In the Public Eye

A season when kids die

jtaylor — Fri, 16 May 2008 15:15:00 GMT

A muggy summer day at a backyard birthday party in Gilroy. Drinks, barbecue, kids in a pool full of inflated toys and rafts. I shooed a bee away from one youngster as he sat on a diving board, chomping on a hot dog.

My kids, ages about 5 and 9 back then in the mid-1980s, got to squabbling, so we bugged out early, to Fresno. Not long after, our phone rang. That youngster on the diving board, he was on life supports. Seems after we left, most of the party moved into the cool indoors. He'd gone into the pool, but even with a few people around, nobody noticed him. He dived, tried to resurface but couldn't get past the inflated pool gear. He sunk to the bottom for, well, what became a lifetime.

A nurse was able to revive him but the brain damage was so severe he spent the remaining years of his life in institutional care. He would have been about 27 now.

I think about him when the first inferno of summer hits the Valley. A time when sober kids and inebriated others jump into the brisk, frigid waters of the Kings River. And a time when adults leave the back door open a crack and the pool becomes a fatal magnet.

Yes, most communities have laws requiring fences around pools. I had a six-foot, black-coated steel fence around my pool in Fresno. But kids are part monkey, innovative. One day my son showed me how easy he could climb it.

Community Medical Centers runs the only combined burn and Level 1 trauma centers between Los Angeles and Sacramento. Our docs and nurses are way too familiar with accidental drownings and near-drownings from pools, canals, lakes -- a little water left in a bathtub. How about if you spare them being part of a tragedy by investing in some vigilance?

Regents boost Valley med school

jtaylor — Wed, 14 May 2008 19:45:00 GMT

It was the marriage of whiplash and deja vu. Hours before Gov. Schwarzenegger debuted the latest version of a hellish state budget proposal, the University of California's governing Board of Regents gave a unanimous thumbs-up for continued planning for a multi-million-dollar Valley medical school headquartered at UC Merced.

Among the regents concerns during the nearly three hours of presentations, Q/A: The state has no money, why are we creating a new money-eating entity? The other UC campuses need the money that would adhere to this project, why not direct dollars to established institutions? The core UC Merced has yet to be fully "UC branded" with excellence, why not solidify that before stretching to create a doctor-making program?

Anybody, including me, who observed or covered as a reporter the creation of the UC Merced campus can be forgiven for having a flashback. Tweak a word or sentiment, and you had similar naysayers 20 years ago when talk turned to plopping a high-tech campus in puddles of fairy shrimp and steer flop.

Would Fresno have been a better location? Yep. But the locals couldn't agree on a site and a strategy, and Merced stepped up. Should Fresno be home to a new med school? Yep. It will be a key player, but ...

A troop of Valley citizens made their case to the regents. UC Merced Chancellor Steve Kang and Dean Maria Pallavicini delivered formal presentation. Kang replied to numerous regents concerns, mostly about fund-raising. No cash in hand, no school. The hardest question, though, and the one that probably needs better answering for the regents: Can you prove that physicians who go to a four-year medical school in the Valley will stay here for their three-year-plus residency or actually open a practice here? That's different than someone who comes here for a residency and stays.

Said Regent Eleanor Brewer: "The medical community has to welcome the students in the community as they graduate, to build a practice."

Regent George Marcus, among one or two others, didn't dismiss that the Central Valley has huge health access issues, fewer docs, more chronic illness. But the med school idea, he said, was in a "fantasy phase." Nope, said Regent Sherry Lansing, "it's a hard-core reality."

Community Medical Centers was among Valley health providers and others that endorsed a new med school. In partnership with UCSF Fresno, Community is the main doctor-recruiter-trainer-retainer in the Valley.

Today's vote gives med school backers a year or so to fashion a formal proposal and business plan for regent review.

Of course, it's about the money -- fighting through the whiplash of hard times (or as one regent suggested, how about tapping million-dollar Valley farmers as donors?).

Final word comes from UC Regent Brewer: "When I think of the Central Valley, if not us, then who else would do this?"

It stinks to be too clean

jtaylor — Mon, 12 May 2008 15:33:00 GMT

I didn't expect a vacation in Monterey -- yelping seals, cavorting otters, lots of good seafood -- would provide a heaping helping of health incidents.

Mold in pricey hotel room showers (OK, it's damp on the coast but ...). Waiter in top-rated restaurant accidentally dangles his tie --- first in the crab, next in the chocolate cake.

But cleanliness, too, can stink. On opening the door to a trendy Pacific Grove eatery -- gag! A deluge of Pine-Sol. And eyeballing the pastries in a Carmel bakery -- another door-opening scent-soaking aroma of the same disinfectant. (My bad: I guess Pine-Sol is trendy!)

I expect my nurse to wear gloves when doing a blood draw, and for hospital bed sheets to be crispy clean. The best hospitals know you can never be clean enough or professional enough. But they set high standards -- like Target 100 at Community Medical Centers, with the goal of attaining 100% satisfaction rates -- measurable -- from patients, staff and physicians.

Customer service apparently needs to make its way to the wealthy Central Coast.

ZIP Coding your lungs

jtaylor — Fri, 02 May 2008 21:19:00 GMT

Valley air stinks and will for years to come. It drives off business and sickens people to death. The American Lung Association, among others, annually reminds us how bad off we are. But those of us who've moved around the country can take that one step further.

How about tracking the air in places you've previously lived? OK, it's a snapshot in time -- you don't live there now, but bad air (water, crime, etc.) tend to be trendy, lingering for years.

If you go to www.stateoftheair.org you can plug in your ZIP Code for an estimate of the ozone and particulate pollutions and some other frequently sorry facts.

So, Fresno County -- "F" for ozone, "Fail" particulates. Milwaukee County, Wis. (previous home) -- "F" for ozone, "Pass" particulates. New London, Conn. (previous previous) -- "D" ozone, "Pass" particulates. Hartford, Conn. -- "F" ozone, "Pass" particulates. Brooklyn, N.Y. (Kings County) -- doesn't collect ozone data, "Pass" particulates.

How bad is too bad? How long do you live in too many bad places before it amounts to something? Can't get that info from ZIP Codes, or my Advair inhaler.

Yelling in DC, and 5 ways to be heard

jtaylor — Wed, 30 Apr 2008 17:39:00 GMT

With so many bodies under the budgetary knife and everyone screaming, who gets 9-1-1 treatment from Congressmen?

The Congressional Management Foundation, a research arm for lawmakers and their staffs, has examined five popular myths and offered how-to's for those trying to make their "Help!" resonate.

Myth: "One size fits all" congressional offices. Reality: Target and tailor the message for each lawmaker and his district. And know what your rep has already done on legislation -- don't ask him to co-sponsor something he's already authored.
Myth: Hide the identity of the group you represent so your note seems spontaneous. Actually, letters from expert sources (patients whose insurers won't pay for chemo, for example) carry more weight than John Does complaining about the overall plight of the uninsured.
Myth: Quantity has more clout than quality. Reality: Short letters with personal stories coupled with a few well-placed (and timed) phone calls and office visits get noticed more than hundreds of boiler-plate letters. Tell how legislation will help or hurt specifically -- don't use "fake Astroturf" regurgitations from lobbying groups.
Myth: Faxes are most effective. Reality: They take more staff resources, not to mention paper and toner. So, it's easy for scads of form letters to backfire.
Myth: Email is ineffective. Reality: Duh! Digital rules. But here, too, hitting send a hundred times with the same generic message to the same lawmaker, even with different names as signatories, looks like a serious abuse of a membership list. It sure ain't serious lobbying.

Having tromped into DC offices lobbying for health care, sometimes just after a group of educator lobbyists but just ahead of a herd of waste management specialists, it's easy to read boredom/exasperation in lawmaker's eyes (and especially their staffs). So if you can be brief and pertinent ("here's how much money was spent on trauma care to people in your district"), you've not only delivered a potentially powerful message, but you may have created an anecdote your rep will repeat in speeches.

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Those were some of the ways mentioned to two-dozen Central California hospital officials April 25 by Assembly Minority Leader Mike Villines of Clovis as he puzzled how legislators may tackle the state's multi-billion-dollar budget deficit.

Although little coherence seems evident in Sacramento, the hammer, the ax, the Big Hurt, the cutting of "meat and bones" as one Valley clinic CEO put it -- is coming.

Ten percent across the board is what's on the table. Some of these cuts, including Medi-Cal, would involve turning away matching federal money -- a double-whammy that Villines said lawmakers would like to avoid. The California Hospital Association reports that the state's community hospitals -- like Fresno-based Community Medical Centers -- lose 22 cents for every dollar of cost incurred for treating Medi-Cal patients. Another 10% cut, the association says, would mean more patients seeking care in emergency rooms and more closures of fiscally strapped ERs.

There's no time for deep reflection, Villines said, this is a horse race. The budget deadline is July 1, a line frequently crossed. But the hole is deepening. As of April 28, two-year deficit projections of $18 billion were being floated.

Over the years, experts have cautioned that the only way health care will be significantly improved is if something unfortunate happens to somebody important. A dire thought. The health "system" in Los Angeles has been hemorrhaging to death for decades. It now has numerous mirror images elsewhere.

"Fear will drive change," Villines said, referring to what might spur legislators. Replace the word "change" with "improvement" -- and I'd be OK with some more belt-tightening.

Highway to hell

jtaylor — Thu, 24 Apr 2008 15:25:00 GMT

Lucky LA. Although lots of services are being cut in the name of budget "austerity," (LA Times headline-ese), the Bureau of Street Services (oxymoron?) will be bumped up 3% so it can repair an additional 60 miles of streets.

That means the city's backlogged calendar of street patch-jobs will decline from 63 years to 43 years, the Times says. (This ain't a waiting list to get Green Bay Packers seasons tickets -- this is busted axles and trips to the orthopod.)

Lucky UC. Longtime Sacramento Bee columnist Peter Schrag quotes UC San Francisco researcher Stanton Glantz as saying the only way to offset the portended cuts in higher ed budgets in California would be enormous -- and unlikely -- increases in student fees or gobs of private contributions.

UC Berkeley, UCLA and maybe UC San Diego will survive the debacle, Glantz predicted, "but the rest of the system will fall apart." (Hello, Merced?)

Lucky USA. Bridges are collapsing, intellectual brilliance sounds like it may become a total accident and nobody in the media has yet done an overall "this-equals-that" analysis of the cuts in mental health services and the number of crimes attributed to those lacking mental health treatment.

We've got 46 million or so uninsured. The California Hospital Association says the total value of uncompensated medical care provided in the nine-county Central Valley is approximately the value of the entire Tulare County citrus industry. Last year, Community Medical Centers alone provided $122 million in un/undercompensated care, more than other area hospitals combined.

We should all appreciate the miracle of awakening each morning, especially if gifted with health, a few dollars in the wallet and a willingness to tackle small problems coming our way.

Tacos, $10 billion and you

jtaylor — Mon, 21 Apr 2008 21:05:00 GMT

The taco chain store was jammed, the teen staff making supremes and nachos as fast at their sanitary-gloved hands could move. But help was needed. And several staffers offered their bare, gotta-rub-my-nose mitts to mash together sliced lettuce and shredded cheese.

Is the slogan "Run (singular?) for the border?"

Reminded me that some time before New Year's 2009, a California budget will be downsized and dished out. At this moment, the $16 billion-and-growing deficit plan includes hacking 10% -- to start with -- across the board from virtually every government-assisted program.

In 2007, California hospitals provided about $9.7 billion in uncompensated care -- you can get some care, but not tacos for free. And at this point, many service providers are calculating what an additional 10% loss will mean. Don't know about you, but I have a hard time getting my arms around such saturated numbers.

What's $10 billion mean? It would buy you roughly two USS Nimitz-class aircraft carriers. It's what the owner of Wild Turkey bourbon (Pernod Ricard) is paying to buy Absolut vodka. And Forbes magazine in 2008 reports that 16 of the world's 100 wealthiest people earn between $9 billion and $10 billion. (BTW, there are evidently 1,062 billionaires in the world.)

But at the taco distillery all I thought of was that budget cuts mean many of the people working here and in other low- to moderate-wage jobs won't get a shot an insurance. So, no preventive care. So, more expensive and multi-hour trips to emergency rooms. More uncompensated care, more closures (70 hospitals and ERs in the state in the last decade, says the California Hospital Association).

More waste, more suffering. And, after a long day of being sick at work, and a long night waiting -- treated/untreated -- at the ER, what's a feverish, bill-paying person to do? Suck it up and go back to assembling lunch. Yeah, I can get my arms around that.

A babysitter tax to save the state?

jtaylor — Wed, 16 Apr 2008 17:47:00 GMT

Should a sales tax on services -- the crew that trims your lawn, your yoga instructor and the person who watches your kids -- be part of the solution to California's $16 billion (so far) budget deficit?

That notion is again being floated by folks like Lucien Wulsin Jr., executive director of the Insure the Uninsured Project, and Sacramento Bee columnist Dan Walters.

Some states do tax services like dating agencies, dog groomers, bowling alleys. Other potentially taxable services include care delivered at hospitals and by physicians, tanning and tattoo parlors and nursing home care. Wulsin also questions whether any true value is delivered by conferring special tax status on nonprofit hospitals.

The Center on Budget and Policy Priorities in DC put out a good position paper in 2003, raising positives and negatives -- like is a state equipped to implement such a tax? Not too shabby a question given the layoffs and program cuts under way in California.

And also in 2003, Donald R. Doerr of the California Taxpayers Association drilled holes in the idea in a commentary available online. His criticisms: It discriminates against small business, will compel companies to buy such things as accounting services out of state, will discriminate against the elderly who are unable to do their own yard work, will soak the poor who drive older cars in regular need of repair and be susceptible to the lobbying of special interests seeking exemptions.

While everyone (selectively, allowing for yacht loopholes) hunts for money -- sustaining or otherwise -- to bridge the deficit, one interesting place to visit is the California Board of Equalization website ( www.boe.ca.gov). Check out the current list of the state's top 250 sales and use tax debtors -- some go back 20 years and the totals involve many tens of millions of dollars.

Better than taxing day-care services or your next haircut?

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In praise of "body snatchers"

jtaylor — Tue, 15 Apr 2008 17:39:00 GMT

Bone-chilling wind and rain. April at Naval Training Center Great Lakes, a teeth-rattling shuttle ride from Chicago's O'Hare Airport.

On cold, gum-encrusted bleacher seats we got to know a few of the 3,000 parents and other relatives of the 709 boot-camp graduates to be. We had three hours to scout through the crowd, relish Sousa marches and, finally, try to find son Daniel who pretty much looked like everybody else. Gotta love the military.

We also glimpsed stern-faced sailors trekking the narrow lines of sailors-to-be standing at attention. Every so often, way too often actually, they helped a staggering man or woman off the event center floor to some recuperation area -- sometimes four sailors carrying one unconscious colleague.

When ceremonies concluded, we went looking for Dan. His Mom had spotted him earlier, recognizing him by a notch in his ear. But there was no celebration moment of hugs and digital flashes among the milling throng. There was no Dan.

Hours later when we hooked up with him and strolled the Gurnee Mills Mall, we learned about "body snatchers" -- and even bumped into the young man who grabbed Dan before he passed out. Locking your knees in place can compromise blood flow after a while. And, no matter how many warnings recruits are given, bearing and posture sometimes outpace putting wisdom to use. Thus, "body snatchers" are designated at every graduation.

Dan's a lot skinnier, taller, more thoughtful and focused than he was on entering boot camp two months back. And he's moving on to his next level of Navy schooling. To him and to the "body snatchers," his Mom and I say: Bravo Zulu! (Navy talk for "well done.")

Touching all the cliched bases

jtaylor — Wed, 09 Apr 2008 17:50:00 GMT

It's time to be transparent. Status quo is not an option. Thanks to some personal pet peeves and a few takeaways from Modern Healthcare magazine, I've fully got some skin in the cliché game.

It is what it is, and going forward it will be problematic and impact us. As a member of the silver tsunami generation, I'm a rider on the perfect storm, a benchmark for futurists.

I'd like to take the bull by the antlers and even-out the playing field by drilling down into bureaucratic silos, blowing up institutional paradigms and generating buzz. As an ink-stained wretch gone fully digital, I know there are many moving parts and they must all be brought on board by the end of the day.

I'm not trying to drive a wedge between stakeholders, but it is what it is, I repeat repetitively myself. But I forgive me myself for the errors of my ways because I know in my heart of hearts, I can't let the perfect be the enemy of the good. Here's hoping against hope that you Digg my Twitr.

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Who'll help Stockton?

jtaylor — Tue, 08 Apr 2008 16:46:00 GMT

The red ink at San Joaquin General Hospital is supposed to be $32 million deep by end of June. It's one of few remaining county-run hospitals in California. Now county supervisors and some area hospitals are sort of talking about what they can do/want to do to avert an inevitable death by poor-patient overload and fiscal starvation.

"The state is basically trying to make the county indigent," Supervisor Larry Ruhstaller told the Lodi News-Sentinel. "If we're that valuable, let's see how valuable we are to (the community's hospitals)," Supervisor Ken Vogel told the Stockton Record.

This is a Valley episode of the recurring Los Angeles nightmare -- county or nonprofit hospitals close their doors. The uninsured find their way to the remaining emergency rooms and shared misery rules the day.

The dialog and any hands-across-the water actions will be interesting to follow. At this point, it looks like Lodi Memorial, St. Joseph's Medical Center, Doctor's Hospital of Manteca and Kaiser Permanente may be at the table with San Joaquin General.

Solutions are in short supply (example: the failed California universal coverage push). Delaying tactics are the only politically feasible options (chucking rocks at the wolf at the door -- example: pending 10% across-the- board California budget cuts, including bucks for San Joaquin Valley hospitals).

Last week, the nonpartisan Families USA group published research showing that every day eight Californians die for lack of health insurance. Stockton, LA, Fresno, anywhere CA -- the dollar's in the toilet but the misery index looks swell.

Are there ugly babies?

jtaylor — Fri, 04 Apr 2008 17:46:00 GMT

No such thing as an ugly baby? That's politically correct but ... It's apparently easier to analyze why babies make us smile.

Wall Street Journal columnist Robert Lee Hotz sums up findings from researchers at Oxford, MIT, USC, Vanderbilt and elsewhere: There's a sliver of your brain (fusiform gyrus in your temporal lobe) that's activated in milliseconds when you see a baby, making you smile. And it's a response that's too fast to be under your control.

Presumably that means, innately, we are all parents at heart. Meaning those who believe in ugly babies should also be smiling on seeing them.

(In the interest of self-protection, as someone who owns a home that's a favorite nesting area, the only truly ugly babies I know are newborn mourning doves.)

Baseball doesn't always $$$uck

jtaylor — Wed, 02 Apr 2008 15:18:00 GMT

A-Rod will make $28 Million this year playing for the Yankees, more than the entire team payroll of the Florida Marlins (quick, name 2 players on that team) -- or roughly enough to keep all of Community Medical Centers operating for two weeks.

Steroids, ticket prices, the cost of garlic fries and stadium parking, millionaire players pretending like their sweat doesn't stink (and should be sold on Ebay). There are lots of reasons to mock/ignore baseball. There are also reasons to celebrate it. Anybody who's seen the movie "Sandlot" knows that.

Haven't been back to my Brooklyn 'hood for years, but a few multi-billion-dollar teams ago, we played stickball on the streets, between bursts of honker-drivers. You needed a broomstick, a rubber ball, a couple of sewer covers to serve as home plate and second base and door handles on parked cars to be first and third.

One day a dozen of us were playing. Suddenly, a batter swung so hard that his broomstick flew across the street and into the storm window of a brownstone where kids were playing. The glass exploded, showering the kids who, somehow, escaped without a cut. Their father was shaken, tearful, relieved but never raised his voice or threatened to call the cops.

He refused our offer to pay for the window. Still, we gathered up every stray dollar and quarter we had, and gave it to him. Maybe it was because we were brought up right. Maybe, at the moment of the accident, baseball -- listening on transistors to the pros while pounding Pensie Pinkies onto tenement roofs -- helped frame a sense of traditional proper behavior.

I thought of that the other day while reading a NY Times column by David Brooks, focusing on a book called "The Mental ABC's of Pitching." One of Brooks' takewaways: ".. you have to build a structure of behavior and attitude. Behavior shapes thought. If a player disciplines his behavior, then he will also discipline his mind."

That's why the best relief pitchers can quickly forget yesterday's blown save -- usually without swearing, kicking dirt or throwing bases -- and be called on again today to practice their craft.

It's still OK to look for role models in baseball. It'd be better to find them at the kitchen table and at the other side of a handshake.

Trimmers and tweakers

jtaylor — Fri, 28 Mar 2008 20:19:00 GMT

Fumbling for CDs. Scolding kids. Trimming nose hairs. Weaving all over the road at various speeds. You've probably seen them all, too (well, maybe not the nose activity, but consider yourself lucky).

Unless there's an accident, or a cop is eagle-eyed or very bored, drivers get away with all these. Come July 1, however, you can be fined for using a cell phone without a hands-free device. And, if you're younger than 18, you're prohibited from using any cell phone, pager or laptop while driving -- lots of luck (and citation opportunities) there.

The two new laws (SB 1613 and SB 33) are good news. But wait. Media have recently pointed to research that finds no significant benefits from hands-free laws (already enacted in places like New York and Washington states and the District of Columbia). Gurus at the University of North Carolina Highway Safety Research Center say hands-free devices may make road problems worse -- with drivers making longer or more numerous calls.

Other researchers say 2,600 people die and another 12,000 are seriously injured annually by crashes involving cell phones. A University of Utah study found that cell phone users performed about as ably as those who were legally drunk.

At issue is something called "cognitive capture" -- being so tweaked out about your conversation that you ignore cues about what is happening on the road.

Of course, we also have GPS gizmos on dashboards. And then there are multiple built-in and portable DVD players on-board clamoring for attention.

Way too many distractions as hordes of vehicles cram chewed-up roads. How best to attain correct "cognitive capture"? I must admit, on seeing the gentleman trimming his beak in a twisted rear-view mirror and steering with his knees, I gave him a citation with my horn.

(More hands-free laws details, http://www.dmv.ca.gov/cellularphonelaws/index.htm )