Ramblings of an Emergency Physician in Texas
He defends Marines and sailors with love and tenacity, protecting them as any Marine would protect a brother-in-arms. He is the epitome of man’s best friend, shielding service members from the enemy while providing companionship and camaraderie. His name is Willy Pete, and he’s a warrior, a protector, a friend. He’s also a dog.
via Michael Yon‘s Twitter feed.
If you needed to find an example of government action designed to make citizenry cynical and disillusioned look no further than this story, from WFAA:
DALLAS — Dallas will keep $2,000 found by a teenager in a parking lot last February.
The money will go into the city’s general fund — not back to Plano high school student Ashley Donaldson, who found the cash in an envelope at the Pavillion Shopping Center in North Dallas.
(The video.)
This after being told she’d get it if nobody claimed it. I found this story on Hot Air, who described it as wall-punching material. They were correct.
So, how much is $2,000 to the city of Dallas? (Hint, their 2010-11 budget is $2,795,393,655 (it’s in the 2011 .pdf file) Two Billion with a B.) 2000/2795393655= 7.15×10-7, or, 0.000000715%
So, you can see they need the money. Certainly means more to the City of Dallas than a 15 year old girl.
An astonishingly unserious look at the budget problem.
Sen. Susan Collins (R-Maine.) said Friday that she will not support the 2012 budget passed by the House last week.
“I don’t happen to support Congressman Ryan’s plan but at least he had the courage to put forth a plan to significantly reduce the debt,” Collins said on “In the Arena” a program on WCSH 6, a local NBC affiliate in Portland, Maine.
…
Collins, who is one of several centrists in the Senate Republican Caucus, did not say specifically what she opposed in the House GOP plan, but she did say that she would like to begin moving the government towards solvency by eliminating ethanol and farm subsidies as well as funding for an extra engine for the F-35 fighter jet.
“There are lots of opportunities to consolidate and save money,” Collins said.
via Collins is first GOP senator to oppose Ryan budget proposal – The Hill’s Floor Action.
I’m not a policy wonk, but I know BS when I hear it.
The Ryan plan proposes to reduce 10 year deficits by 5.8 Trillion, so 580bn/year for 10 years (as an average).
Senator Collins’ proposal: kill off farm subsidies (20bn/yr), Ethanol subsidies (best number I could find was 6bn/year) and kill off the GE ‘second engine’ for the F35 project. I couldn’t find hard numbers for that cost (I suspect there aren’t any that are founded in reality), but found one site that said just futzing with the consideration was costing someone a million a week. Crummy assumption, so let’s say it’s costing that much every day rather than every week. It’s a place to start, so, $365M/year, as a low-ball number, before production. All these numbers may be way, way, off, but let’s use them for illustration.
So, 26.365Bn/yr x 10 years = 263.65 Billion dollars. Which is only 5.537 Trillion short of the Ryan plan goal. Or, to look at it another way, this would knock 4.5% off the Ryan 10 year total. Leaving another 95.5% of the total to be discovered elsewhere.
Perhaps she has a whole lot of consolidating in mind. Maybe she’s going to write a check to cover the balance. Whichever, this statement is politician speak for ‘I’m not going to be the naysayer without a plan, I’m going to point out the things I’d cut as a way of showing I have some ideas, too’. But it’s patronizing when you run the numbers, and discover she’s not the least bit serious.
I’ve been reading about our financial problems, and the idea that we can kill off government checks to NPR and Foreign Aid and we’ll be fine is nuts. It’s not that they’re not worth doing, but it’s such small change that it’s barely even a start. There are no easy answers.
Everyone’s ox gets gored before this gets fixed, and pretending we can cut some fluff or a program that only directly affects a few isn’t serious.
Very neat. Via @CardioNP on Twitter.
3 April 2011. Also: Fukushima Daiichi Nuclear Plant Hi-Res Photos 2:
From a High School friend who went the Navy path, and keeps in touch: RadGuy in West Texas…
My background in nuclear power. I completed 6 years in the US Navy’s nuclear program. I qualified at the Nautilus (S1W) prototype in Idaho, and was assigned for several years to a nuclear power guided missile cruiser. My last year in the Navy was spent planning and performing repair work on submarine, cruiser and carrier nuclear plants. As a civilian, I spent 5 years doing inspection and testing in the engineering department at one of the largest (1250+ megawatts per unit) nuclear plants in the United States. I ended up with a reasonable amount of knowledge enlightened by a great deal of practical experience.
Why is this on a medical blog dealing the Emergency Medicine? The EM system has evolved in a way that the nuclear power industry has not. In EM, many trained technicians have been added over the years; ranging from EMS first responders in the field, to the various techs in-house in most EDs. Having a group of people trained to perform specific tasks not only speeds care, but it allows those dealing with the most serious problems to act with greater focus.
The nuclear power industry has not evolved in a similar manner. An irrational fear of nuclear energy has left power plant operations to be a great mystery, and made outcasts of those who run the plants. This has left us with a very small number of operators run massive plants. Typical coverage might be 4 or 5 operators in the control room, and a similar number out in the plant. In my civilian career, that would be perhaps a dozen per unit, on a two unit site approaching 10,000 acres. Yes, there are more than a thousand other employees, but only around slightly more than 20 on site that are trained and allowed to operate equipment. The high level of engineering and verbatim compliance with written procedures allows this to work. Highly trained people do certain things in a pre-planned certain order.
In Japan we have seen a large, multi unit plant hammered by a huge earthquake and a tsunami. The earthquake was of a severity far beyond what the plant was designed for. All power was lost, and bad things started to happen that could not be coped with by the onsite staff.
The immediate need was for power, and circulating water. A group of trained responders should be available to provide these things from self contained equipment they bring with them. A modern nuclear plant is built on a truly vast scale. Careful modification will be needed so that these crews may begin to provide the needed services without help from the plant operators. The task is to arrive, hook up the needed services, and let the trained plant operator operate the needed equipment inside the plant.
All the equipment should be of a size to be carried in or behind standard size vehicle, say a large pickup or van. The equipment must be self contained, and be simple to operate. These units should be sized to be contained in a large pickup, or towed in a reasonable sized trailer. When needed, they should be suitable for air transport.
A fair standard would be 300 hp class diesel engines, attached respectively to generators, pumps, and air compressors. These should be of a robust but ordinary commercial design. Fuel tanks sized for around 24 hours of operation.
On the plant side, design must allow vital systems to be accessed from outside, with ordinary hand tools. I propose color coded and number steel access plates on the outer walls of various plant buildings. Crews can unbolt the cover plate, expose connections, and hook up the appropriate service.
In Japan, the first need was a power connection for each unit. Assume that first responders begin to arrive around three hours after the initial event. Whether they arrive by road, air, barge or train does not matter. The first units to arrive connect to the first power panel for the assigned unit. This power is not to run plant equipment, but rather to provide power for instrumentation, control and communications. For each unit, this is well within the capacity of a single portable diesel.
Once there is power for communications, and more direct intervention can begin. As additional power units arrive, they can be attached to single plant loads, those deemed most vital at the time. Examples might be a small number of pumps, or even a single large pump. It could be power for a single set of motor operated valves. The power units would be attached under the direction of the operators for each plant. These could be emergency feed pumps, fire pumps, isolated HVAC systems.
Besides power, there may be a need for cooling water. From photographs, it appears the circulating water intake structure in Japan was badly damaged. If the systems are intact, portable power can run some of the pumps. With damage such as occurred in Japan, connections similar to standard dry standpipe fire systems should be provided for in an individual basis for vital loads. This could be heat exchangers for cooling anything from the plant emergency generators, to decay heat removal systems. Single fire engines, or trailer mounted pumps can then provide water for individual loads.
These small interventions will provide time for other needed repairs, and for more trained plant operators, engineers and technicians to arrive. From the available information from Japan, perhaps a dozen such portable units would have allowed things to progress much more slowly. Indeed, with timely intervention and a bit of luck fission products would not have been released.
It is time to accept nuclear power as a part of daily life. The communities that use the power from these plants can also provide support in emergencies. Truly, we are all in this together.
Okay, I’ve been passively watching, safe in my relative geography. Then today I read that there are TWO Fukushima nuclear plants.
It’s F1 that’s having all the problems, reportedly F2 is shut down and cooling off.
When I’m confused about geography, my current go-to is Google Earth.
So:
There are two Fukushima nuclear plants, you ask?
AUSTIN — Texas medical regulators on Friday placed on probation a West Texas doctor involved in the unsuccessful prosecution of two nurses who complained anonymously that the physician was unethical and risking patients’ health.
The Texas Medical Board technically suspended Dr. Rolando G. Arafiles Jr. but allowed him to continue to practice medicine while on probation for four years if he completes additional training.
via Physician who had nurses prosecuted is placed on probation | State | News from Fort Wort….
Ugh.
Welcome to the Donation Page of
Kate Schickedanz
Join me in my efforts to support Tragedy Assistance Program for Survivors (TAPS)!
On March 27, 2011, I will be participating in the Dallas Rock ‘N Roll Half Marathon in support of the Tragedy Assistance Program for Survivors (TAPS). TAPS provides direct support to families who have been impacted by a death in the military regardless of geography or circumstance.
via FY11 Team Run & Remember Rock ‘N Roll Dallas Half Marathon – General Donation.
I wrote about her late husband, an ED Nurse colleague, after his untimely death here. I’m glad Kate is helping others, and TAPS sounds like a terrific program.
I gave to her goal, and hope you’ll consider doing the same.
I’m in one of those phases where feeding the blog is a) not a priority and b) a potential liability, so it’s one of those things.
It’s not that I don’t like all 9 of you readers, I do. It’s just that with the repeal of the 24 hour day I have less time to get work/family/TV/CME/all that other stuff in. 2/3 of my kids have been home for a while, it’s been terrific, and tomorrow I go down to 1/3, keeping the lawyer. Go ahead, tick me off, and find out what having a temporarily unemployed lawyer at the other end of a complaint feels like. He’d like me to tell you that’s a joke, so it is, because he says it is. That’s what a decent legal education gets you.
My medical practice is smooth, and I’ve given a couple of talks to groups recently, so that’s fun. I talked for medical CME about whether non-contrast of the abdomen is ready for ED use (short version, no), and it was decently well received; yesterday I spoke to a nursing CME conference, ditto.
If you’re an ED doc and you haven’t at least looked at how to manage patients who come to your ED with a ventricular assist device, catch up. They are no longer locked up in the CCU, they’re now being sent home with them. This wouldn’t be a problem except they break a lot of rules… like no CPR if pulseless, etc, and some of these are designed to be pulseless. You can see the problem.
As for the liability, I’m getting more leadership/responsibility roles, but middle management types can’t blog those. Paul Levy can, as a CEO, but nobody in the middle can, and it makes sense to me. Lacking amazing stories of management (and I wonder if there are any), nada to blog about. Hold your breath for the reports from my addition to the hospital Bylaws Committee. Yeah, crazy stuff.
On a professional note, I’d like to alert all me ED colleagues that apparently a) jeans are no longer pre-washed before sale b) adolescent females don’t wash them before wear, and c) you’ll see patients in the ED with inexplicably warm yet blue extremities. Connect the dots, win a prize. I’ve picked up 3 of these recently (that have seen other docs who haven’t connected the dots), and have added alcohol-preps to my skin exam in select cases. Awkward diagnosis, and rewarding. (The key is warm, blue extremities but the skin discoloration skips the ‘between the digits’ areas).
I’ll be here. Thanks for checking in.
Ace of Spades HQ has a nice salute to them.
They were murdered (minimally allegedly) by a Physician who should be on trial for Treason as well as murder.
Respect and condolences to the families of those murdered, thank you for their service.
BAKERSFIELD, Calif. (AP) – A doctor involved in an “on-again, off-again” relationship apparently tried to force her way into her boyfriend’s home by sliding down the chimney, police said Tuesday. Her decomposing body was found there three days later.
Awful.
Two nurses in Kermit, Winkler County, Texas felt a Physician had done wrong, and did their duty (which is protected), under the law: they reported the doctor to the State Medical Board.
Then, things got bad, but not like any sane person would think. The nurses were eventually charged in Criminal Court for “Misuse of official information“, the flimsiest of pretexts to punish them for their whistleblowing, which the Texas Medical Board said was both good and correct.
This mattered not, and they were forced to go to trial to defend themselves from imprisonment; They were very quickly found not guilty, then came the civil suit, which catches us up for today’s addition to the story…
First, imagine keeping your job as Hospital Administrator after this kind of public derision. No, it doesn’t end as you’d expect:
Via CBS 7:
A week after it was posted at the Winkler County Courthouse that Winkler County Memorial Hospital Administrator, Stan Wiley, would announce his resignation, he changed his mind.
In what board member, John Walton, is calling “the shortest meeting in the board’s history”, Wiley did not resign.
The resignation was put before the board members as a motion.
John Walton seconded the motion to “accept Wiley’s resignation” but none of the other board members did so.
Wiley then acted as if this were a dramatic show of support and decided to not resign.
Quite the vote of confidence…
That was on August 10th, by the way, the same day, again from CBS 7:
After their original concerns about Dr. Rolando Arafiles were substantiated by a state fine levied against Winkler County Memorial Hospital and an official complaint lodged against the Dr., the “Winkler County Nurses” were “compensated” today for their damages.
The nurses will split a nearly $1,000,000 settlement but nurse Anne Mitchell says this case was never about any money.
Vickilyn Galle and Anne Mitchell believed their anonymous report to the state in 2008 would be just that: anonymous (as is prescribed by nurse reporting laws).
There’s no way they could have predicted that standing up for patients’ rights would get them arrested, then prosecuted, then vindicated and now, more than two years later, leave them hard pressed to find a nursing job.
The four Winkler County Commissioners voted unanimously Tuesday afternoon, to settle the civil suit filed against the county and numerous other defendants.
The move means they are agreeing to pay $750,000 dollars to nurses, Anne Mitchell and Vickilyn Galle.
The county only has to pay $150K, the rest is covered by a risk management pool, which appears to be how Texas Counties self-insure.
I’d like to have seen the trial on this. It’s not enough for two nurses who will have to move a long way to even possibly continue their careers, and the behavior of the Sheriff and Prosecutor in all this is bafflingly ugly.
The lesson? 1) Don’t live in Winkler County, their public decision-making seems atrocious on every level and 2) if you’re going to report someone anonymously, don’t do it from a County owned computer, lest it be ‘investigated’. (Feel free to add your lesson in the comments, but I’m not interested in getting sued, so let’s not libel anyone, shall we?).
HT to Glenn, my West Texas news connection.
Remember this? The Chair of the Arkansas Medical Board being critically injured with a car bomb?
A multi-disciplined physician is on trial for the crime:
LITTLE ROCK – The Arkansas Medical Board chairman, his face scarred and embedded with bits of tire, testified Wednesday that he lost an eye, his sense of smell, teeth and some hearing when a bomb went off in his driveway.
Dr. Trent Pierce testified against Dr. Randeep Mann, who prosecutors say planned the attack as retaliation for the medical board taking away his license to write prescriptions. Pierce took the stand after a jail inmate told jurors Mann had offered him $50,000 to kill Pierce to keep him from testifying.
Wow. I’m glad he pulled through. And I wonder at the (alleged) depravity of those who should have insight.
HT: Glenn
Update: I’m informed by the informative Ramona that neither physician is from Little Rock, actually. (I thought that due to the by line of the original article). So, Non-Little Rock (Big Rock?) docs…
