List Archives

Tue Apr 10 21:53:43 BST 2007

Rick and Anthony,

one last comment:

The person or persons who appear to you to have the gizmos etc may be making the wrong lifestyle decisions, in a manner of speaking, and that may be profoundly frustrating to you. But it is not you who is making the wrong decisions - and at the end of the day it is not you who has to live with the ultimate results of their bad lifestyle decisions. We all deal with people who we may think (based on varying degrees of certainty) are making very bad decisions. This is a common situation and response in all social professions, and in life in general. But I think 'contempt' is out of place because it is harmful to you and to the patient - remember - 'do no harm' (to yourself also). Perhaps this type of professional interaction leaves you angry and dumbfounded, but there may be a teaching moment there. I think it would be better to try to formulate a therapeutic and understandable way to express the realities of the ED financial crisis and misuse (of which you are intimately aware) and I think that is a more professional and compassionate approach to obviously disordered situations that you are powerless (at that time) to alter.

Thanks for your candor,

Skip Tinnell, RN, MSPH

>>> Moore, Rick<Rick.Moore at TriadHospitals.com> 4/10/2007 12:20 PM >>>
Skip,
We are not stereotyping.  Stereotypes are ideas held about members of particular groups, based solely on membership in that group. Paramedic Caruso and I are not assuming that someone is a member of the group in question based on the fact that they have Medicaid, live in subsidized housing, are a particular race or creed or have the latest Razor cell phone for that matter. We base our opinion on the persons comments, concerns etc. When the patient or the patients parents have all the fancy gizmos, plenty of gold jewelry, and tell me that they didn’t go to the doctor because they can't afford to pay him or as some have actually told me, "why pay the doctor, when the ER is free".
Rick

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of skip at c-d-m.com 
Sent: Tuesday, April 10, 2007 12:53 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: [ccm-l] Employment and benefits manipulations

Having frustration does not imply a lack of compassion. Stereotyping does though, because it devalues the basic dignity that every person has. How does having contempt for the people you serve help anyone? How does having compassion for those who seek your help hurt anything? 

The practical problem with stereotyping a 'subset of the population' is twofold: it is too vague a classification to be useful as a triage tool and it leads to unjust misclassifications with the potential for serious error. 

The 'system', or the ED/EMS/Trauma system in particular, is actually accomplishing what it was designed to do. If 'the system' were designed to be selective and two-tiered, there would not be strong local and national laws to assure that everyone has at least basic access to health care. The flaws in the system are apparent, but it would be a sad step backward to dismantle the equitability of the ED/EMS/Trauma system to impose the types of solutions where 'contempt' is an acceptable response on the part of providers to the people who use the services.

Skip Tinnell, RN, MSPH

>>> Anthony Caruso<Medic541 at hotmail.com> 4/10/2007 10:50 AM >>>
Rick, I totally agree with your statement.  

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Moore, Rick
Sent: Tuesday, April 10, 2007 11:15 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: [ccm-l] Employment and benefits manipulations

Since when is being frustrated with a subset of the population that
manipulates and uses to it's best advantage a broken system scandalous and
without compassion? Why should any of us have compassion for those who
mis-use the system to the point that those who have legitimate needs can't
receive the benefits intended. I am all for helping those who have a
legitimate need, but those who show up with a top of the line cell phone on
their belt, kids listening to I-pods, pockets full of Cigarettes and say
"sorry, I can't afford to pay" do not deserve compassion, only contempt for
mis-directing funds needed by those who are truly needy. Rick Moore, RN, LP

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of skip at c-d-m.com 
Sent: Tuesday, April 10, 2007 9:58 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: [ccm-l] Employment and benefits manipulations

As you say, Pret, 'for the love of Christ'. These posts from Mr Caruso,
despite the honesty of frustration, are nevertheless scandalous. Is it so
hard to be compassionate? I wonder if Mr Caruso's patients know he has such
little regard for their human dignity. I bet they do. If compassion is this
dead in the helping professions then no amount of refinancing can fix it,
because the essence of the profession is lost. If Mr Caruso reads the Bible,
a quick review of Matthew 25 is in order.

Skip Tinnell, RN, MSPH

>>> Anthony Caruso<Medic541 at hotmail.com> 4/9/2007 12:26:51 PM >>>
Prêt, I beg your pardon.  I have worked in areas that indeed do have such
amenities at home.  How aggravating it is when they present to you the card
that for them fixes everything.  And not have to worry any consequence
what's so ever of there actions.  The "disabled" man or woman that has no
steady job that uses his Mass health card in the EW cause of his "tummy
ache".  And in the end doesn't have to worry about a copy or that his
insurance for family coverage costs 150 dollars a week.
  Honest, Poor working families?  Yeah I know they exist.  They know how to
restrain themselves from buying the latest Motorola razor phone or the play
stations.  Concocting an upside to poverty is not my point.  However, the
next time you see an ambulance pull in to the bay.  Take the folks to the
side and ask them if they have ever heard of such a story that I have
presented.  
	You work in a  big city hospital I assume.  How many times dose this
happen?  Plane load of immigrants lands from the airport.  Give the Triage
nurse something vague that there kids are experiencing like oh, umm
"headache" for instance.  What a coincidence, all of there children have the
same signs and symptoms.  You know as well as I do that they get a warm meal
and a full work up.  
	My Father came here from Italy, made himself a good reputation as a
landscaper.  Not once, EVER did he take a hand-out from the government.  Go
figure!  Didn’t speak a lick of English and today owns his own business. I
agree that the 99% may be a bit exaggerated but I'm not way off.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Bjorn, Pret
Sent: Monday, April 09, 2007 8:59 AM
To: Trauma &amp; Critical Care mailing list
Subject: RE: [ccm-l] Employment and benefits manipulations

For the love of Christ.  Listen to yourselves.  

How easy it is to concoct an upside to poverty, and to fatten the lore of
welfare manipulation with tales of widescreen televisions and sports cars,
while something like 37 million Americans struggle to feed, clothe, and
shelter themselves while for the most part cheating no one, and asking for
little or nothing, often to their silent and invisible deaths.  

" ...99% of them have a huge entertainment system of some kind.  All of the
fancy gadgets included.  Hi-Def surround sound, hi-def flat screen TV and
hi-def whatever!... "

This is more than an exaggeration; it's a reprehensibly malevolent lie,
clearly penned by someone who hasn't the most remote familiarity with
America's honest poor, most of whom work at least as hard as he does:
families forced to choose between filling a prescription and paying the rent
or buying food; who tolerate their illnesses because they can't afford
insurance and going to a doctor would bankrupt them -- or worse, force them
into welfare.   

How seductively satisfying, the myth that those of us with proper education
and good jobs and warm homes and weekly restaurant tabs and hyperactive
Netflix accounts are somehow victims of the needy.  How utterly obscene to
ignore the corporate welfare shoveled into U.S. energy and pharmaceutical
and insurance interests, or our half-trillion-dollar debacle in the desert,
while enthusiastically shitting on families of four making under $20k per
year.  

Let's use the crackhead with the Playstation to quantify the creeping
failure of our civilization.  

How can we not be sick of ourselves?

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 

On Behalf Of RWolfer at aol.com 
Sent: Sunday, April 08, 2007 8:55 PM
To: trauma-list at trauma.org 
Subject: Re: [ccm-l] Employment and benefits manipulations

In a message dated 4/8/2007 11:42:32 AM Eastern Daylight Time,  
medic541 at hotmail.com writes:

I have  to agree with some of the posts with Dr. Mattox  For many years now
I 

have gone into some of the sate funded housing for people that cannot pay  
for housing themselves.  No matter who you talk to whether it would  be a 
Firefighter, Paramedic or police officer the one thing that all agree  on is

that upon entering the homes of such people is 99% of them have a  huge 
entertainment system of some kind.  All of the fancy gadgets  included.  
Hi-Def surround sound, hi-def flat screen TV and hi-def  whatever!  Upon 
transporting such individuals the first thing that  they present is the
State 
funded health card.  ( I.E medicare or in  Massachusetts Medicaid.) We, the
hard working tax payers, pay  for all of there leisure and time 
off.  If you collect all of this  free care free this and free that what 
incentive do you really need to  have to get off of public assistance?  
Public assistance has become a  way of life for some.  Not a way out as is 
was intended to be. You  have to admit, Dr. Mattox has some valid points.
Anthony Caruso  EMT-P Natick, Massachusetts.

>From: "Ronald Gross"  <Rgross at harthosp.org>
>Reply-To: "Trauma &amp; Critical Care  mailing list" 
><trauma-list at trauma.org>
>To: "Trauma  &amp; Critical Care mailing list"  
><trauma-list at trauma.org>
>Subject: RE: [ccm-l] Employment and  benefits manipulations
>Date: Fri, 06 Apr 2007 13:38:02  -0400
>
>Actually in that case hypocritical would be the term, not  cynical.  I
>hold those upscale hypocrites in the same light as all  the others who 
>want to take everything from everyone and give nothing  to anyone.
>
> >>> "Offner, Patrick"  <PatrickOffner at Centura.Org> 4/6/2007 1:33 PM
> >>> >>>
>But  those same upscale individuals DON'T want to pay for their routine
>and  emergent medical care. In fact, many do not have insurance because 
>they  would rather have a BMW or a large flat screen TV.  Yes--getting 
>cynical.
>
>-----Original  Message-----
>From:  trauma-list-bounces at trauma.org 
>[mailto:trauma-list-bounces at trauma.org]  On Behalf Of Ronald Gross
>Sent: Friday, April 06, 2007 10:13  AM
>To: Trauma &amp; Critical Care mailing list
>Subject: RE:  [ccm-l] Employment and benefits manipulations
>
>Lets be real here  - how many of the indigent patients that receive
>free medical care pay  for their root canals?  In fact, how many 
>actually have any dental  care at all?  None.  They go to the free 
>clinics at the  large city hospitals and get their free dental care 
>(that we all pay  for), while the dentists you talked about continue to 
>serve their  upscale suburban families 3-4 days a week and go to their 
>country homes  the other 3-4 days per week.  Same with the "cosmetic 
>surgeons" or  "sports medicine" ortho guys who do their jobs in nice 
>self-owned and  self-build private clinics and get paid cash by the 
>dentist who blew  out his knee and messed up his nose while skiing at  
>Vail.
>
>Cynical, are we???
>
> >>> "Offner,  Patrick" <PatrickOffner at Centura.Org> 4/6/2007 11:47 AM
>  >>>
>Yes, but it was easier to justify providing some indigent  care(say
>10%) when reimbursement for non-indigent care was reasonable  and 
>appropriate. Now that we have to work 3-10 times as hard to  earn the 
>same income--in the face of inflation and rising malpractice  fees--it 
>seems harder to swallow the "forced" indigent care we have to  provide. 
>It seems that at least 50% of the trauma and emergency general  surgery 
>I see in the ED is uninsured. We still give them excellent care  but it 
>is getting harder to swallow.
>The dentists somehow seem  to have gotten it right. They get 50-80%
>reimbursement on the billings  and charge the patient for the rest. And
>the patients are willing to  pay for the rest. Most dentists that I know
>only work 3-4 days per  week, rarely take call and make a lot more money
>than I do. We on the  other hand get about 30-40% of what we bill and are
>contractually  prevented from balance billing the patient. Moreover, the
>patients now  EXPECT to get their care for free. Why are they willing to
>pay for  their root canal but not for their emergency appendectomy or
>their  elective colon cancer resection?
>
>-----Original  Message-----
>From:  trauma-list-bounces at trauma.org 
>[mailto:trauma-list-bounces at trauma.org]  On Behalf Of Ronald Gross
>Sent: Friday, April 06, 2007 8:54  AM
>To: Trauma &amp; Critical Care mailing list
>Subject: RE:  [ccm-l] Employment and benefits manipulations
>
>Tort reform,  insurance company executive salaries, drug company "R&D"
>costs, etc  - all part of the solution. Not part of the solution - a 
>free lunch and  an excuse for all of the "disenfranchised" whether 
>their condition is  self-imposed or "imposed by others" whoever those 
>"others" might  be......
>
> >>> "Offner, Patrick"  <PatrickOffner at Centura.Org> 4/5/2007 6:46 PM
> >>> >>>
>Dr.  Mattox,
>
>While I agree with you almost 100%--don't you believe  that insurance
>costs are also out of control--to the point that a lot  of people just 
>cannot afford them. Your "fix" is just the tip of the  iceberg--we also 
>need insurance reform as well as tort reform--it is  all intertwined.
>
>-----Original Message-----
>From:  trauma-list-bounces at trauma.org 
>[mailto:trauma-list-bounces at trauma.org]  On Behalf Of KMATTOX at aol.com 
>
>Sent: Thursday, April 05, 2007  3:01 PM
>To: trauma-list at trauma.org 
>Subject: Re: [ccm-l]  Employment and benefits manipulations
>
>
>In a message  dated 4/5/2007 3:48:23 P.M. Central Daylight  Time,
>thoran at sarah. br writes:
>
>Of the  30  -40 million US uninsured how many are the fast driving drug
>addicts,  or  lazy, obese cigarette smokers whom you abhor and how many 
>of  them are ordinary  folks, the people who are apparently easy for  
>you to dismiss , the
>working poor, in jobs that need  filling but just donフ》 get paid very
>well , certainly not enough to  part with 1,200 a month...  maybe the
>receptionist or the cleaner  or the guy in the parking garage, people who
>just  do NOT appear  on your radar because they do NOT read a novel a
>week, do NOT   know the right people, do NOT belong to the right
>organizations, did  NOT go to  the best schools. Never mind Dr. Crippens
>friend but  what about the disabled,  the folks in the other car,  the
>unemployed, the unemployable, good cannon  fo dder but No FREE  LUNCH.
>Never mind that the free lunches are served up in   corporate board
>rooms every where, provided by the moms and pops  investing in  the great
>enterprises that won't provide  health  insurance.
>
>
>
>In every society, and  especially at the local level, provisions are
>made  for
>the  kind of persons you cite above.   Many local good examples   exist.
>
>
>These same individuals do not have state  sponsored lawyer  aid,
>housing aid,
>church aid, food aid,  family counseling, cell phones,  etc.   Why must
>or  should
>health care be any different.    MANY MANY of the  persons you cite
>above CHOOSE
>to not have health dollars   available in order to pay for cell phones,
>send money back to family in  another  country, have a late model car, 
>drink alcohol every day,  go to cock fights, and  have somewhat 
>expensive watches and  designer
>glasses.   I see them  every day, and then they  expect FREE medical
>care.
>WRONG.  One  cannot have it  both ways.    If they go to church, the
>priest
>EXPECTS  them to put something in the collection plate and even pay for 
>some of  their absolution by giving to the church (up to and greater 
>than 10% of  their
>income).   If they need to go to court, they must pay  for an
>attorney.
>
>
>I have NO problem for fairness  with a prorated calculation of a
>discounted bill based on disability,  inability to work (real, and not 
>just a matter of a created social  welfare state to pay someone NOT to 
>work), and a feeling of  responsibility for ones own services, whatever 
>they might be.  It  is not  the state or the employers responsibility 
>to assure that  everyone is provided  all creature comforts from the cradle
>to the  grave.  That is a family and  an individual responsibility.   The
>governmental responsibility is to  protect,  NOT
>PROVIDE.
>
>We in every society MUST also address the  HUGE profits from insurance
>companies, HMOs, and hospitals whose  overhead and payments to upper 
>level
>management and stockholders  are obscene.    The persons who have   been
>unfairly
>burdened with the financing of individual health  care has become  the 
>employer, and that is the most unfair  of all  systems.
>
>Kenneth
>L. Mattox,  MD
>Houston
>
>
>
>**************************************  See what's free at
>http://www.aol.com.
>--
>trauma-list :  TRAUMA.ORG
>To change your settings or unsubscribe  visit: 
>http://www.trauma.org/index.php?/community/ 
>
>***********************************************************************
>****
**
>This  communication is for the use of the intended recipient only.   It
>may contain information that is privileged and confidential.   If you are
>not the intended recipient of this communication, any  disclosure,
>copying, further distribution or use thereof is  prohibited.  If you 
>have received this communication in error,  please advise me by return 
>e-mail or by telephone and delete/destroy  it.
>***********************************************************************
>******
>--
>trauma-list  : TRAUMA.ORG
>To change your settings or unsubscribe  visit:
>http://www.trauma.org/index.php?/community/ 
>
>Confidentiality  Notice
>
>This e-mail message, including any attachments, is for  the sole use of
>the intended recipient(s) and may contain confidential  or proprietary 
>informat
>ion which is legally privileged.   Any unauthorized review, use,
>disclosure, or distribution is  prohibited.  If you are not the 
>intended recipient, please  promptly contact the sender by reply e-mail 
>and destroy all copies of  the original message.
>--
>trauma-list : TRAUMA.ORG
>To  change your settings or unsubscribe  visit: 
>http://www.trauma.org/index.php?/community/ 
>
>***********************************************************************
>****
**
>This  communication is for the use of the intended recipient only.   It
>may contain information that is privileged and confidential.   If you are
>not the intended recipient of this communication, any  disclosure,
>copying, further distribution or use thereof is  prohibited.  If you 
>have received this communication in err or,  please advise me by return 
>e-mail or by telephone and delete/destroy  it.
>***********************************************************************
>******
>--
>trauma-list  : TRAUMA.ORG
>To change your settings or unsubscribe  visit:
>http://www.trauma.org/index.php?/community/ 
>
>Confidentiality  Notice
>
>This e-mail message, including any attachments, is for  the sole use of
>the intended recipient(s) and may contain confidential  or proprietary 
>information which is legally privileged.  Any  unauthorized review, 
>use, disclosure, or distribution is  prohibited.  If you are not the 
>intended recipient, please  promptly contact the sender by reply e-mail 
>and destroy all copies of  the original message.
>--
>trauma-list : TRAUMA.ORG
>To  change your settings or unsubscribe  visit: 
>http://www.trauma.org/index.php?/community/ 
>
>***********************************************************************
>****
**
>This  communication is for the use of the intended recipient only.   It
>may
>contain information that is privileged and  confidential.  If you are
>not the intended recipient of  this communication, any disclosure,  
>copying, further
>distribution or use thereof is  prohibited.  If you have received this
>communication in error,  please advise me by return e-mail or by
>telephone  and
>delete/destroy  it.
>***************************************************************************
**
>--
>trauma-list  : TRAUMA.ORG
>To change your settings or unsubscribe  visit: 
>http://www.trauma.org/index.php?/community/ 
>
>Confidentiality  Notice
>
>This e-mail message, including any attachments, is for  the sole use of
>the intended recipient(s) and may contain confidential  or proprietary 
>information which is legally privileged.  Any  unauthorized review, 
>use, disclosure, or distribution is  prohibited.  If you are not the 
>intended recipient, please  promptly contact the sender by reply e-mail 
>and destroy all copies of  the original message.
>--
>trauma-list : TRAUMA.ORG
>To  change your settings or unsubscribe  visit: 
>http://www.trauma.org/index.php?/community/ 

_________________________________________________________________
The  average US Credit Score is 675. The cost to see yours: $0 by Experian.

http://www.freecreditreport.com/pm/default.aspx?sc=660600&bcd=EMAILFOOTERAVE 

RA
GE

--
trauma-list  : TRAUMA.ORG
To change your settings or unsubscribe  visit:
http://www.trauma.org/index.php?/community/ 

Ithink that this was intended to be a way of "getting folks thru" but is now

a way of life.  We have become a society of entitlement and  "I  deserve and

I need" instead of I worked for this. there are now generations upon  
generations of this.  Some of us were raised to work for what we got and pay
our own 
way.  I think the only way to change this is to stop it and  make people
work 
for what they get.  there is plenty of work out there,  cleaning roadsides, 
taking the elderly to appointments ect.  We see traumas  hurt on ATVs or
drunk 
driving all the time who are on disabiltiy for whatever  reason.  I think
that 
if you can drive a car or ride an ATV you can  work.  there is a job for 
everyone. Heck, McDonalds hires folks with Downs  all the time.  They are
often the 
hardest workers and very proud of the  fact that they have a job and can 
contribute.  I think if you get welfare  or medicare you need to do
something for 
it. You dont get something for  nothing.  Unfortunately we need to change 
generations of thinking.  We  are , as a country and as individuals, going
broke 
working so that others can  sit around and do nothing.  Some of them drive 
better cars and have better  TVs ect than those of us that work our tails
off.

RW

************************************** See what's free at
http://www.aol.com.
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/ 

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.o

List Archives

For your convenience, find the Trauma List Archive Below

[ccm-l] Employment and benefits manipulations