Monday, December 16, 2019

Blame Anderson Cooper

I jokingly blame Anderson Cooper for my ultimate selection of Vanderbilt Medical and Dental Clinic to do my reconstruction work as it is connected to him via his Mother's familial legacy. I doubt that Anderson has ever set foot on the campus or inside the medical facility that bears the name of his predecessors and as the University and Medical facility have long split and only share a name I see no reason why anyone would think this hospital is as elegant and as intellectually interesting as either he or his Mother were or are.

Vanderbilt is a medical behemoth in Nashville and largely responsible for some of the reimagining of everything from malls to neighborhoods thanks to their growth and ever expanding footprint in Nashville, a city dominated by many legacy medical landmarks, one tied to the Frist family, another said family with a storied legacy in America. Perhaps one recalls the former Senator from the state of Tennessee, William Harrison Frist; He is an American physician, businessman, and politician who began his career as a heart and lung transplant surgeon. He later served two terms as a Republican United States Senator representing Tennessee. He was the Senate Majority Leader from 2003 to 2007 and nowhere near as divisive as the current Southern leadership. The Frist family founded HCA and in turn is why the area is known for its role in remaking Nashville as more than music city. Bill worked at Vanderbilt and was a successful transplant surgeon and is still affiliated with them and I am sure like all the wealthy families in the area have no interest in day to day operations as their legacy and footprint in contemporary Nashville is secure and well defined. That is the South, where money talks and the people talk out of two sides of their mouth to tell you what they think you want to hear and what they think they need to hear to be believed. Everyone lies in the South like a dog on a carpet on a hot day so they assume you too lie and if not it does you no favors.

The main players in almost every city, especially the South, are defined by "old money" meaning that most of the family earnings are at least three generations old and come from a business or industry started by a senior Patriarch. Think the Rockefeller's, the Kennedy's, the Mellon's and so forth. Then we have "new money" and that is the first generation who created wealth usually already from a well established family but they were not at that level until they hit the big well.  The Gates family define as such as the senior Bill was already a well established Attorney and the same for Warren Buffett whose father was well connected and in turn those connections enabled the son to better the father.  The Nouveau Riche are the current Tech heads like Zuckerberg who simply just got fuck all lucky.

Now the reality is that it takes three generations to piss off the cash and they usually do through a series of bad decisions and often you see that in many families, like the Hilton's who have Paris that can explain that a name can buy you entry but you still need to work for a living its just the kind of work one does that defines the distinction.  Anderson Cooper has the cache of Vanderbilt but he made his own way through the access that the name provides its just that he chose to actually develop an intellect and manner that demonstrates class is in fact earned and learned.  Try that Countess!  (Watch the housewives of NYC for that reference)

But Vanderbilt is just a name of the past for those in the present and when one thinks of it you think of the school, the football team and the reputation as the "Ivy League" school of the Athens of the South.   A dated reference that has no relevance in the New South as few who live and come from the area go to Vanderbilt let alone any of the schools that encircle the area.  Keep em dumb and they stay stum.   Which is why they rarely vote, have few opinions as those requires thoughts and the ability to think critically, a skill set lacking in the South given its attitude and history regarding public education.   Smarts is for the rich and the rich keep it that way.

I go for my next surgery in a few days the one that was fucked up by the incompetence of the last Intern who was so busy worrying about my Vagina (meaning as a woman how can I function and cope on my own - just fine, thank you.) then the jaw and the bone structure where the implant was being placed. And naturally the implant failed.  A bone graft and implant replacement made simultaneously was done and I was sent on my way pushing back all of my work for another three months. Thanks asshole as he is like all of them in the revolving door of medical care, fuck up one and done.

Vanderbilt has a legacy of problems and a history that includes many issues like the one below.  It is probably why they are pushing back against those who do not want to be anesthetized. Trust me if I had an option on my first run around I would have, they did not even bother to give me a Valium to ease my nerves and were so utterly bizarre pre-surgery that my already high blood pressure was rising and in turn putting me further at risk after keeping me under two hours longer than necessary as they were overbooked. Another problem which they have repeatedly.   My former neighbor who was just out of Nursing school two years earlier was the senior Nurse in the NICU, that must be comforting to parents of at risk babies.   That is nothing compared to all the folks I have seen come and go in my three years there.  I finally quit trying to know names there was no purpose.  Vanderbilt is a dump. But then little in Nashville is anything but.

And this may be why.....

After a patient was killed by the wrong drug, Vanderbilt didn’t record fatal error in four ways
Brett Kelman, Nashville
The Tennessean Published  Dec. 15, 2019 |

Vanderbilt University Medical Center's actions effectively hid the cause of death of Charlene Murphey for 10 months until an anonymous complaint prompted investigations by federal health officials and state law enforcement.

Charlene Murphey, 75, died at Vanderbilt after being injected with the wrong drug.
The hospital didn't report the error to government regulators or its accrediting agency.
Vanderbilt doctors falsely told the medical examiner the death was "natural."

After a Nashville-area woman died two years ago from a grievous medication mistake at Vanderbilt University Medical Center, the hospital's response obscured the error from the government and the public. Vanderbilt violated state law, reported the patient's death as "natural" and swore her family to silence, according to a Tennessean review of hundreds of pages of county, state and federal records.

The hospital’s actions effectively hid the cause of death of Charlene Murphey, 75, for 10 months until an anonymous complaint in October 2018 prompted investigations by federal health officials and state law enforcement.

Those investigations detailed how Murphey was accidentally given a fatal dose a vecuronium, a paralyzing medication that sent her into cardiac arrest while she waited for a medical scan in Vanderbilt's radiology department.

The nurse who injected Murphey with the drug, RaDonda Vaught, was criminally charged with reckless homicide and impaired adult abuse in February, and her case has become a rallying cry for medical professionals who fear honest mistakes will be criminalized. Meanwhile, Vanderbilt, the biggest and most renowned hospital in Nashville, largely avoided repercussions. For the first time, this story explores how the actions — and inaction — of Vanderbilt delayed and hampered scrutiny of Murphey’s death.

In the months after Murphey died in December 2017, Vanderbilt officials did not document or report the deadly medication error in four ways.

Two Vanderbilt neurologists provided false information about Murphey's death, saying she died naturally from a brain injury, according to the Davidson County Medical Examiner.
Vanderbilt did not report the fatal error to The Joint Commission, an independent organization that accredits the hospital, said a commission spokeswoman. Joint Commission policy strongly encourages but does not require hospitals to report fatal medical errors.

Vanderbilt officials "failed to report this incident" to the Tennessee Department of Health even though state law requires the hospital to do so, according to a federal investigation report.
The report also found that Vanderbilt staff did not document the medication mix-up in Murphey’s medical records, then subsequently provided different explanations for the omission.

More: 4 revelations from our story about Vanderbilt and the RaDonda Vaught case

Vanderbilt officials declined to comment for this story. Spokesman John Howser said the hospital would not speak further about Murphey's death "to avoid impacting either our former employee’s right to a fair trial or the district attorney’s ability to pursue the case as he deems necessary and appropriate."

In prior statements about Murphey's death, Vanderbilt officials stressed the medication error was immediately disclosed to her family. The hospital negotiated an out-of-court settlement that bars those family members from discussing her death or revealing the settlement agreement to anyone.

Vanderbilt officials confirmed the settlement during a public hearing earlier this year.

Charlene Murphey’s grandson, Allen Murphey, 35, who is not part of the settlement, said he thinks the hospital tried to hide its mistake and protect its reputation.

“A cover-up — that’s what it screams,” he said. “They didn’t want this to be known, so they didn’t let it be known.”

Court records show syringes and a vial of vecuronium that have become potential evidence in the trial of RaDonda Vaught, a former Vanderbilt nurse accused of killing patient Charlene Murphey with a medication error.

Vanderbilt leaders have acknowledged their response to Murphey's death was flawed. During a February meeting with the Tennessee Board for Licensing Health Care Facilities, Vanderbilt Health System CEO C. Wright Pinson confirmed Murphey’s death wasn't reported to state regulators and said the hospital's response was “too limited.”

At the same meeting, Mitch Edgeworth, who was then CEO of the hospital, said an internal review of Murphey's death led to “opportunities to improve the knowledge of our clinicians regarding reporting" to the medical examiner.

The health care facilities board, which oversees hospitals throughout the state, took no disciplinary action against Vanderbilt.

RADONDA VAUGHT: Vanderbilt largely to blame for deadly medication error, attorney says
‘She held us all together’

Charlene Murphey, who lived most of her life in the Gallatin area, was married for nearly six decades to her teenage sweetheart, Sam, and they had two sons, Gary and Michael.

She was the quintessential Southern matriarch who was always quick with a warm smile, a quip or a plate of food, said grandson Allen Murphey.

“She really was the glue of the family. She held us all together,” he said.

Charlene Murphey fell ill on Christmas Eve 2017. She was diagnosed with a subdural hematoma at Sumner Regional Medical Center, then transferred by ambulance to Vanderbilt, where her condition began to improve.

By Christmas Day, she appeared to be on the verge of leaving the hospital, her grandson said. Family members were so confident she was recovering they decided to delay celebrating the holiday until she was back home in a day or two.

“Everyone was saying at that point the best Christmas present ever would be to not have Christmas at the hospital,” Allen Murphey said. “But it didn’t work out that way.”

On Dec. 26, in preparation for her release, Charlene Murphey was scheduled for a PET scan in the hospital’s radiology department. This scan, similar to an MRI, requires a patient to lie still in a tubular machine for about 30 minutes. Murphey was claustrophobic, so a doctor prescribed her a sedative, Versed, to keep her calm.

In court records, prosecutors said Vaught, the Vanderbilt nurse, attempted to retrieve the Versed from an electronic medication dispensing cabinet but could not find it. She then disengaged one of the cabinet’s safeguards, unlocking more powerful medications, documents show, and typed "VE" into the cabinet's search tool.

She picked the first drug that was offered, documents show. It was not Versed. It was vecuronium.

In court records, prosecutors say Vaught ignored multiple warning signs that she had the wrong drug. While drawing the vecuronium into a syringe, Vaught must have looked directly at a medication bottle cap that said “WARNING: PARALYZING AGENT.”

Prosecutors say Vaught then injected Murphey with the syringe and left her for the PET scan as the vecuronium paralyzed her body. By the time the error was discovered, she had suffered cardiac arrest and partial brain death.

About nine hours later, Muprhey's family, who were once so confident she was coming home, gathered at the hospital to say goodbye.

“But it wasn’t really a goodbye,” Allen Murphey said with tears in his eyes. “I was talking to her, but she wasn’t there. She was long gone.”

Charlene Murphey officially died at 1:07 a.m. on Dec. 27, 2017, when she was disconnected from a breathing machine.

RADONDA VAUGHT: Health officials reverse decision not to punish ex-Vanderbilt nurse for fatal error

Vanderbilt didn't report error to state, feds or medical examiner

Vanderbilt staff told Murphey's family what happened but never documented the vecuronium injection in her medical records, according to a federal investigation report of the death.

One unnamed Vanderbilt official told federal investigators Vaught didn't document the injection because "everyone was focused on resuscitation" and there was "no opportunity" to update the records, the federal report states. Although Vaught is not named in the federal report, the document states the nurse who gave the vecuronium injection said she did not document it in medical records because she was told by a nursing manager it was unnecessary and would be recorded automatically.

The deadly injection wasn't reported to the Davidson County Medical Examiner's Office, which is responsible for investigating non-natural deaths in Nashville. Medical examiner records state Vanderbilt neurologist Dr. Adam Hartman reported the death as having “no foul play suspected" while another neurologist, Dr. Eli Zimmerman, attested Murphey died from "natural causes of complications of the intra-cerebral hemorrhage."

If a vecuronium injection had been mentioned, it would have immediately triggered an investigation, said Dr. Feng Li, the medical examiner.

"Especially with that kind of medication given, we would have investigated the case,” Li said. “We would have taken jurisdiction.”

Li said he changed Murphey’s manner of death — from natural to accidental — in August 2019 to correct the official record.

Vanderbilt did not report the fatal error to The Joint Commission, said commission spokeswoman Maureen Lyons. The commission did not learn about Murphey’s death until after media reports began the following year. It then evaluated the incident and took “appropriate actions,” which are confidential, Lyons said.

The hospital didn't report the fatal medication error to the Tennessee Department of Health, which would have then alerted the state Board for Licensing Health Care Facilities and the federal Centers of Medicare and Medicaid Services (CMS). State law requires Vanderbilt to report all incidents of abuse or neglect with within seven days.

Instead, regulators learned about the death from an anonymous complaint in October 2018. CMS responded with a surprise inspection at Vanderbilt, then threatened to suspend Medicare payments if the hospital did not take steps to prevent a similar death. Within days, Vanderbilt created a written “plan of correction” for CMS.

The Tennessean obtained a copy of Vanderbilt’s correction plan in November through a Freedom of Information Act request.

The corrective plan says Vanderbilt changed its medication dispensing cabinets so vecuronium can no longer be accessed by overriding a safeguard.

The hospital also made the process of obtaining other paralyzing medications more deliberate. These medications can only be accessed by searching a cabinet specifically for “PARA" and require two nurses for an "independent double check." Cabinets display new messages warning these drugs cause "respiratory arrest."

Vanderbilt also revised policies on documenting medical errors and reporting errors to the medical examiner and the Tennessee Department of Health. Hospital policy now specifically requires a medication error to be documented in medical records and reported to the medical examiner if it contributes to a death. Vanderbilt's Office of Risk and Insurance Management is now responsible for reporting errors to the health department.

The hospital added instructions to its medication policies, telling medical staff how to monitor patients after giving them drugs. Previously, Vanderbilt's policies included no such instructions, according to the federal investigation report.

Numerous officials would not comment or answer questions for this story. The Tennessee Department of Health said it would not comment because of pending litigation. CMS declined an interview request and to answer emailed questions. Tennessee Board for Licensing Health Care Facilities officials did not respond to requests for comment. Vaught and her attorney did not agree to an interview. The two Vanderbilt neurologists who misreported Murphey’s death did not respond to multiple email requests for comment. Edgeworth, who left Vanderbilt last year for an executive job at TriStar Health, declined to comment through a spokesperson.

Wednesday, December 11, 2019

Shooting of the Day

Really at this point we have a shooting every day and the reality is some are larger in scope and scale than others.  The minute Police become involved the volley of bullets and collateral damage will be significantly larger thanks to the heavy artillery local forces have access to once used in military operations.   We have a militarized local police force without the training and resources needed to understand how to use and not use said weaponry but it damn sure looks good when out on the streets protecting people from crazed shooters.

What ends up is chaos and more deaths that may not have occurred had they not had such weaponry available and as we already know Police are trigger happy under the most minor of circumstances so ratchet it up when a Cop is killed and then game is on.

The UPS Shootout will I am sure reveal some ugly truths that the deaths of the UPS Driver and the Gentleman in the adjacent vehicle were likely killed by the Police.  The truth about the death of the first responder in the mass shooting at the Borderline Bar and Grill. 

The Las Vegas Shooting that preceded it was also chaos, the Orlando Bar Shooting that lasted well over three hours another badly handled situation that went on far too long and labeled a hate crime for which it was not.   And my personal favorite the Waffle House shooting in Antioch that seemed to be utterly preventable had Police properly investigated the stolen vehicle from the day before but could not manage to find him less than a mile away from the Waffle House for over 23 hours and was found thanks to a citizen who called a hot line. Okay then.

Of course we have school shootings were incompetent School Security Officers failed to do their duty and shootings prevented by Coaches and Teachers who simply spoke to and more importantly listened to the Student stopping what could have been a fatal encounter.

So yesterday I sat though close to two hours of a Police Chief mispronouncing words and making up words to describe "Bad Guys."  Early on the reports described a pair of individuals of mixed gender. Then the original report that it was random where the final shoot out commenced only hours later being declared a hate crime without any substantiative evidence to support this belief.  But it serves to highly charge a community and in turn make it all political on top of emotional for the loss of what appears to be three individuals who may or may not have been killed by the Gunmen that were not Police.  Again we may never find that fact out for many many months. But like all shootings the speculation, the histrionics and random accusations that will lay blame and point fingers that will resolve nothing and stop the real problem - access to Guns.

But again what I truly found appalling was actual local news and the misinformation and their contribution to the histrionics of what already was a serious situation.   I came home got off the Path train knew nothing about it, went for a walk in between the rain, stopped at a store did shopping errands and grabbed a coffee and found out there what was going on.  My Barista and I did laugh at some Instagram posts that had residents dancing to the bullet fire so there you go with that Mr. Roger's in your neighborhood.  And that brings me to the Neighborhood.  The shooting began with the Police officer being killed in a Cemetery in the Greenville area about 15 minutes from where I write this.  Greenville is largely a minority community with heavy crime and violence problems then it moved into the West Bergen area which is slowly very slowly gentrifying.  This area is not served well by either light rail, buses or train system but has super cheap real estate and it is where I initially began my search for apartments when I arrived in JC in August.  It was one day in and after two days of talking to varying Lyft drivers that my conclusions and observations about the area were right - it is not safe, it is under change but about 5 years away from any type of real improvement.  I saw property after property that had been renovated to the top of the line while adjacent to abandoned houses, houses with bars on doors and windows, no grocery stores or services and maybe a block (where the shooting occurred) that had some small businesses that catered to the specific residents that resided in the area as in this case a Kosher market.   But it was not safe and not one that I a 60 year old white woman living on her own would seriously consider no matter how many gas ranges it had.

I had a conversation with a Real Estate Agent from of all places Sotheby's convincing me this was the new "it."  I have never been more insulted and abused by professionals outside of Nashville as I had with the Real Estate Shysters that work here in Jersey City.  Honestly that profession here is a con job with a quality of laziness that reminded me so much of Nashville I could not run away fast enough.  And then I just went to apartment after apartment building on my own contacting their own leasing agents and found utter professionalism, good natured intelligent individuals who followed up with my inquiries and were more than generous with their time.   I cannot say the same for the Sotheby's woman who when I asked about her other properties she informed me that they were not as modern but if I wanted to see them she could meet me there. I see so take me and drive me there no and I am to pay a fee for that?  Yes you take yourself to the property, the agent may or may not meet you there, you may never speak to them ever as they rely solely on texting and then show you a property with no options or information about others that may be available. They don't tell you anything about the neighborhood and expect you to pay them.  One asked me to drive by then text him what I thought and then we could arrange to meet there if I liked what I saw from the outside.  I actually did not do any of that instead I sat at the bank with my banker, we google searched the property looked at it on the map, knew instantly it was not a good area and then went back to our conversation.  He texted me during the meeting I informed him that I was "driving" by right now and it looked sketchy.  He then texted me and asked what time would I like to see it.  I said I am driving to the bank right now to get my finances and will text him later. And that ended that.  I did what I do best handled it on my own. 

Jersey City is in massive transition with money thanks to the opportunity zone tax breaks that have brought a great deal of investment into these areas that are in midst of gentrifying.  But that said it is a constant game challenge to see where the shiny keys land.   I suspect and see that Journal Square area is the new player as it has a Path Station and near a highway connecting to NYC.   It is the coolest hood I have found and is truly not as a dangerous or as inaccessible as the West Bergen area.  I could not believe how bad it was on a Sunday me sitting on stoops for agents to show, to not show, to show up late and the condition of the neighboring houses to think that this is okay for anyone on their own without a car (which they knew) relocating to an area that they did not know.  I have no respect for anyone in that profession and find them utterly irresponsible and the reason some of these problems occur and their role in the 2008 collapse cannot be ignored.

But when you have Journalists descending on an area, interviewing children about being on lockdown and then proclaiming after an eight year old goes, "Yeah I am used to it." as something that these children are familiar with on an ongoing basis does nothing to improve the area or the residents therein.   The reality was NOT ALL schools were locked down and that only the school across from the shoot up was at risk. The reality is that this was a Shelter in Place where kids were fine, the school was locked to outsiders coming in and going out and school went on as normal with no lights out, no hiding under desks or taking to safe locations in the building to wait it out.  That was again a bad version of events as you cannot nor should not have anyone sitting in wait for FOUR hours which they did.  Again what was the point?  Got me but to prove and demonstrate authority.  Would they have done that in the upper scale areas of the city with the larger white population of students? No.  But sure keep faces of color and poor kids locked up in school hours longer than they should, frighten their parents and in reality none of it was anywhere near them other than the school directly across the street.  Funny no one spoke to that Catholic Schools students, why was that?

It was and is a tragedy but what continues to make it as such was the media's coverage, the Police and their incessant need to show force in all situations regardless of need and the reality of our own need for drama when shit happens. This is about guns and more guns and who has got them.  I cannot tell in the words of the Police chief, who the "bad guys" are anymore.

Tuesday, December 10, 2019

Robbed by White Coats

We have an image of the bad Guy wearing a black hat with a menacing mien.  Well that is for story telling of fantasy but in reality we all know that most highway robbers wear Bespoke Suits and smile while cashing the check; However, we neglect the biggest thieves wear white coats.

I have zero respect for the Medical Industrial Complex as my current go around with Vanderbilt confirms that its bad regardless and you have to work around it, be aggressive and demanding and in turn be hated for it.  I am good with that.

When I was nearly killed by my date in 2012 and left for dead I was taken to the public trauma facility, Harborview Medical Hospital in Seattle where they attempted to finish off what my date had not.  Clearly there was a reason I stayed alive and I will never forget nor discontinue telling the story as a word of warning to those who need to know that it is all  not wine and roses when you enter a system as shattered as our medical one.

We live in myopia in this world. We seem to think if we came out unscathed, unharmed and nothing happened to anyone we love or know anything to the contrary is of course wrong, a lie or somehow the fault of that individual who is relaying the story.   We see this of course in the other end of the spectrum with victim mentality that once harmed that individual, that corporation, that situation must be punished and in turn not forgotten. As Confucius said:  To be wronged is nothing unless you continue to remember it.  And we never stop remembering.   And at times there is nothing wrong with it as we can use this as a teaching tool, to correct it for the common good and in turn change how we see ourselves or others with the idea of resolution and growth.  We should never be defined by our worst - that which we have done or have had done.

But the medical industrial complex thrives on negativity as does its brethren in arms - the legal complex.  They are complexes for a reason as they prefer to keep the operational aspect a secret, even from themselves as a way to maintain control, assert expertise and insure their place in society.  White men are good with that.  From the Bible to the law books to the medical books they do a great job of suppressing truths and oppressing others.

After I realized what happened to me at the hands of Harborview the night of February 12th they became the target of my ire as they prevented me from ever finding truth or seeking resolution for what happened to me that night in the hands of my date.  So I picked the bigger of two evils to target and while I may have "failed" in my attempt to sue them I won as I did not pay one single dollar in medical debt despite their efforts to turn me over to collections and I walked out and on with life as now seven years of passed and they can no longer track me like an animal in which to pay it.  I was very keen on that and I kept moving on to ensure that my trail was a complicated one in which to try to do so.  Not everyone has that skill set nor ability so in turn you are their victim again as more and more medical hospitals are doing the reverse and suing their patients for unpaid debt.  Ah the legal system still wins regardless.  Its why I had zero problem doing it per se and again had the skills set, willingness and ability to do so.  It was worth it all. And yes I continue to remember it;

So this weekend I read this editorial about legal fraud by the medical industrial complex. Again nothing shocked me and to those who have had similar experiences this is not new but to those unwilling, unable or simply in denial about how bad it is and refuse to hear the truth I have four words: GROW THE FUCK UP.  I should not have to wish that evil on you or yours to realize how serious it is.  But as the saying goes: Until it happens to you... there by the Grace of God.    Well guess what God is not real so get real.

Where the Frauds Are All Legal

Welcome to the weird world of medical billing.

By Elisabeth Rosenthal
The New York Times
Dec. 7, 2019

Much of what we accept as legal in medical billing would be regarded as fraud in any other sector.

I have been circling around this conclusion for this past five years, as I’ve listened to patients’ stories while covering health care as a journalist and author. Now, after a summer of firsthand experience — my husband was in a bike crash in July — it’s time to call out this fact head-on. Many of the Democratic candidates are talking about practical fixes for our high-priced health care system, and some legislated or regulated solutions to the maddening world of medical billing would be welcome.

My husband, Andrej, flew over his bicycle’s handlebars when he hit a pothole at high speed on a Sunday ride in Washington. He was unconscious and lying on the pavement when I caught up with him minutes later. The result: six broken ribs, a collapsed lung, a broken finger, a broken collarbone and a broken shoulder blade.

The treatment he got via paramedics and in the emergency room and intensive care unit were great. The troubles began, as I knew they would, when the bills started arriving.

I will not even complain here about some of the crazy high charges: $182 for a basic blood test, $9,289 for two days in a room in intensive care, $20 for a pill that costs pennies at a pharmacy. We have great insurance, which negotiates these rates down. And at least Andrej got and benefited from those services.

What I’m talking about here were the bills for things that simply didn’t happen, or only kind-of, sort-of happened, or were mislabeled as things they were not, or were so nebulously defined that I couldn’t figure out what we might be paying for.

To be clear, many of the charges that I would call fraudulent — maybe all of them — are technically legal (thanks sometimes to lobbying by providers), but that doesn’t make them right. And no one would accept them if they appeared on bills delivered by a contractor, or a lawyer or an auto mechanic. There were so many of these charges that I came up with categories to keep track of them:

1. Medical Swag

In the trauma bay, someone slapped a hard brace around Andrej’s neck until scans confirmed that he had not suffered a grievous spinal injury. It was removed within an hour.

The medical equipment company that provided that piece of plastic billed $319. Our insurer paid $215 (90 percent of its discounted rate of $239). We were billed $24, our “patient responsibility.”

Companies are permitted by insurers to bill for “durable medical equipment,” stuff you receive for home use when you’re in the hospital or doctors’ office. That yields some familiar marked-up charges, like the sling you can buy at Walgreens for $15 but for which you or your insurer get a bill for $120 after it is given to you at urgent care. The policy has also led to widespread abuse, with patients sent home with equipment they don’t need: My mom’s apartment, for example, holds an unused wheelchair, a walker and a commode paid for by Medicare, by which I mean our tax dollars. It’s as if you were given a swag bag at a conference and then sent a bill for hundreds or thousands of dollars.

At least with swag, you get to keep it. My husband’s hardly worn neck brace didn’t even come home with us as a souvenir.

2. The Cover Charge

The biggest single item on Andrej’s E.R. bill was a $7,143.99 trauma activation fee. What was that for, since every component of his care had been billed and billed handsomely?

Among the line items: $3,400 for a high-level E.R. visit. $1,030 for the trauma surgeon. Between $1,400 and $3,300 for five purported CT scans. And I say “purported” because one trip into a scanner examined the head, upper spine and maxillofacial bones, but was billed as three separate things. There was also an administration fee of more than $350 each for four injections.

Trauma activation fees have been allowed since 2002, after 9/11, when the Trauma Center Association of America, an industry group, convinced regulators that they needed to be compensated for maintaining a state of “readiness.”

Wait. Isn’t the purpose of an E.R. to be “ready”? Isn’t that why the doctors’ services and scans are billed at higher rates when they are performed in an emergency department?

Despite scrutiny from researchers about whether trauma fees are deserved, trauma activation fees have only grown in size, 15 percent annually in recent years, and can reach into the tens of thousands of dollars. (On average, Medicare pays a fee of about $1,000.) Some have likened trauma activation fees to a cover charge for being wheeled into an E.R. with major trauma. But does a cover charge typically cost more than the meal?

3. Impostor Billing

We received bills from doctors my husband never met. Some of these bills were understandable, like for the radiologist who read the scans. But others were for bedside treatment from people who never came anywhere near the bed to deliver the care.

Andrej had a small finger fracture with a cut that needed some stitches, which a resident, a surgeon-in-training, sutured. But the $1,512 billed came in the name of a senior surgeon, as if he had done the work.

Physicians and many other health professionals are allowed to bill for the work of “extenders” — stand-ins with less training who see patients and work under the supervising doctor. These might be residents, physician assistants or nurse anesthetists, for example. For billing purposes, this allows the senior providers to be in two, three, sometimes more than half a dozen places at once, often even when they are physically miles away.

The resident did a fine job on my husband. But if an assistant did the work, shouldn’t it be billed for less? At law firms, the hourly rates for paralegals and junior attorneys are lower than those for partners.

On a website called Clinical Advisor, a reimbursement expert himself seemed to wonder at the profession’s luck that such billing is tolerated: “I hear people ask, ‘How can I do that? The doctor never saw the patient, never had any interaction with the patient and yet I can still bill this service under the physician?’”

4. The Drive-By

The day before Andrej left the hospital, a physical therapist visited and asked a few questions. From that brief encounter, the therapist noted “ambulation deficits, balance deficits, endurance deficits, pain-limiting function, transfer deficits.” That translated into a bill of $646.15 for what was recorded as a P.T. evaluation “1st session only (billable).” He said he was there for 30 minutes, but he was not. He said he walked Andrej up 10 steps with a stabilizing belt for assistance. He did not. There was no significant health service given. Just an appearance and some boxes checked on a form. It’s a phenomenon called drive-by doctoring.

More shockingly, the drive-bys continued at our home, presaged by a call on Andrej’s cellphone a day after he was discharged. A physical therapist from a private company wanted to visit him for at-home therapy. In his discharge instructions, no one had mentioned this service, and his injury was clearly too fresh to benefit. She came. She didn’t know which body part had been injured and concluded he was in too much pain to participate.

The same company called twice more the following week to schedule visits. By the third time, I told Andrej not to open the front door. Nonetheless, our insurer was billed — and paid — for three visits.

It’s as if Alexa noticed that my dishwasher makes too much noise (it does) and took it upon herself to send over a repair guy. But if I turned him away at the front door, saying I’m O.K. with the racket (I am), would I still be billed for the visit?

5. The Enforced Upgrade

One Monday when Andrej was in pain and out of pills, the trauma doctor suggested we meet in the emergency room, because the trauma clinic was open only from 8 to 10:45 a.m. on Wednesdays and Thursdays.

So we met the trauma doctors in the E.R., and they talked to Andrej, who remained in his street clothes. They gave him a prescription. Because the interaction — which could have happened in the lobby — happened in the E.R., it resulted in an E.R. visit charge of $1,330. But when the trauma clinic is open less than six hours a week, billing for an E.R. visit that doesn’t tap into any of the emergency room resources feels like a scam. Is an E.R. visit determined by the content of the services rendered, or merely by the location?

Andrej had a similar experience when his broken finger was treated with a plastic splint that folded over his fingertip. He complained because the upper layer pressed on the fracture. At a follow-up visit, someone took a pair of scissors and cut off the upper half of the splint and taped the lower half back in place. That translated into a $481 charge for “surgery,” in addition to the $375 charge for the office visit and a $103 facility fee. Doesn’t surgery, by definition, involve cutting into flesh or an animate object — not a piece of plastic?

Sure, it sounds fancy to upgrade a meeting to an E.R. visit, or to call the tweaking of a splint “surgery,” but if an airline overbooks my flight and puts me on another flight where the only seat available is in first class, it does not charge me for the more expensive ticket.

My insurer paid for most of these questionable charges, though at discounted rates. But even a discounted payment for something that never really happened or didn’t need to happen or that we didn’t agree to have happen is still, according to common sense, a fraud.

Why do insurers pay? Partly because insurers have no way to know whether you got a particular item or service. But also because it’s not worth their time to investigate the millions of medical interactions they write checks for each day. Despite the advertised concern about your well-being, as one benefits manager enlightened me: They’re “too big to care about you.” Electronic records, which auto-fill billing boxes, have probably made things worse. For example, the birth of a baby boy may automatically prompt a bill for a circumcision; having day surgery may prompt a check for sedation.

So what is the appropriate payment for swag I didn’t ask for, outrageous cover charges, stand-in doctors, drive-by visits and faux surgery? In some cases, zero; in others, far less than was paid. And yet, these are all everyday, normal experiences in today’s health care system, and they may be perfectly legal. If we want to tame the costs in our $3 trillion health system, we’ve got to rein in this behavior, which is fraud by any other name.

Saturday, December 7, 2019

The Testosterone Zone

The last few days I have been trying to understand and somehow explain the failure of men as I endlessly hear or read another story about a man and his failure to control his most basest of urges which seem to be to fight or to fuck.

Even the most innocuous of men seem to have a switch in their head that seems to turn on or off when it comes to either behavior and that also may be why those men seem to struggle more with sexual identity, personal intimate relationships and in turn their own place in a larger social role.  Those are the men who at 60 suddenly divorce, have literally an identity crisis and find themselves adrift. What used to end up with a man buying a Porche or quitting his job to live on a boat has become so much more.   I think of Bruce Jenner and now Billy Dee Williams who has decided to become fluid in his identity.  Do I care about either man? No but the need for attention is the part I don't understand.  You know who you are early on and at times that challenge to fit that square peg into a round hole is not easy and I should know and mine is not about sexual identity but just being a woman of independence of means and that is not just about finances but about work, relationships and what I believe and do in response to my beliefs about myself.

After what happened to me in 2012 I was not sure what my life would be like without a fuck buddy and I found out its fine.  I cannot be Gay as I was not born that way and no it is not a choice and I choose to be me.   So for someone who enjoys men and in small doses but would like a constant companion on whom to rely I realize that men say that but they do not mean that.  They cannot get enough sex to ever satisfy them and they cannot accept a woman who either agrees nor is willing to not agree.  With men it is no either/or it is neither/nor.  A woman is a whore or a mother and one fucks at will and one just fucks to have children and once that is accomplished their role is asexual and to serve.  Gee where did that one come from? Oh yeah the book of myths.

This weekend I watched three comedy specials with their own take on parenting, relationships and becoming an adult in society as it related to their own experiences and history - Wanda Sykes, Seth Myers and Sebastian Maniscalco.  There are many outstanding ones with similar themes on Netflx right now, many I have seen and some I have not but it is worth ones time to just sit and laugh at the world that seems all out of control and all ironically because of men who stand on two sides of the same argument.  The NATO conference demonstrated that in ways that reminded me of the high school cafeteria with the cool kids laughing at the nerd who later plans his revenge.  And we have seen of late of that pans out usually with guns and ammo not Hookers and blow; the later a way preferable way to give the big finger to the assholes.

But what stood out was Wanda Sykes observations about aging as a woman.  And there I realized that for me I have become invisible, I am to be ignored and when being paid attention to I am done so in a patronizing and condescending manner.  We are seeing this now also pan out with the "OK Boomer" response by Millennials who seem to think our world view is a waste of their precious time away from social media which put us here in the first place.  So okay then!  But her one observation was salient with the lack of Estrogen which is a calming hormone we are becoming men. It explains my anger and my rage of late and why I upset everyone with my directness as that is not how women are dammit!  More subservience and reticence please bitch!

I don't do social media anymore and I loved Twitter in the early days and now I simply glance at it an pimp my blog.  I have a fake Facebook account and email with it and when they get shut down in the occasional sweeps I just come up with another one.  Really Google and other tech firms give no flying fucks about any issues of privacy, fraud or interference in democracy. The more data the better to make money with.   If they cared they would have fixed it like they claim they are fixing the world and making it better, like Theranos only with less bullshit and fraud.   And that was a woman behind that so hey we broke the glass ceiling there!

And that brings me to the sharing economy and the varying startups that have come from them.  Let's see the woman oriented ones are fashion and domestic based - Pinterest, Etsy, Rent the Runway and so forth. The male ones are Uber, Lyft, AirBnb, TaskRabbit, Grinder and other dating apps that are sexual in nature.  Just Facebook with swiping versus liking which is what the face place was about when it started, a way to rate women by nerds who could not get laid. They chose the internet and getting rich over taking up arms.  Good choice.

So this week brought the report by Uber about the number of sexual assaults and other criminal complaints on both drivers and passengers.  I am sure Lyft is the same (and it is)as who hasn't gotten into one of the vehicles to find the signage of both in the car.  I never do any of those services at night and never will without a male companion as frankly they are not the best in the best of times but the few I have had here in Jersey speak very little English and those who do I start up a convo right away and keep talking and we all know how men hate women who talk a lot.  Irony I am rated 5 star! I tip.  That said I have also had amazing conversations with men in those vehicles that lasted long after the ride did and I am better for it.   I actually do know how to converse and when you are willing to find someone to do the same we are all better for it.

And for the record most abuse, violence and societal problems begin on social media and end in a pile of shit.  So much for the social part but ass kicking, murder, suicide, rape (or making it live on and on and on)and gun violence sure that  is pretty social.

So as I try to understand what the fuck is going on and why I feel so afraid, disconnected and in turn just sad, I read the following articles all about the failings of men when it comes to women and sex:

Woman killed after date
Woman killed for ignoring catcalls
Traffic Stop leads to Rape     or Dead Tell No Tales
Rape as Porn Video
Cruise Ships and Rape
How about a Plane  or Another airline perhaps
Caregiver or Taker

I just listed the ones of late these do not include further allegations about Priests, Harvey Weinstein or the other Stein - as in Jeffrey. The fallback to Prince Andrew is enough about that subject for awhile. We have numerous stories of rape and assault all over the globe, just doing a search on the New York Times gave me these articles.  It is a global problem that affects both men and women. Google Hyderbad.  And yes men are also raped by men that are not just Priests. The New York Times did an outstanding investigation of male rape in the Military and of late the boys in Afghanistan. 

My point?  That men have real problems that all the hash tags, marches and collective sighing will not change. We have had legislation for years to prevent sexual abuse including harassment and clearly it failed in the same way the Cops failed to protect people from harm as they seem to be the ones most causing it.   And when it comes to sexual assault they do shit all nothing as the Atlantic found in their article about how many rapes fail to get investigated at any level.  And watch the Netflix series about ProPublica's investigation into a serial rapist - Unbelievable.  You may need a comedy show after that.

Anger, rage, displacement, confusion, sexual identity, sexual frustration, drugs, alcohol, abandonment, isolation, depression, anxiety, poverty, family abuse, sexual abuse, religion and societal pressures are all reasons why we do what we do, why we make bad decisions but nothing women do seems to rise to the level of violence and destruction that men do.  And why? It's the testosterone baby!   That is some shit man that is killing men.  Fuck Viagra, find a way to control that and maybe we have solved some of the problems.  Just some of them.  I am not sure if it is all nature at this point as we have nurtured this for centuries and some things regarding male domination and abuse seem beyond resolution.  We are all losers for this.  Time is up? For what?  It appears as if that time has passed.  Ok, Boomer.