Saturday, August 28, 2010

Haitian Hearts has 141st Patient Accepted in to the USA

When I was working in Haiti in July a very sick man came to clinic early one morning. He was in terrible congestive heart failure and arrived on the back of a little motor scooter.

He has been accepted into a medical center in the USA and will be arriving soon.

See Maria's blog for further details.

Tuesday, August 24, 2010

Long Waits in the Emergency Room

In today's Journal Star there is an article on long waits in the nation's emergency rooms.

Dr. Nick Jouriles, emergency medicine chief at Akron General Hospital in Ohio was quoted in the article:

"The longer people stay in the emergency department, the more likely they're going to have complications, deaths. If they are elderly, they're more likely to end up in the nursing home."

In 2001 I wrote Keith Steffen, CEO at OSF-SFMC in Peoria this letter.

The next day I was put on probation for six months and Keith referred to me as "a malignancy in the emergency department."

I think OSF-SFMC was keeping the hospital full of elective surgical cases to the detriment of my Emergency Room patients.

A few months later Mr. Streffen fired me, and in July, 2002 he cut all OSF funding of Haitian Hearts patients.

Tuesday, August 17, 2010

Will Saint Francis Really do this?

Will OSF allow Jenny to die?

How could OSF do this?

OSF has a shining brand new 300 million dollar medical building. But was this building worth it if the life of one Haitian is ignored?

If Jenny were in Peoria, we wouldn’t keep her invisible. If she asked for medical help, the Peoria community would try and help her. Jenny lives 90 minutes from Miami.

The best medical technology in Peoria should not be used in a discriminatory fashion. Will OSF allow Jenny to die in Haiti with no medical technology at all?


Photo by John Carroll

Examining patients in Haiti is a very humbling experience for me.

When I look at the patient sitting on the examination table in front of me I realize there is no difference between the two of us. We are the same being. He just happens to be in a worse way that particular day than I am. And deep inside I realize some day I will be in his position one way or another.

When one is strong and seemingly in control one can be mistaken and think that he will always be in control of himself and his environment. But that is just not true.

Someday we will all be Haitian-like. We will be looking into someone's eyes pleading for help for ourselves. Will the other person be kind and at least try and help some? When our day comes hopefully we will have some of the dignity that Hatiians display during their dark hours.

John A. Carroll, MD

See the abstract below about humility in medicine.

"The new professionalism movement in medical education takes seriously the old medical virtues. Perhaps the most difficult virtue to understand and practice is humility, which seems out of place in a medical culture characterized by arrogance, assertiveness, and a sense of entitlement. Counter cultural though it is, humility need not suggest weakness or lack of self confidence. On the contrary, humility requires toughness and emotional resilience. Humility in medicine manifests itself as unflinching self-awareness; empathic openness to others; and a keen appreciation of, and gratitude for, the privilege of caring for sick persons. Justified pride in medicine’s accomplishments should neither rule out nor diminish our humility as healers."

Jack Coulehan, MD, MPH
Annals of Internal Medicine Vol. 153 Number 3
August 3, 2010

Monday, August 9, 2010

Keith Steffen and the (Revised) OSF Mission Statement

A recent Journal Star article referred to OSF's new Milestone Project as "monolithic".

The article quoted OSF Keith Steffen extensively. Several of Keith's quotes made me laugh...this one in particular:

"I've never seen the sisters back away from risk, back away from being first or back away from this value proposition of market differentiation. We're different...."

If anyone understands where Saint Francis of Assisi factors in to the "value proposition of market differentiation", let me know.

Wednesday, August 4, 2010

Catholic Health Care Demise...Article and Comments from One Year Ago


There was a time when institutions bearing a Catholic identity, such as hospitals and clinics, would never have agreed to even the slightest hint of deviating from the Catholic Church’s teachings. That was, I am sad to say, a very long time ago.

Today, there appears to be a slow deterioration in the Catholic identity of Catholic health-care institutions. I started to become aware of this over 10 years ago, when the Peoria Protocol first came to my attention. For those unfamiliar with it, the Peoria Protocol, first developed in 1995, was put in place at Saint Francis Medical Center in Peoria, Illinois. The Protocol defines permissible approaches to medical care following a sexual assault. Following are two of its four possible courses of action:

* The woman is determined to be past the early post-ovulatory phase of her cycle if the LH urine test is negative and her progesterone level is greater than or equal to 6 ng/mL. In this situation, the timing of the sexual assault could not have coincided with the presence of an ovum. Hence, it is morally permissible to administer an emergency contraceptive for the victim's psychological benefit.

* Finally, the woman is determined to be in the late post-ovulatory phase if the LH urine test is negative, her progesterone level is less than 6 ng/mL, and she anticipates menstruation in less than seven days. Here, too, it is morally permissible to administer a contraceptive medication.

These two statements, while approved by many Catholic medical ethicists, represent a fundamental moral problem. If the Catholic Church does not condone the use of contraception as medical treatment in any case other than a situation involving a serious medical condition and in which the female abstains from sexual relations during such treatment, how can it be permissible to administer a powerful chemical compound that is known to abort, when there is no serious medical condition and alternative therapies exist?

Neither of the above scenarios described in the Peoria Protocol provide a 100-percent guarantee that a child has not been conceived. Moreover, these statements are nuanced and do not provide adequate safeguards to protect the child, should his conception have occurred as a result of the rape.

One has to wonder why a Catholic hospital would even consider this treatment option.

Saint Francis Medical Center is also involved in dispensing oral contraceptives. The news media reports that its involvement in the distribution of birth control pills is the direct result of a “middle ground” decision:

[W]hen OSF Saint Francis began hiring primary care physicians in the 1990s as part of OSF Medical Group, many of the physicians wanted to prescribe oral contraceptives. Much anguished discussion ensued, said Joseph Piccione, corporate ethicist for OSF Healthcare System.

Yet a middle ground was found. No contraception of any kind would be distributed within the four walls of the hospital itself, Piccione said.

Regardless of walls, there is no Catholic doctrine that would sanction an arm’s-length agreement that the birth control pill can be dispensed under the aegis of the Church.

Then there’s the California case involving known abortionists serving as staff physicians for Catholic hospitals. When Wynette Sills first brought this to our attention earlier this year, we investigated, only to find—to our dismay—that, in fact, the situation is as she originally described it. As Bud Reeves reports,
We want our readers to know that we are continuing with our investigation as well as with our direct action activities regarding Mercy San Juan Hospital (MSJH) and Catholic Healthcare West’s (CHW) practice of allowing identified abortion doctors to practice at MSJH and even be promoted on their webpage. CHW originally excused their promotion and use of three identified abortion doctors as a matter of an insurance requirement. Following my (Bud) efforts to get clarification from Mr. Gardner, last week he sent me a one sentence email which now claims that federal law requires CHW hospitals to allow the abortion doctors to practice in their hospitals. I wrote back to Mr. Gardner and asking him for a meeting or at least giving us the citations for the laws he refers to. So far nothing but silence from Mr. Gardner. Keep this in prayer.
It is probably no accident that about a year ago, Catholic Healthcare West entered into an alliance with human cloning practitioner Advanced Cell Technology, Inc. While it is reported that Catholic Healthcare West will be conducting clinical trials of adult stem cell treatment for heart disease, this alliance raises serious ethical questions, due to the fact that “ACT has previously promoted research that contradicts Catholic principles regarding respect for the rights of the human embryo.”

The problematic nature of such agreements, arrangements and alliances is not by any means limited to Illinois and California. It is a nationwide epidemic, rooted in the age-old dilemma of choosing between God and money. This becomes very clear when revisiting the complexities of the Boston archdiocese’s Caritas Christi mess. You may recall that American Life League was quick to commend Cardinal Sean O’Malley when the archdiocese made this announcement on June 26:

Caritas Christi Health Care, the financially challenged Catholic hospital system founded by the Archdiocese of Boston, is abruptly ending its joint venture with a Missouri-based health insurer at the insistence of Cardinal Sean P. O'Malley, who has decided that the relationship represented too much of an entanglement between Catholic hospitals and abortion providers.

But, within days, we received a telephone call informing us that the agreement had actually not been cancelled. Carol McKinley reported this on her blog, which has thus far not been refuted: “Nobody (including other bishops and cardinals) is able to get details out of the cardinal about what it is he has approved. I think our Catholic pro-life force deserves to know what the actual arrangement is.”

But we do have an inkling when we consider the statement Cardinal O’Malley made, as quoted in the Boston Globe: “By withdrawing from the joint venture and serving the poor as a provider... upholding Catholic moral teaching at all times, they are able to carry forward the critical mission of Catholic health care.’’ The newspaper’s analysis: “Because Caritas will no longer be a joint owner of the insurance venture, the archdiocese is hoping that there will no longer be any question that Caritas will not financially profit from abortions, sterilizations, or other services provided by non-Catholic hospitals.”

A Caritas spokeswoman told the Globe, “This is the right way to move the distraction of the debate of ownership and allow us to be a provider.’’ Here is noted Catholic commentator Phil Lawler’s response: “A debate over involvement in killing unborn babies is a ‘distraction’ from the business of saving lives. A debate over mutilating people to make them infertile is a ‘distraction’ from the distinctive mission of Catholic health care.”

So we are left to wonder if all this means is that Caritas Christi is no longer an official business partner of abortion providers, but still connected with them in some way. Does it mean that Catholic hospitals will continue to refer for abortion, use the morning-after pill to treat rape victims and so forth? Nobody knows!

As I write this, similar problems are developing in New Hampshire, where the pressure is on Catholic hospitals to bend to the will of the state. New Hampshire Right to Life has prepared a set of three videos dealing with the challenges they face at this time. As was the case in Massachusetts, the cause of concern is a merger.

Wisconsin’s Catholic hospitals are also under the gun. Just last year, they were forced to dispense emergency contraception and did not sue, or in any other way, act to protect their Catholic identity. So what will happen now?

Well, the answer, which is frightening to say the least, may be contained in a short commentary written by Catholic Health Association’s president and CEO, Sister Carol Keehan, DC, who attended the March 5 Obama White House Health Reform Summit. She tells us, President Obama also was clear that we will have to spend more money in the immediate future to build the infrastructure to lower health care costs in order to achieve the kind of savings and affordability in the future. He pointed out that this is politically one of the hardest kinds of decisions to make.

It occurs to me that the various pressure tactics already being used by state governments to pressure Catholic hospitals into doing the unthinkable are but one way to tighten the noose as “Obama-care” becomes a reality, if, in fact, it does.

What also occurs to me is that our bishops must speak with a unified voice, without any dissent and without any bureaucratic mumbo jumbo. They must set forth authentically Catholic medical ethics as the only medical ethics that will be followed in a Catholic setting—with or without mergers, alliances or “common-ground” shenanigans. Until that happens, Catholic health care, as we once knew it, will continue to deteriorate and, at some point, will crumble.


I honesty cannot belive that a woman would consider rape to be a gift from God. Maybe you, julie, need to get out in the real world for a while. You will be not be winning anyone's heart and mind by acting like a fanatic

July 22, 2009

It must be that bishops are unable, or unwilling, to teach Catholic beliefs, and so instead appease the culture.

For example, the Peoria Protocol "administer an emergency contraceptive for the victim's psychological benefit" when no physical purpose exists.

And OSF allowing employee physicians to prescribe oral contraceptives because they the doctors wanted to. Teaching employee physician the truth as set forth in Humanae Vitae would have fulfilled the Bishop's and OSF's responsibility, instead!

If Catholic teachers and institutions are not going to stand up and answer the challenges in the hard cases, then what do they understand Catholicism to mean? When do people get the teaching? When does the light shine? When does the Light shine?

If bishops want to restrict themselves to espousing pious practices - which the secular culture may ridicule but nonetheless tolerate, and avoid teaching us how to address the difficult decisions in our lives, then they lead us towards sentimental religiosity and away from truth and heroic living.

David Volk
July 22, 2009

Catholic health care has been sliding down the moral slippery slope ever since it permitted replacement of the demoniacal possession theory of disease with heretical scientific theories of disease.

July 22, 2009

The Massachusetts law requiring that emergency contraception be provided at hospitals to rape victims went into effect in late 2005. There is no exception for Catholic hospitals and none are known to have refused to comply with the law. One of the ways the medication works is by preventing the implantation of a newly conceived human being in its mother's uterus. This is an abortion. Governor Romney vetoed the legislation, and the Catholic hierarchy made no effort to round up the votes (one-third from either house of the legislature) needed to sustain the veto. Never mind that about 70 percent of the members were Catholic! Apparently diocesan leaders decided it would not be worthwhile to risk antagonizing the heavily Democratic legislature by working to sustain a Republican governor's veto.

Charles O. Coudert
July 22, 2009

John Carroll to Webmaster
Submitted Comment

One has to know Peoria’s local politics to really understand what is happening at OSF- Saint Francis Medical Center regarding Catholics and contraception. What has happened is quite complex and not transparent.

OSF hired Catholic ethicist Joe Piccione in the early 90s and made him OSF Corporate Ethicist. According to the Peoria Journal Star articles from that time, one of Mr. Piccione’s main goals was to work with the Catholic Diocese of Peoria and make an ethical loophole which would allow OSF to be in the contraceptive business. The rationale was that this would help OSF stay competitive in the Peoria medical marketplace.

OSF’s Mr. Piccione and Bishop John Myers of the Catholic Diocese of Peoria were able to establish a policy which allowed OSF physicians to write for contraceptives ('limited private practice'). At the same time, OSF HealthPlans insurance provided a wide array of oral contraceptives and sterilization methods.

These policies were implemented, as explained to me by Mr. Piccione, using ethical firewalls to separate the evil act (contraception) from OSF. The “limited private practice” policy and third party payers supposedly provided the firewalls.

However, when interviewed by the Peoria Journal Star 15 years ago, Mr. Piccione, stated that their hands would be dirty with this policy.

And just recently, OSF purchased Carle Clinic in Bloomington, Illinois. Carle serves over 37,000 patients. Carle Clinic representatives have told me that their physicians will soon become OSF employees and will write prescriptions for oral contraceptives in this newly purchased OSF facility.

Unfortunately, these Peoria policies and practices are in opposition to the fundamental teachings of Humanae Vitae. However, as pointed out in Judie’s commentary, the Catholic Diocese of Peoria is not alone in succumbing to the forces of the medical marketplace.

John A. Carroll, MD
Peoria, Illinois

Tuesday, August 3, 2010

Haitian Adoptions

Photo by John Carroll/July 28, 2010
Beautiful Haitian of thirty seven babies, toddlers, and children in an orphanage in the capital going nowhere quickly. How sad and how bad.

My wife Maria and I adopted a Haitian toddler several years ago. It took 20 months of agonizing paperwork (done by Maria). The bureaucracy on both sides of the water was terrible. (We had to be fingerprinted three times by the US government. And our adoption documents sat in various Haitian ministries for months at a time...just needing one director's signature.)

It has not been uncommon during the past twenty years to walk down the street in Port-au-Prince and be offered a baby/child to adopt by a desperate adult caregiver. In fact that happened frequently. And still does post earthquake. (We were offered a baby who was born in July by the parents...but the offer was made to us in May.)

Haitian parents love their kids, they just can't feed and educate them. So there are hundreds of thousands of orphans in Haiti.

Haiti just went through the biggest natural disaster ever recorded. In history. Ever.

Were mistakes made with hustling over 1,100 kids out of Haiti to be adopted AFTER the earthquake? Probably.

But are mistakes being made now by slowing Haitian adoptions? Yes, definitely, with many Haitian kids suffering in every fashion you can imagine.

See article below.

August 3, 2010

After Haiti Quake, Adoption Chaos

BAXTER, Minn. — Beechestore and Rosecarline, two Haitian teenagers in the throes of puberty, were not supposed to be adopted.

At the end of last year, American authorities denied the petition of a couple here, Marc and Teresa Stroot, to adopt the brother and sister after their biological father opposed relinquishing custody.

Reluctantly, Mr. and Mrs. Stroot, a special-needs teaching assistant and a sales executive with four children of their own, decided to move on.

Then on Jan. 12, a devastating earthquake toppled Haiti’s capital and set off an international adoption bonanza in which some safeguards meant to protect children were ignored.

Leading the way was the Obama administration, which responded to the crisis, and to the pleas of prospective adoptive parents and the lawmakers assisting them, by lifting visa requirements for children in the process of being adopted by Americans.

Although initially planned as a short-term, small-scale evacuation, the rescue effort quickly evolved into a baby lift unlike anything since the Vietnam War. It went on for months; fell briefly under the cloud of scandal involving 10 Baptist missionaries who improperly took custody of 33 children; ignited tensions between the United States and child protection organizations; and swept up about 1,150 Haitian children, more than were adopted by American families in the previous three years, according to interviews with government officials, adoption agencies and child advocacy groups.

Among the first to get out of Haiti were Beechestore and Rosecarline. “It’s definitely a miracle,” Mrs. Stroot said of their arrival here, “because this wasn’t going to happen.”

Under a sparingly used immigration program, called humanitarian parole, adoptions were expedited regardless of whether children were in peril, and without the screening required to make sure they had not been improperly separated from their relatives or placed in homes that could not adequately care for them.

Some Haitian orphanages were nearly emptied, even though they had not been affected by the quake or licensed to handle adoptions. Children were released without legal documents showing they were orphans and without regard for evidence suggesting fraud. In at least one case, two siblings were evacuated even though American authorities had determined through DNA tests that the man who had given them to an orphanage was not a relative.

“I feel a weird sense of survivor’s guilt,” said Dawn Shelton of Minnesota, who hopes to adopt the siblings. “So many people died in Haiti, and I was able to get the life I’ve wanted.”

In other cases, children were given to families who had not been screened or to families who no longer wanted them.

The results are playing out across the country. At least 12 children, brought here without being formally matched with new families, have spent months in a Pennsylvania juvenile care center while Red Cross officials try to determine their fate. An unknown number of children whose prospective parents have backed out of their adoptions are in foster care. While the authorities said they knew of only a handful of such cases, adoption agents said they had heard about as many as 20, including that of an 8-year-old girl who was bounced from an orphanage in Haiti to a home in Ithaca, N.Y., to a juvenile care center in Queens after the psychologist who had petitioned to adopt her decided she could not raise a young child.

Dozens of children, approaching the age of 16 or older, are too old to win legal permanent status as adoptees, prompting lawmakers in Congress to consider raising the age limit to 18.

Meanwhile, other children face years of legal limbo because they have arrived with so little proof of who they are, how they got here and why they have been placed for adoption that state courts are balking at completing their adoptions.

One Kansas lawyer said he satisfied a judge’s questions about whether the Haitian boy his clients had adopted was an orphan by broadcasting announcements on Haitian radio stations over two days, urging any relatives of the child to come forward if they wanted to claim him.

Another couple seeking to adopt, Daniel and Jess McKee of Mansfield, Pa., said Owen, 3, who can dribble a basketball better than children twice his age, arrived from Haiti with an invalid birth certificate — it shows him as 4 — a letter in French signed by a Haitian mayor that declared him an orphan, and stacks of handwritten medical records from his time in a Haitian orphanage.

Their prospective daughter, Emersyn, also 3, came with no documents at all.

“As things stand,” Mrs. McKee said, “I’m basically going to show up in court and tell a judge, ‘These kids are who I say they are,’ and hope that he takes my word for it, because if he asks me to prove it, I can’t.”

Later, she added, “I guess the government said, ‘Let’s just get the kids out of Haiti, and we’ll worry about the details later.’ ”

Decisions Made in Haste

Administration officials defended the humanitarian parole program, saying it had strict limits and several levels of scrutiny, including reviews of adoption petitions by the State Department and the Department of Homeland Security in Washington and Port-au-Prince, the Haitian capital.

But they also acknowledged that the administration’s priority was getting children out of harm’s way, not the safeguards the United States is obligated to enforce under international law.

Matt Chandler, a spokesman at the Department of Homeland Security, said the evacuations were done in the best interests of children who faced “an uncertain and likely dangerous situation that could worsen by the day, if not by the hour.”

Whitney Reitz, who oversaw the parole program at the Department of Homeland Security, acknowledged that the decisions were hastily made.

“We did something so fast,” Ms. Reitz said at a conference in New York in March. “We did something that normally takes a couple of years and that we normally do with excruciating care and delay. There’s so much time for deliberation in the way the program normally goes, and we condensed all that into a matter of days.”

There is no evidence to suggest that the evacuations were driven by anything other than the best of intentions. And with untold numbers of unaccompanied children in Haiti, the hemisphere’s poorest country, left fending for themselves or languishing in institutions, it is not hard to make the case that those who were evacuated are better off than they would have been in the hemisphere’s poorest country.

Many now live in the kind of quiet, scenic towns depicted in Norman Rockwell paintings. They are enrolled in school for the first time. They have grown inches, gotten eyeglasses and had their cavities filled.

And they are learning what it feels like to have a mother and father wake them up every morning and tuck them into bed every night.

But child protection advocates like Marlène Hofstetter at Terre des Hommes, an international child advocacy organization, contend that those ends do not justify the means. Rushing children out of familiar environments in a crisis can worsen their trauma, she said. Expediting adoptions in countries like Haiti — where it is not uncommon for people to turn children over to orphanages for money — violates children’s rights and leaves them at risk of trafficking, she added.

“I’m certain that one day these children are going to ask questions about what happened to them,” Ms. Hofstetter said. “I’m not sure that telling them their lifestyles were better in the United States is going to be a satisfactory answer.”

Even though the humanitarian parole program has officially ended, it remains a source of tensions between American-run orphanages in Haiti and international child protection organizations.

The advocates, led by Unicef, have refused to place children who have lost their parents or been separated from them in some foreign-run orphanages, fearing they would be improperly put into the adoption pipeline before they had the chance to be reunited with surviving relatives.

And the pro-adoption groups, led by the Joint Council on International Children’s Services, accuse the advocates of using endless, often unsuccessful, attempts to locate the children’s biological relatives to deny tens of thousands of needy Haitian orphans the opportunity to be placed in loving homes.

“Unicef’s idea is to house children in tents, and tell them that maybe in five years their relatives will be found,” said Dixie Bickel, who has run a Haitian orphanage called God’s Littlest Angels for more than two decades. “What kind of plan is that?”

Washington Feels Pressure

Concerns about child trafficking led China, after its 2008 earthquake, and Indonesia, after the 2004 tsunami, to suspend all international adoptions, despite intense pressure by pro-adoption groups in the United States, according to Chuck Johnson at the National Council for Adoption.

After January’s quake, Haiti, though, was hardly able to stand on its own feet, much less push back, Haitian officials acknowledged. Orphanage directors with political connections in Washington said they saw an opportunity to turn the tragedy into a miracle. Some issued urgent pleas, saying that the children in their care had had been left without shelter, and that the orphanages’ limited stocks of food and water made them prime targets for looting.

In the United States, adoptive parents contacted anyone they knew who might have money, private planes and political connections to help them get children out of Haiti. Evangelical Christian churches, which have increasingly taken up orphan care as a tenet of their faith, were also mobilized. Before long, legislators and administration officials were getting calls from constituents.

Senator Mary L. Landrieu, a Louisiana Democrat and adoptive mother, has been a champion of the cause and pushed administration officials to help bring Haitian children here after the quake. “I wouldn’t be the least bit surprised if there are some errors that were made,” Senator Landrieu said in an interview about the rescue effort, “but you want to err on the side of keeping children safe.”

On Jan. 18, less than a week after the earthquake hit, the secretary of homeland security, Janet Napolitano, announced that the United States would lift visa requirements for those orphans whose adoptions had already been approved by Haitian authorities and those who had been matched with prospective parents in the United States.

The requirements were written so broadly, adoption experts said, that almost any child in an orphanage could qualify as long as there were e-mails, letters or photographs showing that the child had some connection to a family in the United States. And by the time Ms. Napolitano announced the program, military flights filled with children were already in the air.

“The standard of proof was very low,” said Kathleen Strottman, executive director of the Congressional Coalition on Adoption Institute, a nonprofit group that is a leading voice on American adoption policy. “That’s why the administration ended the program as quickly as they did,” she added, “because they worried the longer it was open, the more opportunities they would give people to manufacture evidence.”

Obstacles to Adoption Vanish

Over the next several weeks, orphanages big and small were nearly emptied, whether or not they had been affected by the earthquake.

The staff at Children of the Promise, about 90 miles from Haiti’s capital, barely felt the temblor. But 39 of the 50 children there were approved for humanitarian parole, even though none of them had been affected by the disaster and the orphanage had not yet received the proper license to place children.

Rosemika, 2; Alex, 1; and Roselinda, 1, offer a look at the typical humanitarian parole case. Rosemika’s mother died before the quake. The other two children were given up for adoption because their parents could not provide for them.

Jenny and Jamie Groen, a missionary couple from Minnesota who were volunteering at the orphanage, had fallen in love with the children and decided to adopt them.

Under normal circumstances the couple would have had to get special permission from Haiti’s president to adopt because they are both 28, and the government requires at least one of the prospective parents to be older than 35.

After the quake, Prime Minister Jean-Max Bellerive summarily signed off on their adoption — as he did with all humanitarian parole petitions submitted to him by the United States — without checking the Groens’ qualifications.

Meanwhile, the couple rushed back to the United States for the background checks and home study their own country required for them to take children into their care. And they submitted e-mails, photographs and a Dec. 2 newspaper clipping to prove that their commitment to adopt the children predated the earthquake.

During a recent visit to the orphanage in Haiti, surrounded by peasant hovels and sugar-cane fields, Ms. Groen, now pregnant, said she and her husband were still trying to absorb how quickly they were going from an empty nest to a full one.

It has been a whirlwind for the children’s biological relatives as well. The girls’ relatives still regularly visit the orphanage. “That’s the thing that’s so different about Haiti,” Ms. Groen said. “It’s not full of unwanted children. It’s full of children whose families are too poor to provide for them.”

That appeared to be the predicament shared by Beechestore, 14, and Rosecarline, 13, who are going through all the turmoil of adolescence, exacerbated by a confusing legal tug of war.

In the spring of 2008, their biological father had told the American authorities that he had placed the children for adoption only because he thought they would be educated in the United States and then returned to Haiti. Once he understood the implications of adoption, he refused to give them up.

In November 2009, American authorities formally notified the Stroots that their adoption petition had been denied.

By then, the Stroots were spent — emotionally and financially. The effort to adopt the children had taken four years and $40,000. Rather than appeal, the Minnesota couple decided it would be best for everyone to end their efforts.

Then the earthquake hit. Homeland Security, which earlier had denied visas to the children, reversed course without consulting the children’s biological father or the Stroots. “One day, we’re being told we can’t have the kids,” Mrs. Stroot said. “The next minute, we’re getting a call telling us we need to get them winter coats. It was crazy.”

In late July, a Minnesota judge awarded the Stroots legal custody of the children. Neither the previous denial nor the views of the children’s biological father were mentioned during the proceeding, the Stroots said.

Since then, the newly expanded family has moved on to more mundane matters, like dentist appointments, vaccinations and back-to-school shopping.

“God got done in 10 days,” Mr. Stroot said, “something human beings couldn’t do in years.”

Erin Siegal contributed reporting from Oakland, Calif. Barclay Walsh contributed research from Washington.

Catholics and Fear of Church Hierarchy in Peoria

Peoria Journal Star

Forum: Catholics shouldn't be afraid to challenge church hierarchy

Posted Jul 31, 2010 @ 10:45 PM

With the sale of Resurrection Church in LaSalle, plus the demolition of St. Benedict's in Ladd and the loss of attendance in the four suspended churches in our area, it is time to challenge the church's hierarchy.

We have little authority in church governance. We must challenge this clerical pyramid that is secretive and above scrutiny. We must take a stand for accountability in overseeing the complexities of church finances and all church functions.

We want a diocese, monastery or abbey to be like that of a poor workman who is not sure if tomorrow he will find work or bread. We want them to be filled with those who with all their being share their suffering with those they preach to.

We no longer want a diocese, monastery or abbey whose leaders concern themselves with their own survival and security, free from fear, care or anxiety, while the parishioners are uneasy about what the future holds in their Catholic community. It is easy to speak of spiritual poverty, to fill one's mouth with pious words based on scriptural readings, and yet lack for nothing.

It is time, the parishioners take back the churches they paid for, furnished and repaired. It is time for the laity to handle church operations and let the priests be responsible only for what is sacred.

We have too many priests who live comfortably while parishioners struggle for their church's survival. This has to stop. There are few priests who emulate the poor Nazarene and the humble Jesus.

We need a crusade to recover "Christianity" from the clerical elite. This must come about in order to ensure our Catholic faith.

Carlo Olivero


Monday, August 2, 2010

A Lesson for U.S. Health Care

Photo by John Carroll
Les Cayes, Haiti
July, 2010

In Haiti, a Lesson for U.S. Health Care


In February, a month after Haiti’s earthquake, I went down to Port-au-Prince as part of a team that was helping to reactivate cardiac care in the city’s public hospital. For several months since, I have observed how the earthquake and its aftermath profoundly changed Haiti’s health care system. Over that time, I have come to the unorthodox conclusion that Haiti’s tragic experience may show us a way to improve health care in the United States.

Let me explain. The sudden availability in Haiti of free high-quality care from foreign doctors put enormous competitive pressure on the private local doctors, who had already been working under difficult conditions. Watching this situation unfold, I found myself wondering if the same would happen to private medical services back in the United States were our government to suddenly provide high-quality, low-cost health care.

Haiti, with the worst health care record in the Western Hemisphere — the infant mortality rate is nine times that of the United States and the maternal mortality rate is 50 times as high — was ill prepared to help disaster victims. For the public hospital in Port-au-Prince, earthquake damage only made things worse. Into this vacuum surged hundreds of international doctors and nongovernmental health care organizations.

In the beginning, of course, those with immediate injuries were treated first. But even after the earthquake victims had been taken care of, lines more than a quarter-mile long still formed at the hospital entrance. There were mothers carrying babies with swollen bellies, prematurely old men and women with waterlogged legs and labored breathing, people with painful sores and lots of people coughing. These were Haitians who’d had no access to medical care in a long time and who suddenly saw hope in a hospital full of foreign doctors eager to help at no charge.

This humanitarian aid came with a downside though: it caused many of Haiti’s local private clinics to lose business. One such clinic is Michel Théard’s cardiac practice, near the public hospital where I worked. Before the earthquake and during the immediate aftermath, Dr. Théard did echocardiograms (ultrasound images of the beating heart) for cardiac patients, because the public hospital lacks the equipment to do them. His ultrasound pictures, and those done by other private Haitian cardiologists, often at charity rates, enabled us to diagnose many conditions for patients in the public hospital.

But because Dr. Théard, and the private hospital with which he is affiliated, cannot compete with free foreign doctors, there is a danger that he will no longer be able to stay in business and provide echocardiograms for the poor.

There are many other services that only private doctors provide in Haiti, because the public hospitals are so poorly financed. The rudimentary intensive care unit at the public hospital has no heart monitors, oxygen sensors or any other kind of modern medical equipment. The only thing “intensive” about the I.C.U. is that a health care worker (doctor, nurse or nurse-anesthetist) is present at all times. A CT scanner donated to the hospital in the early ’90s lies rusting outside one of the buildings, sad evidence of the public medical system’s failure to provide adequate care.

Patients who can afford it get specialized procedures like CT scans and echocardiograms at private clinics and then return to the public hospitals for free care. This is also the case for many medicines: family members buy them at a pharmacy and bring them back to be kept under the patient’s hospital pillow for dispensing at the prescribed times.

Perversely, by shoring up the capacity of the normally dysfunctional public health system during this crisis, the foreign doctors may be further damaging Haiti’s fragile medical sector. Once they leave, who will be left with the will and the capital to adequately care for Haitians?

What may be needed, some have suggested, is for key nongovernmental organizations now offering health care in Haiti to work alongside the government’s Ministry of Health to rebuild destroyed facilities and to better train Haitian doctors and other providers. If the organizations could also cooperate financially by directing some of their budget into accounts run jointly with Haiti’s Ministry of Health, the government could reimburse providers like Dr. Théard for their work, thus removing competition between the foreign doctors and local private doctors. In time, as the Haitian government took control of health care delivery and education, the nongovernmental organizations would fade from the scene.

HAITI’S crisis — and its possible solution — provides a mirror for understanding our own difficulties delivering good health care in the United States. After all, it was a similar tension between private and public medical care that made it impossible for Congress, in passing reform legislation this year, to create a single-payer public health system. Many private health-care organizations — primarily for-profit insurance companies — strenuously resisted it, fearing that if the government suddenly provided high-quality, low-cost care for a significant part of the population, they would lose profits or go out of business. Worries about competition between public and private medicine, in other words, are universal.

It is clear that the American health care system functions at a much higher level than its Haitian counterpart does, but that’s mostly a matter of national wealth. Our healthier economy has allowed us to have a relatively viable private-sector health care system, though there remains tremendous disparity from one economic class to another in infant and maternal mortality and access to basic care. And now, because the growing cost of our health care system is unsustainable, we are faced with the need to consider an alternative.

The Haitian situation also suggests a solution — a way to provide health care for all in the United States without destroying our private medical sector. (This, by the way, was always President Obama’s goal, no matter how the right tried to defame his proposals.)

A public-private partnership like the one contemplated for Haiti could be created here. The government, through the Centers for Medicare and Medicaid Services, could team up with health care systems that provide high-quality care to people of all income levels — Kaiser-Permanente, in California, comes to mind, as does the Mayo Clinic network; the Geisinger Health System, in Pennsylvania; Partners HealthCare, in Boston; and Intermountain Healthcare, in Utah — to provide a public option. Private doctors could be paid for the work they did for the new public entity. People who did not want to join such a health plan could remain with their current private insurers.

Health care systems wishing to be part of the new partnership would have to demonstrate competence as well as fiscal responsibility. Those that did not provide good care at a reasonable price might fail, but in the long run the system could serve the broadest cross section of America, and it could do so without undermining private doctors — or at least not those who are motivated by care itself rather than by mere profit.

Although it is unrealistic to expect Congress to rewrite the health care law to allow for this proposal, there is room within the law for a state or regional pilot project to experiment with public-private medical partnerships.

Dr. Théard’s clinic in Port-au-Prince has not yet closed, but he tells me it is now fighting for its life, with little or no money for salaries, equipment or rent. “We are still open but without any help from any sector,” he said in an e-mail last week. “Equipment needs repair, buildings need repair and we are doing the best we can.”

Haiti’s need to fix its health care system is, if anything, more urgent than ours. But its best solution, a public-private partnership, is one that could easily work for America, too.

James Wilentz is a cardiologist at the Lenox Hill Heart and Vascular Institute.