Thursday, November 28, 2013

The Elephant In the Room: Partying Like It's 1986

Boys and girls, let's flash back to those thrilling days of yesteryear.
To 1986, to be specific.

Our beloved federal representatives, in the spirit of Satan Santa Claus, bestowed upon our republic (and to a great degree, most of our own professions) two acts of public munificence scarcely to be imagined (at least by anyone who can balance a checkbook).

I refer to the Immigration Reform and Control Act, and the Emergency Medical Treatment and Active Labor Act, whose passage the same year was anything but coincidental.

EMTALA was, in almost every way, the prequel to Obamacare. It mandated (without anyone anywhere paying for it) that all hospitals with emergency services had to provide them to anyone and everyone who walked in, regardless of ability to pay, citizenship status, or any other wee considerations.

Imagine, if you will, McDonald's mandated to give away free cheeseburgers to everyone who demanded one under the same (lack of) restrictions, and then come up with your best guess as to how long before they'd go bankrupt and close forever.

Except that, as a rule, hospitals are full of people who don't want to close, because they're genuinely concerned with finding a way to help people rather than shutting down forever. Because unlike a fast food restaurant, when hospitals close, people don't just miss lunch; they die.

Nonetheless, skyrocketing unreimbursed expenses under EMTALA have driven hundreds of hospitals, especially the smaller community hospitals you may remember if you're over 30, right off the financial cliff and out of business forever, along with no small number of larger facilities as well, due to the crushing burden of unreimbursed care to the indigent and illegal. (CA has lost something like 80 hospitals in the last 15 years, when last I looked, and chiefly for exactly this reason.)

Many others (Kaiser, I'm looking at you) simply curtailed or eliminated emergency services, thus ducking the law (legally). Which then made the wait for you or I to be seen at the hospital ERs remaining climb from minutes, to hours, to even days now at some inner city locations.

The huge hospitals and health care chains that remained had to find a way to make ends meet and buffer the enormous financial losses, so they began padding their bills. Your aspirin, for example, now costs $20. Mind you, it's still bought at $0.02@, but the cost to the insured helps subsidize the 999 other ones given out free (or at least unreimbursed by the recipients, or anyone else) to homeless, indigent, poor, uninsured, and illegal aliens, all by the trainload daily at every hospital impacted by the new law. Nothing in the new law gave these folks any incentive to make better life choices, nor any likelihood they'll ever have to pay for all the "free" health care that Tip O'Neill and Congress started handing out to them, as they have for almost 30 years now. After helpfully inviting 3 million folks to partake of American citizenship with IRCA the same year.

Flash forward, and let's see how those two genius moves have worked out:
Hospital emergency care impacted.
Health care cost rocketing to Jupiter.
Wait times to the moon.
Another 10-20 million folks thronging here illegally, and partaking of all the benefits of "free" health care, among other things.

So, in order to wipe out the scourge of uninsured patients and rampant runaway costs, we get EMTALA on steroids: Obamacare! (Because as we all know, if smashing your thumb with a hammer hurts, the best cure is to take a sledgehammer to your entire hand!)

By forcing millions of young healthy people who could formerly choose to do without it to get health insurance under Obamacare (under pain of IRS enforcement and hefty fines), the government, in collusion with the insurance companies, and against the interests of everyone, not least of them those millions of young healthy folks, has found a new way to pay for care for the unemployed, indigent, insane, and illegal patients, and now everyone else gets to pay for it all, forever! It's a Health Care Miracle!! (Well, except for that whole crashing 1/6th of the American economy like it were the LZ Hindenburg thing. FWIW, the hospital I formerly worked out has laid off 40% of staff across the board, in the fear certainty that reimbursement schemes will bankrupt them. Which put 1200 formerly insured and gainfully employed folks, and their families, in the unemployment line to buy...wait for care from Obamacare! Genius, no?)

And more doctors leave the profession forever (25% of our ED doctors group retired last December, most of them years early, and the group has no plans to replace them anytime soon), most of the rest curtail or cease entirely accepting Medicare or any other government insurance, more hospitals close, the wait gets longer at the ones which remain, and the billing price of everything, like that $20 aspirin, is worse than gasoline: rising indefinitely, with no end in sight.

Meanwhile, your employers cancel (or will shortly) your policies, cut your hours to <29@week, or just lay you off outright. And the insurance companies sit back, as their willing shark-smiling minions at the IRS shovel you one and all into their maw, by the government's requirements that everyone buy insurance they don't need - like mandatory mammogram and maternity coverage for men - at prices they can't afford.

And giving out health insurance cards without making more doctors for those suddenly insured people to see, means that all those patients without appointments, but still having a problem, will now the Emergency Department! Brilliant!

Cue government single payer in 3, 2,...

Next up: Let's bring that whole Amnesty Thing up for discussion again, so we can "solve" that problem like we "solved" the health care "crisis".

The biggest problem isn't that the Obamacare sign-up website is broken.
It's that someday, it's going to work exactly as designed.
Grab your wallets, and run for your lives.

Friday, November 22, 2013


"Flaming Hot Cheetos are bad, and lead to unnecessary ER visits."

Color me shocked! Shocked I say.

In other news, water is wet, fire burns, and it gets dark after sunset.

O, if only someone had perhaps mentioned this terrible affliction.

Oh wait, I did that, as has probably every nurse doing triage or treatment in any ED that sees kids with sign-in complaints for "abdominal pain" or "possible rectal bleeding."

But don't worry motherfathers, we buy our docs rubber gloves and surgilube by the case, so if you want your child serially introduced to the TSA standard pre-boarding rituals (and evidently, the Deming, NM PD Roadside Assistance Program), keep handing junior those little bags of flaming death, and see whether or not you pay my mortgage again this month.

Friday, November 8, 2013

Once More, With Feeling

So apparently, law enforcement in the Southwest has taken to doing this on a regular basis:

Customs/Border Patrol Doing Anal/Vaginal Probes Without Warrants

Look, I'm over here by the Pacific Ocean. Maybe the Constitution is different for us here.

But evidently, in what is now the third such story in three days, law enforcement (in this case actual federal agents) took a woman from the border to a local hospital presumably to have licensed medical professionals go poking all up in her stuff.

I'm not a Constitutional scholar, but I have a not too startling suspicion that if the police aren't entitled to just stick their hands up into my body cavities anyways, any such explorations are neither actually "reasonable", nor what anyone with an IQ north of their shoe size would call so. Let alone how any judge not certifiably insane would see it.

So for anyone from say, Texas or New Mexico...WTF?

Someone with a badge comes in and asks you politely to please go poking around in Mr. Jones or Ms. Sanchez in ways you wouldn't consider without a 27-page pre-op form under normal circumstances, and yet in these cases we have doctors (and possibly assisted by nurses etc.) falling all over themselves to violate policy, procedure, standards of care, professional ethics, and state and federal law with the studied casualness of retarded sociopathic serial abusers, raised on lead paint chips and high on crack.

I repeat for emphasis:  

I've searched diligently to find the story where law enforcement officials held medical staff at gunpoint and demanded the procedures be done, but so far that search is in vain.

Now look, I like police officers, as a rule, knowing their job is just as nasty and a wee bit more dangerous than ours, with similar clienteles. I joke with them, work with them, hell, I've even been related to them both by blood and by marriage, and I know there's both good ones and bad ones.

But these abuses aren't taking place on roadsides at 2AM with no one around or watching.

They're happening, serially, in accredited medical facilities, and performed by professional, theoretically conscientious, and undoubtedly licensed and usually board-certified medical staff. WHO SHOULD EFFING KNOW BETTER, and not to put too fine a point on it, with an average IQ advantage over the minions of law enforcement of 20-30 points most days, and an additional 4-10 years of post-secondary education.

In places that are supposed to be bastions of dignity, caring, and scrupulous professionalism, rather than modern re-creations of Dr. Mengele's konzentrationslaager infirmary.

So yet again, I repeat: if you're in any way involved in the profession of medical practice, and have participated in this, please, for the good of humanity, burn down your hospital, and then go home and kill yourself, or at the minimum, go down to the local state attorney general's office and turn state's evidence, followed by giving a full and complete public allocution of your and your colleague's crimes on live TV.

And then apologize, as you contemplate living the rest of your life as a traitor to the profession, and a pariah among decent human beings. Because we really need people like you in this profession, and probably walking the planet, like we need a dose of the clap.

And consider yourselves lucky that we don't let villagers come with torches and pitchforks and take you one and all to a well-deserved stake cookout in your honor.

Thursday, November 7, 2013

Raping The Constitution - Just Another Day in Deming NM

(I'm cross-posting this, because there's way too much crossover applicability to the medical field going on here. - A.)

Caveat: Good cops are worth their body weight in gold. Bad ones can - and should - be melted down to make fishing sinkers.

"Welcome to Deming NM, where the only safe @$$holes wear badges!" - proposed sign for the Deming NM Chamber of Commerce to put up at city limits

Yes, I'm late getting to this, because everyone else is having so much fun with it.

First, the LINK.

Now, the highlights:

One Mr. Eckert, of southern New Mexico, having concluded his shopping at a local Wal-Mart last January 2nd, did a rolling not-quite-a-stop as he left the parking lot, and was immediately selected to donate to the town's tax coffers pulled over for a  moving violation by the Deming PD.
Whereupon, for this grave breach of public order and safety, he was ordered to exit the vehicle.
(WTF. Why?? For a ticket, all you need is a promise to appear, and normal observables for citing officers don't include the behavior of your ass muscles.){Update: Aha! Because their Talking Dog told them! More later.}

Whereupon, based on personal observation, and a career familiarity with proper buttocks etiquette, Officers Assclown and Dipshit decided that the driver was almost certainly clenching his cheeks to maintain an imaginary stash of illicit narcotics in his booty hideout.
Whereupon they contacted and received from a local graduate of New Mexico's finest internet law school and all-night taco stand judge a search warrant for the anus of the motorist in question.

Apparently in Luna County, NM, probable cause of no more than some jackassical officer's desire to have a peek up your ass is sufficient to set aside the entire Bill Of Rights.
There's doubtless a thumping sound coming from the vicinity of 77 graveyards as the signers of said document spin in their graves.

Our brave butt pirates in blue took him to a local Deming ER, whereupon the medical professional on duty told them not just no, but Hell NO! because performing such a procedure, warrant or no, was a violation of his professional ethics. Doctors typically bill separately from the hospital, so this guy's medical group should award him an on-the-spot 5-figure cash sum for sparing them the lawsuits and ridicule to follow, a sum that should be matched by the hospital out of sheer gratitude. And if the AMA has an Ethics prize, this unnamed doctor just won it for 2013, whether they acknowledge it or not.

Undeterred by such flawless ethical reasoning, Officers Assclown and Dipshit, assisted at some point by Officer Shitforbrains, and later joined by Hidalgo County sheriff's deputies Bumblefuck, Stumblefuck, and Bufflefuck, trundled the motorist outside the county limits (and the limits of the jurisdiction of said search warrant, nota bene) to the Gila Regional Medical Center in Silver City NM, in Hidalgo County, where the local disciples of Dr. Mengele were more than happy to use a search warrant from an alleged judge in another county as a pretext for an epic butt-fishing expedition.

As noted in the federal filing complaint and linked story, the motorist was then subjected to the following:

1. Eckert's abdominal area was x-rayed; no narcotics were found.
{Nota bene that at this point, it ceased being a search, and the torture began. - A.}
2. Doctors then performed an exam of Eckert's anus with their fingers; no narcotics were found.
3. Doctors performed a second exam of Eckert's anus with their fingers; no narcotics were found.
4. Doctors penetrated Eckert's anus to insert an enema.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
5. Doctors penetrated Eckert's anus to insert an enema a second time.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
{At this point chronologically, after failing to notice that the warrant itself was invalid in their locale, no one noticed that the time limit for said warrant had also expired even if it had been a valid warrant. Which it wasn't.}

6. Doctors penetrated Eckert's anus to insert an enema a third time.  Eckert was forced to defecate in front of doctors and police officers.  Eckert watched as doctors searched his stool.  No narcotics were found.
7. Doctors then x-rayed Eckert again; no narcotics were found.
8. Doctors prepared Eckert for surgery, sedated him, and then performed a colonoscopy where a scope with a camera was inserted into Eckert's anus, rectum, colon, and large intestines.  No narcotics were found.
Throughout this ordeal, Eckert protested and never gave doctors at the Gila Regional Medical Center consent to perform any of these medical procedures.

This all took place in January 2013, and while it's a wonderful practical demonstration of Obamacare a few months early, like most of the activities of the current president, it's also a wee bit afoul of tiny details like the Bill of Rights and that pesky Constitution thingie.

My original response to that catalogue of nonsense was to a fellow online commentor who wondered why they didn't "just give him a dose of salts, and wait for the results" is as follows:

Because he has the legal right to refuse anything and everything. The only thing that can be done to anyone without their own consent in the ER is drawing blood for alcohol/drug tests, and administering emergency psych medication and strapping them down when they're actually violent and a danger to themselves or others (by which I mean swinging punches, kicking, and frothingly Hannibal Lecter bite-happy, not merely enamored with dropping F-bombs due to a lack of serotonin or social graces).

For everything else, they can tell everyone up to and including the President to "Eff off" with a mere 500 years of English Common Law and the full faith and credit of the U.S. Constitution on their side, something I regularly have to remind both cops and doctors of, but which our Legal Dept./Risk Mgmt. drones pound out in memos about 3X/yr.

Evidently somebody forgot to tell the local gauleiter, statspolizei, and the local disciples of Dr. Mengele in this instance that this sort of behavior was rather discredited post-1945.

Remember this when someone tells you the average h.s. grad doesn't need to know civics and political history for life beyond the 12th grade.

"These guys need to be locked up."

Letting the punishment fit the crime dictates that during confinement, they also be placed in restraints - by court order - and ass-raped by convicts repeatedly.
It's also funnier that way.

And for the record, every medical professional who didn't say not only "no" but "Hell no!" at the offending facility, from the lowest clerk up to the attending physician, just forfeited their licenses to practice, everything they own, and the next 10 years of their lives, at minimum.

Whether anyone admits it or not, this victim is on the short list to becoming the new co-owner of that entire hospital. This is a $20M judgement, and that's if it never gets to a jury's ears. He'd be crazy to settle for anything less than that, and if he has competent counsel, they've made that clear to him.

If it were me, I'd let them off with $5M in damages, provided they all stood in the town square for a week while any resident of the city limits was permitted to come up and kick them in the crotches as hard as they desired, once apiece.

And in all probability, Eckert was still issued a citation for the moving violation, and the medical center sent him a $6000 bill for sexually assaulting and humiliating him with glee multiple times, and showing a shockingly reckless disregard for anything we normally associate with professional ethics or common sense.

But, as countless late-night infomercials have told us, "Wait - there's MORE!"

They've done this before!

And come to find out, the original suspicion in both cases was the K-9 partner of Officer Shitforbrains: Leo the Ass-Sniffing Drug Dog!

Whose Crack Hound certification as a drug dog expired in 2011, at least a year before both incidents. Thus neither the dog, nor the probable cause, passed the smell test.

Not to mention that he doesn't know drugs from dirty underwear, and the false positives in both such notable occasions were ignored by everyone from Officer Shitforbrains to the Chief, because ass-raping both the citizenry and the Constitution in Deming and Hidalgo County is apparently so commonplace there that it doesn't even rate a yawn.

And notably, they again took their prospective butt-rapee to the same Gila Regional Medical Center in Silver City. One might notice a pattern here.

To the disciple(s) of Dr. Mengele working at that particular would-be Nazi Concentration Camp Processing Station and Sexual Assault Training Camp brilliant example of what you get when you make doctors the tools of the government at Gila RMC, particularly the really really questionable ones who should probably have been flunked before licensure, and be dissecting cattle for the local butcher shop instead of practicing medicine last seen at Auschwitz circa 1944, and best left there:
Show some self-respect, and burn down your hospital, for the good of all mankind, not least of which includes the local citizenry.
And then, please, if you personally had anything whatsoever to do with participating in the above or similar incidents, with all dispatch, go home and hang yourselves, as a mark that you have some shred of personal honor and a sense of shame.
Or turn yourselves in and become State's Evidence witnesses, and offer a full confession. It's the very least you can do, and clearly long overdue.

And one wonders just how many times this sort of outrageous conduct will have to be repeated before the Governor of New Mexico directs the State Police to step in, suspend the entire city of Deming Police and Hidalgo County Sheriff's Departments, and take over both until further notice to restore the rule of law and order, after referring both and any other such matters (and if they've done this twice, they've probably done it twenty times) to the state's Attorney General for some rather speedy and sweeping show trials in Albuquerque, ideally no later than close of business Friday.

When the U.S. Attorney for New Mexico will commence an investigation into the issuance of dodgy search warrants by judicial jackholes in and around Luna County has not been addressed, even by reporters who should know better. C'mon, counselor, this is an easy ticket to Congress or the governorship, and looks to be as hard as shooting fish in a barrel. Jump right in.

No points for guessing the winners of the 2013 Jackbooted Thugs Of The Year Award, by miles.

Nuke the site from orbit. It's the only way to be sure.

And please, for the love of all that's holy, it's long past time for SCOTUS to revisit the Fourth and Fifth Amendments relating to automobile and personal searches during traffic stops, and the admissibility of using drug dog "testimony" as probably cause for doing anything but handing out Milkbones. I pray that counsel for plaintiff uses some of the undoubted civil damages in this case to seek redress at the highest level for what has become a long train of abuses and usurpations of the Constitution, evincing a design to reduce us all under absolute despotism. Jefferson had a solution for that. What say let's nip things before we go there?