Peoria's Medical Mafia

An account of how a large Catholic medical center has lost its way. Go to pmmdaily.blogspot.com to see recent updates.

Wednesday, October 11, 2006

Pre-Introduction Peoria's Medical Mafia


Pre-Introduction--Peoria´s Medical Mafia

Dear Readers,

Jackson Jean-Baptiste is pictured to the right in a photo from Haiti during the Spring, 2005. Jackson died in January, 2006.

The following are the first 12 posts. There are 66 posts on this site. At the bottom of each post is an option for a "newer post" or "older post".

Synopsis of Emergency Medical Services
Introduction--Peoria's Medical Mafia
Keith's Letter
Conversations with Keith
Conflict of Interest
OSF-AMT Relationship
Emergency Room Overcrowding
OSF Emergency Room Patient Satisfaction
Fear at OSF
Conversation with Sister Canisia
Conversations in Church
Sister Judith Ann


Please go to PMMDaily.blogspot.com for updates.

Wednesday, July 12, 2006

Synopsis of Emergency Medical Services in Peoria


Synopsis of Emergency Medical Services in Peoria

Peoria’s Medical Mafia documents thoughts regarding Emergency Medical Services (EMS) in Peoria, Illinois. There are approximately 65 posts on this web log, many of them regarding EMS.

Peoria has a population of 113,000. The Peoria Fire Department (PFD) is non transport and provides service at Basic-D level with basic medication. Several years ago the PFD purchased a very nice ambulance using the Foreign Fire Fund. The PFD applied to the Peoria Project Medical Director for permission to outfit this vehicle, their only ambulance, with various basic and advanced life support materials and equipment. This request was denied by the Project Medical Director. The PFD then sold this ambulance because it was not being used.

Peoria has an advanced life support company, Advanced Medical Transport (AMT), which transports patients and gives the only paramedic care in Peoria. It is considered a not-for- profit entity but grosses over 7 million dollars per year. AMT is supported by all three of Peoria’s hospitals. OSF-SFMC, the largest medical center in downstate Illinois, is considered the “resource hospital” for the Peoria Area EMS. All three medical centers have administrators that sit on the AMT Board of Directors. AMT suffered significant legal troubles several years ago when the federal government investigated it for Medicare fraud based on coding and charging. AMT was fined over 2 million dollars by the federal government.

The OSF-SFMC Emergency Department Director is also the Corporate Medical Director for AMT. He was the Project Medical Director for many years in the Peoria area and was salaried by both AMT and OSF-SFMC for his services. Numerous people in the area believe this arrangement constitutes conflict of interest. The PFD also believe that many obstacles have been created over the years to keep them at a basic non transport level so AMT can continue as the only paramedic and transport agency in Peoria.

I believe that Peorians have suffered and died in the pre hospital setting and continue to do so because of the paramedic/transport monopoly. Incredibly, the PFD has paramedics that cannot use their life saving abilities at the scene when they work as firefighters; however, when they “moonlight” for AMT, they are able to use their advanced life support skills.

Similar business arrangements as described above probably occur in other locations around the nation. But just because banks are robbed in many cities, does not mean it is right to rob banks in Peoria.

I hope this web site is informative. Some day Peoria will change for the better regarding EMS and pre hospital care. The system took a while to become this ill and it will take a while to recover.

John A. Carroll, MD
July 12, 2006
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September 30, 2006

Arthur Kellermann, M.D., M.P.H. published an article in the September 28, 2006 New England Journal of Medicine. He is chairman of the Emergency Department at Emory University School of Medicine.

Dr. Kellermann begins his article describing waiting in the ambulance bay at Grady Memorial Hospital in Atlanta on July 27, 1996, awaiting 35 severely injured bombing victims in Atlanta. It sounds like things went as well as possible and the ER was working normally five hours later. Would that happen in Peoria? I don’t think so.

The Institute of Medicine recently released three reports regarding Emergency Medical Care in the United States. It can be seen at www.iom.edu. Dr. Kellermann sat on a committee which did the report.

Collectively, the committees describe an over burdened emergency system that is rapidly approaching its limits. Dr. Kellermann states, “With more patients needing care and fewer resources to care for them, emergency department crowding was inevitable.”

Dr. Kellermann writes about “boarding patients in exam rooms or hallways who need inpatient care”. He notes the very negative and dark side of ambulance diversion and that cities may experience the “health care equivalent of a “rolling blackout”. Everyone’s care is affected…”

Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) in 1986 which allowed everyone in the United States to acquire legal rights to emergency care. However, Dr. Kellermann argues that because this mandate (EMTALA) was unfunded, it created a perverse incentive for hospitals such as OSF-SFMC to tolerate Emergency Department overcrowding and divert ambulances while continuing to accept elective admissions.

My letter to OSF CEO Keith Steffen in September, 2001 was asking for his leadership and help for problems in Peoria that were very similar to problems addressed by the IOM in 2006. I was fired several months after writing Mr. Steffen in 2001.

I communicated with Dr. Kellermann and spoke to the Project Medical Director of another city with 5 million people regarding the unfortunate EMS situation in Peoria. The Project Medical Director asked me what would happen in Peoria if there was a mass casualty with the Peoria Fire Department at a Basic level and nontransport. Good question, but I doubt this will be answered in Peoria, until after the problem occurs. Peoria will be in for a cruel awakening.

Dr. Kellermann stated in the article that the “IOM committee calls on hospitals to end the boarding of admitted patients in emergency rooms and the diversion of ambulances, except in extreme cases, such as community wide disasters”. OSF, are you listening?

He concludes that the IOM envisions a “coordinated, regionalized, and accountable emergency care system that is capable of delivering lifesaving treatment to all in need”.

Currently, this is not the system in Peoria for reasons outlined in this web log.
----------------------------

October 20, 2006:

The September, 2006 issue of Emergency Medicine News published a letter I wrote regarding emergency department overcrowding in Peoria and the consequences of what happens when doctors bring up sensitive topics. ("Paying the Price for Speaking Up").


Emergency Medicine News:
September 2006 - Volume 28 - Issue 9 - p 10-11



Paying the Price for Speaking Up

Carroll, John A. MD
Peoria, IL

Editor:

I agree with Dr. Edwin Leap's opinion in his March column, What Are We Afraid Of? (2006;28[3]:15.) Physicians need to go public with patient care concerns. I believe physicians don't speak up because they fear losing their jobs and being marginalized in their community. That was my experience.

I live in a mid-sized, Midwestern city, and in September 2001, I was placed on six months' probation from my job as an emergency physician at a large medical center. I was confined to working in the urgent care center. My probation occurred the day after I wrote a letter to the hospital administrator (with copies to all the attending physicians in the ED including the director) about my concerns regarding long waits in the ED. When I wrote the letter, the ED was crowded, patients were lying on gurneys in ED hallways, and patients were signing out because I could not admit them to a bed in a timely fashion.

After I started my probationary period, the ED director told me that I could return to the main ED if I were evaluated by the hospital's wellness committee for burnout (a point not mentioned in the probationary letter). The hospital administrator referred to me as a cancer in the department who needed to be cut out before it metastasizes.

The ED had a dismal patient satisfaction rating of 33 percent and a low employee satisfaction level at that point. As the weeks went by, I continued to work in urgent care, but I refused to be evaluated by the wellness committee. The administrator who had referred to me as a cancer was discussing my case inside and outside the hospital. I was made the problem rather than placing the blame on the systematic deficiencies that plagued the ED.

While working an urgent care shift in December 2001, I was called to the administrator's office, and with another administrator, the ED director, and hospital legal counsel present, I was fired. After 20 good years as a resident and staff physician there, I packed up my gear and left.

The reason I wrote to the hospital administrator that September was that ED crowding and hospital bed capacity are systemic hospital issues. I also did not think the ED director would do much. Besides being the ED director, he had been the project medical director for the previous eight years, and he was still on the payroll of the city's only private ambulance company, the exclusive provider of the city's paramedic and transport prehospital care. The hospital is the base station for the area, and is the main supporter of the lucrative private ambulance service. Our fire department is held to a nontransport basic level, and according to the firefighters, obstacles were thrown up over the years by my boss when they attempted to advance their level of care for the citizens of the city. This arrangement was known all over the state in EMS circles and considered a serious conflict of interest by many.

Before and after I was fired, I attempted to go through channels within the medical center to explain my concerns for the prehospital patient and about the long waits in the ED. Administrators, corporate, and the ethics committee would not address my complaints. Letters to the JCAHO and the state department of public health were not helpful.

I have picketed the hospital, written letters to the local newspaper, and presented frequently to the citizens' forum at city council meetings. I also have written a web log, www.peoriasmedicalmafia.com about the past five years. Recently, a local newspaper editorial stated that our ED was seeing almost twice the number of patients that the original ED was designed to accommodate safely, and it noted that diversion of patients due to insufficient hospital bed capacity was a significant issue.

The most difficult part of this experience isn't being unemployed. It is abandonment by people who I thought would stand up for quality care issues facing our community. Many of my physician mentors who taught me patient care when I did my residency there no longer will see me or speak to me. The religious community that founded the medical center is silent, and the business community in our close-knit city supports the medical center and the private ambulance company. The EMS issues here that could be improved for public health reasons are relegated to secondary importance, with money taking precedence.

I would do this again but only reluctantly. Going public is necessary for physicians if we want positive change. It is not a heroic thing to do. It should be expected. But be ready to pay the price.

John A. Carroll, MD
Peoria, IL

© 2006 Lippincott Williams Wilkins

Wednesday, March 15, 2006

Introduction--Peoria's Medical Mafia

Introduction-Peoria’s Medical Mafia

Medical mafia—I have never forgotten when a well-known Peoria physician used this term to describe for me how the medical system operates here in River City. Physicians and institutions in central Illinois sometimes make decisions based on what is best for their bottom line rather than the patient’s health. Greed motivates this situation and fear—fear of job loss and other financial punishments, fear of ostracization by a close knit community—keeps it in place. The term medical mafia perfectly explains much of the four-year saga I have been on since being fired from OSF St. Francis Medical Center in 2001.

In the hopes that constructive changes can be made regarding some dangerous situations, I want to share my experiences with as many people as possible. After years of attempting to work within the confines of OSF and the Catholic Diocese of Peoria, I finally realized that there is no adequate checks and balances within either system. Silence and denial are integral components to stifle ideas. Although not ideal by any means, a weblog (blog) seems the best way to disseminate this information.

My objectives are to detail serious problems related to OSF, Emergency Medical Services in Peoria, The Catholic Diocese of Peoria, and Haitian Hearts. I will show how the problems involving all four entities are linked. I will discuss how powerful men and women can hurt the not-so-powerful people in central Illinois as well as sick Haitian children needing heart surgery.

The first step toward change is an awareness of the problem. I want to educate people as to how these organizations really operate. I have 4 years of letters, articles, and notes of conversations that I have used in this blog. These sources will provide evidence for the events I will describe. I will include names at times and will leave other names out to protect people from injury.

The blog is divided into 3 main sections: OSF, Haitian Hearts, and Emergency Medical Services in Peoria. All are written in as much of a chronologic order as I could to keep 4 years of material as understandable as possible.

It is possible this site will anger powerful people and institutions. If I am told to “cease and desist” from further writing, I will let you know and take appropriate action. If changes occur in systems that our failing us now, I will also let you know.


John Carroll, M.D.

Keith's Letter


Keith’s Letter

On September 26, 2001, I worked the 3-11 shift in the ER at OSF. I had elderly patients as usual and several signed out and went home when they realized how long they were going to wait for a bed in the hospital. They were sick, and I intended to admit them, but they just couldn’t take lying on a stretcher for many hours and so politely told me that they “needed to go home”.

The ER has an administrator on call every night to call at home if there are problems an attending physician in the ER would want to discuss. These calls usually did not help at the time the call was made.

On September 27, 2001 I decided that Keith Steffen, CEO at OSF-SFMC, should at least know of my concerns and wrote him a letter and copied it to all of my colleagues in the ER and to other OSF administrators. (See letter below.) Someone warned me that I might get fired if I sent the letter. I knew that to be true, but thought it needed to be done.

I did not hear back from Keith but did hear the next day from Dr. George Hevesy who had been promoted to ER director on August 1 to replace Dr. Rick Miller. His secretary handed me his letter to me as I was starting to resuscitate a man in the ER who had a cardiac arrest and was brought in by ambulance.

George’s letter put me on probabation for 6 months. It also stated that starting in November, I would only work in OSF Prompt Care. Hevesy did not disagree with the content of my letter but told me that I had gone around normal communication channels and that I would be suspended from the ED for 6 months. After I read the letter, I called George at OSF’s new Center for Health where he was working and asked him if he was really serious about what he had written. He said that he was and for me to stop in and see him sometime so we could talk.


-----------------------


September 27, 2001

Keith Steffen, Administrator
OSF Saint Francis Medical Center
Peoria, Illinois 61637

Dear Keith:

I started working at OSF-SFMC in 1971 as an orderly on 8B. Most of my last 30 years have been spent inside this building. OSF-SFMC means everything to me. Please interpret the following knowing my heart and spirit are with St. Francis and always will be.

I worked 3-11 last night in the main ER. The ER mayhem and disarray that usually exists was actually somewhat manageable. However, patient-waiting time from disposition to arrival on the floor was unbearable. Two sick patients of mine, rather than staying in the ER all night, politely decided to sign out, go home, and hope for the best.

Giving appropriate care in the ER can be challenging but having no room upstairs to admit the patient can be life threatening to the patient. Should I call other medical centers around the area/state for their admission and subsequent care before I see the patient or after? Studies have shown increasing time spent in the ER increases patient morbidity. Obviously, I don't want to do this. Please tell me what to do.

An ER crisis has been occurring for many years in our ER. But last night with "home diversion" of patients we have reached an all time low. This cannot continue.
I need an immediate answer from you today as to how I should approach these sick patients and their families. I will meet with you any time today or tonight.
My pager is always on (679-1980.)

Sincerely,

John A. Carroll, MD

cc: Sue Wozniak, Chief Operating Officer
Tim Miller, MD, Director of Medical Affairs
Susan Ehlers, Assistant Admimstrator Patient Care Delivery Systems
Paul Kramer, Executive Director of Children's Hospital of Illinois .
Lynn Gillespie, Assistant Administrator Organizational Development
Emergency Department Attendings
---------------------------------

On April 6, 2006 the Peoria Journal Star published the article below regarding the new Children's Hospital that will be built. Please note Mr. Steffen's comments regarding bed capacity problems and patient diversion at OSF. Was this institutional neglect by OSF attempting to stack to many patients inside the medical center? How many people suffered under this system? When I wrote him almost five years earlier, I was immediately placed on probation and then fired three months later. Will that be Mr. Steffen's fate as well?

What the Journal Star did not report was that Jackson Jean-Baptiste, a Haitian Hearts patient, was refused care at OSF and died several months ago. Many Haitian Hearts patients are now suffering and being denied care at OSF. This is contrary to what Catholic social teaching states and the Catholic Bishops Ethical and Religious Directives mandate.

Haitian Hearts obviously did not financially break OSF with the announcement of their new 200 million dollar building. It is truly a blessing for central Illinois children. However, Haitian children deserve the best available as well.

Until OSF can change its heart and return to the founding Sisters mission philosophy, they will have the technolgy but not the touch. The picture is of a Haitian baby where I work in Haiti. This hospital has no running water...a bit different than OSF-CHOI.


A medical milestone
Saint Francis expansion will alter Downtown landscape


Thursday, April 6, 2006

BY DAYNA R. BROWN

OF THE JOURNAL STAR

An eight-story, concrete and glass addition to OSF Saint Francis Medical
Center will permanently enhance Peoria's medical skyline - and the area's
economy. This new facility will be home to the Children's Hospital of Illinois and
is the largest building construction project in Peoria history.

"It's unusual for a community of this size to have its own children's
hospital," said pediatrician Dr. Rodney Lorenz, who also is interim dean at
Peoria's medical school. "We are blessed."

The new building will be located north of the hospital's main facility. It
will sit on the site of Medi-Park 1, which will be torn down when a new $33
million parking deck is completed later this year.

Construction is difficult on the site because it slopes 60 feet from top to
bottom. But it was the only area on the hospital's 33-acre campus where
there was enough room for this facility, administrators said. The
Children's Hospital wanted to stay on the Downtown campus because there is
$45 million in annual savings by sharing services with St. Francis.

The expansion is needed because the hospital is out of space,
administrators said.

St. Francis had to divert patients to other hospitals Wednesday, and it has
been that way much of the past month because there aren't enough beds, CEO
Keith Steffen said. Just last year, more than 200 patients had to be sent
to other locations.

But when the $234 million construction project is completed, that no longer
will be a problem, Steffen said.

"We've seen significant growth over the past few years," Steffen
said. "We'd be remise . . . if we didn't respond."

The new building will be 440,000 square feet, almost twice the size of the
hospital's Gerlach Building, which houses surgery, the emergency
department, most of medical imaging and five intensive care units.

It will allow for the consolidation of all of the Children's Hospital
services, which are currently located in six buildings, and provide all
pediatric patients private rooms.

"Right now it is hard for people to find the Children's Hospital because
it's buried in St. Francis," said Dr. Rick Pearl, surgeon-in-chief of
Children's Hospital. "I just run in circles, all day long."

The new facility, which will be physically attached to St. Francis but will
have its own entrance, will bring the hospitals staffed beds from 560 to
616. It will have three floors dedicated solely to children. Another three
floors will have shared services for adults and children, including surgery
rooms and the emergency department.

The decor will be "kid-friendly," with bright colors, play areas, music and
favorite children's characters, doctors said. And the rooms will provide
space for parents to stay with their child.

"I think it's very important for a child to feel comfortable," said Dr.
Ravindra Vegunta, director of pediatric minimally invasive surgery at
Children's Hospital. "The more happy the patient, the more cooperative a
patient and that will aid in recovery."

There will be one adult cardiac floor in the new building because more
space was needed for that department, administrators said.

Moving the pediatric services out of the current facility will free up
needed space for adult patients and other hospital needs, administrators
said.

The project also will include a "much needed" emergency department
expansion. The current emergency room was constructed to serve 32,000
patients annually, but this year it will surpass 62,000, Steffen said.

St. Francis is the largest hospital in downstate Illinois, employing
approximately 5,200 people, and the only Level 1 trauma center in the area.
In addition to 850 construction jobs, the project will create a need for
another 1,000 jobs related to health care.

Children's Hospital of Illinois was formed in January 1990, and draws from
a 30-county area. Annually, it admits about 5,000 children and treats
30,000 outpatients.

Areas hospitals - including Methodist Medical Center, Proctor Hospital and
Pekin Hospital - have given support for the project, Steffen said.

If the plans are approved by the state, which is required, construction
will begin in spring 2007, with a completion date of 2009. Hospital
officials plan to file for state approval by the end of the month, and said
they believe they will be approved.

"We are in the business of patient care," Steffen said. "This project
says . . . we are going to do it more efficiently, more effectively, more
conveniently."


Dayna R. Brown can be reached at 686-3194 or dbrown@pjstar.com.

----------------------------

The Journal Star then offered this editorial--

Monday, April 10, 2006

When Keith Steffen, OSF Saint Francis Medical Center CEO, got to work Wednesday morning, he was greeted with familiar news: the intensive care unit was full. Because of overcrowding, St. Francis annually diverts 200 patients to other hospitals, 100 of them children. That space crunch is precisely why Steffen would announce later in the day a $234 million expansion of St. Francis. The largest medical center in downstate Illinois isn't big enough.

The single biggest private building project in Peoria's history, if approved by state regulators, will shoehorn an eight-story building onto the Downtown campus and position St. Francis to meet the medical needs of central Illinois and beyond for the next 25 years. Once the so-called Milestone Project is done, St. Francis will have three new floors for the Children's Hospital of Illinois, three more for diagnostic services and surgery, one for adult cardiac patients and a new and bigger emergency room.

With the expansion, all of the hospital's 616 rooms - it has 560 now - will be private, which has health and customer satisfaction advantages. New surgery rooms will be large enough to accommodate robotics and other technology, some $47 million worth. A larger ER will no longer have to operate at twice capacity.

Simply put, the 440,000-square-foot addition - twice the size of the Gerlach Building that spans Glen Oak Avenue - will make St. Francis more competitive in a changing marketplace. Rural hospitals are referring more patients to Peoria than ever before. Some 35 percent of St. Francis' customers come from outside the Tri-County. One of the biggest growth areas is pediatric care, especially for high-risk infants.

OSF officials say the added efficiency will help keep a lid on inflation-shattering medical costs. The Children's Hospital, for example, is spread across six buildings. Now make that one. Administrative offices scattered across the city also will come under one roof after construction is completed in 2009.

This project benefits more than just St. Francis. First, it will create 850 construction jobs and up to 1,000 more permanent ones, including 300 more nurses and technicians. Second, it anchors Peoria's medical community Downtown for as far as the eye can see. When St. Francis built its Center for Health on Route 91 five years ago, there was a fear the hospital might eventually move north. No more. Between this project, OSF's $33 million parking deck now under construction and Peoria Surgical Group moving to the medical school campus, private medical investment Downtown will approach $300 million. What a boost for Renaissance Park.

This also will create a new front door for St. Francis off a rebuilt Interstate 74. Anything that makes it easier to navigate this labyrinth of a hospital is a plus. Finally, this expansion was endorsed by Methodist and Proctor hospitals. Hallelujah. Doesn't happen enough.

There will be naysayers. Indeed, it's a lot of money to add fewer than 50 patient rooms. Then there is the question of need. The Illinois Health Facilities Planning Board initially refused to approve the Center for Health on that basis. Ultimately jam-packed surgery rooms and full intensive care beds showed the flaws in that analysis. It's hard to imagine state regulators not looking favorably on this request.
----------------

My comments:

Finally, after many years, it was stated that the ER at OSF was operating at twice its capacity. Even Mr. Steffen stated that they would be "remiss" if changes weren't made. OSF has been "remiss" for many years now regarding excessive patients in the ER and inadequate bed capacity in the main house.

In the April, 2006 issue of Academic Emergency Medicine an article regarding overcrowding in the emergency department describes the problem very clearly. The journal reports, "The phenomenon of emergency department crowding has become recognized across the globe as a serious public health threat. ...experts widely agree that crowding in the emergency department (ED) is a system-wide problem, not one that results solely from problems in the ED or one that can be addressed using only ED based solutions. Crowding has become a shared burden for emergency providers. Each of us has a collection of stories to tell about how crowding has affected our patients, their families, our cowokers, and our own professional satisfaction."
----------------------------
June 16, 2006
Emergency System Called Very Ill

On June 15, 2006, USA TODAY had the above headline over an article on their front page.

The nation’s emergency medical system is in a dangerous state of crisis, says a new series of landmark reports. The Institute of Medicine recently released extensive reports which were prepared by a 40-member board after a two-year investigation. The IOM report states that the U.S. life saving system is failing.

The IOM reports detail how hundreds of thousands of lives are affected every year by EMS deficiencies that are not obvious. The chair of the panel, Gail Warden, stated that “in most communities, there is a crisis under the surface.”

Many emergency rooms barely can handle their daily patient loads, children don’t always get good care, and the quality of rescue services is erratic, the report says. A USA TODAY probe found a 10-fold difference between major cities in cardiac arrest survival rates.

Dr. Arthur Kellermann, director of the Center for Injury Control at Emory University School of Medicine in Atlanta stated that the problem with hospital bed capacity slows the emergency department admission of sick patients and more patients are diverted to other hospitals. In every minute of every day, an ambulance carrying a patient is turned away “diverted” when an emergency room says it is too full to take patients.

This sounds very much like OSF in Peoria. Throughout this website, I have questioned the monopoly of paramedic transport care in Peoria. The IOM report mentions, crowding and ambulance diversion also occur because of lack of coordination among emergency medical response teams and hospitals…as well as entrenched professional interests. With regards to Peoria, I would say the “entrenched professional interests” are centered around the medical centers and their relationship with Advanced Medical Transport.

There is a “crisis under the surface” in Peoria that will eventually become apparent.
-------------------

Emergency Medical News
October, 2008

In 2006 there were 119.2 million ED visits in the United States.

Dr. Arthur Kellerman agreed that it was easy to blame the problems of crowding on the uninsured. "It gives the decision-makers an excuse to ignore it or blame an unempowered segment of society. These aren't contributing to the growth of emergency department visits," he said. "We know the major problem in crowding is the boarding of patients."

Dr. Peter Viccellio commented on crowding in the ED: "...the problems and solutions are necessarily institutional, and cannot be addressed by focusing on the ED in isolation."

I believed in 2001 and still believe in 2008 that my letter to Mr. Steffen, other OSF administrators, and to my colleagues in the ER was was appropriate and that changes needed to be made to protect our ER patients.
-----------------------

February, 2009

Well, the financial crisis in the U.S that is putting many people out of home and job is also putting many of them in our overcrowded ER's. See this post.

So in addition to OSF's greed, the dismal national economic picture in 2009 will imperil people's health all the more.

--------------------

October, 2009

Annals of Emergency Medicine, October, 2009

ED crowding affects care negatively.

Not only does it reduce access to emergency medical services, but also it is associated with delays in care for cardiac, and stroke patients, as well as those with pneumonia, and is associated with an increase in patient mortality. ED crowding has been associated with prolonged patient transport time, inadequate pain management, violence of angry patients against staff, increased costs of patient care, and decreased physician job satisfaction.
--------------

More about ED crowding...even in 2010. Why would Dr. Hevesy put me on probation in 2001 after I wrote Mr. Steffen about my concerns?


www.medscape.com
From American Academy of Emergency Medicine
Washington Watch: CDC Report on ED Capacity
Kathleen Ream


Posted: 02/05/2010

The Centers for Disease Control and Prevention (CDC) recently released a report entitled Estimates of Emergency Department Capacity: United States, 2007. This report is based on data from the CDC's 2007 National Hospital Ambulatory Medical Care Survey (NHAMCS). Inaugurated in 1992, the NHAMCS is now the longest continuously running national survey of hospital ED use.

The report notes that over the last several decades, the role of the ED has expanded from primarily treating seriously ill and injured patients. The report recognizes that EDs now also provide urgent and unscheduled care to patients unable to access their providers in a timely fashion and provide primary care to Medicaid beneficiaries and uninsured patients. As a result, EDs are frequently overcrowded with the most common contributing factor being the inability to transfer ED patients to an inpatient bed once the decision is made to admit them. "As the ED begins to 'board' patients, the space, the staff, and the resources available to treat new patients are further reduced," the report states. It continues, "A consequence of overcrowded EDs is ambulance diversion, in which EDs close their doors to incoming ambulances. The resulting treatment delay can be catastrophic for the patient."

According to the CDC survey, approximately 500,000 ambulances are diverted annually in the United States. The survey also shows that large EDs serving more than 50,000 patients each year represent just 17.7% of all EDs in the nation, but account for 43.8% of all ED visits in 2007. The implication, according to the report, is that small EDs with annual visit volumes of less than 20,000 patients may not experience crowding.

Other data from the survey show that about one-half of all hospitals with EDs had a bed coordinator or "bed czar," 58% had elective surgeries scheduled five days a week, and 66% had bed census data available instantaneously. Electronic medical records (EMRs), either all electronic or part paper and part electronic, were used in 62% of EDs. Basic EMR systems containing patient demographics, problem lists, clinical notes, prescription orders, and laboratory and imaging results were reported in l5% of EDs. However, the CDC could not accurately determine the prevalence of fully functional EMRs that also include features such as electronic transfer of prescription orders, warnings of drug interactions or contraindications, and reminders for guideline-based interventions.

Additional survey data show:

Overall, 62.5% of EDs reported that they board admitted ED patients for more than two hours while waiting for an inpatient bed. Among EDs that board patients, 14.8% use inpatient hallways or other space outside of the ED when critically overloaded. A "full capacity protocol" that allows some admitted patients to move from the ED to inpatient corridors while awaiting a bed was used by 21.1% of EDs.
EDs with more than 20,000 annual visits comprised more than 70% of EDs in metropolitan statistical areas (MSAs). When compared to EDs in rural areas, EDs in MSAs were more than twice as likely to board patients for more than two hours in the ED while waiting for an inpatient bed (77.4% versus 32.8%).
More than one-third of EDs had an observation or clinical decision unit. About a third of EDs used a separate fast track unit for non-urgent care.
In the previous two years, 24.3% of EDs increased their number of standard treatment spaces, and 19.5% expanded their physical space. Of those EDs that did not expand their physical space, 31.5% plan to do so within the next two years.
Zone nursing was employed in 35.3% of EDs. "Pool nurses" that can be pulled to the ED to respond to surges in demand were available in 33.2% of EDs.
Bedside registration was used in 66.1% of EDs, with 40% using computer-assisted triage. Electronic dashboards were utilized by 35.2% of EDs, and 9.8% used radio frequency identification tracking.
GAO Study Finds ED Crowding Continues
According to a Government Accountability Office (GAO) report released June 1, hospital EDs continue to be overcrowded, with lack of access to inpatient beds continuing as the main contributing factor. The GAO first reported that most emergency departments experienced some degree of crowding in 2003 (Hospital Emergency Departments: Crowded Conditions Vary among Hospitals and Communities, GAO-03-460). The GAO was asked to revisit this issue in response to several studies that have associated crowded conditions in EDs with adverse effects on patient quality of care.

The GAO examined three indicators of ED crowding - ambulance diversion, wait times, and patient boarding - along with various factors that contribute to crowding. In doing so, the GAO reviewed national data, conducted a literature review of 197 articles, and interviewed individual subject-matter experts and officials from the Department of Health and Human Services (HHS) and professional and research organizations.

National data showed that about one-fourth of hospitals reported going on ambulance diversion at least once in 2006. According to the GAO's analysis of 2006 data from the HHS's National Center for Health Statistics, average wait times continued to increase, with significant numbers of visits exceeding recommended wait times based on patient acuity levels, as summarized here:

Patients needing immediate care (recommended maximum wait to see a physician of less than one minute) waited an average of 28 minutes to be seen by a physician. 73.9% of these patients waited longer than the one-minute recommendation.
Patients with emergent conditions (recommended maximum wait of 14 minutes) waited an average of 37 minutes to see a physician. 50.4% of emergent patients waited longer than 14 minutes.
Patients with urgent complaints (recommended to be seen within 60 minutes) waited an average of 50 minutes, with 20.7% of patients waiting longer than 60 minutes.
Semi-urgent conditions (two-hour maximum wait recommended) had an average wait time of 68 minutes, with 13.3% of patients waiting longer than the maximum recommended timeframe.
Non-urgent patients (24-hour recommended timeframe) had an average wait time of 76 minutes, with no ED reporting wait times to see a physician in excess of 24 hours.
Although national data on patient boarding is limited, the articles reviewed by the GAO and the experts interviewed reported that the practice is a continuing problem due to the lack of access to inpatient beds. In turn, the lack of access to inpatient beds is due to the competition for available beds between hospital admissions from the ED and scheduled admissions, such as elective surgeries, that can be more profitable for the hospital.

While the GAO found that studies on solutions to ED crowding are also limited, strategies have been successfully implemented in isolated cases. One solution found in case studies conducted at several hospitals was to streamline elective surgery schedules, thereby increasing the opportunity for ED admissions. Regarding ambulance diversion, some local communities have established policies that make diversion the last resort for any hospital, as it often leads to critical cases not receiving the immediate care they need. Other strategies include the use of on-call physicians to determine the best ambulance destination for each patient or state policy prohibiting hospitals from going on diversion unless under inoperable conditions.

Strategies to decrease ED wait times included increasing the speed with which laboratory results are available, accelerating care during the triage process by eliminating some of the administrative work associated with patients entering the ED, and implementing a system allowing non-urgent patients to be seen by a medical provider other than a physician. However, none of the strategies to address crowding have been assessed on a state or national level.

The GAO found that there are several other frequently reported causes for ED crowding, including a lack of access to primary care; a shortage of available on-call specialists; and difficulties in transferring, admitting, or discharging psychiatric patients. Less commonly cited causes of ED crowding included an aging population, increasing acuity of patients, staff shortages, hospital processes, and financial factors.

For the full report, go to http://www.gao.gov/new.items/d09347.pdf.
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Hi Everyone!

It is June, 2010. Can you believe it?

Well, Emergency Department crowding is still an issue in 2010 just as it was in 2001.

Here is a post from today.

We will stay in touch.

jc

June 26, 2010
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Hi Everyone,

Well, it is May, 2011. Time flies when you are having a good time.

I posted this article yesterday.

We will stay in touch and thanks for reading.

jc

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Hi Everyone,

Today is June 1, 2011.

I posted this today.

Later,

jc

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Hi Everyone,

Today is October 17, 2011.

I posted this today.

Stay well.

John

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Dear Everyone,

It is December 23, 2011. It is very sunny and clear today. I still need to rake some leaves in the backyard.

Hope you are well.

I posted this today.

Merry Christmas,

John

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May 27, 2012

Dear Everyone,

It is Memorial Day Weekend. Hope you all are well.

I posted this article yesterday. It is from Edmonton and mentions a doctor who notified administrators of his concerns of danger in the ED due to overcrowding in 2008. But his concerns were not addressed.

This sounds familiar to me.

Also, in Peoria, we now have two fire stations that are paramedic. And in the near future all new firefighters in Peoria will have to be paramedic. Please see this post.

So times are changing for the better in Peoria. Change is hard when corruption is deep. And when our local medical leaders who have corrupted the system here for so long are gone, things will be much better for EMS in Peoria.

John

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April 18, 2014
Good Friday


Please read this article from Medscape.

Have a good Easter Sunday.

John

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Conversations with Keith Steffen


Conversations with Keith

I spoke with an OSF administrator, Dr. Tim Miller, in early October, 2001, and he stated that I was right and that “OSF had ignored the main campus”. He was referring to my letter to Keith Steffen regarding lack of bed capacity in the hospital for emergency department patients. The focus had been on the Center for Health that OSF had just competed north of the City. It cost 38 million dollars. Some of our patients in the ED didn’t even have pillows on their gurneys to lie on. I thought the ER was quite dysfunctional and our patient satisfactions scores were 33%, the lowest at OSF.

I copied excellent articles from the journal “Society for Academic Emergency Medicine” regarding ER overcrowding for multiple administrators. I heard back from no one in administration at OSF regarding the articles.

My first meeting with Keith was on Oct. 5. I expressed to Keith my concerns with lack of bed capacity at OSF and the long waiting times for patients in the ER, and also discussed the fact that Hevesy had placed me on probation for 6 months on September 28, 2001, the day after I wrote the letter to Keith. Keith told me that things were being done about the bed problem and that he (Administrator of OSF-SFMC) could do nothing about Hevesy putting me on probation.

However, Keith changed the topic of the conversation very quickly. He seemed to be very concerned about a petition that was going around in my support and asked me the names of the nurse or nurses who started the petition. I did not tell him because I feared for their jobs if he found out their names. He repeatedly tried unsuccessfully to get their names from me.

Keith then likened me metaphorically to an uncontrolled hemorrhage in the ED and a cancer in the ED that needs to be “cut out before it metastasizes”. I was quite surprised to hear this. I really didn’t know Keith well but figured out this was going to be tough go.

He also was fixated on the concept of fear. He told me, “Fear is a good thing amongst employees.” Rather strange, I thought.

As the next couple of months went by, very unusual things happened in Keith’s office. During one meeting with him, Keith said, “You know, John, the Apostolic community has a problem with you.”(Keith is an Apostolic Christian). This statement totally caught me off guard. The Apostolic Christians in the area were host families for Haitian kids and very close friends of mine. I couldn’t understand what he was talking about. Keith would look at the carpet, shuffle his feet, smile and say, “You know, John, when this comes out about you, it won’t be good.” I would ask him the same question each time—“When what comes out about me, Keith?” He would never answer but would just shake his head and smile. He went through this same ritual several times with me over the course of a couple of months.

I wasn’t the only one he planted these seeds with.

My brother went in to talk with Keith during the next couple of months and he told Tom, “There is a side of your brother that you don’t know.” This disturbed my brother greatly because there is no side of me that he doesn’t know. What could Keith be doing or thinking with this mantra of his?

On December 5 Keith had a meeting with two Apostolic Christian nurses who had important positions at the medical center to his office and stated the following: “John has done very bad things. People don’t know this side of John.” One of the nurses had helped start another petition on my behalf that really irritated Keith. Keith threatened to sue that nurse even though she had done nothing wrong and cleared it with Human Resources at OSF before she started the petition. Keith wanted to know the status of that petition as well, and the nurse told him that people were very afraid. Keith replied that was good. He then reiterated that the people did not know what they were signing and they did not know the whole story and they did not know the “real John Carroll”. Keith told the nurses there should actually be greater fear in the hospital. Keith went on to tell the nurse that he had spoken to Representative Ray Lahood and Monsignor Rohlfs and that they now understand that I have the problem. I had spoken to both of them and they were quite complimentary towards me. (I heard through the grapevine that Keith had made a very urgent phone call to Rohlfs one day to try and explain his side of things.) Keith even went on to say that “Rick Miller had been right all along.” When I asked the nurse if she meant that Keith was referring to me being frustated in the ER, she said “no”. It appeared that Keith was referring to something else, something much worse than frustration. The other nurse said nothing but was listening to all of Steffens comments about me.

A well known lady in the Peoria community, whose family had hosted a Haitian Hearts child, told me how she went in to Keith’s office and he told her that they had asked me to seek counseling and that if she knew the OSF side of the story she would agree with Keith and OSF. She didn’t know what to think. Keith was definitely doing some damage and spreading seeds of doubt regarding me outside the medical center. She told me this story with her husband present. I could tell they were very apprehensive about what was occuring. Her husband had no idea what to say or do. They both have excellent jobs in the Peoria community and both knew what would happen if they went to bat publically for me.

Another business lady in the community who had never met Keith went in on my behalf after she was told by Sister Judith Ann to do so. Keith talked a lot about the devil with her and stated, “When the devil ensnares someone and pushes him up against the wall, we find out what that person is made of.” This lady was quite scared and wanted to leave Keith’s office at that point. Keith commented to her on the way out that if she talked about their conversation “…maybe we won’t be friends anymore.” (She had never met Keith prior to this.) She couldn’t wait to leave his office. When I asked Sue Wozniak about this a couple of months later she said “ it sounded like a threat”. The business lady thought so too.

Keith talked about my employment at his church in Washington, Il. I know who he talked to. They told me. At one point, Steffen stated, that “each time he (Steffen) sees a Haitian child, it makes me (Steffen) want to puke.” Keith’s inappropriateness knew no bounds.

So there really wasn’t any confidentiality with Keith. OSF attorney, Doug Marshall, would monitor Keith at times in Keith’s office and tell him to watch what he was saying because I was shaking my head and writing everything down. Keith’s mantra to me about “the other side of me will come out and it won’t be good” was never said in front of Marshall, that I know of, so Keith can deny this if he wants. But he will have to deny it a lot if ever questioned under oath because he said it to many people.

Does this sound like the way the CEO of the largest employer in Peoria should act? Doesn’t seem to be great management skills to me. Open and honest communication, one of the Sisters mission statements was absent with Mr. Steffen.

After Keith fired me on December 18, 2001, he distributed a fax to the rest of the medical center (that was written by hospital spokesman Chris Lofgren) as if he was trying to protect me. A lot of people told me about this nonsense. (See post "Conversations with Chris").

Then things got worse.

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Before I met with Keith as described above, I sent him this note pleading for help for the Emergency Room from OSF administration:

Handwritten Note from Dr. John Carroll

10-01-01

Dear Keith,

As you mayor may not know, the ER is in "tough straits" - patient care and waiting time is very lengthy.

I would love to have you or another administrator spend a couple of shifts with me this week in the ER. I work 3-11 and 5-1. You would see patients with me. The objectives of this would be to:

1. See the ER from "ground zero" - this would prompt ideas on how to solve some of these issues. I will tell you how I see the issues and how time could be saved for the patient (from triage to final disposition). There is a huge crisis occurring in our ER now.

2. Your presence would definitely be a "morale improver" for the ED staff and for the patient when he realizes an administrator is personally concerned as well.
I really believe an administrator's presence would be a "win-win" for OSF and ER patients.

Please strongly consider joining me in the ER.

Sincerely,

John

Addendum:

May 22, 2008--Keith refused to come to the ER when I proposed this to him in 2001. He stated that if he came to the ER other hospital departments would want his presence, and he could not be everywhere.

As I look back at it, I doubt the ER had his full attention compared to other big money making departments (like Surgery) and the new Center for Health. The ER and its overcrowding would just have to wait.

In the May 15, 2008 issue of the New England Journal of Medicine is an article written by David J. Shulkin, M.D.

Dr. Shulkin makes late night administrative rounds at the hospital where he is president and chief executive officer. He noted the "stark discrepancy in quality between daytime and nighttime inpatient services."

His goal is to improve his hospital quality of care during the nighttime hours.

Dr. Shulkin writes:

"The consequences of service deficiencies during off-hours include higher mortality and readmission rates, more surgical complications, and more medical errors."

He feels that his midnight rounds were proving a good way to help him understand and address concerns of off-hours staff.

"In order to identify problems and design effective solutions, it is critical to gather such front-line information, and to do so, senior hospital administrators need to see firsthand the working of the "other hospital". I strongly encourage my counterparts else-where to conduct at least 1 week's worth of night rounds each quarter."

"Close attention should be paid to the needs of patients and their families, any procedural and communications issues among staff members, and most important, the quality of dialogue between administration and staff members regarding the organizatiion's inpatient service and safety priorities."

Keith probably needs to read this NEJM article.


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May 14, 2006

In this weeks New England Journal of Medicine, George Annas wrote an article, "The Patients Right to Safety--Improving the Quality of Care through Litigation against Hospitals.

Annas reports, "...safety must be an explicit organizational goal that is demonstrated by clear organizational leadership...This process begins when boards of directors demonstrate their commitment to this objective by regular, close oversight of the safety of the institutuions that they shepherd."

He continues,"...(hospital) safety cannot become an institutional priority without more sustained and powerful pressure on hospital boards and leaders---pressure that must come from outside the health industry. In hospital care the challenge is to reform corporate governance to make hospital boards take their responsibility for patient safety at least as seriously as they take the hospital's financial condition."

“The major safety-related reasons for which hospitals have been successfully sued are inadequate nursing staff and inadequate facilities. Since providing a safe environment for patient care is a corporate responsibility, understaffing is corporate negligence. “

In 1991, for example the Pennsylvania Supreme Court stated simply, “Corporate negligence is a doctrine under which the hospital is liable if it fails to uphold the proper standard of care owed the patient, which is to ensure the patient’s safety and well-being while at the hospital.”

During one of my first conversations with Keith Steffen, I told him I was worried about “institutional malpractice” at OSF. He asked me to define what that meant and I remember replying that he would understand the concept better than I would. He did not reply further. I thought that too many patients were being kept for long periods of time in the ER in 2001 to their detriment. I realize that Mr. Steffen is a small player in the entire scheme and agree with Annas and the New England Journal of Medicine that the Board of Directors at OSF needs to play a bigger role in guaranteeing safety of patients at OSF.

Keith Steffen and the Apostolic Christian Community

Keith And The Apostolic Christian Community

The only reason I bring up this topic is because Keith Steffen talked about them so much in his office with me, he seemed to be fixated on the Apostolic Christian community in the area. Keith is an Apostolic Christian as well.

During one of my initial “conversations” with Keith, he smiled, looked down, and told me that the “Apostolic Christians in the area have a problem with you”. He never told me what this meant but would add that the “other side of you is going to come it won’t be good”. He never explained this either. I asked him what he meant by these statements and Keith would just smile, shake his head, shift his feet, and look down at the floor in his office.

I have known many Apostolic Christian (AC )nurses around the OSF medical center for 25 years. Many are close friends. I ate dinner with them in their homes, took care of their family members, and they took care of my family as well with any needs we had. They universally showed empathy for their patients. The closeness of their families and the sincerity of their church and community is remarkable—something that all faiths should try and achieve. When a Haitian child died in the Peoria area, the Roanoke Funeral Home conducted the services, the Roanoke AC church was filled with white, middle class church goers, the Haitian child lay in a casket that was nicer than her home in Haiti, and her Haitian mom and sister were flown to the States to be with her during her last days. The dead child's mom and sister sat in the first pew as the AC community supported them with tears in their eyes. One had to be there to see the best side of the U.S. showing its support for their Haitian neighbors who have nothing but God in their corner.

Anne is a great friend of mine and an AC nurse at OSF. She travelled to Haiti many times and worked in our clinics there. Haitian Hearts and its children could not have survived without her. She took care of kids with heart problems in Haiti, arranged their travel, found host families in the Peoria area, took care of kids in her home, helped with the kids in the hospital, took care of them postoperatively, and took them back to Haiti to their parents. She helped raise funds ($1.1 million) for Haitian Hearts that all went to Childrens Hospital of Illinois. She gave talks all over the area for Haitian Hearts and Children’s Hospital. Her brother adopted a baby from Haiti who had heart surgery. Her entire family was involved with Haitian kids. Anne never complained about her incredible work load.

Through Anne and the host families from her church, I met many Apostolic Christian families who hosted Haitian children in their homes. The kids were part of their families and in their Christmas pictures. These families spent many agonizing days in the OSF-ICU with these kids after surgery. They took the kids on vacation with them when they were better. They travelled back to Haiti with me and gave the kids back to their biologic Haitian moms and saw the shacks and slums where these kids lived. They built new homes for the families and sent the Haitian kids to school. Great things happened with these relationships that Steffen was trying to destroy. Why Steffen would say that the “Haitian kids make me want to puke” remains problematic for these host families and for all of us involved in the care of these kids.

Steffen talked to members of the AC community about me at his church in Washington prior to firing me. (He denied this to my brother.) I took the liberty of talking to Steffen’s elder (Ron Messner) about the problem. I requested a meeting with the elder, Keith, and another AC member of the community who had travelled to Haiti with me many times. I thought that OSF’s administrator needed a good talking to by his elder. The elder agreed but when I was leaving his office, he told me he would “never see me again”. I e-mailed Steffen to tell him the good news of a meeting that would foster open and honest communication, a mission statement at OSF that Steffen constantly referred to. Steffen sent my request to OSF attorney, Doug Marshall, who stated that Steffen would not be part of this meeting. Just like the elder predicted. I don’t blame OSF for not wanting him to be there. He might talk again. (Neither the Apostolic Christian Church nor the Roman Catholic Church would be able to control the powerful leaders at OSF.)

Prior to Steffen firing me, he met with a couple of nurses in the medical center who happened to be AC. He said very bad things about me and threatened to sue one of the nurses who was supporting me. From my understanding, ACs don’t sue. What was Steffen thinking? Did he not agree with this religious principle of the AC church? Was he trying very hard to intimidate this nurse who had would do more real work for the Sister’s mission in one day than Steffen every did? Another nurse who is not AC told me that Steffen referred to the nursing staff at OSF as “widgets”. She did not view this as complimentary. And when the some of the nursing staff were considering unionizing a couple of years ago, Steffen came out with a diatribe about the nurses threatening them not to unionize at OSF. (A friend of mine’s wife was a nurse at OSF and was asked my management nurses if she was going to sign the petition to unionize…maybe a little intimidation and fear were being used…) Steffen told me in his office that if any nurse wanted to leave OSF, this was fine with him. But at the same time, OSF was raiding the Phillipines for foreign nurses to try and help fill the nursing shortage that plagues OSF as it does other medical centers in the United States. Referring to OSF nurses as “widgets” seems quite inappropriate with or without a nursing shortage.

I agree with Steffen’s suggestion that much of the AC community did have a problem with an OSF employee. However, that employee wasn’t me.
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June 3, 2006

The nurses in the OSF ER were very discontent with how things were going in 2001. Employee satisfaction in the ER was poor. I knew how Keith Steffen treated a nurse, spoke of nurses, told me that it was fine with him if nurses left OSF, and strongly discouraged a nursing union at OSF, so it did not surprise me to learn that OSF was traveling to the Philippines to recruit nurses. As doctors and most administrators know, nurses make or break a hospital.

The New York Times ran an article on May 24, 2006 “U.S. Plan to Lure Nurses May Hurt Poor Nations”. The article stated:

“Public health experts in poor countries, told abut the proposal in recent days (the proposal to allow foreign nurses to immigrate easily to the United States), reacted with dismay and outrage, coupled with doubts that their nurses would resist the magnetic pull of the United States, which sits at the pinnacle of the global labor market for nurses...

Removing the immigration cap, they said, would particularly hit the Philippines, which sends more nurses to the United States than any other county, at least several thousand a year. Health care has deteriorated there in recent years as tens of thousands of nurses have moved abroad.

“The Filipino people will suffer because the U.S. will get all our trained nurses,” said George Cordero, president of the Philippine Nurse Association. “But what can we do?”

Dr. Jaime Galvez Tan, a medical professor at the University of the Philippines stated, “...the flight of (Filipino) nurses had a corrosive effect on health care. Most Filipinos died without medical attention in 2003, just as they had three decades earlier. Tan went on to say, “I plead for justice. There has to be give and take, not just take, take, take, by the United States.”

As stated in the article, providing appropriations for domestic nursing programs would be morally much more acceptable than bleeding the nursing work force in the developing world.

OSF, are you listening? Joe Piccione and Dr. McShane, where are you? This seems like a topic that Bishop Jenky should involve himself in quickly to help protect the people of the Philippines from the tactics of OSF in Peoria.
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June 14, 2006

Poaching Nurses

The Lancet medical journal June 3, 2006 contains an article “Poaching Nurses from the Developing World”.

The article gives grim statistics. The American Hospital Association reports that here are 118,000 current vacancies of qualified nurses in the U.S. Nursing schools in the U.S. do not have sufficient staff and 32,000 students were refused entry into Baccalaureate level nursing programs in 2005.

Developed countries have long looked upon the developing world as a nearly limitless source of willing labor to fill the nursing shortage. 50,000 nurses have immigrated to the US in the last decade. Most of the countries from which these nurses come are facing extremely serious public-health problems, including epidemics of HIV/AIDS, malaria, and tuberculosis. These are the same problems we see in Haiti everyday. Haiti and the rest of the developing world cannot afford to lose these nurses who frequently manage an entire ward of a hospital when there is no doctor available.

The Lancet reports, “Only 10% of the global burden of disease is concentrated in the Americas, but 37% of all health professionals work there”. A UN report reinforces that this brain drain of health workers is effectively subsiding care in the rich world. Clearly, further migration of workers will be disastrous for developing countries.

OSF-SFMC in Peoria and other large medical centers in the U.S. that attempt to lure nurses from their dirt-poor home countries should realize what they are doing. Diana Mason, editor of the American Journal of Nursing, said the main problem here is the “primary moral issue of draining these countries of their much-needed nursing resources and further undermine their healthcare infrastructure and the health of their people (and thus of their economies).” Mason states that a recent report by the Institute for Women’s Policy Research suggests that the nursing shortage continues as a result of collusion among hospital administrators to keep wages down and of longstanding gender-based wage discrimination. Can you believe it?

According to Lancet, the U.S. Congress should be creating ways to fund and strengthen the nursing infrastructure in the US, thereby developing a local workforce. Nursing salaries could rise and the poaching of nurses from the developing world would no longer be necessary. And most importantly, patients in the Philippines, Africa, and Haiti wouldn’t lie in their hospital beds without care.

Conversations with George

Conversations With George

Dr.George Hevesy became Director of the OSF-ED on August 1, 2001. He replaced Dr. Rick Miller. Two other attending physicians "ran" against George as ED physicians voted over the phone. Sue Wozniak was given the phone vote and George was made Director of the Emergency Department at OSF. Business would continue as usual.

I wrote my letter to Keith Steffen, Administrator of OSF-SFMC, on September 27, 2001 detailing my concerns regarding bed capacity at OSF and long waiting times for patients in the ER. George put me on probabation the next day and said I would no longer see patients in the main ER starting November 1.

On October 5 and November 9 I met with George in his office. The following notes are from both meetings:

George stated that he agreed with the content of my letter. He did not agree that I had gone outside of communication channels. He also that the emergency department lacked a leader for the last one and one-half years (Rick Miller). He said he would be frustrated also. I wrote directly to the head of the hospital because I did not think George would really do much with my complaints and “bed capapcity” at OSF was an issue for administration.

George told me that all I needed to do to get back into the main emergency room was to see Dr. Richard Lee who was in charge of the Wellness Committee at OSF because I was “burned out”. His original letter, of course, had not mentioned this. My whole future flashed in front of my eyes when George said this. I could see what was going to happen. An attending physician in the ER had questioned George and Rick Miller that if they thought I was really burned out, why were they letting me continue to work in the main ER until November 1. George came to his senses and realized he should be consistent and moved me to Prompt Care shifts after my colleague made that observation. (The real issue was that George did not want to have to change the work schedule because the other attendings would be quite upset with him.) So I started 10 hour Prompt Care shifts in October and worked more hours than any other attending physician in the department until I was fired in December.

Interestingly, at a prior Emergency Department staff meeting directed by George in August, he told the entire room of physicians that “we are all crispy critters”. This meant that we were all burned out with the dysfunctional emergency room that was overcrowded, noisy, with lengthy patient waiting times and very sick patients. He scolded four physicans for their treatment of nurses and the language that was used against one nurse by a physician. When I asked George if all the physicians in the department were going to have to see Dr. Lee, he replied, “of course not”. I told George that his measures against me were very punitive in nature and were slapping the messenger because of the message. On November 11, when I asked George twice to give me examples that showed I was burned out, he shook his head and gave no examples whatsoever.

What most people did not know, were the conversations that I and others were having with Keith Steffen upstairs. Steffen was saying to me “when this comes out about you, this won’t be good.” He was telling others the same and that “John Carroll has done bad things” and that “John Carroll is a bad person”. He told my brother ‘there is a side of John that you don’t know”. Steffen would not tell me what he was talking about. He was talking to people in his church and to various community leaders about me. Steffen even told me that if I saw Dr. Lee, there would still be “some baggage”. A number of my physician partners told me they would see Dr. Lee also, if I would, so I could retain my job. My partners did not want to see me fired. They were not aware of the seeds of doubt that Steffen was creating in the community at OSF and outside the medical center. I was trapped and the witch hunt was going full force.

(Interestingly, I talked to Dr. Lee on the phone. I have known him for greater than 20 years. He told he that Rick Miller had talked to him about me in the summer and Dr. Lee told Miller to “handle it in the department”. He could see no good reason for the referral.)

I continued to work my shifts and take care of Haitian Hearts patients in the hospital. Steffen told me he would fire me if I had not seen Dr. Lee by December 11, 2001. I travelled to New Orleans that day with Paul Kramer. As the plane took off from the Peoria airport, I looked at my watch and it was 11:10 AM. I told Paul, “I just got fired…” Paul didn’t say much. I gave a speech to the National Business Aviation Association for OSF Childrens Hospital and Haitian Hearts the next day to 1,000 private jet owners regarding the good work being done in Peoria. August Busch III was the keynote speaker.

When I got back in Peoria, Keith sent for me. I went in to his office and asked him if he fired me while I was in New Orleans. He said he had not because “I was trying to raise money for Childrens Hospital with my speech in New Orleans regarding Haitian Hearts and Children's Hospital of Illinois”.

While I was seeing patients in Prompt Care at OSF in the morning on December 18, Hevesy came to the area and said that Steffen wanted to see us. I passed a colleague of mine walking down the hall who had been called in to work for me. He nodded. I knew what was going to happen. As we walked down the main hall near administration, Sister Canisia was putting up Christmas decorations. Hevesy said, “Good morning, Sister.” She didn’t even look up at him.

In the administrative office was OSF’s attorney Doug Marshall, Dr. Tim Miller, George, and of course Keith. They all looked so serious and solemn as they sat on Keith’s couch like good little soldiers. Keith’s bible was in its usual prominent location. Interestingly, Keith was not shuffling his feet nervously, smiling at the floor and saying “another side of me is going to come out.” Keith handed me a two page letter firing me from the medical center that I loved so much. I was fired because I did not see Dr. Lee as George had demanded. Not doing what Hevesy and Steffen demanded was the best move I ever made. It took a total of about 3 minutes to let me go after 21 great years at the hospital I loved.

Keith asked me if I had any questions. I had many, but it was too late. Steffen told me that I needed to leave the hosptial then. I picked up my stethescope and brief case from Prompt Care, a nurse hugged me, and I was gone.

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Letters from Dr. Gene Couri and Dr. Sonja Simenauer:


October 3,2001
George Hevesy M.D. OSF/SFMC
Dear George,

After reading John's letter, and finding out your response I felt it imperative to write you as your friend and your employee as to how this will affect our group and most of all our patients. I have known John for 17 years, share few common bonds with him outside of work, and have an incredible admiration and respect for him as a fellow physician and human. In these times of frustration, and chaos it is easy to see those particular points about someone that are irritating to us. John like all of us does not break this rule, but those things that are sometimes irritating are also his greatest assets.

A dedication to his patients needs that exceeds the distractions about him. When I work with John I have learned the importance of attention to the individual patient. Patient's medical needs are addressed with a focused comprehensive history, physical, and appropriate lab evaluation. No matter how busy, how chaotic, John will not saaifice this standard to the distractions of the ED.

A dedication to the art, and science of medicine. I have always admired John's discipline for furthering his knowledge base and frequently in adult and pediatric patients I tap this knowledge base on line. It had been frustrating and intimidating to work with someone like this as the residents staffed with him, and gave him the teaching awards. This had challenged me to work harder, read more, and hopefully teach in a better fashion.

A dedication to the mission of OSF. What can be said about a man who forsakes having children, and dedicates the vast majority of his time and money to saving the lives of someone else's impoverished children? These actions certainly remind us of what we should be doing, or at least helping with, and yet we are not pushed by John only self reminded of our shortcomings.

A dedication to the search and revelatim of the truth. This by far is John's greatest asset that defines who he is, and at the same time his greatest liability. My interactions with John have not always been pleasant, but have always been truthful and from his heart. John could certainly be more tactful or politically correct but truth to him is either black or white, and unfortunately he has not learned shades of gray.

George it certainly has appeared that in the past few years we have been pushing John out the door. His academic hours have vanished, his colleagues are afraid to agree or associate with him as he has not been politically correct, and the new nursing statff has brought preconceived prejudices to the ED. I was certainly hoping that your handling of our most valuable asset to the group would be done with patience and wisdom realizing what John brings to our ED. I understand there needs to be order in our group, and hope that this problem can be resolved as rapidly as possible to bring John back to our ED. I know it was not your intention, but by letting our most outspoken member go you send an all too familiar message to us all. Our worth should not be determined by our ability to "get along", but to serve our patients and the mission of Saint Francis. The integrity of our work should be determined by how much we are willing to personally sacrifice for our worth in our job.

John has put his job on the line for what he believes is the best interest of our patients. Life in our group would be easier without John, just as our life would be easier without a conscious. John represents the "Gold Standard" of an OSF employee, and I truly believe you have the ability to use this for our groups' benefit.

George our group needs to make a radical change, no more of the old smoke and mirrors, but a clear . delineation of what we need to do for our patients, you/our administration, and our hospital. We as your employees need to be rewarded for making the difficult choices and self-sacrifice, and politics as we once knew it needs to go away.

Thanks George,

Gene Couri



Sonya D. Simenauerer,D.D.S., M.D.
PROCTOR PROFESSIONAL BUILDING 5401 N. Knoxville Avenue Peoria, Illinois 61614 Telephone: (309) 692-1496

November 2, 2001
Dear Mr. Steffen:


I was shocked to learn of the loss of Dr. John Carroll in the emergency room. He is a wonderful addition to St. Francis Hospital and one of the best pediatric ER doctors. He has displayed great dedication to the needy children of Haiti and brought credit to your hospital.

Above all when my father was in a coma at St. Francis ICU, he stopped by everyday to comfort me even though he was not involved in my father's care.

I have directed all of my patients to go to St. Francis ER because of the good care that your doctors, like Dr. Carroll, give to my patients. His reputation, commitment, and dedication to others is an asset to your hospital.

Thanks for your time,

Sonya D. Simenauer, D.D.S., M.D.

(After Dr. Simenauer wrote this letter to Mr. Steffen, Dr. Hevesy called her and was very upset with her for writing this letter of support for me.)

Tuesday, March 14, 2006

Conflict of Interest

Conflict of Interest

During the fall of 2001 many people told me that Dr. George Hevesy was receiving a salary from Advanced Medical Transport (AMT). This seemed unbelievable to me. They usually followed up their statements with, “You know this is conflict of interest”. Another physician in the OSF ER screamed at me in anger about Hevesy’s conflict.

Hevesy was wearing many hats. He was the newly appointed Director of the ER at OSF and had been the Project Medical Director (PMD), for about 10 years. As PMD he was in charge of all the ambulances in central Illinois—approximately 70 agencies. Hevesy was (and is) Corporate Medical Director of AMT. The following year, OSF-SFMC would appoint him as President of the Medical Staff at OSF.

I filed under the FOIA at the Illinois Department of Public Health in Springfield for a conflict of interest statement. The document arrived after many months of trying.

Below are some excerpts from the IDPH statement regarding conflict of interest. It is not signed. It begins,

“In accordance with Section 515.320 j Scope of EMS Service, the Peoria Area EMS System is herein notifying the Department of a Stipend received by the EMS Medical Director from an EMS Provider in the System. Specifically, the Peoria Area EMS Medical Director, Dr. George Z. Hevesy, receives a stipend paid by an ALS provider, Advanced Medical Transport of Central Illinois.The stipend is justly provided to the EMS Medical Director for oversight and consultation provided to this comprehensive EMS provider. This EMS provider accounts for the majority of the System’s EMS responses and interfacility transfers. Additionally, this EMS agency provides a unique regional critical care (inter-facility) transfer service under the direct medical control of the EMS Medical Director.

This stipend does not create an agreement or atmosphere which makes the EMS Medical Director answerable to or directed by the EMS provider. Nor has it influenced the Medical Director’s assistance of other providers.

The Peoria Area EMS Medical Advisory Board and the Ambulance Board of Directors, consisting of representatives of the Peoria area hospitals, have reviewed the stipend and believe there is no potential or actual conflict of interest.”
----------------------------

The “EMS provider” stated above is AMT. I wonder what the PFD would say about influencing the medical director’s assistance with regards to the PFD? The Ambulance Board of Directors must be the AMT Board of Directors because there are no other ambulances in Peoria.

This is truly an amazing document. (Please see last post in this blog regarding Doug Marshall's comments regarding PAEMSS and IDPH and the confusion that is created by the statement in the Journal Star that PAEMSS is an arm of IDPH. Doug Marshall is OSF attorney and PAEMSS attorney.)

Locally and nationally, people in EMS told me this represents conflict of interest. Firefighters stated that they “tap their toes nervously” and wait for AMT to arrive when they have a patient with severe breathing problems and are unable to help the patient other than give basic life support, even though the PFD had firefighters with advanced skills (Intermediate and Paramedics). Many firefighters in the Peoria area, told me that Hevesy “obstructed” their departments when they attempted to upgrade their services for their citizens. The municipal fire departments are not paying Hevesy; AMT is. AMT is the only paramedic and transport service in the city of Peoria.

Three are two fundamental ethical premises that guide prehospital medical care. The principle of justice implies that the system be fair and equitable. The principle of beneficence requires that actions and intentions are in the best interest of the patient.

In the April 5, 2005 Annals of Internal Medicine a Position Paper regarding medical ethics stated the following: “The physician must seek to ensure that the medically appropriate level of care takes primacy over financial considerations imposed by the physician’s own practice, investments, or financial arrangements. Trust in the profession is undermined when there is even the appearance of impropriety.”
“…Physicians must be conscious of all potential influences and their actions should be guided by patient best interests and appropriate utilization, not by other factors.”

Do you think this constitutes conflict of interest?

In December 2002, my brother and I met with Monsignor Rohlfs and the Canon Law Lawyer for the Diocese of Peoria, Patricia Gibson. We met with them in Monsignor Rohlfs office. We expressed our concern with the conflict of interest regarding our EMS system as described above. They helped us draft a letter of petition to the OSF Sisters requesting a Catholic tribunal court against OSF because of OSF’s association with AMT and Hevesy.

However, in February of 2003, when I met with Monsignor Rohlfs and Patricia Gibson, they told me that if I pursued a tribunal regarding OSF’s role in this matter, the Diocese would withdraw its support from Haitian Hearts. They also stated that they would blame me in the media for the failure of the program. I was stunned to hear Monsignor Rohlfs say this. The Diocese effectively held the Haitian kids who needed heart surgery hostage to protect OSF from a Church tribunal. This was very hard to accept.

I filed the petition anyway with Bishop Jenky, who refused to consider it. (See his written response below.)

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July 27, 2013

The Peoria Journal Star reported today that Peoria Fire Department Engine 4 will be upgraded to advanced life support and transport.

See this post.

Where are Drs. Hevesy and Miller now? They were not at the press conference.

Conflict of interest in Peoria is rampant regarding EMS.

Will they ever admit they made a mistake? We will see.

John
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November 1, 2013

Hi everyone.

This was posted a couple of days ago regarding physician conflict of interest.




John

OSF-AMT Relationship

OSF-AMT Relationship

On September 27, 2001, I wrote a letter to Keith Steffen, CEO at OSF-SFMC, stating that I thought the bed capacity at OSF was not sufficient for the number of patients we were seeing in the ER. We were just keeping people too long in the ER before getting them upstairs and in their hospital bed. I sent this letter to my ED colleagues and other administrators.

Dr. Hevesy suspended me from the ER the next day, put me on probation for 6 months, and banned me from the main ER at OSF for writing this letter.

In October, I had a meeting with Hevesy in his office. He had been appointed director of the ED on August 1. People warned me that Hevesy was meeting with Andrew Rand in his office, but that didn’t mean much to me at the time. Many people in the area had recently told me that Rand was paying Hevesy for his services and they thought this represented conflict of interest.

I waited outside Hevesy’s office for 15 minutes, until Rand came out. I asked Hevesy why he had me wait while he met with his business partner. Hevesy had no immediate answer.

Why Rand was even allowed on OSF’s campus was questionable. AMT, under his watch, the year before had been fined $2 million for Medicare fraud by the federal government. AMT had been “upcoding”, i.e. charging the patients too much and the taxpayer was footing the bill. But Rand retained his position as director of AMT. This news was downplayed in Peoria and the 3 medical centers in Peoria helped bail AMT out of this financial mess. OSF is the biggest supporter of AMT and has significant interactions with this not-for-profit agency.

AMT grossed over $7 million a few years ago. Several years ago, Rand’s salary was $183,000 and Hevesy’s annual income was over $400,000 per year. But the PFD, who responds to approximately 10,000 health related 911 calls per year collects nothing for their responses.

Unfortunately, in Peoria there is a long history of friction between AMT and the PFD. It’s simply about money.

On May 1, 1996 there was an interesting article in the PJS headlined: “Ambulance Plan Abandoned–Fire Department to Add Defibrillation Program”. The article seems like it could almost have been written yesterday. AMT was worried that the PFD would go into the ambulance and transport business. Rand was worried about AMT. Chief Ernie Russell stated, “When we first started looking at this we had to answer was the service being offered now at a quality that we wanted. We said “no”. We wanted quicker response and the defibrillation ability…”

So what this all meant from my sources was that the decison was made for the PFD to stay at basic level. They couldn’t even give basic drugs and had to wait for AMT to arrive if the PFD was at the scene first for AMT to give advanced drugs and shock the patient. But the firefighters bought their own defibrillators to shock hearts during a cardiac arrest in ‘96 or ‘97. In a PJS editorial that preceeded this article on February 18, 1996, the editors state, “What we have heard is a medical community speaking up in support of AMT…George Hevesy, emergency services director at St. Francis Medical Center, says he fears city-run service would lack the expertise, the funding and the medical supervision to provide a high quality of care.”

This was an amazing statement by Hevesy because he was in charge of all the emergency agencies in central Illinois including the PFD and if the PFD lacked the expertise or lacked the medical supervision, that was Hevesy’s responsibilty. The Journal Star did not report that Hevesy was on AMT’s payroll and that their was obvious conflict of interest.

Where were Hevesy’s statements encouraging the PFD and helping the PFD acquire the life saving defibrillators prior to 1996? The American Heart Association stated in 1992 that all basic units (like the PFD) should be shocking people at the scene of a cardiac arrest. AMT was doing this in 1992, why not the PFD? Patients were being defibrillated at the scene of a pre hospital cardiac arrest since 1967! Where was Hevesy and his boss Rick Miller regarding this in Peoria? Why do the administrators from all three Peoria hospitals come to the City Council meetings over the years when AMT is the topic?

The Journal Star stated everything was fine with the emergency medical services in Peoria in 1996 just like almost everyone is saying in 2005. It is not based on any statistics. It is just a “feeling”. And a fair amount of local business pressure to keep things as they are in Peoria.

What would the public and the PJS say if the PFD were slipping the doctor in charge of all ambulances in Peoria a nice salary? Would that be reported in the media?

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December 30, 2012

Dear Everyone,

Since I posted the above article, two Peoria Fire Department stations are now paramedic. And all firefighters hired in Peoria are now being trained as paramedics.

So these actions seem to fly in the face of what was being stated in the mid-90's by our physicians in charge of EMS in Peoria.

Please see this post from today.

Happy New Year 2013.

John
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February 26, 2013

AMT is trying to take over Chillicothe's ambulance system.





We will see what happens.

John
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June 4, 2013

Good morning, everyone.

The article tweeted below was in the Journal Star this morning.





Have a good day.

John




Emergency Room Overcrowding

Emergency Room Overcrowding

The letter I wrote to Keith Steffen, adminstrator at OSF-SFMC, dated September 27, ‘01, described my thoughts and concerns about the OSF- ER after working an afternoon shift the day before. Elderly patientes signed out and went home because they just didn’t want to wait for a bed in the hospital to open up so they could be admitted. I felt very uneasy signing these sick people out of the ER to go home.

The Annals of Emergency Medicine headline an article in the January, 2000 issue “Overcrowding in the Nation’s Emergency Departments: Complex Causes and Disturbing Effects”. During the 90’s, overcrowding in emergency departments became a national issue. It didn’t just involve OSF in Peoria. The article stated, “ED overcrowding has multiple effects, including placing the patient at risk for poor outcome, prolonged pain and suffering of some patients, long patient waits, patient dissatsifaction, ambulance diversions in some cities, decreased physician productivity, increased frustration among medical staff, and violence….Unless the problem is solved in the near future, the general public may no longer be able to rely on ED’s for quality and timely emergency care, placing the people of this country at risk.”

In my opinion, this described OSF-ER almost perfectly. Thus, when I wrote Steffen my concerns and then met with him for the first time in early October, I had no idea that he would metaphorically refer to me in the meeting as a “cancer in the ER that needs to be cut out before it metastasizes” as well as a “hemorrhage that needs to be stopped before the bleeding gets out of control”. How his medical descriptions of me as a cancer and a hemorrhage related to bed capacity and overcrowding at OSF, remained a mystery to me. He didn’t seem to be focused on the important issues for OSF. He seemed to be focused on the concept of fear amongst employees and finding out from me which nurse started a petition in support of me and the problems I had addressed. And the ER director, George Hevesy, put me on probation for 6 months from working the ER the day after I sent this letter.

Almost a year after Steffen fired me from OSF, an article appeared in the journal “Academic Emergency Medicine”–The Elusive Nature of Quality. It discussed that systems need to change before emergency rooms can change for the better:

“Front line care providers (doctors working in the ER) are the frequent targets of criticism regarding the quality of care, and are often the recipients of the metrics we use to measure quality. These dedicated, skilled, and talented clinicians are often powerless when systems changes are needed, but they are held accountable for their actions within a SYSTEM THAT CANNOT ALLOW SUCCESS.

“The true route to achieving quality begins with an enduring commitment from the highest leaders of the organization, willing to exercise their authority for productive benefit. If the board of trustees and the CEO do not actively support excellence in the ED, enduring improvements are unlikely.

“If the messasge is not loud and clear that the patients in the ED must be served optimally by every service with impact, then mediocrity will be the norm. Responsibility must be properly allocated, which is a task of the leaders. No system is successfull without effective leadership.

“If we accept that the formula for quality begins with leadershhip, then the top of the hospital administration must set the expectations for all critical congributors to the ED.

“The essential element of leadership is strong principle.”

These paragraphs define the situation perfectly, in my opinion. However, Steffen and Hevesy must not believe in their validity based on their punitive actions against someone who pointed out to them the problem that needed their attention. And both Steffen and Hevesy told me that there were serious problems with leadership in the
OSF-ER.

On June 3, ‘05, a tiny article appeared in the Journal Star: “Peoria Hospital Opens New Emergency Unit”:

“OSF-SFMC opened its new $2.4 million Emergency Care Unit on Thursday. The 13-bed facility…will serve as an observation area for patients with chest pain, heart failure and asthma.

Mike Cruz, the assistant director of the OSF-ED stated, “It should help significantly…because of the operational components. This will increase total capacity (for emergencies) by about 30 percent. Given that we haven’t had a new facility recently and there has been a volume increase…it will help”.

Notice that it wasn’t Hevesy or Steffen that made this announcement to the public. This needed to happen years before and “the main campus (downtown OSF) had been ignored” according to Dr. Tim Miller in OSF administration when I met with him in September, 2001, after I had written my letter to Steffen.

In April, 2006 when OSF announced its new 234 million dollar campus renovation, Keith Steffen stated that this would include a "much needed" improvement in the Emergency Room which was built for 32,000 patients but is currently expected to have 62,000 visits in 2006.

Why did Mr. Steffen refer to me as a "cancer in the Emergency Department" when I brought the OSF bed capacity problem to his attention in 2001?

OSF’s leadership definitely is lacking, not based on strong principle, and needs a change.

------

Hi Everyone,

It is October 17, 2011.

I posted this today.

Hope you are well.

John

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Dear Everyone,

Today is December 6, 2012.

Hope you are all ok.

This article is from Annals of Emergency Medicine 2012 and regards how ED overcrowding contributes to patient mortality.

I hope you have a good Christmas and healthy New Year.

John