issue in 2010

In September, 2001 I wrote a letter to OSF-SFMC CEO Keith Steffen regarding my concerns regarding the danger of ED overcrowding at OSF. I thought the patients were in danger due to long waits in the ED.

I was put on probabtion the next day and fired three months later.

During the following nine years I have followed the Emergency Medicine literature regarding solutions for ED crowding.

The following few paragraphs were written by Dr. Shari Welch in the June, 2010 issue of Emergency Medicine News.

ED overcrowding is an issue that all medical center administrators need to understand and be proactive to protect their patients and their community.


Dr. Welch:

Another innovation, the Full Capacity Protocol, shows that patients can be safely boarded in hallways upstairs with excellent results when all hospital beds are full.

A patient with a hip fracture would be boarded on the orthopedics floor, a TIA patient would be boarded on a neurology floor, and so forth.

Peter Viccellio, MD, at the State University of New York at Stony Brook has written several articles demonstrating that there is no increase in the mortality rate and that length of stay is shortened when patients are boarded upstairs instead of the ED. (Many of Dr. Viccellio's articles are available on; type “Viccellio” in the search box.)

Patients actually spend very little time in the hallways upstairs; somehow the system finds a bed for them. Boarding on the floor is usually done with the patient occupying an actual hospital bed. It is quieter than the ED, and patient satisfaction improves with the adoption of the policy and procedure. A copy of the full capacity protocol is available on Dr. Viccellio's web site (

Another cause of delays is patients occupying beds waiting for a resident workup. Just say “no!” It might be possible to allow this practice in an Express Admission Unit, but admitted patients must not occupy precious ED beds for the convenience of the house staff.

Boarding admitted patients in the ED is bad for patients, bad for departments, bad for the community, considering the direct connection between boarding and diversion. Low-acuity patients at your door have little to do with the solutions to boarding. Boarding relates to flow, and is a system problem with system solutions.

Improving admission operations is the one thing you cannot fix in a vacuum. Start by educating the leadership of your organization about the bad outcomes associated with boarding. Introduce them to data-driven solutions that are system solutions. Show them the compelling data on the subject.

Above all, be vigilant about ED bed minute utilization. ED bed minutes are for diagnosing and treating patients, not boarding them!

Friday, June 25, 2010

"Honest Services" in Illinois...You Have to Read This...Please!

Does Congress have the guts to fix what court gutted? Honestly, no.

John Kass

June 25, 2010

It's not every day that President Barack Obama and the Congress are handed an easy campaign issue by the Supreme Court on the touchy subject of political corruption.

And who isn't against political corruption?

On Thursday the Supreme Court gutted a key tool used by federal prosecutors to fight white-collar political corruption. It's known as the "honest services" clause. It deals with the tangible right of Americans to expect honest service from their elected officials.

Even in Illinois.

The court decided that the law was too vague. And since it was also used to convict business crooks like Enron CEO Jeffery Skilling and Chicago media baron Conrad Black, their lawyers are overjoyed.

But the ruling will have its biggest impact on political prosecution cases, because the justices limited theft of honest services to direct bribery and extortion.

Such thinking is simplistic. Big-time political corruption isn't about greasy envelopes stuffed with cash, passed in some alley behind a tavern.

Rather, high-level corruption is circular, buffered and layered. Elected Official A helps Donor B to compensate Contractor D, who takes care of Regulator C as A's nephews get rich.

"There is no question that the court has just raised the bar for prosecutors in public corruption and corporate malfeasance cases," said former Assistant U.S. Attorney Patrick Collins, now in private practice.

Collins should know. He put former Republican Illinois Gov. George Ryan behind bars. Collins also prosecuted Robert Sorich, the patronage chief for Mayor Richard Daley.

Sorich ran a massive and illegal hiring scheme that allowed Daley to build vast armies of political workers to control elections in Chicago and Cook County. Those armies sent Rahm Emanuel to Congress from the 5th Congressional District.

And now Sorich's lawyers will no doubt use Thursday's ruling in his favor.

Once again the justices left it up to Congress to write a new law expressly stating what's honest and what's crooked in our politics. Why not consider this a wonderful teaching moment?

What an amazing opportunity for Obama and the Congress — the Democrats and the Republicans — to begin debating honesty in government. I'm sure they'll call a committee and put it all on C-SPAN.

But if all we hear from our president is silence, I guess we've got to wonder:

When Obama and all his chattering media suckups insisted that the guy from Chicago was truly a different kind of politician who would "transcend the broken politics of the past," did they really mean it?

And what about the Republicans? When they constantly harp about Chicago-style corruption, do they mean that the investigators should stay off their home turf and concentrate only on Chicago?

After the Supreme Court's opinion was released Thursday, you could almost hear the champagne corks popping behind locked doors in the offices of every crooked politician along The Chicago Way.

And along its minor roads, such as the Boston Way, the New Jersey Way, the Sacramento Way, you name it, it's all the same, but practiced best by the guys from Chicago, who combine public service with family fortunes. And since they write the laws, it's all legal.

Happy days are here again. Right, boys?

As if to celebrate, Sorich's old boss, Mayor Daley, announced this week that City Hall would sign private agreements with management companies and let them do the hiring in city government. Reporters who should know better said it was reform.

Yet private management contracts aren't subject to the same Freedom of Information scrutiny as is government. Private companies can hire who they want, without much explanation. The only explaining they have to do is explain to the mayor.

Perhaps they'll hire Sorich to review city job applications, as he did in the old days.

"Of course I'm disappointed; it's extremely disappointing" said David Hoffman, a former federal prosecutor and the Democratic candidate for the U.S. Senate who did not loan money to mobsters.

Hoffman now teaches on corruption and politics at the University of Chicago.

"Now, in cases where there's no clear quid pro quo, you'll find prosecutors hesitating," Hoffman said. "And that's a shame."

He and Collins noted that the 7th Circuit Court of Appeals had upheld the Sorich conviction.

That panel of judges ruled that if a public official violates his or her fiduciary duty to the public and becomes involved in fraud for private gain for themselves or for some other party, the money doesn't have to go into the official's pocket to be ruled a crime.

So the president and Congress could use that 7th Circuit opinion and make a new, tough corruption law within a week. When they say they're the change we've been waiting for, they meant it, right?

"When corruption occurs, absolutely something is stolen from the people," said Hoffman. "Something tangible. The right to honest government is more valuable to us than money."

And when corruption becomes institutionalized, as it has been in Illinois, the people become exhausted. They see how the political bosses reward their servants, they hear whose children get clouted into the public universities. That's when they're tempted to do something shameful:

Fall to their knees before the political lords.

And that's what's truly corrosive.

Political corruption isn't only about the theft of honest government. It's what's stolen after that. Our dignity.

Surely the president and the Congress — both Republicans and Democrats — understand this. And surely they'll do something about it before the mid-term elections in November.

I mean, who isn't against political corruption?

Copyright © 2010, Chicago Tribune

Wednesday, June 23, 2010

Illinois Finance Authority Mentioned Again in Blago Trial

Yesterday I posted regarding Governor Blago and the Illinois Finance Authority and OSF in Peoria.

The article below is from the Tribune this morning (6/23/2010).

What did Blago expect from Peoria?


More pressure to fire Tribune editorial board

Another wiretap recording played at the trial this morning dealt again with Gov. Rod Blagojevich's alleged desire to see Chicago Tribune editorial writers fired in exchange for his support for a state deal to buy Wrigley Field.

In a call on Nov. 6, 2008, Blagojevich can be heard talking to his chief of staff, John Harris, and telling him to deliver a message to Tribune Co. to make changes on the editorial board.

Harris said on the call he was in between meetings with a Tribune executive, Nils Larsen, and that he would tell Larsen to fire the editorial board.

But to that point, Harris testified, he had not told Larsen about the governor's request. "Because it was wrong to do so," Harris testified.

On the call, Blagojevich told Harris the plan was a priority and that he should "stay on it." He asked if Harris thought Tribune had gotten the message about the editorial board.

"He got it loud and clear," Harris said on the tape.

But Harris told the jury that was not the truth. In reality, Harris said, he had only suggested to Larsen that negative editorials about the governor could derail the proposal.

"What does this mean to them? $500 million?" Blagojevich asked about a plan to have the Illinois Finance Authority assist in a Wrigley plan. Harris indicated it was more like $100 million.

--Jeff Coen

Tuesday, June 22, 2010

Rebuilding Stalled in Haiti

US Senate report says Haiti rebuilding has stalled


PORT-AU-PRINCE, Haiti — Haiti has made little progress in rebuilding in the five months since its earthquake, because of an absence of leadership, disagreements among donors and general disorganization, a U.S. Senate report says.

Obtained Monday by The Associated Press, the eight-page report is meant to give Congress a picture of Haiti today as U.S. legislators consider authorizing $2 billion to support the country's reconstruction.

That picture is grim: Millions displaced from their homes, rubble and collapsed buildings still dominating the landscape. Three weeks into hurricane season, with tropical rains lashing the capital daily, construction is being held up by land disputes and customs delays while plans for moving people out of tent-and-tarp settlements remain in "early draft form," it says.

The report was written by staff of Sen. John Kerry, the Massachuetts Democrat who is chairman of the Senate Foreign Relations Committee, and other Democrats who interviewed U.S., Haitian, United Nations and other officials and visited resettlement camps, hospitals and schools throughout the quake zone.

"While many immediate humanitarian relief priorities appear to have been met, there are troubling signs that the recovery and longer term rebuilding activities are flagging," said the report, which is scheduled to be released Tuesday.

Three times it says the rebuilding process has "stalled" since the Jan. 12 disaster.
The report also criticizes the government of Haitian President Rene Preval and Prime Minister Jean-Max Bellerive, saying it has "not done an effective job of communicating to Haitians that it is in charge and ready to lead the rebuilding effort." The report calls on Preval to take a "more visible and active role, despite the difficulties."

Bellerive responded to the criticism in a Monday interview with the AP. He said officials are working hard behind the scenes to ensure reconstruction does not simply mean the rebuilding of barely livable slums.

"We understand the impatience and we are the ones more frustrated than anybody," the prime minister said. "It took some time. I believe four months (since a U.N. donors' conference in March) to plan the refoundation from such a disaster is pretty acceptable."

With a chuckle, he also said it is unfair for U.S. officials to take him to task when the Senate still has not approved aid money that Secretary of State Hillary Rodham Clinton promised at the donors' conference.

"They ask me to move more projects when the money is still on hold," Bellerive said.
In all, just 2 percent of the $5.3 billion in near-term aid pledges have actually been delivered, up from 1 percent last week.

The report expresses concerns that even once the money is in hand, it will not move quickly enough to help. The funds are managed by a 26-member reconstruction commission led by Bellerive and former U.S. President Bill Clinton that started its operations last week.

While the report calls the commission the "best near-term prospect for driving rebuilding," it also says the panel "has the potential to dramatically slow things down through cumbersome bureaucratic obstacles at a time when Haiti cannot afford to delay."

The report notes disagreements among donors over strategy, approach and priorities, saying the disputes "are undercutting recovery and rebuilding."
The reconstruction panel includes representatives of donors who pledged at least $100 million in cash or $200 million of debt relief, including the United States, Venezuela, Brazil, Canada, the European Union, the Inter-American Development Bank and the World Bank.

Bellerive said the report's criticism that the panel has been too slow in organizing is already moot. "We had a meeting, we have an office, we have administrative support," he said.

One thing on which all parties agree is the importance of November elections. The legislature has almost entirely dissolved after members' terms expired because the quake forced the cancellation of February legislative elections. Preval's five-year term ends next February; an attempt to prolong his term by several months if elections are not held resulted in protesters clashing with police in front of the ruins of the presidential palace.

Failing to hold the November elections on time, even despite the losses of the electoral commission's headquarters and records, could imperil "Haiti's fragile democracy," the report says. But it expresses limited optimism that a plan for holding the vote is "apparently imminent."

Copyright © 2010 The Associated Press. All rights reserved.

Did Anyone Do Blago Favors from Peoria?

See this article from Tribune today.

A few years ago, Governor Blago, through the Illinois Finance Authority (IFA), issued Peoria's OSF a 460 million dollar bond to help finance OSF's new Milestone Project. This was the second largest in IFA's history.

It doesn't seem like Governor Blago wanted to do much for free if we believe the FBI wiretaps and prosecution witnesses in the Blago trial.

Wonder what the story was in Peoria that prompted Gov. Blago to be so generous with OSF?

Tuesday, June 15, 2010

Tony Rezko

What you didn't know about Obama and Rezko by Rick Moran.

Sunday, June 13, 2010

Jenny (continued...)


Photo of Jenny in June, 2010 by John Carroll.

Dear OSF-Saint Francis Medical Center, Mr. Steffen, Mr. Marshall, and Sister Judith Ann,

This is Jenny.

She is 30 years old now and had heart surgery at OSF in Peoria in 1999 when she was 19 years old.

Haitian Hearts paid $23,000 dollars cash to Children's Hospital of Illinois for Jenny's surgery in 1999.

During the last decade we have examined Jenny in Hati many times, evaluated her Haitian echocardiograms, and supplied her with medication.

Jenny needs repeat heart surgery now because her valve repairs done at OSF need to be revised. Jenny is in congestive heart failure now and managed with medication.

I have looked for several years for a US medical center to reoperate Jenny but cannot find a center that wants to accept Jenny. They all feel that Jenny is OSF's ethical and medical responsibility.

On January 12 of this year Jenny was seated at her desk on the fourth floor of the bank where she works in Port-au-Prince. She heard a loud noise and the bank began to shake back and forth.

Her friends and fellow employees ran down the stairs and out of the building but Jenny sat frozen in fear at her desk. She said that her legs would not work.

Several minutes later, after the shaking had stopped, her friends ran upstairs and grabbed her and led her down the stairs. No one was hurt at the bank and the building suffered no major damage.

Jenny had to walk home not knowing whether her family survived the quake. As she walked down the dark streets, Jenny heard many people screaming trapped in buildings and saw dismembered extremities lying in the streets. Bodies were everywhere.

Jenny did not know it at the time, but 140,000 of Haitian brothers and sisters had just died during the violent 45 second earthquake, and over the next month, the mortality would rise to an estimated 230,000.

She arrived home three hours later and found her family to be fine, but the walls of her house were cracked and her house was not safe to live in.

For the next few months after shocks continued and Jenny and her sister slept in a small abandoned car near her house. After a small tent was donated to them by Rotary Club, they started living/sleeping in the tent.

Jenny kept going to work through all of this upheaval and was able to do this in congestive heart failure.

Jenny's history and exam now is not good and she needs surgery soon.

Sister Judith Ann, Mr. Steffen, and Mr. Marshall, if you will open your arms once again for Jenny, Haitian Hearts will pay you $23,000 dollars again, we will get her Haitian passport renewed, we will obtain her US visa to travel to Peoria, we will purchase her roundtrip airline tickets, Jenny can live with us in Peoria, and we will continue to provide her with medication post operatively.

I plead with you to follow OSF's founding Sisters Mission Philosophy. Jenny has survived the earthquake. Please give her another chance with her heart.


John Carroll

Friday, June 4, 2010

Pope Benedict

"From today's crisis, a church will emerge tomorrow that will have lost a great deal. She will be small and, to a large extent, will have to start from the beginning. She will no longer be able to fill many of the buildings created in her period of splendor. Because of the smaller number of her followers, she will lose many of her privileges in society. Contrary to what has happened until now, she will present herself much more as a community of volunteers...As a small community, she will demand much more from the initiative of each of her members and she will certainly also acknowledge new forms of ministry and will raise up to the priesthood proven Christians who have other jobs...It will make her poor and a church of the little people...All this will require time. The process will be slow and painful."

Father Joseph Ratzinger, 1969
Catholic theolgian