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Wed Nov 28 11:23:07 GMT 2007

November 28, 2007

Israel and Palestinians Set Goal of a Treaty in 2008 
By STEVEN LEE MYERS and HELENE COOPER

ANNAPOLIS, Md., Nov. 27 — The Israeli and Palestinian leaders committed themselves on Tuesday to negotiate a peace treaty by the end of 2008, setting a deadline for ending a conflict that has endured for six decades.
The agreement stopped short of the binding negotiating outline that many Palestinians had hoped for, but it revived a peace process that the United States had left dormant for seven years. 
Its success, both sides said, will depend in part on how vigorously President Bush pushes Palestinians and Israelis toward resolving the core issues that have bedeviled peace negotiators since 1979: the dismantling of Israeli settlements in the West Bank, the borders of a Palestinian state, the status of Jerusalem and the fate of Palestinian refugees who left, or were forced to leave, their homes in Israel.
In announcing the agreement at an American-sponsored peace conference here, Mr. Bush plunged the United States back into the role of an Arab-Israeli peacemaker — an approach he had previously shunned — at a time when wars in Iraq and Afghanistan have helped bring the American image in the Muslim world to historic lows.
But in Gaza, reaction to the peace conference was far from favorable. Crowds of more than 100,000 protested the conference. A Palestinian man was reported killed at a West Bank protest. 
“We meet to lay the foundation for the establishment of a new nation: a democratic Palestinian state that will live side by side with Israel in peace and security,” Mr. Bush told officials from 49 countries gathered at the United States Naval Academy. 
Flanked by Prime Minister Ehud Olmert of Israel and the Palestinian president, Mahmoud Abbas, Mr. Bush cast peace between Israelis and Palestinians as part of a broader struggle against extremism in the Middle East. 
It was a moment of diplomatic theater, endorsed by the attendance of a member of the Saudi royal family and framed by many participants’ concerns over the increasing influence of Iran and Islamic radicalism in the region. 
The moment was orchestrated by Mr. Bush, who pledged that the United States would “monitor and judge the fulfillment of the commitment of both sides.” The agreement, cast as a “joint understanding” between the Israelis and the Palestinians, fell short of the detailed five-page document that Palestinian officials have been seeking. But it went somewhat further than the Israelis had wanted, calling for an immediate start to wide-ranging talks aimed at reaching a final accord within 13 months.
“We agree to immediately launch good-faith bilateral negotiations in order to conclude a peace treaty, resolving all outstanding issues, including all core issues without exception, as specified in previous agreements,” the joint understanding said. “We agree to engage in vigorous, ongoing and continuous negotiations, and shall make every effort to conclude an agreement before the end of 2008.”
It was not clear until Mr. Bush, Mr. Olmert and Mr. Abbas stepped onto the podium in the ornate frescoed Memorial Hall at the Naval Academy, near a replica battle flag from the War of 1812 declaring “Don’t Give Up the Ship,” whether the Israelis and Palestinians had agreed on anything. 
Even on Tuesday morning, Mr. Bush held last-minute talks with Mr. Olmert and Mr. Abbas, while outside the room, Secretary of State Condoleezza Rice buttonholed the chief Israeli and Palestinian negotiators, Foreign Minister Tzipi Livni of Israel and Ahmed Qurei, a former Palestinian prime minister, to wring agreement on the wording of the accord. 
In making the announcement, Mr. Bush read aloud the joint understanding wearing his glasses, suggesting that there had not been enough time to convert the newly completed document to large type for his speech. 
Mr. Abbas shook hands with Mr. Olmert and Mr. Bush and then pointedly and emotionally put all of the most divisive issues squarely at the center of the talks that are scheduled to begin on Dec. 12.
“I am not making an overstatement, Mr. President, if I say that our region stands at a crossroad that separates two historical phases: pre-Annapolis phase and post-Annapolis phase,” Mr. Abbas said. “I say that this opportunity might not be repeated. And if it were to be repeated, it might not enjoy the same unanimity and impetus.”
When Mr. Olmert spoke, he too was emotional and highly personal. “We want peace,” he said. “We demand an end to terror, an end to incitement and to hatred. We are prepared to make a painful compromise, rife with risks, in order to realize these aspirations.”
The gathering brought about the highest-level official contacts yet between Israel and Saudi Arabia, which do not have diplomatic relations. Seated across the room and squeezed between the delegates from Senegal and Qatar, Prince Saud al-Faisal, the Saudi foreign minister, took notes during Mr. Olmert’s remarks, his head slightly bowed. When he arrived in Washington on Monday for the conference, Prince Saud vowed that he would not shake Mr. Olmert’s hand.
Mr. Olmert looked directly across the hall at Prince Saud and said that Israel aspired to “normalization” with the Arab world. 
“There’s quite a lot that separates us,” Mr. Olmert said. “Nevertheless, there is also a great deal that we share. Like us, you know that religious fanaticism and national extremism are a perfect recipe for domestic instability and violence, for bitterness and ultimately for the disintegration of the very foundations of coexistence based on tolerance and mutual acceptance.”
When the Israeli leader finished his speech, Prince Saud politely clapped. Later, during remarks to the foreign ministers, Prince Saud said that “the time has come for Israel to put its trust in peace after it has gambled on war for decades without success.” He called on Israel to withdraw from the West Bank. 
Palestinian officials said one obstacle to the joint statement had been Israel’s refusal to include a reference to the Arab League peace initiative. That initiative, which was reaffirmed by Arab nations this year, called on Israelis and Palestinians to reach an “agreed” resolution of the refugee issue.
Israeli officials do not like that term and have been adamant that Palestinian refugees have a right of return only to a future Palestinian state, not to Israel. They fear that including the Arab League language in the joint statement could handcuff them later in negotiations.
The two sides resolved the issue by leaving mention of the Arab League initiative out of the joint understanding. But Mr. Abbas and Mr. Olmert mentioned it during their speeches.
Mr. Bush cast the reinvigorated negotiations as a historic moment, an opportunity to advance democracy in a region torn by conflict, with the United States and its troops intricately entwined in it. “And when liberty takes root in the rocky soil of the West Bank and Gaza, it will inspire millions across the Middle East who want their societies built on freedom and peace and hope,” he said.
The significance he assigned to overcoming the Israeli-Palestinian conflict echoes the importance he has previously assigned to efforts in Iraq. That country, and the American war there, went unmentioned in Mr. Bush’s remarks on Tuesday, though he did mention Lebanon’s aspirations for peace and independence from Syrian influence.
Iraq declined to attend the conference here, said the State Department spokesman, Sean McCormack. 
The White House said Mr. Bush’s role would be as a mediator, willing to weigh in on the negotiations when necessary, but leaving the workaday details of American diplomacy to his secretary of state, Ms. Rice. 
“Secretary Rice will be doing a lot of that heavy lifting, in terms of the travel to the region and helping them, as she has been,” said the White House press secretary, Dana Perino, describing the difficult diplomacy ahead. “But what the president told the leaders today is that he’s only a phone call away.”
Middle East experts said that perhaps the best thing to come out of the Annapolis conference was that it had publicly committed Mr. Bush, Mr. Olmert and Mr. Abbas to pressing for peace.
“Annapolis means that everyone has a lot more invested,” said Daniel Levy, a former Israeli negotiator. But, he added, “Now there’s also a lot more to lose.”

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Site Map--Forwarded Message Attachment--From: roydanks at hotmail.comSubject: RE: going thereDate: Tue, 27 Nov 2007 12:28:16 -0600To: trauma-list at trauma.org

It's the Rob, Ron and Roy Show! Haven't seen the movie, but now I'm curious.... Caring for soldiers...somewhat of a moral obligation...feel guilty watching from afar. I totally agree that large public hospitals are doing a great thing.  I know David Feliciano and he is a great guy, working in austere circumstances....like Mattox, Demetriades...the list is long....well, honestly, we all are at our own level. But those people who sit on boards, who create committees so that they have one more meeting to attend and spread their thinly veiled agenda, drive me crazy.  And heaven knows we ALL know these people.  They wear many faces, but deep down are the same.  And, unlike the cream rising to the top, these folks have smooged their way up and risen to their level of incompetence.  to wit:  _________________________________________________________________Share life as it happens with the new Windows Live.Download today it's FREE!http://www.windowslive.com/share.html?ocid=TXT_TAGLM_Wave2_sharelife_112007
--Forwarded Message Attachment--From: PatrickOffner at Centura.OrgSubject: RE: Trauma caseDate: Tue, 27 Nov 2007 12:27:49 -0700To: trauma-list at trauma.orgSome follow-up on my young boy with the IVC clot. Nobody seems to beable to figure out how to get the images off the PACS system so that Ican send them. I am not sure how motivated the radiologists are toaccommodate my request--given my conversations with them about thiscase...At any rate, a second follow up usd showed that the "clot" hadcompletely disappeared. Anticoagulation was stopped and the patient wasdc'ed. He is to follow up as an outpatient to get the IVC filterremoved. I hope this actually happens. Some of my colleagues havecriticized me for stopping the anticoagulation--they wanted a 3 monthcourse--mostly for medicolegal concerns. I just disagree--and had a longtalk to patient and family about this. Thanks to all for the input.   Patrick J. Offner MD MPHChief, Surgical Critical CareSt Anthony Central Hospital -----Original Message-----From: trauma-list-bounces at trauma.org[mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald GrossSent: Friday, November 23, 2007 12:58 PMTo: trauma-list at trauma.orgSubject: RE: Trauma case AW GEEZ Patrick - can you imagine what those guys are gonna do to thispoor kid if you are away for a whole weekend?????? Just pullin' yer leg, Pat. Have a great weekend. Ron >>> "Offner, Patrick" <PatrickOffner at Centura.Org> 11/23/2007 1:47 PM >>>It is retrievable--but as you know that doesn't always lead to removal.I am still trying to get the images. I am off for the weekend now--somay not be until Monday!   ________________________________ From: trauma-list-bounces at trauma.org on behalf of Ronald GrossSent: Fri 11/23/2007 11:20 AMTo: trauma-list at trauma.orgSubject: RE: Trauma case   I didn't even want to ask! >>> <rfsmithmd at comcast.net> 11/23/07 12:47 PM >>>I don't suppose it was a removable filter -------------- Original message --------------From: "Ronald Gross" <rgross at harthosp.org> > See Pat - this was all your fault. You should have NEVER TAKEN A DAYOFF!!!!!> ;-)> Hang in there, my friend. You got caught up in this one just 'cause.Looking> forward to seeing those images, if at all possible.>> Take care,> Ron>> >>> "Offner, Patrick" 11/22/07 11:47 PM >>>> Thanks for your response. Trust me you are preaching to the choir--Iwas> one unhappy camper when I came to work and saw what had transpired. I> now wish that I had cancelled all that nonsense when I had the chance.I> certainly don't use troponins or echos for blunt myocardial> injury--unless there is some other factor(hemodynamic instability not> responding to usual measures, elderly patient with concern for cardiac> event leading to the injury, etc). I was even more unhappy with theIVC> filter placed in the usual infrarenal location=BELOW this supposed> thrombus. And in a young patient. I want to stop the anticoagulation> and pull the filter ASAP. I am concerned that these imaging studiesand> their official dictations will come back to haunt me, though. I willtry> to get the IVC ultrasound, gram and CT images off the server to send.> Regarding the chest wall pain--I believe the patient sustained a> significant hit to his chest wall and has a chest wall contusion orrib> fractures not apparent on plain film or CT. Thanks again.>> Pat>>> Patrick J. Offner MD MPH> Chief, Surgical Critical Care> St Anthony Central Hospital>> -----Original Message-----> From: trauma-list-bounces at trauma.org > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross> Sent: Thursday, November 22, 2007 8:20 PM> To: trauma-list at trauma.org > Subject: Re: Trauma case>> OOPS! Ken, I completely forgot the chest pain issue that sparked the> whole workup!!>> >>> 11/22/2007 9:42 PM >>>> 1st. He complained of left posterior chest wall pain and got a> $200,000.00 workup for anterior and right chest issues. What> ever happened to> his left posterior chest wall pain??>> 2nd I am surprised that someone did not order a Cardiac Cath with> stents and Plavix. Would have fit with the rest of the wild goose> chases>> 3rd. I have seen the CT and Cavogram "shadow" of a presumed clot,> which> was GONE a week later on subsequent grams WITHOUT anticoagulation.>> 4th. Where was the IVC filter placed. If it was not ABOVE the> supposed> clot, it is inserted totally un necessarilly.>> 5th. Could you reporduce and send the cavogram of the clot? You> have> launched on a long term care, which in itself has very little evidence> based> support, on the cavogram alone.>> 6th. If I were the patient I would want to be OFF the coumadin> today.>>> k>>>>>> **************************************Check out AOL's list of 2007's> hottest products.>(http://money.aol.com/special/hot-products-2007?NCID=aoltop0003000000000 > 1)> --> 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?/community/ >>*****************************************************************************> This communication is for the use of the intended recipient only. Itmay> contain information that is privileged and confidential. If you arenot 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 bytelephone and> delete/destroy it.>*****************************************************************************> --> 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?/community/ --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/  --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/    *****************************************************************************This communication is for the use of the intended recipient only.  Itmay contain information that is privileged and confidential.  If you are notthe 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 bytelephone and delete/destroy it.*****************************************************************************--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/--trauma-list : TRAUMA.ORGTo 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.***************************************************************************** 
--Forwarded Message Attachment--From: Rgross at harthosp.orgSubject: RE: GradyDate: Tue, 27 Nov 2007 15:08:49 -0500To: trauma-list at trauma.orgRob, If you are bad at stirring things up, I sure as hell don't want to meet the guy that is "good"!!  ;-0 Take care,Ron PS; I am not one to believe in conspiracy theories.  When we start alleging 'conspiracy' to me it means that we haven't found the true responsible party, and have decided to stop looking.  Just MHO! >>> "Robert F. Smith" <rfsmithmd at comcast.net> 11/27/2007 1:08 PM >>>Ron, Uh, I haven't gotten to the "all wars" part yet after just over an hour. Ifthis list watches that movie..... Katie bar the door! Holy Moly, I thought Iwas bad at stirring things up. Rob -----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald SimonSent: Tuesday, November 27, 2007 11:31 AMTo: Trauma &amp; Critical Care mailing listSubject: Re: Grady In a semi related matter, have any of you seen Zeitgeist? Its a movie thattalks about war (all wars) and that they are all financially driven. I amaware that it us pretty biased but it does open ones eyes to someinteresting coincidences. You can only get it online. Okay back tobusiness....ron simon Robert F. Smith wrote:> Ron and Roy,>> So we should close the few remaining public hospitals in the US > because of the low lifes that seek care there?>> And the compelling reason to have our soldiers continue to get killed > in Iraq is because if we brought them all home some of them would get > killed in the process?>> Rob Smith>> PS Please tell me you're not saying Iraq was involved in 9/11. And I > also think drug pricing here is an outrageous boondoggle and all > solutions should start with getting rid of the lawyers.>> -----Original Message-----> From: trauma-list-bounces at trauma.org > [mailto:trauma-list-bounces at trauma.org] > On Behalf Of Ronald Gross> Sent: Tuesday, November 27, 2007 10:31 AM> To: Trauma &amp; Critical Care mailing list> Subject: RE: Grady>> Roy,>> You actually said what I was thinking but didn't have to stomach to > put it out there.>> Ron>>   >>>> Roy Danks <roydanks at hotmail.com> 11/27/2007 10:12 AM >>>>>>>         > Yes, by all means.  Let's continue to fund those who won't go out and > work for a living, who are too lazy to flip burgers at McD's, who > would rather peddle drugs than legal wares, who use violence to solve > problems, who have children but no way to pay for them...let me pay > more taxes so that others can live the high life and never lift a finger.>  > And, let's take funding away from the soldiers in Iraq so they don't > have the means to defend themselves.  Let's forget 9/11, it was > probably a once-in-a-lifetime occurrence.>  > Pret, how would you pull out of Iraq?  Have you contacted your > Congressman or the President with a grand plan?  How do you pull out > thousands of soldiers without leaving a few behind to be > massacered?And, the answer isn't "we should never have gone there".  > Because, we are there and without a plan to get out, we'll be there a longtime.>  > Hey!  Maybe the physicians at Grady could work for less money!  Yeah!  > Cut their earnings so that others may continue to suck off the governmenttit!>  > Get real, Pret.  You're not part of the solution.>>>>   >> Date: Tue, 27 Nov 2007 09:24:21 -0500> From: pbjorn at emh.org> To:>>     > trauma-list at trauma.org> Subject: RE: Grady> > Sad that all this red > ink comes to a small fraction of one per cent of> Georgia's share of > federal healthcare reimbursement slashed by the> current > administration.> > Fifty million dollar budget shortfall? End the Iraq > war six hours early> and let Grady keep the change.> > Pret Bjorn> > Bangor, ME USA> > > > > -----Original> Message-----> From: trauma-list-bounces at trauma.org>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert F. Smith>Sent:> Tuesday, November 27, 2007 7:52 AM> To: rockmd at aol.com; 'faran bokhari'>Cc:> 'Trauma &amp; Critical Care mailing list'> Subject: Grady> > > > > Atlanta Hospital Moves to Unburden Itself of Debt > > > By KEVIN SACK> > <http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sa > ck> /ind> ex.html?inline=nyt-per> and SHAILA DEWAN> > <http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_d > ew> an/i> ndex.html?inline=nyt-per> > > ATLANTA, Nov. 26 - The > politically appointed board of Atlanta's troubled> charity hospital > effectively voted itself out of business Monday, the> first> step in > at least a short-term escape from the insolvency that had> threatened> > the region's only top-level trauma center.> > Without the financial > bailout made possible by the vote, the hospital,> Grady> Memorial, was > at risk of not meeting its payroll, perhaps by the end of> the> year, > hospital officials had warned. Though Grady, like most public> > hospitals> > <http://topics.nytimes.com/top/news/health/diseasesconditionsandhealth > to>> pics> /hospitals/index.html?inline=nyt-classifier> , has faced > pics> intermittent>> financial crises in the past, this one has generated real anxiety> > <http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/o > ve>> rvie> w.html?inline=nyt-classifier> because of its roots in a > rvie> collision of>> national forces, including the unchecked growth of uncompensated care> > and> deep cuts in government reimbursements. > > Political leaders and > medical officials have worried that Grady, woven> into> Atlanta's > social fabric since 1892, might follow Martin Luther King> Jr.-Harbor > Hospital in Los Angeles County as a casualty in 2007. If so,> the> > consequence would be a "patient tsunami" at other area hospitals, the> > Metropolitan Atlanta Chamber of Commerce said in a report earlier > this> year.> > Grady - which supplies the region with its only 24-hour > trauma center as> well as poison control and burn units and large > clinics for AIDS> > <http://health.nytimes.com/health/guides/disease/aids/overview.html?in > li>> ne=n> yt-classifier> and sickle>> <http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/ov > er>> view> .html?inline=nyt-classifier> cell anemia - has operated in the > view> red> for> 10> of the last 11 years. It is expected to run a deficit of $50> million to> $55> million in this year's $730 million budget. > > The > hospital owes an accumulated $63 million to its biggest creditors,> > the> medical school at Emory University> > <http://topics.nytimes.com/top/reference/timestopics/organizations/e/e > mo> ry_u> niversity/index.html?inline=nyt-org> and the Morehouse > School of> Medicine,> which provide its doctors and have threatened to > train residents> elsewhere.> Republican state legislators had > threatened a state takeover if> local> officials did not reconstitute the hospital's governance > local> structure.>>   >> Following a raucous meeting marked by chants and protest, the >> 10-member>>>     > Fulton-DeKalb Hospital Authority voted unanimously to hand daily > control>> of> Grady and its affiliated clinics and services to a nonprofit> corporation> to> be formed for that purpose.> > A Chamber of Commerce > corporation> to> task> force had advised earlier this year that a> governance change was > needed to remove the hospital from the control of> the> elected > commissioners of Fulton and DeKalb Counties and to restore the> > confidence of lenders, foundations and Georgia's Republican leaders. > > > Advocates for patients have warned that the hospital would become > less> responsive to community needs if it was operated by a less > political> board.> But with few other options and Grady's fiscal > condition worsening, the> authority felt it had little choice.> > "Inthree weeks, our cash position would have been zero,"> the> authority's> vice chairman, Dr. Chris Edwards, said at the > the> meeting> Monday.> > In its resolution, the hospital authority, which would > continue to own> Grady's buildings and land, made explicit that its > willingness to> hand> over> control depended on substantial financial commitments from > hand> over> both> the> public> and private sectors.> > Before the lease, to be executed > the> public> by> Dec. 31, becomes effective, the> hospital> must receive written > commitments for a capital infusion of $200 million> from> businesses > and philanthropies.> > In addition, the resolution demands that state > leaders provide written> support for $30 million in new state aid.> > > A. D. Correll, a former chairman of the Georgia-Pacific Corporation > and> the> co-chairman of the task force, said he considered the vote a > critical> first> step, though with provisos attached. "They were asurprise, a lot of> them,"> Mr.> Correll said of the conditions, "and they require action on a whole> > lot> of people's parts." > > Mr. Correll said a single anonymous donor > had agreed to give the> hospital> $200 million if the donor approved > of the governance system changes. He> said> he was confident that the > private sector could raise an additional $100> million in two or three > years.> > The fate of the hospital has become a keenly watched civic > drama,> overlaid> with issues of race and class. > > Some black > activists and elected officials had warned that the> governance> > change would shift control of the hospital from black political > leaders> to> white business leaders. The hospital's problems, they > said, are> financial> and not political.> > Chamber of Commerce > officials, white and black, have responded that the> only> color that > matters in the campaign to save Grady is green. And> justifiably> or > not, they say, business leaders and state officials were willing to> > participate in a rescue only if they saw a real departure from past> > practice, when the hospital's board was perceived to lack technical> > expertise and the will to block corruption and cronyism.> > > > --> > 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?/community/ > _________________________________________________________________> Share life as it happens with the new Windows Live.Download today it'sFREE!> http://www.windowslive.com/share.html?ocid=TXT_TAGLM_Wave2_sharelife_1 > 12007-> -> 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?/community/ >> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/ >>    --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/ 
--Forwarded Message Attachment--From: Rgross at harthosp.orgSubject: RE: going thereDate: Tue, 27 Nov 2007 15:11:23 -0500To: trauma-list at trauma.orgRob, What saddens me is how many people don't want to remember that we are able to sit here and go back and forth, in a free and prosperous nation (OK so there are those who would debate that last statement, but not I) BECAUSE there were a lot of good people in our past that didn't think twice about risking and losing their lives for "this". Ron >>> "Robert F. Smith" <rfsmithmd at comcast.net> 11/27/2007 1:15 PM >>> Ron and Roy, I deeply admire the courage you show in volunteering to help take care ofour soldiers in conflict. It just saddens me that fine people are riskingand losing their lives for this. Rob --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/  
--Forwarded Message Attachment--From: Rgross at harthosp.orgSubject: RE: Trauma caseDate: Tue, 27 Nov 2007 15:17:13 -0500To: trauma-list at trauma.orgWOW - you could make a movie......"VOMIT Gone Wild" >>> "Offner, Patrick" <PatrickOffner at Centura.Org> 11/27/2007 2:27 PM >>>Some follow-up on my young boy with the IVC clot. Nobody seems to beable to figure out how to get the images off the PACS system so that Ican send them. I am not sure how motivated the radiologists are toaccommodate my request--given my conversations with them about thiscase...At any rate, a second follow up usd showed that the "clot" hadcompletely disappeared. Anticoagulation was stopped and the patient wasdc'ed. He is to follow up as an outpatient to get the IVC filterremoved. I hope this actually happens. Some of my colleagues havecriticized me for stopping the anticoagulation--they wanted a 3 monthcourse--mostly for medicolegal concerns. I just disagree--and had a longtalk to patient and family about this. Thanks to all for the input.   Patrick J. Offner MD MPHChief, Surgical Critical CareSt Anthony Central Hospital -----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald GrossSent: Friday, November 23, 2007 12:58 PMTo: trauma-list at trauma.org Subject: RE: Trauma case AW GEEZ Patrick - can you imagine what those guys are gonna do to thispoor kid if you are away for a whole weekend?????? Just pullin' yer leg, Pat. Have a great weekend. Ron >>> "Offner, Patrick" <PatrickOffner at Centura.Org> 11/23/2007 1:47 PM >>>It is retrievable--but as you know that doesn't always lead to removal.I am still trying to get the images. I am off for the weekend now--somay not be until Monday!   ________________________________ From: trauma-list-bounces at trauma.org on behalf of Ronald GrossSent: Fri 11/23/2007 11:20 AMTo: trauma-list at trauma.org Subject: RE: Trauma case   I didn't even want to ask! >>> <rfsmithmd at comcast.net> 11/23/07 12:47 PM >>>I don't suppose it was a removable filter -------------- Original message --------------From: "Ronald Gross" <rgross at harthosp.org> > See Pat - this was all your fault. You should have NEVER TAKEN A DAYOFF!!!!!> ;-)> Hang in there, my friend. You got caught up in this one just 'cause.Looking> forward to seeing those images, if at all possible.>> Take care,> Ron>> >>> "Offner, Patrick" 11/22/07 11:47 PM >>>> Thanks for your response. Trust me you are preaching to the choir--Iwas> one unhappy camper when I came to work and saw what had transpired. I> now wish that I had cancelled all that nonsense when I had the chance.I> certainly don't use troponins or echos for blunt myocardial> injury--unless there is some other factor(hemodynamic instability not> responding to usual measures, elderly patient with concern for cardiac> event leading to the injury, etc). I was even more unhappy with theIVC> filter placed in the usual infrarenal location=BELOW this supposed> thrombus. And in a young patient. I want to stop the anticoagulation> and pull the filter ASAP. I am concerned that these imaging studiesand> their official dictations will come back to haunt me, though. I willtry> to get the IVC ultrasound, gram and CT images off the server to send.> Regarding the chest wall pain--I believe the patient sustained a> significant hit to his chest wall and has a chest wall contusion orrib> fractures not apparent on plain film or CT. Thanks again.>> Pat>>> Patrick J. Offner MD MPH> Chief, Surgical Critical Care> St Anthony Central Hospital>> -----Original Message-----> From: trauma-list-bounces at trauma.org > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross> Sent: Thursday, November 22, 2007 8:20 PM> To: trauma-list at trauma.org > Subject: Re: Trauma case>> OOPS! Ken, I completely forgot the chest pain issue that sparked the> whole workup!!>> >>> 11/22/2007 9:42 PM >>>> 1st. He complained of left posterior chest wall pain and got a> $200,000.00 workup for anterior and right chest issues. What> ever happened to> his left posterior chest wall pain??>> 2nd I am surprised that someone did not order a Cardiac Cath with> stents and Plavix. Would have fit with the rest of the wild goose> chases>> 3rd. I have seen the CT and Cavogram "shadow" of a presumed clot,> which> was GONE a week later on subsequent grams WITHOUT anticoagulation.>> 4th. Where was the IVC filter placed. If it was not ABOVE the> supposed> clot, it is inserted totally un necessarilly.>> 5th. Could you reporduce and send the cavogram of the clot? You> have> launched on a long term care, which in itself has very little evidence> based> support, on the cavogram alone.>> 6th. If I were the patient I would want to be OFF the coumadin> today.>>> k>>>>>> **************************************Check out AOL's list of 2007's> hottest products.>(http://money.aol.com/special/hot-products-2007?NCID=aoltop0003000000000  > 1)> --> 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?/community/ >>*****************************************************************************> This communication is for the use of the intended recipient only. Itmay> contain information that is privileged and confidential. If you arenot 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 bytelephone and> delete/destroy it.>*****************************************************************************> --> 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?/community/ --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/  --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/    *****************************************************************************This communication is for the use of the intended recipient only.  Itmay contain information that is privileged and confidential.  If you are notthe 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 bytelephone and delete/destroy it.*****************************************************************************--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/ --trauma-list : TRAUMA.ORGTo 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.  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--Forwarded Message Attachment--From: scampbell at valornet.comSubject: RE: Native of AtlantaDate: Tue, 27 Nov 2007 14:19:24 -0600To: trauma-list at trauma.orgSo right about doing what you have to do and so on.  I raised 3 kids as a single parent with no child support, and never tried to get the benefits.  I would not mind all the money spent on welfare type programs so much IF the recipients had to pass the same drug test that I have to pass to earn the money, and pay the taxes that fund it. To my opinion -- one failed drug test, and one benefit held, might cover the costs of a whole lot of other tests.  Granted some kids might have less, but who says it is all going to them now? Just an opinion-- Sara> > From: Roy Danks <roydanks at hotmail.com>> Date: 2007/11/27 Tue PM 12:16:35 CST> To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>> Subject: RE: Native of Atlanta> > Robert,>  > Well said!>  > If you want great onion rings in Missouri, go to "The Pear Tree" in Bevier, MO...about 2 1/2 hrs from KC...to die for!>  > Yes, get out of Iraq.  But how????  Really, it's perplexing.  I doubt we'll get anyone on this list who says "we have to stay in Iraq!"> My feeling is, hey, we tried.  We got rid of "him" and give them a shot at democracy...ain't taking the bait.  Suicide bombs and religious/political division is much more inviting.>  > Speaking of Religion and politics...whatever happened in Ireland?  How did the Catholic-Protestant battle ever come to an end?  I missed that somewhere along the say...I think I was in residency...it's all a blur.>  > Illegals: again, as I said, I don't like the idea and would prefer they not come across under the cloak of darkness...but they do work and to some extent help our economy...but I would guess that a family of 5 buying groceries weekly is quickly trumped by a single fall by a roofer...with pneumo's, fractures, a vent, trach, bolt, and lots of time in house...rehab....>  > I just get really frustrated by those who refuse to work.  I mean, I have had some sort of job since I was about 14.  From bucking haybales to pumping gas.  I was glad to have an income.  And I grew up poor.  My mom never took "gov't handouts"...it wasn't a matter of pride, we just bucked up and did what we had to to get by.>  > RD> _________________________________________________________________> You keep typing, we keep giving. Download Messenger and join the i?m Initiative now.> http://im.live.com/messenger/im/home/?source=TAGLM--> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/>   
--Forwarded Message Attachment--From: kmattox at aol.comSubject: Re: Trauma caseDate: Tue, 27 Nov 2007 20:36:48 +0000To: trauma-list at trauma.orgThx for followup.   I have seen and consulted in several of these cases w "clot" at the IVC - R RA junction.   All cleared at next CT.     K  Sent via BlackBerry by AT&T -----Original Message-----From: "Ronald Gross" <Rgross at harthosp.org> Date: Tue, 27 Nov 2007 15:17:13 To:"Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>Subject: RE: Trauma case  WOW - you could make a movie......"VOMIT Gone Wild" >>> "Offner, Patrick" <PatrickOffner at Centura.Org> 11/27/2007 2:27 PM >>>Some follow-up on my young boy with the IVC clot. Nobody seems to beable to figure out how to get the images off the PACS system so that Ican send them. I am not sure how motivated the radiologists are toaccommodate my request--given my conversations with them about thiscase...At any rate, a second follow up usd showed that the "clot" hadcompletely disappeared. Anticoagulation was stopped and the patient wasdc'ed. He is to follow up as an outpatient to get the IVC filterremoved. I hope this actually happens. Some of my colleagues havecriticized me for stopping the anticoagulation--they wanted a 3 monthcourse--mostly for medicolegal concerns. I just disagree--and had a longtalk to patient and family about this. Thanks to all for the input.   Patrick J. Offner MD MPHChief, Surgical Critical CareSt Anthony Central Hospital -----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald GrossSent: Friday, November 23, 2007 12:58 PMTo: trauma-list at trauma.org Subject: RE: Trauma case AW GEEZ Patrick - can you imagine what those guys are gonna do to thispoor kid if you are away for a whole weekend?????? Just pullin' yer leg, Pat. Have a great weekend. Ron >>> "Offner, Patrick" <PatrickOffner at Centura.Org> 11/23/2007 1:47 PM >>>It is retrievable--but as you know that doesn't always lead to removal.I am still trying to get the images. I am off for the weekend now--somay not be until Monday!   ________________________________ From: trauma-list-bounces at trauma.org on behalf of Ronald GrossSent: Fri 11/23/2007 11:20 AMTo: trauma-list at trauma.org Subject: RE: Trauma case   I didn't even want to ask! >>> <rfsmithmd at comcast.net> 11/23/07 12:47 PM >>>I don't suppose it was a removable filter -------------- Original message --------------From: "Ronald Gross" <rgross at harthosp.org> > See Pat - this was all your fault. You should have NEVER TAKEN A DAYOFF!!!!!> ;-)> Hang in there, my friend. You got caught up in this one just 'cause.Looking> forward to seeing those images, if at all possible.>> Take care,> Ron>> >>> "Offner, Patrick" 11/22/07 11:47 PM >>>> Thanks for your response. Trust me you are preaching to the choir--Iwas> one unhappy camper when I came to work and saw what had transpired. I> now wish that I had cancelled all that nonsense when I had the chance.I> certainly don't use troponins or echos for blunt myocardial> injury--unless there is some other factor(hemodynamic instability not> responding to usual measures, elderly patient with concern for cardiac> event leading to the injury, etc). I was even more unhappy with theIVC> filter placed in the usual infrarenal location=BELOW this supposed> thrombus. And in a young patient. I want to stop the anticoagulation> and pull the filter ASAP. I am concerned that these imaging studiesand> their official dictations will come back to haunt me, though. I willtry> to get the IVC ultrasound, gram and CT images off the server to send.> Regarding the chest wall pain--I believe the patient sustained a> significant hit to his chest wall and has a chest wall contusion orrib> fractures not apparent on plain film or CT. Thanks again.>> Pat>>> Patrick J. Offner MD MPH> Chief, Surgical Critical Care> St Anthony Central Hospital>> -----Original Message-----> From: trauma-list-bounces at trauma.org > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Gross> Sent: Thursday, November 22, 2007 8:20 PM> To: trauma-list at trauma.org > Subject: Re: Trauma case>> OOPS! Ken, I completely forgot the chest pain issue that sparked the> whole workup!!>> >>> 11/22/2007 9:42 PM >>>> 1st. He complained of left posterior chest wall pain and got a> $200,000.00 workup for anterior and right chest issues. What> ever happened to> his left posterior chest wall pain??>> 2nd I am surprised that someone did not order a Cardiac Cath with> stents and Plavix. Would have fit with the rest of the wild goose> chases>> 3rd. I have seen the CT and Cavogram "shadow" of a presumed clot,> which> was GONE a week later on subsequent grams WITHOUT anticoagulation.>> 4th. Where was the IVC filter placed. If it was not ABOVE the> supposed> clot, it is inserted totally un necessarilly.>> 5th. Could you reporduce and send the cavogram of the clot? You> have> launched on a long term care, which in itself has very little evidence> based> support, on the cavogram alone.>> 6th. If I were the patient I would want to be OFF the coumadin> today.>>> k>>>>>> **************************************Check out AOL's list of 2007's> hottest products.>(http://money.aol.com/special/hot-products-2007?NCID=aoltop0003000000000  > 1)> --> 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?/community/ >>*****************************************************************************> This communication is for the use of the intended recipient only. Itmay> contain information that is privileged and confidential. If you arenot 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 bytelephone and> delete/destroy it.>*****************************************************************************> --> 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?/community/ --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/  --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/    *****************************************************************************This communication is for the use of the intended recipient only.  Itmay contain information that is privileged and confidential.  If you are notthe 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 bytelephone and delete/destroy it.*****************************************************************************--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/ --trauma-list : TRAUMA.ORGTo 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.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/
--Forwarded Message Attachment--From: roydanks at hotmail.comSubject: RE: Trauma caseDate: Tue, 27 Nov 2007 15:22:51 -0600To: trauma-list at trauma.orgRule #1: Do the right thing for the right reasons.  You did. Rule #2: See rule number 1 A quote from one of my all time favorite movies, Shawshank Redemption: The Warden:"....Lord, it's a miracle!  Man just up and vanished, like a fart in the wind!"....seems like these clots do that too...Curious, huh? RD_________________________________________________________________Put your friends on the big screen with Windows Vista® + Windows Live™.http://www.microsoft.com/windows/shop/specialoffers.mspx?ocid=TXT_TAGLM_CPC_MediaCtr_bigscreen_102007
--Forwarded Message Attachment--From: roydanks at hotmail.comSubject: RE: Native of AtlantaDate: Tue, 27 Nov 2007 15:30:44 -0600To: trauma-list at trauma.orgYeah, and I'm not here to complain or whine.  But my mom raised my sister and I on a teacher's salary in the 60's, 70's and 80's.  We had junk cars...gas prices were outrageous...my dad never paid a red cent in support...we actually went almost a year without a refrigerator and at one time had no hot water for 2 years (we boiled water on the electric stove and took baths with very little water)...and we never took assistance.  It (living) can be done on very little money.  And, places like starbucks and mcD's have great benefits packages.  It just kills me. I'd much rather support a dubious war and long waits in the airport security line for a safer America, than a bunch of lazy so-and-so's who just don't want to get up early or work late. I'm not saying assistance is wrong, but it is very much abused. And don't even get me started on those who pay taxes and send their kids to private schools, home schooling or the lack of discipline in the public schools!  As for the latter, I think, like public hospitals, they are doing a good, if not great thing, with very little.  Problem is, the same folks who jam the ERs with an earache, sore throat or rash (that's been there for a month) are using the public schools as child care and rearing.  I remember getting spanked with a paddle in grade school.  Quite certain I deserved it and learned from it... But, I digress...  _________________________________________________________________You keep typing, we keep giving. Download Messenger and join the i’m Initiative now.http://im.live.com/messenger/im/home/?source=TAGLM
--Forwarded Message Attachment--From: medic0947969 at yahoo.comSubject: an interesting news articleDate: Tue, 27 Nov 2007 13:37:22 -0800To: trauma-list at trauma.org   http://news.yahoo.com/s/ap/20071127/ap_on_re_eu/france_violence     Now being from one of the poorest cities in the US, the whole Urban gunfire thing is a realatively normal event for me. But It seems quite new to Paris. I have no details on this except for the article, but after a discussion here about removing high velocity projectiles earlier this year, was wondering if anyone closer to the event has any information on why this was done in this particular case.         "Fillon spoke with a firefighter who was shot by rioters and handled the bullet that was extracted from the man's arm."      Mike        ---------------------------------Never miss a thing.   Make Yahoo your homepage.
--Forwarded Message Attachment--From: rfsmithmd at comcast.netSubject: RE: going thereDate: Tue, 27 Nov 2007 17:07:09 -0500To: trauma-list at trauma.orgDifferent THIS, no? -----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]On Behalf Of Ronald GrossSent: Tuesday, November 27, 2007 3:11 PMTo: 'Trauma &amp; Critical Care mailing list'Subject: RE: going there Rob, What saddens me is how many people don't want to remember that we are ableto sit here and go back and forth, in a free and prosperous nation (OK sothere are those who would debate that last statement, but not I) BECAUSEthere were a lot of good people in our past that didn't think twice aboutrisking and losing their lives for "this". Ron >>> "Robert F. Smith" <rfsmithmd at comcast.net> 11/27/2007 1:15 PM >>> Ron and Roy, I deeply admire the courage you show in volunteering to help take care ofour soldiers in conflict. It just saddens me that fine people are riskingand losing their lives for this. Rob --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/ --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/  
--Forwarded Message Attachment--From: medic0947969 at yahoo.comSubject: RE: GradyDate: Tue, 27 Nov 2007 17:41:23 -0800To: trauma-list at trauma.orgIt is always interesting to read the endless dispute between the haves and have nots.      The arguement on paying for people who do not work, "have too many babies", "live off your earnings" and "solve problems with violence" is quite old. It comes down to culture. In what I imagine to be our culture as educated healthcare providers is the good of indivuduals and consequently our society. But the people you are speaking of don't enjoy the benefits of current western beliefs, though they do live with us.  Their culture is similar to ours a few decades ago(yep 10's of years not hundreds). As humans I think we all have the same potential. but vastly different values. They have a home range, in which they vigorously defend resources and reproductive rights. They form alliances for the mutual protection of their treasures as well as to increase their resources. If this were not enough, in classic feudal form, the use of violence is consdered acceptable in order to take resources from others who have gathered them and are not capable of defending them. (though some might argue this is a Bush culture too)      At our current sociological level, we like to give the state a monopoly on violence. Armies, SWAT Teams, Police, etc. To Be turned on other states and 'criminals." So naturally we look down upon others who don't share the same beliefs. But do we accept responsibility for causing it?     For example, having too many children. Now all in the US who are on this list i am sure you have noticed how the cycle of trauma rotates around government check day, Places I have been in the US during the beginning of the month you see the affects of affordable/available drugs, during the middle there is the affects of running low on money. You start to see violence and lower quality intoxications. By the end there is high violence and crime victims and the cycle repeats next month.      But here is an example of why people don't like antropologists. Similar to aid to impovershed nations, we supply aid in the form of Mana. You give resources and the inhabitants use them till they are gone, because somebody else will give them more. You need only to last until the next cycle. world health bodies and charities alike have found this unsustainable. For the last several years the focus to develop local economies and ween off the need for mana. In the US last year there were 700,000 less jobs for non college grads.(source some yahoo news headline) Very few people can rise from a slum to a professional. So unless an effort is made to give the masses a chance to produce sustainable resources, most effectively by low income jobs, you'll supply the mana every month. On top of that we have laws and values where every life is precious, so if they get hurt, they get help. There does not exist the same reason or capability to avoid injury or sickness as a producer in our society.      People like us don't have a bunch of children we can't pay for because we desire the rewards that can be achieved by limited reproduction. To many poor there exists no way to reach these rewards, giving them only the hope their children will be better off. Because of our value on potentials of children, we introduce curative medicine with no cost to the parent. This allows survival of those that would perish prior to reproduction. So your consumers continue to exponentiate. Add this to the consumption of your own children and elderly, and as I have said many time, consumers outnumber producers. (your tax dollars at work)      Compare to France today. A large body of poverty rallying against the state with violence. No different than the old mobs with rope, torches, and pitchforks going to the castle. In the US we give only enough to keep this at bay. Would you turn the violence of the state against the poor? Of course not. But we keep trying to integrate them to be culturally like us. A big jump. I wager impossible in all but a few exceptional people. So if you don't want to keep paying for it, you need to give these people a way to produce.      Some say take from the wealthy to fund the poor. But what happens if we take everything from those who have it? The cycle continues as the culture is unchanged.  Then there is no producer capable of sustaining it.      Never mind the Iraq war, how many have written to their represenatives to do things like repealing minimum wage or setting up labor jobs that would create these micro-economies? If you are going to change culture it takes not only money but opportunity. A lot of people in poverty are addicted to drugs and alcohol. So you set up 0 tolerence policies that exclude them. Criminal background checks that further exclude them, making rehabilitation or integration impossible. Now they cannot produce at all. What good is paying to teach a skill or educate somebody who cannot get a job? Waste of money. What good is it when there are no jobs because labor costs are unsustainable? Every dollar they produce is one less of yours they consume. Why demand it be all or nothing?     As for taking money from Iraq, that war is financed on debt. Allowng somebody to keep the change, just means we'll all pay the interest on it for generations to come. You want to take out an industry? Nevermind Military industrial, how about insurance companies? They set the prices for healthcare. They are the people lawyers believe they are taking money from everytime you get sued. How many lawyers would waste their time if the money wasn't there? If it wasn't cheaper to settle than fight? It is handing money out. Why blame a lawyer for getting in line? I wish I could get in line too.     The money the US spends on healthcare is unsustainable, that is why it keeps getting cut. I challenge anyone to come up with a healthcare system funded by something other than a VAT. It is the only scenario I can imagine where funding comes from all consumers not just producers.      If as a society we value everyone, where even those who cannot afford can receive care, we have to pay some heed to the bean counters. Do you really believe charity hospital closures is not a sign of impending doom? If a private hospital could only take paying customers, with the current rate of uninsured and increasing costs, how many will be able to pay in 5 years? In 10 years? How will the hospital stay open or pay us?     Anyone here ever read the book "who moved my cheese?"     It's all related to Trauma, we all eat and have nice things because of it. In our unsustainable system as well as our sociological values our cheese is not only moving, the piece is getting smaller.   Mike  ( I like to think only a spoon can stir things up better than me.)   Ronald Gross <Rgross at harthosp.org> wrote:  Rob, If you are bad at stirring things up, I sure as hell don't want to meet the guy that is "good"!! ;-0 Take care,Ron PS; I am not one to believe in conspiracy theories. When we start alleging 'conspiracy' to me it means that we haven't found the true responsible party, and have decided to stop looking. Just MHO! >>> "Robert F. Smith" 11/27/2007 1:08 PM >>>Ron, Uh, I haven't gotten to the "all wars" part yet after just over an hour. Ifthis list watches that movie..... Katie bar the door! Holy Moly, I thought Iwas bad at stirring things up. Rob -----Original Message-----From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald SimonSent: Tuesday, November 27, 2007 11:31 AMTo: Trauma & Critical Care mailing listSubject: Re: Grady In a semi related matter, have any of you seen Zeitgeist? Its a movie thattalks about war (all wars) and that they are all financially driven. I amaware that it us pretty biased but it does open ones eyes to someinteresting coincidences. You can only get it online. Okay back tobusiness....ron simon Robert F. Smith wrote:> Ron and Roy,>> So we should close the few remaining public hospitals in the US > because of the low lifes that seek care there?>> And the compelling reason to have our soldiers continue to get killed > in Iraq is because if we brought them all home some of them would get > killed in the process?>> Rob Smith>> PS Please tell me you're not saying Iraq was involved in 9/11. And I > also think drug pricing here is an outrageous boondoggle and all > solutions should start with getting rid of the lawyers.>> -----Original Message-----> From: trauma-list-bounces at trauma.org > [mailto:trauma-list-bounces at trauma.org] > On Behalf Of Ronald Gross> Sent: Tuesday, November 27, 2007 10:31 AM> To: Trauma & Critical Care mailing list> Subject: RE: Grady>> Roy,>> You actually said what I was thinking but didn't have to stomach to > put it out there.>> Ron>> >>>> Roy Danks 11/27/2007 10:12 AM >>>>>>> > Yes, by all means. Let's continue to fund those who won't go out and > work for a living, who are too lazy to flip burgers at McD's, who > would rather peddle drugs than legal wares, who use violence to solve > problems, who have children but no way to pay for them...let me pay > more taxes so that others can live the high life and never lift a finger.> > And, let's take funding away from the soldiers in Iraq so they don't > have the means to defend themselves. Let's forget 9/11, it was > probably a once-in-a-lifetime occurrence.> > Pret, how would you pull out of Iraq? Have you contacted your > Congressman or the President with a grand plan? How do you pull out > thousands of soldiers without leaving a few behind to be > massacered?And, the answer isn't "we should never have gone there". > Because, we are there and without a plan to get out, we'll be there a longtime.> > Hey! Maybe the physicians at Grady could work for less money! Yeah! > Cut their earnings so that others may continue to suck off the governmenttit!> > Get real, Pret. You're not part of the solution.>>>> >> Date: Tue, 27 Nov 2007 09:24:21 -0500> From: pbjorn at emh.org> To:>> > trauma-list at trauma.org> Subject: RE: Grady> > Sad that all this red > ink comes to a small fraction of one per cent of> Georgia's share of > federal healthcare reimbursement slashed by the> current > administration.> > Fifty million dollar budget shortfall? End the Iraq > war six hours early> and let Grady keep the change.> > Pret Bjorn> > Bangor, ME USA> > > > > -----Original> Message-----> From: trauma-list-bounces at trauma.org>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert F. Smith>Sent:> Tuesday, November 27, 2007 7:52 AM> To: rockmd at aol.com; 'faran bokhari'>Cc:> 'Trauma & Critical Care mailing list'> Subject: Grady> > > > > Atlanta Hospital Moves to Unburden Itself of Debt > > > By KEVIN SACK> > > ck> /ind> ex.html?inline=nyt-per> and SHAILA DEWAN> > > ew> an/i> ndex.html?inline=nyt-per> > > ATLANTA, Nov. 26 - The > politically appointed board of Atlanta's troubled> charity hospital > effectively voted itself out of business Monday, the> first> step in > at least a short-term escape from the insolvency that had> threatened> > the region's only top-level trauma center.> > Without the financial > bailout made possible by the vote, the hospital,> Grady> Memorial, was > at risk of not meeting its payroll, perhaps by the end of> the> year, > hospital officials had warned. Though Grady, like most public> > hospitals> > > to>> pics> /hospitals/index.html?inline=nyt-classifier> , has faced > pics> intermittent>> financial crises in the past, this one has generated real anxiety> > > ve>> rvie> w.html?inline=nyt-classifier> because of its roots in a > rvie> collision of>> national forces, including the unchecked growth of uncompensated care> > and> deep cuts in government reimbursements. > > Political leaders and > medical officials have worried that Grady, woven> into> Atlanta's > social fabric since 1892, might follow Martin Luther King> Jr.-Harbor > Hospital in Los Angeles County as a casualty in 2007. If so,> the> > consequence would be a "patient tsunami" at other area hospitals, the> > Metropolitan Atlanta Chamber of Commerce said in a report earlier > this> year.> > Grady - which supplies the region with its only 24-hour > trauma center as> well as poison control and burn units and large > clinics for AIDS> > > li>> ne=n> yt-classifier> and sickle>> > er>> view> .html?inline=nyt-classifier> cell anemia - has operated in the > view> red> for> 10> of the last 11 years. It is expected to run a deficit of $50> million to> $55> million in this year's $730 million budget. > > The > hospital owes an accumulated $63 million to its biggest creditors,> > the> medical school at Emory University> > > mo> ry_u> niversity/index.html?inline=nyt-org> and the Morehouse > School of> Medicine,> which provide its doctors and have threatened to > train residents> elsewhere.> Republican state legislators had > threatened a state takeover if> local> officials did not reconstitute the hospital's governance > local> structure.>> >> Following a raucous meeting marked by chants and protest, the >> 10-member>>> > Fulton-DeKalb Hospital Authority voted unanimously to hand daily > control>> of> Grady and its affiliated clinics and services to a nonprofit> corporation> to> be formed for that purpose.> > A Chamber of Commerce > corporation> to> task> force had advised earlier this year that a> governance change was > needed to remove the hospital from the control of> the> elected > commissioners of Fulton and DeKalb Counties and to restore the> > confidence of lenders, foundations and Georgia's Republican leaders. > > > Advocates for patients have warned that the hospital would become > less> responsive to community needs if it was operated by a less > political> board.> But with few other options and Grady's fiscal > condition worsening, the> authority felt it had little choice.> > "Inthree weeks, our cash position would have been zero,"> the> authority's> vice chairman, Dr. Chris Edwards, said at the > the> meeting> Monday.> > In its resolution, the hospital authority, which would > continue to own> Grady's buildings and land, made explicit that its > willingness to> hand> over> control depended on substantial financial commitments from > hand> over> both> the> public> and private sectors.> > Before the lease, to be executed > the> public> by> Dec. 31, becomes effective, the> hospital> must receive written > commitments for a capital infusion of $200 million> from> businesses > and philanthropies.> > In addition, the resolution demands that state > leaders provide written> support for $30 million in new state aid.> > > A. D. Correll, a former chairman of the Georgia-Pacific Corporation > and> the> co-chairman of the task force, said he considered the vote a > critical> first> step, though with provisos attached. "They were asurprise, a lot of> them,"> Mr.> Correll said of the conditions, "and they require action on a whole> > lot> of people's parts." > > Mr. Correll said a single anonymous donor > had agreed to give the> hospital> $200 million if the donor approved > of the governance system changes. He> said> he was confident that the > private sector could raise an additional $100> million in two or three > years.> > The fate of the hospital has become a keenly watched civic > drama,> overlaid> with issues of race and class. > > Some black > activists and elected officials had warned that the> governance> > change would shift control of the hospital from black political > leaders> to> white business leaders. The hospital's problems, they > said, are> financial> and not political.> > Chamber of Commerce > officials, white and black, have responded that the> only> color that > matters in the campaign to save Grady is green. And> justifiably> or > not, they say, business leaders and state officials were willing to> > participate in a rescue only if they saw a real departure from past> > practice, when the hospital's board was perceived to lack technical> > expertise and the will to block corruption and cronyism.> > > > --> > 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?/community/ > _________________________________________________________________> Share life as it happens with the new Windows Live.Download today it'sFREE!> http://www.windowslive.com/share.html?ocid=TXT_TAGLM_Wave2_sharelife_1 > 12007-> -> 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?/community/ >> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/ >>  --trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/--trauma-list : TRAUMA.ORGTo change your settings or unsubscribe visit:http://www.trauma.org/index.php?/community/         ---------------------------------Be a better pen pal. 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--Forwarded Message Attachment--From: rlwigle at yahoo.comSubject: RE: GradyDate: Tue, 27 Nov 2007 18:47:39 -0800To: trauma-list at trauma.orgOK, I said I was going to keep quiet but- Having done my fellowship at Grady I can say with certaintythat Dr Mattox is absolutely right that the issues there goway back before the first Gulf War. They are a combinationof many issues only some of which are mismanagement. Andfor a good part of those blame the politicians, not theadministration-- mos tof whom, at least when I was there,were working far longer hours at far less pay than theycould have gotten from any other institution. They were ledfrom the top by an administrator from the public hospitalold school- a type that Dr Mattox and the older members ofthe list will remember-- that truely were dedicated, not tothe financial progress of their institution -although theywere financially savy- but to having the ability to providethe best possible care for everyone who presented to theirfacility. Hard to believe in this day and age of milliondollar CEOs isn't it Rather blame the present medical "business" climate,hospitals that are more than happy to rake off theprofitable patient without seeing the borderline or nonprofitable individual-not to mention absurd overheadsproduced by escalating drug prices, layers of unnecessaryadministrators and all the other ills that are routinelyhashed over on this list When I was at Grady (or as we knew it "The Gradies") it wasfunded out of two county budgets plus whatever the variouspenal institutions that we served kicked in. A payingpatient was almost unheard of, they were selectively takento other facilities-- if we had some one with Medicare itwas almost a cause for celebration. At that time Atlantawas starting the trauma system designating process-- thattells you how long ago it was. One of my jobs as a fellowwas to put together the documentation for Grady'sapplication so I was intimately involved with the process.At that time, as I remember, there were 22 hospitals in theAtlanta Metroplex applying for designation as either a I orII. Again, as I remember, eventually we ended up with aboutseven designated facilities. And now Grady is "the only 24 hour trauma facility"? (andby the way what is a non 24 hour trauma facility?) Need we look any further for what is really wrong?  R Wigle MD FACSLTC USA (Ret)  --- "Robert F. Smith" <rfsmithmd at comcast.net> wrote: > Roy,> > Re: years of mismanagement. No doubt. Ditto for the big> hospital in Chicago.> I think the creation of a "non-political" governing> agency could be an> important first step. It's a model that's recommended by> virtually every> "blue ribbon" commission that looks at problems of public> hospitals. I hope> it helps. Obviously I think these hospitals do a lot of> good for people> whose access to quality care is limited.> > Rob> > -----Original Message-----> From: trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org]> On Behalf Of Roy Danks> Sent: Tuesday, November 27, 2007 12:56 PM> To: Trauma & Critical Care mailing list> Subject: RE: Grady> > Rob,>  > I don't have a solution for Iraq, but what little I> understand of war (and,> it's complex), if we just up and pull out, we're going to> leave a few troops> behind...we can't possibly get every one out, en masse. > Do I think we are> in Iraq for solid reasons?  No.  But, hindsight is 20/20,> to abuse a cliche> and we have to support the current troops, that's all I'm> saying.  Would I> go to Iraq and be a surgeon there?  Absolutely. >  > Public hospitals:  First, Rob, I didn't use the term low> life's...that's> yours buddy.  Not disagreeing, but I don't need that one> charged to me.> Ah....I don't know the answer to this.  I mean, here I> am, for all intents,> a "rural" trauma surgeon.  Sure, we're Level I...we have> about 10%> penetrating trauma.  I can't imagine how they do it at> Grady, LAC, Ben> Taub...all of those.  We know this is an expensive> business, but we can't> expect the feds to bail everyone out all of the time. > Grady is where it is,> presumably, because of years of poor management and> neglect.  Give them more> money and they'll find a way to blow it.  We have proven> that time and again> in medicine.  Businessmen we ain't.>  > It goes back to the Biblical reference of giving versus> teaching a man to> fish for food....>  > Sincerely,>  > Roy> > > > > From: rfsmithmd at comcast.net> To:> trauma-list at trauma.org> Date: Tue, 27 Nov> 2007 10:53:31 -0500> Subject: RE: Grady> > Ron and Roy,>> > So we should> close the few remaining public hospitals in the US> because of> the low lifes> that seek care there?> > And the compelling reason to> have our soldiers> continue to get killed in> Iraq is because if we brought> them all home some> of them would get killed in> the process? > > Rob Smith>> > PS Please tell me> you're not saying Iraq was involved in 9/11. And I also>> think drug pricing> here is an outrageous boondoggle and all solutions> should> start with> getting rid of the lawyers.> > -----Original> Message-----> From:> trauma-list-bounces at trauma.org> [mailto:trauma-list-bounces at trauma.org]> On> Behalf Of Ronald Gross> Sent: Tuesday, November 27, 2007> 10:31 AM> To:> Trauma & Critical Care mailing list> Subject: RE:> Grady> > Roy,> > You> actually said what I was thinking but didn't have to> stomach to put it> out> there.> > Ron> > >>> Roy Danks <roydanks at hotmail.com>> 11/27/2007 10:12 AM> >>>> Yes, by all means. Let's continue to fund those who> won't go out and> work> for a living, who are too lazy to flip burgers at> McD's, who would> rather> peddle drugs than legal wares, who use violence> to solve problems,> who have> children but no way to pay for them...let me> pay more taxes so> that others> can live the high life and never lift a> finger.> > And, let's> take funding away from the soldiers in Iraq so they don't> have> the means to> defend themselves. Let's forget 9/11, it was probably a>> once-in-a-lifetime> occurrence. > > Pret, how would you pull out of Iraq?> Have you contacted> your Congressman> or the President with a grand plan? How> do you pull out> thousands of> soldiers without leaving a few behind to be> massacered?And,> the answer isn't> "we should never have gone there".> Because, we are there> and without a plan> to get out, we'll be there a long> time.> > Hey! Maybe> the physicians at Grady could work for less money! Yeah!> Cut> their earnings> so that others may continue to suck off the government> tit!> > Get real,> Pret. You're not part of the solution.> > > > > Date:> Tue, 27 Nov 2007> 09:24:21 -0500> From: pbjorn at emh.org> To:>> trauma-list at trauma.org> Subject:> RE: Grady> > Sad that all this red ink> comes to a small> fraction of one per> cent of> Georgia's share of federal> healthcare> reimbursement slashed by> the> current administration.> > Fifty> million dollar> budget shortfall? End> the Iraq war six hours early> and let> Grady keep the> change.> > Pret Bjorn>> Bangor, ME USA> > > > > -----Original> Message----->> From:> trauma-list-bounces at trauma.org>>> [mailto:trauma-list-bounces at trauma.org] On> Behalf Of Robert F. Smith> Sent:> Tuesday, November 27,> 2007 7:52 AM> To:> rockmd at aol.com; 'faran bokhari'> Cc:> 'Trauma &> Critical Care mailing> list'> Subject: Grady> > > > Atlanta> Hospital Moves to> Unburden Itself of> Debt > > > By KEVIN SACK>>><http://topics.nytimes.com/top/reference/timestopics/people/s/kevin_sack>>> /ind> ex.html?inline=nyt-per> and SHAILA DEWAN>>><http://topics.nytimes.com/top/reference/timestopics/people/d/shaila_dew>>> an/i> ndex.html?inline=nyt-per> > > ATLANTA, Nov. 26 -> The politically>> appointed board of Atlanta's troubled> charity hospital> effectively voted>> itself out of business Monday, the> first> step in at> least a short-term>> escape from the insolvency that had> threatened> the> region's only> top-level> trauma center.> > Without the financial> bailout made possible by> the vote,> the hospital,> Grady> Memorial, was at risk of> not meeting its> payroll,> perhaps by the end of> the> year, hospital> officials had warned.> Though> Grady, like most public> hospitals>>><http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthto>>> pics> /hospitals/index.html?inline=nyt-classifier> , has> faced> intermittent>> financial crises in the past, this one has> generated real> anxiety>>><http://health.nytimes.com/health/guides/symptoms/stress-and-anxiety/ove>>> rvie> w.html?inline=nyt-classifier> because of its roots> in a collision of>>> national forces, including the unchecked growth of> uncompensated care> and>>> deep cuts in government reimbursements. > > Political> leaders and medical>> officials have worried that Grady, woven> into> Atlanta's> social fabric>> since 1892, might follow Martin Luther King> Jr.-Harbor> Hospital in Los>> Angeles County as a casualty in 2007. If so,> the>> consequence would be a>> "patient tsunami" at other area hospitals, the>> Metropolitan Atlanta> Chamber> of Commerce said in a report earlier this>> year.> > Grady - which> supplies> the region with its only 24-hour trauma center> as> well as poison> control> and burn units and large clinics for AIDS>>><http://health.nytimes.com/health/guides/disease/aids/overview.html?inli>>> ne=n> yt-classifier> and sickle>>><http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/over>>> view> .html?inline=nyt-classifier> cell anemia - has> operated in the red>> for> 10> of the last 11 years. It is expected to run a> deficit of $50>> million to> $55> million in this year's $730 million> budget. > > The>> hospital owes an accumulated $63 million to its biggest> creditors,> === message truncated ===         ____________________________________________________________________________________Be a better pen pal. Text or chat with friends inside Yahoo! Mail. 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