City of Santa Monica promotes promiscuity...

...among ground squirrels by providing them with free birth control, subject to Santa Monica residency requirements, Mr. P. Lamont Ewell presiding!

In an unprecedented display of poor judgement, even for Santa Monica "standards", the City of Santa Monica does it again.

Here we were griping about healthcare-impotent Los Angeles BOS, while the public health masterminds in Santa Monica have come up with a plan to administer inmmuno-birth control to ground squirrel population of Santa Monica at a cost of up to $10.00 per squirrel.

I called the City of Santa Monica today to get a guesstimate of ground squirrels in the city limits and was refused a coherent or substantive answer.

Santa Monica "leadership", probably does not know the exact number of infectious diseases that were transmitted from squirrels to humans over the past 10 years, outcomes and costs of such alleged transmissions?

City of Santa Monica is not interested in protecting its residents and hundreds of thousands of visitors to the city from Hepatitis A in restaurants, farmers' markets, catering companies, bars, wholesale and retail markets.

Instead of pursuing an imaginary zoonatic threat, they could have considered handing $10.00 to each homeless person in Santa Monica in exchange for a pledge not to urinate on the Promenade!

We gripe, you decide, if you want to eat in Santa Monica.

Be Well!

"Board of Stupidvisors" (BOS)?

If one Googles "Board of Stupidvisors" one will come up with over 600 mass media references for a number of counties.

Why do residents of so many counties appear to be "lees-than-tickled" with our elected "servants"--members of the respective counties Board Of Supervisors (BOS)?

Maybe, it's because mine (BOS representative), for example, is more interested in watching himself on TV surrounded by men/women in uniform and flashing lights, than protecting the health of county residents.

Even though in Los Angeles County the final responsibility for health care services, public health, and emergency preparedness rests with the Committee of the Whole (meaning all persons elected to the BOS), there are definite "champions":

Gloria Molina, the first latina elected to BOS in 2/1991 distinguished herself in the health arena by protecting county library services whenever there was a fiscal problem with health services. A former smoker, she voted to re-appropriate (take away) $60 million in Tobacco Securitization towards County USC Replacement Project to be opened 11/2007. A "4 vote" item stuck in a budget request eliminating possible objections and/or discussions. Maybe she should use her quilting skills to patch up county's health system that's falling apart.

Zev Yaroslavsky, my BOS representative and a budget "expert", has been re-directing Master Tobacco Settlement Funds to non-tobacco related activities since 1998. Being in charge of the County Fire and County Sheriff departments allows Mr. Yaroslavsky ample media exposure. I wish he was as interested in provision of emergency health service in medically under served Malibu. Yes, MELibu, that does not have a single medical facility open after hours. Similarly, he does not seem to be interested in emergency preparedness, and did not support Malibu Medical Reserve Corps (MMRC).

Yvonne Braithwaite Burke--Member of the BOS since 1992-- continues to preside over the slow and painful demise of the King Drew Medical Center. Under her l"eadership" the BOS and its appointees failed to hire required number of outside doctors and nurses to roam the hallways to protect patients from medical mishaps. Burke proclaimed she: "... would not allow hospital to shut down, no matter how bad its problems and over my dead body..." She, and her colleagues, hired Navigant, an outside firm to turn around King Drew Hospital, spent hundreds of thousands of taxpayer dollars, but did not accomplish what they said they would.

Smartvisor Don Knabe is responsible for the Department of Consumer Affairs and leads the health carING by example--he is the Vice Chairman, Health Sub-Committee, National Association of Counties.

Smartvisor Michael D. Antonovich (also responsible for the office of the Coroner and Mental Health Services) reacts quickly and appropriately to the recent case of Hepatitis A in a cook with a major catering company. He states, that the case: "... demonstrates the major impact that this food-borne disease can have on restaurants, catering companies and consumers..."

Despite the fact that LA County Public Health Department took appropriate action to inform those who were at risk, and to offer prophylaxis for those for whom it was still potentially effective, it is still a prevalent serious disease.

His motion, scheduled to be heard on Tuesday March 6, 2007, which if passed, will instruct the Director of Public Health to review the relevant public health literature, and report back to the Board in 30 days with an analysis, including cost-benefit calculations concerning the question of whether Hepatitis A vaccinations should be required for food service workers in restaurants, catering companies, and in wholesale markets.

In the presence of abundantly clear and convincing evidence of the Hepatitis A vaccine safety & efficacy, it's really a matter of dollars and sense. Sense of doing the right thing to protect residents of and visitors to our great County of LA.

The non compliant restaurants, catering outfits, wholesalers and retailers must be fined severely to generate additional revenue for Hepatitis A vaccination of their employees.

Mandatory multilingual education, when monitored and enforced, can be as effective as vaccinations in preventing the spread and outbreaks of this serious disease.

Talking about proper hand washing techniques, recent studies have demonstrated the effectiveness of 6-step technique, as part of the safe hand washing is extremely effective in preventing the spread of the Avian Flu.

In our humble opinion, an ounce of prevention is better (faster and cheaper) than a pound of cure. Which box are you in LA County BOS Members.

We gripe, you decide!

"Mangled Healthcare" for All

With great fanfare the Consumer Federation of California (CFC) announced on February 27th, 2007 that "...every Californian deserves access to high quality, affordable health coverage"--a noble concept, indeed.

I certainly agree that “Our health care system is a disaster for the uninsured and insured alike. Nearly seven million Californians are uninsured. Co-payments for workers are skyrocketing, and businesses that cover their employees are being crushed under the rapid escalation in insurance premium rates."

When originally introduced to this naive country and promoted by then, and still, misguided and ill qualified Mrs. Clinton and her Jackson Hole task Force, it was defined as: " A prepaid risk-based system of integrated health care delivery, having appropriate capabilities to improve quality of care and manage utilization and cost of a given population.” (Thomas Morrow, MD., at NMHCC/IT Fall 1998, Los Angeles, CA)

Here are my postulates of "Mangled Care" vs Managed CarING:

•If someone is already paying a lot, let him or her continue
•Even if a lot of people complain about quality of managed care, it won’t contain cost
•Never provide coverage unless the treatment is unpleasant
•Quality is being in a waiting room with people who earn more money than you do

Managed care is an oxymoron by default--this system that should have been providing health carING, while managing costs--in its present form is better described as mangled health care.

The for-profit (and very profitable) “managed care” companies have embraced, and are functioning under divergent and practically mutually exclusive core values.

These companies are obligated to provide (or rather severely ration) health care services. They are also obligated to generate consistent profits for the executives and shareholders of those companies.

When the provision of proper health care and managed care companies profits come into direct conflict, it creates a “double explosion” of the system, where the availability and quality of health services goes down, while costs of services and mangled care companies' profits go up.

This abominable situation creates significant “counter-incentives” to provision of appropriate, accessible, affordable health carING to Californians, which can be gauged by the divergence coefficient.

In addition to the conflicting core values, “business disconnects” exist due to logistical, financial, physical and ethical aspects of mangled health care:

•The recipient usually does not request, does not order or pay for the service.
•The payor never requests, does not receive nor order the service.
•The orderer does not pay nor receive the service.

Governor Schwarzenegger, a traditional foe of pro-patient health care reforms, now says he wants to address the health care crisis. Unfortunately, the governor’s proposal puts too much of the burden on the uninsured, and it fails to control cost increases. Similarly, Sen. Kuehl “Zelda’s Single Payor Legend” falls far short of the target.

While it’s true that every other industrial democracy offers universal health coverage to its citizens, it does not translate into universal health carING, and in the case of Canada and England is actually counter-productive.

Surely, universal health care made some inroads in Hawaii, but only because it is a State with a super tight control of population---there are no immigrants (especially illegal) pouring over the boarder from the rest of the world. California, from the point of health care services, is a perpetual bottomless barrel, with fixed amounts of moneys paying into the system, while an ever-increasing numbers of residents generate a snowball demand for services.

Before declaring that health care (not just basic and/or catastrophic), but in fact “appropriate” (cosmetics?) health care “…is a right, not a privilege – and every Californian deserves access to high quality, affordable health coverage…” the CFC might want to clarify the definition of a “Californian” to prevent even faster emptying of the “bottomless barrel”.

CFC’s purposely trying to confuse general public and exert undue influence on Legislators by implying that just because they are uninsured resident of California, they are uncared for. Nothing can be further from the truth--the tax-paying and health insurance-paying Californians are actually paying for the care of the un/under insured.

I also disagree with CFC’s assertion on the issues of providing “…universal health insurance for all Californians at no added cost simply by taking the for-profit insurance industry waste out of the system and using those dollars for the delivery of health services”.

Health consumers can request and receive health carING from doctors, nurses, pharmacists, hospitals, labs, pharmaceutical companies, etc, without mangled care companies.

Doctors, nurses, pharmacist, hospitals, labs, pharmaceutical companies, etc, can provide health carING without mangled care companies.

Healthcare consumers (Payors) can pay for health carING without mangled care companies.

Only complete elimination of the middle man-managed care companies can generate enough money to provide universal health carING.

Its time to move from patient-driven to health consumer-administered health carING.

California Government can only guarantee universal health care when all of the recipients of such care, including the illegals, pay their fare share.

Be Well!

Zelda's Single Payor Legend

TRI-PAC Health and Wellness Advocacy vociferously opposes the reintroduction of SB 840 (Kuehl, D-Santa Monica, aka Zelda Gilroy).

In 2004, TRI-PAC leadership met with Deputies from the Office of Senator Sheila Kuehl and their “consultants” to inform and educate them, as well as to express objections and call for amendments. Unfortunately, our discussions fell on deaf ears.

Last legislative session, on request and recommendation of TRI-PAC, the Governor responded favorably and vetoed the bill (SB 840).

The education and teaching community have done a great disservice to their students, parents, to their profession, and should be ashamed of themselves for supporting and advocating passage of such misinformed and misguided policy and legislation which is not in the best interest of children, families, current and future generations of Californians.

Single payer health care is a system where government pays for all health care costs usually from taxes. Private hospitals and physician practices may remain private. Single payor is distinct from socialized medicine; hospitals are run by the government and medical professionals are employed by the government.

In 1975 my mother and I went to visit relatives in Winnipeg, Manitoba, Canada. My Dad (now deceased) was an ophthalmologist who stayed behind to tend to his patients. I went swimming in Lake Winnipeg. I got stung in the eye by a mosquito. I could not be seen nor could I get a prescription. There was a fee dispute between the physicians and the Manitoba Provincial Government. The system came to a grinding halt. There was a physician classmate of my Dad on site. He stood firm with his colleagues in "solidarity" and would not see me. I returned from our visit to Winnipeg with the stinger in my eye as a Canadian "souvenir".

In the ensuing 30 years, there have been no material improvements to the Canadian system—people still have to wait for elective surgery, CAT Scan, MRI, and other ancillary service that we take for granted.

Now, that the health care proposals by the Senate President Pro-Tempore, the Assembly Speaker, the Governor, and Senator Kuehl (which was heard separately) begin their way through the legislative process.

I have been informed that all these bills will be negotiated and combined into a single bill for passage by both the Assembly and the Senate and forwarded to the Governor for signature.

SB 840 is a "legend" in the minds of misguided politicians.

Its intent is not doable.

It will not cover the uninsured.

Robert Donin,
President, TRI-PAC Health and Wellness Advocacy
11693 San Vicente Boulevard, #346
Los Angeles, CA. 90049
robertdonin@yahoo.com

Epiphany from hospice professionals.

The American Academy of Hospice and Palliative Medicine (AAHPM), composed of physicians and medical personnel (an industry association) who are expert in end-of-life care, has removed its opposition to terminal patients’ right to request aid in dying from their doctor. The hospice physicians said use of the term “suicide” to describe the terminally ill patients’ aid in dying is “emotionally charged” and is not “accurate.”

Indeed, for the past 10 years, I've been referring to subject process as "dignified passage".

The medical personnel who provide care to patients at the end of life examined the use of the word “suicide” to describe physician-assisted death and found that “the term PAD captures the essence of the process in a more accurately descriptive fashion than the more emotionally charged designation Physician-assisted Suicide.” California hospice care physicians working to pass the California Compassionate Choices Act (AB 374) applauded the national medical experts’ change of position. "

No matter which definition one subscribes to, the only issue is person's right to self determination and resulting informed choice of pain-free dignified passage.

In the meantime, be well!

Additional information about AB 374 and end-of-life choices and language can be found at: http://www.caforaidindying.org/

More on Hippocratic Oath

In his comment this morning Mr.Roland Halpern said: "Dr. Steve Miles researched the Oath in its historical context and is of the opinion that the reference to not giving a deadly drug had nothing to do with physician aid in dying, but rather was an admonition to doctors not to use their position of trust to gain access to those in power for the purposes of assassinating them. It appears that during the time the Oath was apparently “written” (the first copies weren’t found until hundreds of years latter) there was a lot of political upheaval in Greece and it was not uncommon for politicians to eliminate their competition. Miles points out that many physicians were servants of the state, very much like soldiers, and could be given orders to poison the enemy"

I do not profess to be a scholar of Hippocratic Oath, and am thankful to Mr. Roland Halpern for his valuable comment. Dr. Miles' interpretation of the classical version further supports my contention that there is no prohibition against physicians’ participation in assisted suicide and/or lethal injection.
Furthermore, it is my strong belief that physicians have moral, professional and legal obligation not to abandon their dying patients, especially when they are most vulnerable and dependent. To abandon a dying patient would be hypocritical and nihilistic.

Keep reading. Keep writing. Be Well!

Hippocrates: Do's & Dont's

During my media appearances and in response to the postings on this blog, I am frequently asked how physicians can reconcile their role as healers with participation in physician-assisted suicide and/or lethal injection. Frequently, the Oath of Hippocrates is cited as “the governing” document.

The oath is, and always was, ceremonial only--just like traffic signs in the city of New York, that functions only as general guideline.

The modern version of Hippocratic Oath, written in 1964 by Louis Lasagna, then Academic Dean of the School of Medicine at Tufts University states that a physician “…will apply for the benefit of the sick, all measures (that) are required, avoiding those twin traps of overt treatment and therapeutic nihilism…” Clearly, in cases of chronic debilitating, and frequently fatal diseases, usually associated with intractable pain, one should not over treat and concentrate only on proper pain control and patients comfort.

The modern version of the Oath also states that “…it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play God…” The recently reintroduced Compassionate Choices Act of 2007 (California AB374) specifically addresses physicians’ responsibility and respect for patients’ right to self-determination and the right-to-die with dignity. More importantly, the modern Hippocratic Oath recognizes the concept of medical futility.

Similar safeguards should be in place when taking person’s life by lethal injection. A recent article published in the Lancet (Volume 365, Page 1412, April 16, 2005) is a study of post-mortem blood tests that in 43% of reviewed cases, thiopental levels (a drug used to put people to sleep) in the subjects were too low to prevent awareness, pain and suffering.

Double trained in Anesthesiology and Pain Management, I bring over 30 years of academic and clinical experience Attending Anesthesiologist to the argument.

A Diplomate of the American Academy of Pain Management, Associate in Medicine of the American College of Legal Medicine, and a Diplomate and Distinguished Fellow of the American College of Ethical Physicians, I am more than qualified to represent an alternative viewpoint that an Anesthesiologists participation in the preparation and administration of the legal injection is needed to protect the condemned from undue pain and suffering, and their right-to-die with dignity.

An earlier, “classical”, version of the Oath was translated from Greek and interpreted by Ludwig Edelstein in 1943. It is by far more conservative and discriminatory against women than the current one. It starts with a “mini-oath and covenant” of allegiance to:”...Apollo Physician and Asclepius and Hygiea and Panacea and all of the gods and goddesses…”; and promises to teach the art of healing free, but to men only: “…and to regard his offsprings as equal to my brothers in male lineage and to teach them this art-if they desire to learn it without fee or covenant…”

The “classical” version weighs in on some other “hot” health/ethical/legal issues of our society: “…I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy. In purity and holiness I will guard my life and my art…”

Obviously, the questions of how physicians can reconcile their role as healers with participation in physician-assisted suicide and/or lethal injection, are probably asked by the conservatives who obviously prefer the “classical” version of the Oath.

And if physicians were even close to practicing their art in “purity and holiness” why are there so many lawsuits and investigations by the Medical Boards?

“…May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”

Be Well!