Wednesday, April 30, 2008

The Saga of a Hospital Closing Part 2

The minute that doctor had opened his mouth, we all knew that the opportunity for any cooperation between the Board and Staff was lost.

At that point without hesitation a member of the Board of Governors jumped up almost hitting the ceiling and very apoplectically said this meeting is over, He not only was on the board of the bank that had underwritten most of the loans to the hospital, but was also one of the political bosses in Somerset County, thus a power in the state Republican Party. His political impact would ultimately determine the fate of the Hospital.

Although there would be no future talks, the entire staff continued to use the Hospital for selected patients. For most physicians that created no problem, since our surgical patients were referred to surgeons in our primary institutions.

Soon after that episode, all four quality members of the medical executive committee resigned. Their replacements were second rate at best.

The successor Radiologist had been fired from his Philadelphia Hospital, and there were X-rays that were misread. I was reluctant to trust his reports.
The Pathologist was adequate but did not compare either in personality or person with his predecessor.

The new Chief of Staff, an internist, had been associated with one of the New Brunswick Hospital as Director of Medicine, and supposedly was not popular with its staff. He was a very bigoted individual who stated that he would never have “any foreign legion”(meaning Korean or Indian doctors) in HIS hospital.

A good community hospital had become not only an uncomfortable but also an unsafe place to practice.

After the new Chief of Staff arrived, both the Obstetrician and I were called before the Board of Governors for a hearing, prior to removing our privileges.

I thought I was innovative by appearing with my attorney and a tape recorder which we placed on the center of the table and turned it on. Initially the lawyer on their Board sputtered about the recorder, but yielded to our insisting on having a record of the meeting. The hearing was brief and terminated without action or comment.

The next day I learned that the other doctor, at his conference with them the day before, had upstaged me by appearing not only with his attorney but also with a court stenographer to record his meeting.Incidentally, we had not communicated with each other prior to the hearings

Fortunately all members of the “Volunteer Medical Staff” could admit patients to other area hospitals. Confidence in the reliable in the interpretations of X-rays was lost and the quality of some labratory procedures seemed to be diminished. Therefore, most physicians proceeded to admit all but emergency cases to their primary institution.

The patient census fell below 50%. What was never publicized was to all intents and purposes for the first time, to my knowledge; physicians had literally boycotted a hospital. No hospital can survive with an occupancy rate below 70%. (See JFK's occupancy rate in its CN application). This ultimately ended with the hospital becoming bankrupt.

There were three exceptions. When the original cardiologist left, two young internists in partnership in Warren were awarded the EKG concession. They felt they could not afford to give up the hospital. However, when the Medical School assumed the operations these two joined Muhlenberg’ staff.

One primary care physician who had had his privileges suspended or revoke at St. Peters in New Brunswick and at Somerset Hospital accounted for almost 90% of admissions after the others had independently ceased using Raritan Valley. He was acceptable to the Medical School faculty since he referred all of his in patients.

Because of, the political influence on the hospital board, the State persuaded the Rutgers Medical School to abandon its plan to build a teaching hospital adjacent to the medical school. Instead, to convert RVH into its teaching hospital, even though it could not be adequately expanded and was quite a distance from the medical school. The taxpayers had again bailed out a politician’s blunder.

Perhaps the moral of this tale. if any, lies in the fact that in this case the Chairperson of the Governing Board felt that it was his prerogative to make all decisions relating to patient care, and his Board did not honor their fiduciary responsibility.

Similarly, one can surmise that in MRC’s situation, a CEO, whose Board had forgotten that he worked for them not the reverse. has made an decision based on economics rather than community health needs in an attempt to solve financial problems which might have been aggravated by previous operational decisions.

THE SAGA OF A HOSPITAL CLOSING

Three decades ago this area witnessed the closing of another acute care hospital.

This is the tale of the Raritan Valley Hospital, and my intimate involvement.

By the early '60s there had been an extraordinary population explosion within the areas around Plainfield. There was pressure for building a new hospital in Edison and also to replace the antiquated and condemned privately owned Bound Brook Hospital.

Both objectives were completed by the end of the decade. The Edison hospital, JFK, ultimately in 1997 became the controlling partner in a union with Muhlenberg

A group had been formed to build a hospital in Green Brook Township close to Bound Brook. The intent was to able to better serve a large but developing rural area not easily covered by the hospitals in Somerville, Plainfield, New Brunswick, Morristown and Summit. There existed a good road network from the North, East and West of Bound Brook.

Unhappily, for unknown reasons, the new hospital, Raritan Valley Hospital was built on land within the Green Brook flood plane and was restricted to a two-story high building.

I had a substantial practice from the Dunellen and Middlesex area and obtained Staff privileges there in addition to Muhlenberg.

Although I did not like the fact that only a select five full-time employed physicians would have the sole power to act for the medical staff, there were many positive reasons for that choice.

I was particularly impressed with four of the full time doctors, who not only were extremely competent but also decent human beings. In my 45+ years in practice I can remember only a few other Radiologist who I held in as high regard as Raritan Valley’s.

The Internist, a qualified Cardiologist,was a warm and friendly individual who fortunately retained his position at NYU. The Pathologist was most knowledgeable and after leaving this hospital became professor of Pathology at a southern medical school. The Anesthesiologist was extremely competent.

The fifth full time physician, the Chief for Surgery, was not board certified.One of his qualifications was a distant relationship to the Chairman of the Hospital Board. This surgeon’s cases seemed to have an excessive morbidity rate. Also, regrettably, controversial medical care decisions in the "Medical Board” often resulted in a four to one vote, with the one vote being adopted by the Governing Board.

Ultimately, the other four members of the executive committee called for an open but informal staff meeting in the Hospital’s cafeteria to discuss the problem.I attended that meeting out of curiosity.

In the middle of that meeting, the Chairman of the Board entered the meeting room and interrupted the discussion. He said “This meeting is illegal. I will not have a hanging jury destroyed this brilliant young man. You are to leave at once."

The result was that no one left and an ad hoc volunteer medical staff was organized.
A steering committee was formed. Some one said Yood you’re the senior person here (I was in my early 40s so that was a shock, I was getting old) you are going to be our President! An astute Obstetrician from the Bound Brook/ Somerville area was the Vice President and chief motivator. Incidentally he had been born in Plainfield.

For the only time in my medical career, 100 percent of the physicians on the hospital staff contributed $100 to pay for legal action. We employed a lawyer recommended for his hospital expertise. Unfortunately we had little help from the State Society.

We met several times with the Executive Committee of the board and almost had straightened out for the problems when one of our steering committee members, a surgeon who had spent years in the army, unexpectedly spoke up saying "I charge this Board as deliberately trying to sabotage the medical staff."

To be continued

Monday, April 28, 2008

COUNCIL AGENDA SETING SESSION

For information; this can be an informative session where the members discuss and decide upon the Resolutions to presented for action their next business meeting (5/5/08.) Incidentally 5/6/08 Tuesday the public hearing on the granting Solaris a CON to close MRH will be at the High School 6-8 pm

Mr. Baldwin the Executive Director of FAITH, B RICKS and MORTAR .gave a presentation on what this volunteer group since its inception in 1993, has accomplished in the restoration of abandoned or severely dilapidated property. They deserve all the praise that they can get.

One new Resolution is for $60000.00 for the PMUA to remove the unusable concrete sewer pipes from the East 2nd St. debacle and stored in a code violation at their site. I would like to know if the City was compensated by the vendor for extra costs, which I think I once read was $1000000.00, needed to finish the project.

We should be gratified to learn that there will be a major road resurfacing program this year. The RFPs are due to go out on 4/24/08. Expected work should begin in August and be completed by Sept 26. Among the streets are Watchung Ave, Kensington, Netherwood Ave and about ten more.

At the Citizens Participation segment at the end,four speakers addressed the impending MRH closing One requested that the Council members attend the May 6 public hearing and they agreed to have one Councilman probably Harold Gibson its President make a statement for the entire body.

Others talked about the impact upon Plainfielders and one asked them to be proactive and enact a Resolution authorizing the city to seek an injunction in case the CON is granted. There was no reaction to this request. We will see if this Council is truly concerned about Plainfield’s health needs.

For those who may wonder, Ethelred the Unready was not caught with his pants down. The name was given because he was illiterate! Imagine the King of England could not read or write.

THE UNREADY

The penultimate Saxon King of England (or at least part of it) the great-great grandson of Alfred the Great. was known as Ethelred the Unready. He was succeeded by a son Edmund Ironsides who was forced to cede half of the Kingdom to Cnut, King of the Danes.Edmund was murdered by a noble who was hiding in the outhouse pit, and when Eddie came in stabbed him through the rectum.
This rainy morning I feel like Ethelred, Unready, having nothing written and knowing that my hunt, and peck typing takes too much time.I trust that after tonights Council meeting, I will have an inspiration for tomorrow other than the hospital situation.
Therefore there will be no tirade or nostalgia

Sunday, April 27, 2008

TOASTERS and ROADS

During the depression years and for several decades after WWII when the electric toaster, fan, or radio stopped working we took it to the repair shop. Electric motors failure was most often a result of armature failure which was “cured” (a medical term) not by replacing but by rewinding. As we became an affluent society of baby boomers it was easier to throw the appliance out and replace it. With the advent of manufacturing outsourcing this also became much cheaper.

Likewise, potholes were a rarity. Communities constantly maintained their paved roads. Although some were still paved with cobble stones, and minor roads often consisted of a mixture of fine gravel and tar over their dirt base asphalt had become the dominant materiel. During the year whenever possible all cracks in the asphalt were sealed by applying liquid tar. Pavement breaks were completely repaired.

For at least the last two decades no cracks have been tarred. Instead they have remained a source for water contamination and the inevitable formation of pot holes. Street openings are closed with substandard methods the quality of the material used is lower than the original pavement’s. There is no attempt to seal the margins between the patch and the original. Moreover when the road is paved there is little if any attempt mad to seal the joints between adjacent sections. If and when potholes are intermittently cold or hot patched many adjacent pot holes remain untouched.

The problem is not unique to Plainfield for it is certainly State wide. However our Queen City’s roads are far worse than those in any other surrounding community.

Contractors and Utilities that open the road should be mandated to return that area to its original state. If they refuse legal action against them must be taken.

Heavily traveled Leland and Watchung Avenues are not only a civic disgrace but a danger to property and life. There is probably not one street in Plainfield without unrepaired damage. How many times has the city been responsible for damaged tires, wheels or axels?

Many repavement projects have been on the books or contemplated for year s but for various reasons postponed. How many more years will we have to wait before our uncaring or incompetent city government will act?

Perhaps we should outsource our road maintenance.

Saturday, April 26, 2008

Service club meetings; Besides the Park Hotel before 1945, some clubs met and ate a t the restaurant in the Somerset St. wing of the Tepper's store. Rotary and Kiwanis held luch meetings, the Lions met Wednesday nights. Meetings usually lasted about an hour.

SERVICE CLUBS

I have no ax to grind today. Instead on will dwell a little on community service clubs and perhaps some time in the future go into greater detail about Plainfield’s Lions Club.

Civic Service Clubs were a tradition of community involvement in the first half of the 20th century. The membership was drawn from individuals from a universal range of occupations. Often the club rules limited membership to only one person from any particular slot. Membership was by unanimous, less one, vote of the club membership.

In Plainfield there were clubs franchised by the three major international organizations, Rotary, Kiwanis, and Lions, The Lions, the youngest, was chartered in 1921. After WWII both an Optimist and a Frontier clubs were organized.

Regrettably, these clubs were ethnic and religiously bigoted in their selection of members. The Lions Club accepted Jews from its inception. The other two did not until decades after WWII. On the other hand, the Lions was the last to have Afro-American memberships.

To my knowledge, in Plainfield only the Lions and Rotary are still in existence.

Each club met as frequent as weekly for lunch or dinner. The site of their meetings was the Park Hotel until its demise.

Each club had a different community project agenda. I am familiar with that of the Lions. Besides focusing on services for the blind, an international project, Plainfield Lions Club constructed and for many years until the 70s maintained a campsite for use by local area boy scouts and girl scouts. The camp site on the Watchung/ New Providence border was donated by Harvey Rothberg ,a local lawyer.It became useless when its northern portion was absorbed by route 78.

I was a member of the Plainfield Lions club from 1946 for over four decades. During my presidency in 1960-61 we had over 120 members, all actively involved. At one meeting we were honored by Eleanor Roosevelt coming down to our meeting and briefly addressing us

As civil organizations took over many of the projects volunteers did, the service clubs lost their motivation and dwindled away.

Friday, April 25, 2008

CHANNEL 74

I have no words of wisdom (?) to share today.

Instead, I prefer use my blog for comments on yesterday’s Plainfield Today.

The Needler .Dan, is as usual right on target regarding; Channel 74.

The Cable Advisory Commission has failed to act in a positive way for years.Even before Comcast closed its Rock Ave, facility its treatment of Plainfield was high handed.
The use of a Plainfield Public Access channel was at best limited and hap hazard whether this was a inherited problem from the initial McDonough franchise or just Administration and
Council indifference is a moot point. Obviously, the Council and its committee for unknown reasons did not appropriately fulfill its fiduciary responsibility.

There is a significant problem; the Public Access Channel is only open to Comcast subscribers. Since DIRECTV etc does not have to have a franchise agreement it does not provided such service. Verizon provides its service through a statewide franchise. It is not obligated to participate. If I am wrong please advise me. Who has suggestions on how to make such a
channel available to everyone?

An inventory of equipment and supplies and checked against records must be done. If there
has been significant loses that would merit a criminal investigation.

Your suggestion of a city operated blog is a brilliant radical idea. All governmental meeting
schedules and their minutes should be published. This would fulfill the intent of OPMA and
OPRA.

An informed and knowledgeable public is the base of an utopian community

Thursday, April 24, 2008

CANDOR

I once read an old Arabian proverb; “Examine what is said, not him who speaks”.

With that in mind, I am giving my opinion of the following remarks, as reported in the Star Ledger. by Solaris’s CEO, McGee, at Monday’s Plainfield Council meeting in reply to Councilmen’s questions

# Why did Solaris choose to shut Muhlenberg and not its sister hospital, JFK Medical Center in Edison?

McGee's answer: Muhlenberg loses more money than JFK because it takes in more uninsured, undocumented patients and receives dwindling funds from Medicare and Medicaid.

Comment: JFK does not intend to admit uninsured undocumented or Medicaid patients if it can help itself. If Solaris does not have to care for indigent and uninsured patients, it will improve financially. Let Plainfield’s ethnic diversity be damned. .

# Why hadn't some services from JFK been transferred to Muhlenberg to make up for the losses?

McGee's answer: Patients from JFK have been hesitant to seek treatment at Muhlenberg, and many services require state approval, so simply transferring them to another hospital is impossible.

Comment: (A) An elitist’s remark Isn’t prejudice grand? If a needed service was offered only at MH they would go there. Did anyone explore the possibility of converting the patient rooms into single occupancy? That would have blunted some of the bigotry (B) I am sure that a needed service in a health system could get the CON for a simple in system transfer. Muhlenberg’s elective Cardiac Angioplasty service, a profitable operation not available at Kennedy, is one that would need a CON to move. That can’t be granted until after MH closes. Muhlenberg’s Residency Programs are facility approved by the certifying organization and cannot be transferred without appropriate certification. This does not come easily.

# Were uninsured patients -- who hospital officials say accounted for a substantial amount of Muhlenberg's $17 million in losses last year --systematically moved from JFK Medical Center to Plainfield?

McGee's answer: No

Comment: Probably his only bona fide reply. Since Edison is a very affluent community, there are few financially stressed and uninsured who live there and would seek services at JFK. Also it is not too difficult to develop a lack of available beds and thus a need to divert or transfer from the ER.

Wednesday, April 23, 2008

PONDERINGS


Unfortunately I was unable to get a clear image of the copy of the 2006 Solaris officers’ compensation provided yesterday by the “Needler”. However I find elements of Mr. McGee’s $652,000, not including perks most interesting.

60% came from the “The Community Hospital Group, DBA (?) JFK Medical Center’’ I assume it is the parent organization that includes not only the not profit hospital, but also the free standing surgery center, the imaging center, the rehab units and buildings on the other side of James St. etc.

30% comes from the “Muhlenberg Regional Medical Center.” I am not sure if the very profitable Surgery Center in Watchung is included or what other for profit components falls under this umbrella. Certainly the greatest portion of this reimbursement is from the operation of the money losing hospital. How much is attributed to the Nursing and technical schools, as well as rent for the dialysis facility.

About 9% is from the separate for profit facilities such as “assisted living”, the Harwick Nursing Homes Inc, etc.

It would be interesting to know the complete breakdown of Solaris’s balance sheet and of each of its components. I hope they are available before the Commissioner of Health issues the need certificate.

I also wonder if Hartwick in Plainfield is tax exempt. I would think that as a profit enterprise it should be paying its fair share for the access to the community’s facilities.

While I am on that subject, Plainfield for over 3 decades has been the site of most of Union County’s “half way houses” and handicapped residencies. They are not tax payers. Yet use Plainfield resources such as fire protection, police, emergency etc. If like the AARP residency on Knollwood where the fire department seems to respond to at least once a month, they are a drain onn our already strained resources.

Who compensates the city for these costs? Has anyone reviewed the tax exempt or relief rolls for appropriateness in recent years?

Tuesday, April 22, 2008

MUHLENBERG CLOSURE

Post Council Meeting Impressions

The presentations from Solaris officials and Assemblyman Green before a packed court room did little to change the fact that there is no money.

McGee reiterated that Muhlenberg has lost money for years. He stated that JFK (and Solaris) has loaned MH funds to the tune of several million dollars to keep it operational and now JFK was also in poor financial status.

I am naive about corporation finance s, but it seems to me that although big corporations have many units with separate budgets the financial statements are reported as a composite of all operations. Resources are shared through the parent, not borrowed or loaned. Certainly the source of losses as well as profits should be identified and corrective measures taken as needed. Does Solaris have such a financial balance sheet including its for profit components?

Give Green the benefit for trying at this late date to salvage some workable health care plan. However, all the surrounding hospitals together do not seem to have enough resources to make up for the loss of MH. Example JFK can absorb perhaps 500 of the 1100 yearly deliveries. Where will the rest go?? Will we have to have a birthing facility in the MH building? Or build a free standing facility? What will happen to patients in the MH ER who need emergency angioplasty? Will they become a statistic?

The New Jersey Commission on Rationalizing Health Care Resources lists at least 8 issues that should be addressed to determine whether a hospital is essential to maintain access to health care.

1. Whether the services provided by a hospital are available and accessible elsewhere in the hospitals market available. Accessibility is questionable

2. What the impact on residents would be in terms of travel time/distance to access hospital care in the event of the hospitals closure Bad

3. Whether a hospital is part of a hospital system and the resources available le—to support a financially distressed facility a-yes, b –no

4. What public transportation alterations or other solutions are available or would be necessary to maintain access to care in the event of a hospitals closure No satisfactory answer

5. What quality of care and efficiency improvements are possible and necessary in a financially distressed hospital not addressed to date

6. What potential access to care implications would be for (a) particular medical underserved population if a hospital were to close has not been completely and satisfactorily addressed

7. What the potential impact on access to key ambulatory services would be if a hospital ceased to act as an inpatient facility this can be no problem

8. What the impact on employment in the hospital market area would be should a hospital close loss of a minimum of 800 jobs

It would seem that the negatives outweigh the positives to justify closing the hospital except for one thing-MONEY.

(italics are my comments)

Monday, April 21, 2008

NOSTALGIA

Financial Institutions

In the 20s Plainfield boasted six banks in the downtown business area: The Plainfield Trust Co, a state chartered bank on the SW corner of Park and Second, the First National Bank on Front Street facing Park Ave.,The Plainfield National Bank on the south side of Front Street opposite Tepper’s, the State Trust Co. on the NE corner of Park and North Ave.the Plainfield Savings Bank on the SE corner of Park and Front., and the Mid City Trust Company on the NE corner of Watchung and Front, now the site of Payless Shoes.

There were also two savings institutions, not banks. Unlike traditional banks the S&Ls were cooperatives. The depositors were the shareholders proportionate to the value of their accounts. One, the Plainfield Savings and Loan was on the eastern side of the Park Ave block between Front and Second, the other, The Queen City Savings and Loan on the SW corner of Park and Fourth.

In the 1929 crash and subsequent bank failures the Plainfield National Bank failed. Its assets and deposits and Federal Charter were taken over by the Plainfield Trust Company. The Plainfield Trust also helped the First National survive the run on the banks.

Orvis Brothers; a Wall Street Brokerage firm, had a branch office on the same side of Park Ave. as the Plainfield Trust and the Courier News printing plant.


NON SEQUITUR

To zzzz, Thank you for your comment. I do not wish to bore. There were two long items that day and I would like to know if there was any specific problem. I am a novice at this game and your help is appreciated. If I had your email address I would answer you directly. Thanks

MUSE

Watching the telecast of the Pope at Yankee Stadium on Sunday, the first day of Passover, made me reflect on how much we owe our distant ancestors. If there had been no exodus from Egypt, the Israelites would have never evolved the concept of a benevolent forgiving monolithic deity. There would have been no Christianity, no Islam, no Old Testament. Since most humanity can not be agnostic, what gods would we be worshiping now?






Sunday, April 20, 2008

THE HOSPITAL CRISIS AND UNDERPRIVILEDGE HEALTH CARE

In my previous article regarding health care for the underprivileged I alluded to the impact from the Social Security Act of 1965 and especially Title XIX which established Medicaid.
To digress a little we should remember 1965 was an earthshaking year that had tremendous impact on Lyndon B Johnson’s administration. Less we forget t his was the year in which Johnson escalated the military adventure begun by Kennedy in support of South Viet Nam into a major conflict
Not only did that war rapidly become a morass devouring physically and mentally America’s youth. Unfortunately, for various reasons most were members of minority ethnic groups. But the fall out a great and lasting impact not only on the quality of life in this country but also on the United States relationship with the world in general.
1965 was the year of the college campus flag burnings and riots. Nationwide civil unrest exploded in the Selma and Montgomery riots. Malcolm X was assassinated. M martin Luther King led the March on Montgomery Alabama.
Remarkably, Johnson a true son of the bigoted Texas border society had become, for better or worse, one of the leading civic and social reformers in our history. His visionary “The Great Society” was to remake this country and cure its ills’
One action, the Voting Act of 1965 prohibited the use of literacy as a voting qualification. This enfranchised a large portion of the population who had received little education.
For the purpose of this discussion on the deterioration of health care delivery, we must turn to the other great reformation of that year. Which forever changed and in m y opinion for the worse this nation’s health care.
It came about as two amendments to the Social Security Act. Title XVIII became known as Medicare and Title XIX became known as Medicaid. Title XVIII includes Part A, which provides hospital insurance to the aged, and Part B which provides supplemental medical insurance. Title XIX proclaims that at the states discretion, it can finance the health care for individuals who were at or close to the public assistance level.
The Democrat’s solution resulted in Medicaid which was created on July 30, 1965 through Title XIX of the Social Security Act. Although there was provision for federal funding for political reasons the program was not federally administered. Each state was allowed to voluntarily opt into and administer its own Medicaid program. While the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards. The fact is that there is no national standard.
State participation in Medicaid is voluntary; however, all states have participated since 1982.
Certainly this well meaning flawed legislation was a major factor leading to today’s health care financial crisis that has (1) reduced the quality of care, and (2) led to the demise of many hospitals.
Early on enterprising and often unscrupulous entrepreneurs including unfortunately unprincipled physicians established “ health clinics in designated inner city locations, Because the Medicaid reimbursement was free flowing even if inadequate, the clinics prospered for a long period of time. Due to lack of oversight fraud was rampant resulting in a large drain on available funds.
The Hospitals discovered that they could now be paid for both in-patient and out-patient care. Not only could they bill for the institution’s services but also for the professional portion of care. The latter portion was not distributed to the physicians rendering the services but retained in the hospital coffers. Unfortunately many hospitals were also not above questionable billing practices.
Naturally those doctors treating patients in the outpatient setting resented someone else collecting and keeping the proceeds for their work. The doctors actively sought to be able to bill for their services.
The hospitals thinking they had the golden goose began to employ under contract physicians or residents to staff the clinics. And soon began to employ hospital based physicians.
The previous uncompensated services were now a cost item. Obviously the operational costs rapidly increased. The non –profit hospitals had met all deficits through charitable gifts. All produced a yearly budget which often was more illusionary than factual. Few hospitals were able to identify actual costs and often the final budget was just numbers.
Additional operational cost resulted from the paper work needed to meet mandated reports from various governmental agencies. This increased with the advent of the managed health care plans. Moreover, unions found a fertile field among all groups employed in hospitals. All has resulted in a massive increase in hospital operating expenses.
At the same time the federal government supported HMOs appeared on the scene. The big insurance companies as well as fly by night entrepreneurs found the captive patient panels to be cash cows. Traditional commercial health insurance held no clout and was discouraged; by selective bargaining against competitive hospitals the carriers were able to pay sub-minimal amounts for hospital services. In some cases as with Blue Cross and Muhlenberg the carrier would not sign a care contract with a hospital.
Hospitals that provide a disproportion of uncompensated care cannot survive under present conditions. To close them only means that the burden and its negative results will either be shifted to other institutions or those needing health care will not be able to receive it.
There are other factors, involved in the financial crisis that has impacted upon the hospitals; however I will not go into them in detail at this time. I will suggest that the Baby Boomers generation is more materialistic than their parents and charity per se has a low priority. A major source of meeting deficits is lost.
Additionally I am convinced that in this ‘Soprano State” so much tax funds were siphoned off for other agendas that little was left to meet required hospital obligations. Medicaid reimbursement was cut to a level that met only a fraction of the true costs.
Government has created this Frankenstein and it should be up to the state to cure not destroy the victims of its malfeasance.

Saturday, April 19, 2008

HOSPITALS AND HEALTH CARE FOR ALL

Historically charity and the community’s health care had been a local affair. This concept was exceptionally strong in the Northeast. Many municipalities, such as Plainfield, had well organized Welfare and Health Departments.

Hospitals were mostly non-profit, owned by a self perpetuating board of trustees. These institutions were formed by concerned individuals often stimulated by some loc al catastrophe. In Plainfield, Muhlenberg was conceived after a local train accident.

They provided for all, irrespective of ability to pay, a contemporary standard of hospital care. Those who could not afford private care patients were admitted to “ward services”. Services rendered were equal to all.

For ambulatory patients there were also outpatient clinics of all the major specialties. All staffing except for the physicians was the hospital’s responsibility. Funding for these services came from charitable gifts plus grants from the municipalities served by the institution. No one was turned away

Professional services were provided on a “Pro Bono” basis by the doctors as part of their obligation for the right to treat their patients in that hospital. This usually amounted to the equivalent of 3 months or more a year depending on the specialty. The younger physicians manned the outpatient clinics. The older ones treated those patients that were hospitalized. Prior to the 60s most physicians were also general practitioners who practiced all phases of medicine but some became more proficient in various specialties.

On busy "in hospital" services such as Surgery, Medicine, and Pediatrics there were customarily four senior along with at least four junior attending physicians who shared at designated intervals the year round patient care responsibilities.

Where the hospital had an internship program, the physicians on service were their supervisors and teachers. All this was done without compensation. The doctor’s payback came from referrals which routinely went to the senior service member.

All staff members were responsible for emergency room service in their specialty. The emergency room was not used as a walk in medical clinic. The ER was not a substitute for a physician’s office. A doctor or his substitute was expected to be available 24/*7 in an emergency. It was inconceivable to ask a patient to call 911 (which did not exist) or go directly to the ER.

Except for the “interns” who in community hospitals served for one or two years with only being compensated with room and board, there were no paid hospital based doctors.

Under this setup, the costs of providing patient care were shared by professionals, municipalities and the public in general through philanthropic giving. The quality of care was good for all and the institutions could survive.

In other parts of the country, the voluntary health services were not as well established. Therefore well meaning social planners sought an alternate mechanism to assure adequate medical to the under privileged.

Lyndon B Johnson’s administration was one of great social reformation. Their solution resulted in Medicaid, which was created on July 30, 1965 through Title XIX of the Social Security Act. Each state administers its own Medicaid program while the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.

State participation in Medicaid is voluntary; however, all states have participated since 1982

Perhaps this well meaning legislation was the one factor that has led to the health care financial crisis that has (1) reduced the quality of care, and (2) led to the demise of many hospitals.

I shall amplify on that statement in a subsequent posting.

Your comments are desired and most welcomed. I do not wish to post anything that is not of interest. Thank you.

Friday, April 18, 2008

Muhlenberg

No number of public gatherings or letters will changed what has been predetermined years ago. The two public hearings before the Department of Health and Senior Services will be a farce to fulfill pro forma requirements prior to issuing the Certificate of Need for Closure.

Solaris has tipped its hand by dividing the Muhlenberg campus into separate plots.

The Commissioner of Health and Senior Services has remarked that closing Muhlenberg Hospital will strengthen JFK Hospital. It seems irresponsible that one individual or administrative agency should have such absolute control over the populations needs.

I do not believe that our local governments can or will help keeping Muhlenberg open as a functioning full health facility If our representatives cannot find the will to act or give a believable explanation why they did not, we who voted them into power should remember at election time.,

Therefore, I would propose that our elected representatives in the Assembly and State Senate draw up and force passage of legislation that would specifically delineate criteria including among other items ease of access, public transportation community demographics which must be met before a health care facility can be closed. I am sure such legislation will meet Constitutional requirements.

Non-profit hospitals cannot survive under present government and insurance reimbursement schedules. The only solution is for State or even municipality group ownership of hospitals in the so called inner city environment. Unfortunately, the funds needed would have to be raised through taxes, not a political popular item.

Finally, upon the inevitable issuing of the Certificate relating to Muhlenberg, the governing bodies of all municipalities in the Muhlenberg service area should seek an injunction against implementing that certificate.

It is ironic that the Democratic Party which advocates health care for the lower income classes will close a high grade institution to favor one in an affluent community. Nor will its controlled legislature or state administration provide sufficient funding to provide the degree of care that party deems the right of all citizens.

I hope this weekend to write a short article on the history of health care to the underprivileged.


64 YEARS AGO CONTINUED

Holland had been the first daytime airborne operation, but “Varsity”, using the 17th and the British 6th Airborne, was the first (and last) time that gliders landed in an area not previously secured by parachutists.

For the first time the operation called for the use of a double tow of gliders pulled by C46s instead of the customary C47 single tow. My Jeep was in one glider and the medical supply trailer in the adjacent one. Four men plus a pilot and co-pilot were in each.

I rode in the Jeep with my driver and two aid men. About halfway to the drops zone we ran into rough air and were forced to retie the Jeep's restraining ropes. That was difficult since there was little room and we had to lie on the jeep to reach down the sides. When flack appeared below and shrapnel flew around us, I was happy to have the Jeep's steel floor instead of just the glider's plywood floor under me.

Fortunately, we missed our DZ and landed on the wrong far side of the Wessel River. Since the Germans were waiting with 88mm cannon, every one who landed in our designated DZ was killed. One of the two medical officers for the 2nd battalion was a casualty.

The glider came to a stop in a plowed field. Before we could move, or even breathe a sigh of relief, the glider pilot and co-pilot dashed for the cover of the woods, climbing over the Jeep and us and out the door. During “Varsity” (Wessel), the glider pilots were to rendezvous and form a temporary infantry company, instead of heading to the rear ASAP. They defended an important cross road from counter attack.

We lifted the nose and drove the Jeep out of the glider over to the other glider with the trailer. Due to the plowed ground, we had difficultly lifting the nose and pulling the trailer out of the glider.

While we were occupied, a German soldier came out of the woods dangling aluminum anti-radar foil from upraised hands. I could not be sure that he wished to surrender. I told my men to scatter, and to this day, I insist that they "scattered" in a straight line behind me. However, he was a youngster who was overwhelmed by the airborne assaults and had enough of the war.

I had no idea where we were. Nothing resembled what I had studied on the aerial photo maps. I showed the German where we wanted to be. He pointed out where we were; on the wrong side of the river. He agreed to lead us to the river and to a crossing near the farmhouse. Being lazy, I “permitted” him to carry my heavy medical bag and field pack. With my “captive as guide we took off in file, the jeep towing the trailer, supposedly in the direction of the Wessel River.

We reached what look like an overgrown brook and followed a dirt road on the bank for a short distance. Suddenly, we noticed American soldiers lying prone sheltered by the brook’s near bank. It was our A Company whose Captain yelled out “Doc get down. We are in the midst of a fire fight”. However, we had heard no shots, so we went down the bank, waded across the ankle high "river" and up the other side while the Jeep and trailer went over a little bridge. We soon reached our destination, a farmhouse that had been designated for use as our aid station.

Wednesday, April 16, 2008

64 YEARS AGO

Today I have commitments that will prevent me from writing a column. Perhaps I may be egotistical and since on Wednesday eve had not specific ax to grind, I thought I could share in installments a small portion .of "Old Doc’s War".

It has been 64 years and 1 month since the American Armies crossed the Rhine. The majority of us who were there have gone on to greener pastures.

I also plan to publish” Plainfield Nostalgia” on a weekly basis.
OPERATION VARSITY

Montgomery was in command of what was to be the first trans-Rhine advance on German soil. He was amassing a tremendous number of heavy artillery on the west bank. The initial crossing, after the heaviest artillery bombardment and air attack of the war, was to be made by British Commando forces. Simultaneously, as the 17th Airborne seized the crossings over the Wessel River, the British Army and the American 9th Army would cross the Rhine on pontoon bridges to join these forces. “Varsity” was a well planned operation. Unfortunately for Monty, a few days earlier Patton’s forces were able to unexpectedly seize the bridge at Remagen and beat him into Germany proper.

For security purposes, during the third week of March, we moved into what was in effect a concentration camp bordering on an airport outside Paris. The camp was surrounded by two rows of barbed wire with a restricted entrance gate and guarded form the outside by armed soldiers. I think the airport was Le Bourget where Lindberg had landed. There was no entry or exit except by written order. None the less, secrecy had already been breached. The Germans were broadcasting radio warnings that they would be waiting for us, even giving the general location of the Drop Zone.

One day a GI "accidentally" shot himself in the foot while cleaning his rifle”. I had to take him to a hospital in a Paris suburb. The ambulance left the camp headed for Paris. We entered the city through (the names of the 'gates" may be wrong) the Porte de St Michael. At the first intersection, we made a left turn. Upon reaching the next boulevard, we made another left turn and exited the city limits through the Port de Italia and proceeded a few miles to the hospital. That was my first visit to" gay Paree"

Fortunately, after the end of the war in Europe I was temporarily detached from my post with the 82nd in Berlin to serve for 6 weeks as Chief of the Venereal Disease Service in the only American Army Hospital inside Paris.

The morning of the operation, March 24, 1944, the "condemned men” were served a special (last meal) breakfast. Instead of the dried scrambled dehydrated eggs to which we were accustomed, we had all the “fresh” eggs we wanted cooked to order or a small steak. Unfortunately,there was no bacon or sausage. The majority chose the eggs, a real treat.

To be continued .Glider flight and landing.

"OLD DAYS" Pictures

To GB Park, The Plainfield Library has several collections of Plainfield Photos going back to the 19th century. Perhaps they can mount an exhibit or the news media publish selecteded ones.
I wish to thank those who sent comments on my 4/15 posting. It gratifying to know that I have at least three readers. To those who asked questions, I will try to answer as best as possible.
"Anonymous Maria" Your question addresses one of the prime reasons the public should attend Council sessions. During the Agenda Setting work meetings the public has no opportunity to comment except at the end of the meeting. However, at the public business meeting there are several opportunities provided by rules and regulations. Before the Resolutions are acted upon, any member of the public has 3 minutes to comment on any or all Resolutions up for vote, with the exception of those on the "Consent Agenda" which at the work session were placed there because of a so called "non controversial status" and are not available for discussion.
However the Council's rules permit any citizen or Council member to request the removal of any consent resolution to non consent status and thus subject to comments. In my experience these requests have never been denied by a roll call vote.
The resolution I had requested to be moved involved a contract of over $100.000. I just felt that this amount should not be considered routine. Professional contracts can be awarded without bids. Any contract so awarded should be subject to "pay to play" scrutiny.
Regarding pictures of prewar Plainfield; Out of perhaps 2000 prints and slides stashed here and there in our house the only non family pre-war (WWII, was there any other?) ones that I can remember is one of my 7-8 grade accelerated class.
Problems arise from the"Vista" operating system on my new computer. I had no choice and had to dump XP and Office 2004. Microsoft is in retrograde progress.
My first computer was a Kaypro, which I chose because it was portable, almost 30lbs. It used 5" floppy discs and had about 1 mg memory. The operating system was CPM which became extinct when IBM introduced its personal computer using Microsoft's DOS operating system. It was easy, using methods common to OS for even a novice to write or change a program, also the risk was small because the only place anything could be saved was on the floppy.

Today's Courier's Editorial.
It took legislative action to grant Plainfield the means to sack Chief Santiago. I am not sure of the constitutionality of such vindictive legislation. That is for lawyers and the courts to decide. However if it can work in this case , could not legislation be enacted to provide specific pro and con guidelines needed for granting a "Certificate of Need for Closure"?

In the future;
There will be many days when I may have no ax to grind. Therefore there will be no comments or postings. However, I would like to post a frequent perhaps regular intervals vignettes of Plainfield Nostalgia. Most will come from a monograph bio that I wrote at my children's request. It consists of 4 books,titled "The Age of Naivete" (Pre WWII), Old Doc's War'- 50 pages with some photos, "Maturity" post war personal and general subjects, and " Voyages of Discovery"- trips that my wife and I were fortunate to enjoy in our healthy years. Exotic places included Iran and Afghanistan in the early 70s. Is there interest?
Several years ago I gave a copy of "Old Doc's War" to the Plainfield Library. It may be retrievable.

Tuesday, April 15, 2008

PLAINFIELD NOSTALGIA
In the twenties Plainfield possessed three movie theaters, and one other theater that was home to a stock company. Some of its actors became prominent in Hollywood.
In the later part of the decade, the Plainfield Theater was remodeled into a baroque edifice, imitating an Egyptian temple complete with swastikas decorating pseudo columns inside the auditorium and renamed the Paramount Theater. The entrance was change from Park Ave to Second Street. Many years later, it was featured in an American Heritage article (I think Oct. 1961) as a prime example of that type architecture.
Temple Sholom in the 50s was the largest Reformed congregation in New Jersey west of Newark and north of Trenton. Because it was undergoing construction of a new large sanctuary and school, it rented this theater for the High Holy days Services. Needless to say, the swastikas and gargoyles were covered. The congregation was large enough to fill the theater.
The Strand and Oxford theaters plus the Paramount were part of the Read chain. The other independently owned movie theater, the Liberty, was the first to have “refrigeration”, an air conditioning system, and the first to show sound movies. The Jazz Singer played there. The first sound movies used a sound system called” Vita Phone”, which used records which were not always synchronized to the film.
The movies were inexpensive, 10 cents a show. Besides the feature, they always included a newsreel and a short feature, typically an Our Gang or a Laurel and Hardy comedy, or a cartoon. On the weekends the Oxford and the Liberty programs included a serial. The most popular were the Westerns with Hop A long Casidy, or Tom Mix, etc..Other popular serials included Buck Rogers, Flash Gordon or Lassie. In order to attract customers there often were double features and during the depression, these movie houses were the free source for every day china and glasses promotions. The "depression glassware" from these theater promotions have become valuable antiques.
The Oxford frequently featured vaudeville acts as part of its presentations.

COUNCIL AGENDA MEETING
Monday night's meeting was short lasting about 90 minutes. The most interesting portion was the last, the Public comments section. The final speaker was Assemblyman (not Citizen) Green who spoke for about 5 minutes regarding Muhlenberg Hospital's demise. Unfortunately I thought his presentation was rambling and I am not sure what he said. I gather that he felt that the previous administration ( Plainfield's) had a responsiblity dating back 5 years ago. He seemed to infer that he was aware of the closing a year ago and his talks with Solaris were fruitless. Plainfield must accept the fact that this action is irrevocable. If some one can clarify his remarks for me I would appreciate it.

Comment: The issuing of a Certificate of Need for closure is an administrative action not subject to legislative approval. However, I wonder why the legislative body could not pass a law with specific guidelines to be met before a SNH can be closed. Criteria that would prohibit such action should also be delineated. It seems weird that the party that expounds universal health care can not find the means to protect what is operational.

Monday, April 14, 2008

BOE
When I was growing up the School Board was an appointed body by the Mayor with Council’s approval. Plainfield’s system had one of the highest ratings in the country. Graduates, quotas permitting, were admitted to all of the prestigious colleges. During my children’s school years the system underwent a major change. The 6-3-3 schools replaced the k to 8th grade, 4year high school configuration.
It was during that period that the elected board came into existence. The prevailing thought of the time was to give the public greater input by selecting the Board’s membership. In theory that was an excellent idea, However too many of the candidates. Had n arrow self serving agendas Moreover, instead of the elections being non political, the local organization frequently ran a slate for the vacancies. With an organization behind them, the entire slate usual placed all members on the Board. The Board of Education became a minor league for aspiring party politicians. adopting all of the vices of a city government.
Despite the fact that the “school budget” is one of the biggest devourers of our local tax dollars. only about 10% of the electorate participated in these elections. That statistic leading to the ability for small power groups to dominate the Board is why I have always felt that the appointed board would be a more effective format.
Unfortunately in Plainfield an appointed board of team players would place the local dominant political party in absolute control of the Board of Education.
The ideal solution is an increased citizen’s awareness in the significance of the BOE elections, resulting in voting participation equal to that in the general elections.

Sunday, April 13, 2008

Apology

I unfortunately made a typo error and misspelled Martin Helwig's name. Sorry. Olddoc.

PROMULGATION

After 62 years as a registered Republican, provided fate does not intervene, I intend to change my party affiliation on Monday April 14th. I have been informed that this is the last day it can be done.
Why? It is not the fact that the bigoted godly Republican Right turns me off, for I also can not tolerate the equally virtuous Democratic Left that will give every thing I have to the masses in exchange for votes.
The quality of the candidate, not party affiliation, should be the only criteria in voting. Thus I have often voted for a Democrat even for President.
In a political venue where one party dominates, the true election and the only time a choice can be expressed ,is the primary.
Therefor, I expect to exercise my right and duty as a citizen by being able to make a choice. Whether and when I change parties again is unimportant. Time will tell. However I reserve my right to be an effective Independent under the New Jersey laws..
POLICE DIVISION PAYROLLS
For those who have not read it, I would call your attention to Bernice Paglia’s excellent Blog at http://plaintalker.blogspot.com/. .Her Sat. 4/12/08 edition calls attention to reimbursement for the Police Department. Also to the newly appointed civilian director, Mr. Hellwig.
Several questions arise:
Where did the Ordinance creating the position include a pay scale? Since no schedule has been established, where are the funds to come from? I do not remember seeing an item referring to this position in the approved budget.
Does the administration intend to pay him from the day he was appointed,21 days before the position could be legally established?
How will the Greenies explain this?. The local Democratic party has a history of making a charade of its own rules and more importantly the City Charter.
The “Soprano State” is interesting reading. RECOMMENDED.
Too bad the local Gannet papers do not do in depth investigative studies of local political units in Central New Jersey.

Saturday, April 12, 2008

Hospitals and Politics.

This is the initial get it off my chest comment. `

Today's Courier News confirms that JFK plans to start closing some Muhlenberg Hospital's services as soon as Father's Day. No certificate for closure has been issued as of this date. Nor have the mandated public hearings been held. JFK's action confirms this observers opinion that this is a political "fait accompli" and the entire process is a farce.
`The Commissioner of Health and the state Democratic party pay only lip service to the questions of health care for the under-privileged. Institutions that render such services when public funding is less than 50% of costs.
New Jersey to my knowledge no public funded hospitals to render essential local health care. A plan for State or local Communities to assume the operational responsibilities for inner city hospitals such as Muhlenberg must be formulated as an alternate before closing can be permitted. The downside of course is that not only will this mean a raise in taxes (unacceptable) unless funds are diverted from other non essential pet projects, but will be an opportunity for a politician's gold mine.
Perhaps if local and county political leaders of both parties were truly interested in public welfare the present impending catastrophe would not be possible. Past actions or the lack of any discernible positive efforts by our represenatives in State government would reinforce that impression. Would it not be nice if the electorate would remember this in coming elections.

Mission

This Blog will periodically and with no set time interval reflect a senile octogenarian's views on politics, life, Plainfield, NJ, perhaps religion, or any inane subject from A to Z. Since I am having trouble finding cognizant peers, these will be comments that I would like to share. Perhaps, someone may find time to reply pro or con, or even act upon.