[ccm-l] Employment and benefits manipulations

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Skip,
Thanks for this comment, you have certainly pointed out a less harsh way =
to deal with reality.
Rick=20

-----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 3:54 PM
To: Trauma & Critical Care mailing list
Subject: RE: [ccm-l] Employment and benefits manipulations

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=A1=AFt =
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?=20

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.=20

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. =20

-----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]=20
On Behalf Of skip at c-d-m.com=20
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 >>>
Pr=A8=BAt, 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. =20
	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. =20
	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=A1=AFt 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]=20
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. =20

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. =20

" ...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.  =20

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. =20

Let's use the crackhead with the Playstation to quantify the creeping
failure of our civilization. =20

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]=20

On Behalf Of RWolfer at aol.com=20
Sent: Sunday, April 08, 2007 8:55 PM
To: trauma-list at trauma.org=20
Subject: Re: [ccm-l] Employment and benefits manipulations

=20
In a message dated 4/8/2007 11:42:32 AM Eastern Daylight Time, =20
medic541 at hotmail.com writes:

I have  to agree with some of the posts with Dr. Mattox  For many years =
now
I=20
=20
have gone into some of the sate funded housing for people that cannot =
pay =20
for housing themselves.  No matter who you talk to whether it would  be =
a=20
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=20
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=20
funded health card.  ( I.E medicare or in  Massachusetts Medicaid.) We, =
the
hard working tax payers, pay  for all of there leisure and time=20
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? =20
Public assistance has become a  way of life for some.  Not a way out as =
is=20
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"=20
><trauma-list at trauma.org>
>To: "Trauma  &amp; Critical Care mailing list" =20
><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=20
>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=20
>cynical.
>
>-----Original  Message-----
>From:  trauma-list-bounces at trauma.org=20
>[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=20
>actually have any dental  care at all?  None.  They go to the free=20
>clinics at the  large city hospitals and get their free dental care=20
>(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=20
>country homes  the other 3-4 days per week.  Same with the "cosmetic=20
>surgeons" or  "sports medicine" ortho guys who do their jobs in nice=20
>self-owned and  self-build private clinics and get paid cash by the=20
>dentist who blew  out his knee and messed up his nose while skiing at =20
>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=20
>appropriate. Now that we have to work 3-10 times as hard to  earn the=20
>same income--in the face of inflation and rising malpractice  fees--it=20
>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=20
>[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=20
>free lunch and  an excuse for all of the "disenfranchised" whether=20
>their condition is  self-imposed or "imposed by others" whoever those=20
>"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=20
>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=20
>[mailto:trauma-list-bounces at trauma.org]  On Behalf Of KMATTOX at aol.com=20
>
>Sent: Thursday, April 05, 2007  3:01 PM
>To: trauma-list at trauma.org=20
>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 =20
>you to dismiss , the
>working poor, in jobs that need  filling but just don=A5=D5=A1=B7 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,=20
>drink alcohol every day,  go to cock fights, and  have somewhat=20
>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=20
>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=20
>just a matter of a created social  welfare state to pay someone NOT to=20
>work), and a feeling of  responsibility for ones own services, whatever =

>they might be.  It  is not  the state or the employers responsibility=20
>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=20
>level
>management and stockholders  are obscene.    The persons who have   =
been
>unfairly
>burdened with the financing of individual health  care has become  the=20
>employer, and that is the most unfair  of all  systems.
>
>Kenneth
>L. Mattox,  MD
>Houston
>
>
>
>**************************************  See what's free at
>http://www.aol.com.
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_________________________________________________________________
The  average US Credit Score is 675. The cost to see yours: $0 by =
Experian.

http://www.freecreditreport.com/pm/default.aspx?sc=3D660600&bcd=3DEMAILFO=
OTERAVE=20

RA
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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 =20
generations of this.  Some of us were raised to work for what we got and =
pay
our own=20
way.  I think the only way to change this is to stop it and  make people
work=20
for what they get.  there is plenty of work out there,  cleaning =
roadsides,=20
taking the elderly to appointments ect.  We see traumas  hurt on ATVs or
drunk=20
driving all the time who are on disabiltiy for whatever  reason.  I =
think
that=20
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=20
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=20
it. You dont get something for  nothing.  Unfortunately we need to =
change=20
generations of thinking.  We  are , as a country and as individuals, =
going
broke=20
working so that others can  sit around and do nothing.  Some of them =
drive=20
better cars and have better  TVs ect than those of us that work our =
tails
off.
=20
RW



************************************** See what's free at
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