Tuesday, July 7, 2020

Gone to the Dogs

The Police manipulate the Public, the Prosecutors in every city manipulate the Jury and the Judges that oversee the system are manipulating the system to find an outcome that will get the reelected.  We elect County Sheriffs, City Attorney's, Prosecuting Attorney' s and of course Mayors who nominate and hire the Police to run the City bureau.  We elect almost everyone who serves public interests.  When was the last time you went to a School Board meeting? To a permit hearing? To a City Council meeting? When did you go to your local officials office? To the State house to see Bills being passed? When did you ever willingly unsolicited walk into a Federal or Municipal court house to see the business being done?  Get back to me then and I will respect and listen to you.  I have as a Student, a Teacher, a Defendant and a litigant.  I represented myself in my civil case against Harbourview and took that to the Supreme Court of Washington. They did not hear the case but they did offer a "ruling."  I filed paperwork, I roamed halls, I sat through hearings, read brief after brief and filed my own. I went to free legal clinics and hired Paralegals to help me draft briefs and I sat through my own trial with two "highly respected" Attorney's and watched a cluster fuck play right out in front of me.  Right now my former Attorney, Ted Vosk, is rambling on on Facebook about his mental health and how he is now mentally ill. Good to know that .... NOW. But in the interim his former friend, Kevin Trombold, still practices. The former Prosecutor from the City, Jennifer Miller, is now a practicing Attorney, defending the same people she used to not.  She is a hypocrite and a fraud and that is the system, liars and those they think are the liars are not the ones sitting in the chairs, they are the ones who prop up the system and maintain its illusion.

Police do it two ways - Good Cop/Bad Cop. That scenario is not the one seen in NYPD Blue or  such its the one that stands at civic events, football games and such that are paid overtime to pretend to be a better member of the community they serve, to keep people "safe" and they are the ones that do the talks at schools or other venues about issues that are important regarding public safety.  They are liars and frauds the same way Ted Vosk, Kevin Trombold, Jennifer Miller and Willie Brown the Judge in my case are. They are not interested in justice or seeking truth they are into collecting scalps and checks. The money made by the system fuels the system, from bonds, to bail to fees and fines and without them you have no system.  Defunding the Police is the first step in reformation.

Note, I said first step. This is a fucking huge road and seriously I doubt anyone has a clue how bad it really is. It is why the OWL (old white lady) whose only privilege I had was to hire incompetent Attorney's and in turn then realized after 25K that fund had to stop and in turn hide my money, and eventually run so far away that eventually that too had to stop and now its time to tell the story of how bad it was and is and what has to be done.

First up the bullshit about Cops in the schools,  not needed and in Nashville at the two worst schools they up and quit so pussy does not quite justify how bad that school was/is and how the Cops were seat filling like the rest of the staff to house the most disturbed group of youths to cross those doors. All but one or two were white the rest all shades of brown and black.  It was a dumpster.  But they have arrested small elementary aged children for throwing a tantrum, not a chair, a tantrum.  Okay then.  This is where we are in America.

The next is the absurd military gear these morons get as if Al Queada is going to show up in bumfuck nowhereville any day and institute Sharia law is another aspect of defunding the Police. That shit costs money to upkeep and train and use so dump it.   I love these towns in Jersey that have this equipment. Yes on 9/11 the planes flew over as in over and went right for the towers, you were literally not on their radar.

These are also the toys that these douchebags bring to community affairs and have kids ride or climb on as if they are little GI Joes. No that is the military who should be doing that not you.

Then we have the issues of warrior cop that accompanies the military policing nonsense that includes the training that is not a part of the Police Academy but funded by their union and the mentality that accompanies this is all part of the thin blue line.  And this is where sick in's and work slow downs, meaning responding to calls are a part of this.   Note the summer has ticked up in violence and the reality is that where Police should be present, on driving through hot zones and areas where it most occurs they are not.  Well some of it has to do with the idea that the protests and assaults on them and their vehicles are a part of that but here is that whole community policing thing and in fact communication with the area, their activists and leaders (again those elected folks) which would help in resolving some of this.  A leopard does not change its spots but it makes a nice coat!  (That means in other words rethink how you will use something to your advantage)

Lastly let's talk about Police Dogs.  Radley Balko used to almost daily top his column in the Washington Post about how cops killed another dog.  I too nearly had that happen to me in Arizona when pulled over the lady cop threatened to shoot my dog in the back seat who was unrestrained, as well we were driving,  and I had to calm her down, myself down, all while fearing for both our lives.  Arizona I hope you all die of Covid.  I have nothing good to say about that state and this is over Tennessee, where I lived, but even that is not something I would wish on them.   But the irony is that the same assholes who kill dogs repeatedly, yet have killer dogs that are so super trained that they can sniff drugs and sense you are a criminal just by the piss you have in your pants after having one of them hauled out near you to add to the dynamic.  This by the way is what we call a trigger as you become more afraid the Police uses this as some sort of super radar that they have to say, "You seem nervous, what are you hiding? " Again using myself as an example, when Vanderbilt called the Police on me for a wellness check (again several days earlier over my tantrum, so good on that one) they said that very same thing and said, "You seem anxious." Yes you fuckwit it's 7 in the morning I am getting ready for work, in my PJ's and don't have even my teeth in (hence the tantrum) and you are at my door over an issue a week ago.  Really, anxious you say?  Who the fuck wouldn't?   But irony, or just that in a crisis I do, I calmed down said I am going for my phone right over there to call an Attorney, you can step out and wait while you get a warrant for this instrument I am supposed to be using on myself due to my tantrum at Vanderbilt were they thought I would kill myself.  Okay, sure let's roll.  As the irony that they could have killed me in the same spot and accomplish that goal was racing through my mind the entire time. I WAS LUCKY, I used the white privilege thing and for whatever reason it worked.  That was the ONE TIME but I lived in Nashville and racism is a dish served with sweet tea and biscuits and that I knew and used to my advantage. Sorry folks you do what you need to to stay alive.

Cops kill. They kill people, they kill animals.  Are they warriors or are they murders? I go with the latter.  They do not, Serve and Protect, not at all.

I read this editorial in the Post and I agree, the bullshit dogs must go. The junk science they use is also another problem that lends itself to many arrests that are not actually valid.  Yet that myth about the super sniffer has made it to the Supreme Court.  Sorry again folks you need to do your homework on that one, I can't spell it out more clearly. Dogs do not smell Pot, Meth or any other drug.  But they can respond to their owner and trainer and in turn follow the lead.  That is what dogs do.. Again lies they tell you over and over again without real science to support it is America and it is our Criminal Justice System.  Lie Detectors, Booze-omters, Fire tracing, name one, pick one.  With regards to dogs today they are not bred to be vicious, some breeds are more adaptable as they have been and the training enables that DNA to kick into gear.  Hunting dogs, working dogs they are all part of animal husbandry when it comes to the dog world, watch Westminster Kennel Club shows to learn about breeds and what they were originally bred to do and be.  But they are domesticated adorables.  Cats on the other hand.....  I miss you Emma, best Shar Pei/Lab Mix ever.  18 years of love all unconditional, all perfect.  No dog could ever replace you.

Don’t overlook one of the most brutal and unnecessary parts of policing: Police dogs

The Washington Post
Christy E. Lopez
Contributing columnist
July 6, 2020

As we engage in long-overdue discussions about how to reimagine public safety, we must not overlook one of the most brutal, unnecessary and racialized components of policing: using police dogs to bite people.

We’ve long allowed ourselves to be gaslit by the narrative of the lovable police dog. This year in St. Paul, Minn., not far from where George Floyd was killed, news reports celebrated the retirement of “Havoc” and his visits to hospitalized children. Not mentioned alongside images of cupcakes with pawprint frosting was that Havoc’s day job was to bite people upon command. Or the review showing that St. Paul K-9s were “routinely used on nonviolent offenders who were nearly always fleeing or hiding instead of threatening harm or displaying weapons.” Or that most people bitten were young black men — even a 12-year-old boy.

In our dichotomous public safety world, a police dog can bite a boy in the evening and the next day visit the hospital where the boy is recovering.

St. Paul is not an aberration. The extent to which we have normalized — and subsidized — police departments’ use of dogs to attack human beings should be chilling. The fact that we fawn over those same dogs at community events — without a thought of whose bodies those dogs have bitten — should be more chilling still.

There may be a place for search-and-rescue bloodhounds and explosive-sniffing dogs in a rational public safety system. But “criminal apprehension” dogs used to find and bite whomever the police tell them to need to be part of the national conversation about ending unnecessary force.

Police canines are bred and trained to ensure that their bite is far more severe than a normal dog bite. The pressure from a police canine bite has been likened by one court to the force of being run over by a car. For decades, the canine-industry contended that police dogs usually cause only minor injuries and bite for 10 to 15 seconds. The era of body cams and cellphone recordings shows they often bite for much longer and cause significant injury.

Unlike normal dogs, police canines are trained to bite hard, use all their teeth and bite multiple times. Studies have found that over 3,500 police canine bites annually result in emergency room visits, and that canine force results in a higher proportion of hospital visitations than any other type of police force. On rare occasions, police canines have killed people, including a suspected burglar, a likely trespasser and a homeless woman.

This level of violence cannot be justified by the threat posed. Police dogs routinely use force that unquestionably would be unlawful if used directly by a police officer. The dogs are overwhelmingly set on people suspected of crimes like burglary, car theft, trespassing, traffic violations or “fleeing” from the police, and often used during political protests and immigration raids.

Police canines also inevitably make mistakes, attacking innocent bystanders and their own handlers. A Justice Department attorney investigating the New Orleans Police Department observed a police dog bite its handler twice within a few hours. Canines also do not always stop biting even when ordered to do so. Indeed, at least one canine-industry certification standard passes a dog even if it re-bites and has to be ordered to stop four times. By the way, certification is not universally required.

Nor can we ignore any longer that police canines cause disproportionate and profound harm to black and Latinx people. Our country has a long history of racialized used of canine violence, from dogs used to hunt fleeing enslaved people and terrorize civil rights protesters, through the present day. Racial and ethnic disparities in police dog bites persist over time and across the country. Canine force reviews, like the decades-long examination of the Los Angeles Sheriff’s Department, consistently show disparities; during one six-month period, their canines bit only black and Latinx people. In a nine-year nationwide study of emergency room visits for police K-9 bites, 42 percent of the approximately 33,000 bite victims were black. If we are serious about beginning to atone for the disproportionate harm policing has caused black and Latinx communities in this country, it is difficult to see how we can continue using police attack dogs.

For years, I have asked police chiefs and sheriffs: Why do you use canines to bite people? Small-town chiefs talk about dogs as a retention tool — keeping officers with little opportunity for upward advancement happy. In all departments, chiefs talk about not wanting to pick this particular battle with agency culture. All understand the corrosive impact police canines have in black, Latinx and poor neighborhoods. Each recognizes that current technology — including cameras and small robots — provides alternatives to using dogs to bite people.

But, the chiefs say, “the public loves them.”

In other words, as with so much of policing, police order dogs to attack people not because public safety requires it, but because we the public have told police we’re okay with that. If the movement to reimagine public safety means anything, surely it means that is no longer the case.

Sunday, July 5, 2020

4 Stars!

Ever pass by billboards advertising hospitals? Ever heard an ad that professes quality care at this fine institution of medicine? Well great, how much is it? Do you take my insurance? Are your prices negotiable if one pays cash versus insurance versus credit? What if I pay up front?  What about post care and follow up, is that included?

In getting care you have to negotiate unless you are brought in on a stretcher.  Even the Dental Clinic across the street is clear that they will charge this for an uninsured patient if they pay up front as they bill the insurance so much more, are paid only so much and in turn dental insurance only covers 1,000 annually.  Medical insurance is more complicated for reasons that have never been clear and that is why it is outrageously expensive and absurd.  Time for single payer and if you want to pay more then go right ahead and I will pass on the view room as long as the care is the same. Oh wait...

Hospital ratings often depend more on nice rooms than on health care

By Eve Glicksman
July 4, 2020
The Washington Post

As research findings go, this was a Holy Yikes. A study of 50,000 patients throughout the United States showed that those who were the most satisfied with their care (the top quartile) were 26 percent more likely to be dead six months later than patients who gave lower ratings to their care.

The study, “The Cost of Satisfaction,” appeared in JAMA Internal Medicine.

Oh, the irony. The most satisfied patients not only died in greater numbers but racked up higher costs along the way. Plus, health-care providers receiving the top satisfaction scores were rewarded with higher reimbursements by the Centers for Medicare and Medicaid Services (CMS), which administers the patient survey.

Lead author Joshua Fenton, a professor of family medicine at the University of California at Davis, had set out to measure the relationship between patient satisfaction and hospital resource use, drawing on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Ultimately, his research raised questions about whether CMS is dangerously off target in collecting patient satisfaction data to drive health-care improvements.

That was 2012. More research published this year by two sociologists likewise found that a patient’s hospital recommendation had almost no correlation to the quality of medical care received or patient survival rate. The researchers looked at CMS hospital data and patient surveys at more than 3,000 U.S. hospitals over three years. The hospitals where fewer patients died had only a two percentage point edge in patient satisfaction over the others.

What’s going on? Cristobal Young, associate professor of sociology at Cornell University and lead author of the study, calls it “the halo effect of hospitality.” Young found that what mattered most to patients in ratings were the compassion of nurses and amenities like good food and quiet rooms. It’s why hospital managers are being recruited from the service industry and we’re seeing greeters in the lobby and premium TV channels in rooms, he says.

Patients tend to value what they see and understand, but that can be limited, Young continues. They give hospitals good cleanliness ratings when they observe waste baskets are emptied and sheets are changed. “They can’t see a virus or tell you how clean the room is in ways that matter,” he says.

Similarly, patients can tell you if a physician communicates well. But most people do not have the medical skills to assess whether a physician provided the appropriate diagnostic test or made suitable recommendations, Fenton says.

In his study, patients receiving more medical interventions, treatments and hospitalizations were more satisfied with their experience. Yet, after adjusting the 26 percent mortality rate of the satisfied patients with data about their baseline health and comorbidities, their death rate soared to 44 percent over the patients who weren’t as happy with their care.

One possible explanation is that every surgery, procedure or medication carries the potential to leave you worse off. While a patient may perceive that more aggressive treatment is better, “overtreatment” can hasten death, too.

There is a more insidious reason satisfied patients did not track with better medical outcomes, though. The majority of hospitals and medical practices today are rewarded with higher compensation, promotions, bonuses or increased CMS reimbursements for attaining high patient satisfaction scores. The twist is that the path to keeping patients happy can run counter to best medical practices.

A patient may give an unfavorable rating to a physician who refuses to write an unsafe opioid prescription or order an unwarranted CT scan. A doctor may not bring up a patient’s obesity or cognitive impairment to avoid the person’s ire on a survey later.

In a 2014 study of 155 physicians by the University of Wisconsin-Madison’s School of Medicine and Public Health, close to half said that pressure to please patients led to inappropriate care including unnecessary tests and procedures, hospital admissions, and opioid or antibiotic prescriptions.

“Time after time, studies show that physicians who accede to patient requests have higher patient satisfaction,” Terence Myckatyn and co-authors wrote in a 2017 article exploring how patient satisfaction scores affect medical practice. Keeping patients happy is not always the best strategy for patient wellness or physicians, however, says Myckatyn, a plastic and reconstructive surgeon at Washington University School of Medicine.

“Directly tying financials to surveys as a metric to evaluate physicians can be shortsighted and unfair. It’s a difficult calculus,” says Myckatyn, stressing that patient surveys should be only one measure in the toolbox for assessing health-care providers.

CMS posts patient satisfaction data on its Hospital Compare website along with medical statistics about surgery complications, infection rates and mortality. But it’s the hotel-like amenities that seem to drive ratings, so that’s where many hospitals have invested, Young says.

He points to the new $2 billion Stanford Hospital in Palo Alto that offers private patient rooms, each with a 55” television and iPad so patients can stream Net­flix, order a burger from the cafeteria, or video conference with family. This is how hospitals are competing with each other in a consumer market where medical quality indicators can take a back seat, he says.

Whether the 29-question HCAHPS survey has led to better medical care, Fenton credits public surveys for keeping hospitals and physicians accountable for treating patients with respect and dignity. What he objects to is the harm done by conflating patient satisfaction with the technical quality of medical care.

Likewise, Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association (AHA), sees patient satisfaction and medical outcomes as apples and oranges. They are each important and don’t have to correlate. In addition, whether a nurse responds quickly to a call button is not just about hospitality, Foster maintains in reference to Young’s study.

“If a patient needs to use the restroom and a nurse doesn’t arrive in a timely fashion, patients [who go on their own] can fall,” she says. “[The nurse’s responsiveness] becomes a crucial clinical outcome issue.”

Akin Demehin, AHA’s director of policy, also believes patient surveys have a place in improving medical care. “Patients have unique insights that only they are in a position to convey,” Demehin says.

Several hospitals were able to reduce their readmission rates after taking a close look at patient comments regarding problems in care coordination and hospital discharge, he says.

Collecting patient feedback began its ascent in 1985 when Press Ganey Associates introduced a survey to measure health-care provider performance. Ten thousand medical institutions today still use it. By 2006, CMS was distributing the HCAHPS survey to randomly selected patients around the country.

Once the Internet exploded, consumer-driven health care was out of the gate. Online ratings for restaurants, electronics, and the patient experience became “part of our modern day currency,” says physician Raina Merchant, director of the Center for Digital Health at the University of Pennsylvania Perelman School of Medicine and associate vice president at Penn Medicine.

Merchant studied the impact of patient ratings on Yelp and found they were strikingly parallel to HCAHPS results. The significant difference, she says, is that Yelp reviews cover a broader range of concerns than standard surveys. You’ll find more detailed patient-to-patient information about billing, comfort care, medical costs and the experience of family caregivers, for instance.

Health-care providers “miss an opportunity to learn about consumers if they don’t pay attention to social media,” says Merchant, who sees online reviews as “democratizing.”

Will covid-19 change how we rate physicians and hospitals? “Think about how much we spend on the health-care system in the U.S. Then when we need basic things like swabs [to test for coronavirus] we don’t have them,” says Young, “. . . or nurses and doctors straining to have [personal protective equipment].”

“It’s mind-boggling,” he says. “Maybe the coronavirus will help reprioritize everyone’s thinking about medical quality. Nobody is thinking about how nice their [hospital room] views are anymore.”