Saturday, May 31, 2008

NOSTALGIA

I am sure that there are still many Plainfielders who remember the building that stood on the northern corner of East 4th St. and Watchung Ave.? Today most of that site is occupied by the Police Station/City Court.

The “Academy’s large structure last day’s were as a Roller Rink. That was at the end of the heyday of roller-skating. It also was the site of professional and AAU boxing. Several area Golden Glovers saw action in that ring.

In the 50s, after the Plainfield Lions Club’s paper drives were no longer worthwhile money raisers, for several years the club sponsored an amateur boxing card. All the money raised went for three projects; Boy Scouts, Girl Scouts and the Blind. They were initially well attended but the event was dropped due to the rise in criticism of the sport.

Since I had to volunteer to be the ringside physician, I was happy that there were never any serious incidents and I would no longer have to sweat out that evening.

Friday, May 30, 2008

STATUS MUHLENEBRG

There may be a light at the end of the tunnel. I have become optimistic that there will be at least a substantial delay in the granting of Solaris's CN and perhaps an outright denial until December. Continued pressure developed by the Courier News in its editorials, Olive Lynch and her Buy Muhlenberg cohorts-see today's Courier, Dan Damon in his Blog have put Solaris on the defensive with large advertisement spreads and board members letters to the editor. It seem to becoming more difficult for Commissioner Howard to justify an apparent fait accompli statement. The letters in the Courier must have impact. As Dottie Gutenkauf noted in today's paper-Don't believe the spin doctor, believe those who use the facility.
When will Solaris make its 2007 financial reports available? What is the delay in filing? Is it possible that there is no justification for the claimed $17.6 mil loss? Oh yes,"Figures don't lie, but liars do figure"

Thursday, May 29, 2008

PRIMARYS JUNE 3rd Part 2

THIS YEARS PRIMARY ELECTIONS

June 3rd is primary day. In Plainfield that is the most important election. Locally, Republicans have little to choose, and cannot impact on the results of November’s general election.

To win the Democratic primary for local and even state offices is tantamount to being the general election winner. That is unfortunate, but an approximate 10:1 voter registration in effect makes this city a political microcosm of a country like North Korea. One man decides who is elected, what legislation is passed, who gets contracts. This is an unhealthy situation, and must be altered. Regrettably that requires a revolution in his party. It has happened before and can happen Tuesday.

Because of party affiliation and residency I cannot cast a ballot in all the local, county and Statewide elections. Nonetheless, I will offer my choices and why. No one has to accept my selections, but it would be nice.

LOCAL
COUNCILPERSON AT LARGE; I am bothered about why any individual would contribute $200,000.00 to an election according to the reports of Jerry Green’s comments Tuesday night. Since there has been no denial, that reason ,alone, prevents me from supporting Harold Gibson. He would be so indebted that on any issue Jerry Green could dictate his vote. Moreover, Gibson claims to have done everything possible in support of Muhlenberg, but his Council has refused to act upon my request for an proactive action . His major claim has been the institution of a generic prayer before meetings. Big deal. years ago although I did not feel it important enough for the Council to be aware that the prayer to open the meeting was in violation of Federal statures. I did objected to the religiously oriented prayer as offensive to many Plainfielders Afterwards, until I stopped attending meetings there was a non sectarian prayer. I don’t think that generic is the right term, it sounds like a drug.

Annie McWilliams, young bright and new to politics. Her father’s involvement would have given her insight. WE must trust that she will remain independent and not sell her soul for a political career. ---my choice

Republican Deborah Dowe; a snowball in * has a better chance.

THIRD WARD COUNCILPERSON; There are three candidates in this ward. Like Gibson, Don Davis the incumbent is unacceptable. Moreover he has a record of voting along the player line even though he has a perceived conflict of interest.

Adrian Mapp has been there before and had not been outstanding. Too often he tended to pontificate. He was elected Freeholder when the McWilliams group was in favor and dumped when the split occurred. I am afraid that he will either be antagonistic or again curry favor of the party boss.

Olive Lynch, a completely newcomer, deeply interested in Plainfield and its problems. Her ability to grasp and analyze facts of a problem would make her a valuable Councilperson. We need diversity of opinion on the Council. My vote if I could.

COUNTY:FREEHOLDERS

I no nothing about either party’s candidates. It is one of the most lucrative elected positions in the state. Freeholders control enormous powers and money but stay below visual threshold. The group that are in have been there too long for our good. More research needs to be done to determine if any of the opposition candidates would be better. The “Regular” or county organizations slate represents individuals being reward for past or anticipated favors. The Democratic Primary also has an opposition slate which may be former Libraterians. Take your pick

The nominated candidates that are on the county party’s slate

STATE :

U.S. SENATOR: None of the three Republican’s have a historical chance of being elected. Zimmer is an old hat. Since loosing his Representative seat he has been a Lobbyist in DC. Murray Sabine is a Professor at Ramapo College, a former Libertarian and supporter of Ron Paul. Joseph Pennacchio is a State Senator the candidate of the endorsed by the county Republicans-nuff said. Zimmer is the party’s best chance.

The other two need research, but I don’t feel that they have the weight.

Of the three Democrats; time for change, Lautenberg is a Corzine Democrat, nuff said. Andrews has shown in the House that he cannot be a party hack. Cristello, the mayor of Morristown has been noted for his use of police in his crackdown on “illegals” in Morristown. He tried to have the Police Department certified as Immigration Agents PICK-Andrews.

HOUSE OF REPRESENTATIVES: Democrats: Pallone is the incumbent and there is no reason to “junk” him as the Party’s candidate.

Republicans: McLeod, County’s Party hack, same old blarney. Hogan , 28 years old, for no other reason I would vote for him as a idealistic newcomer. Has no chance.

For this election I know for whom I will vote. Of course that is no guarantee that they will receive my vote in November when I can ignore Party lines.

WE ARE NOT ALONE

From today's LA Times. California with its supposed universal type health care faces the same problems as New Jersey. Apparantly they have been more agressive in remedial action not just abandoning facilities.

Hospital's cuts sow anxiety in South L.A.
May 29 2008

Centinela Hospital in Inglewood.
Annie Wells, Los Angeles Times
Centinela Hospital in Inglewood.
Changes at Centinela deal a fresh blow to the area's healthcare.
By Daniel Costello, Los Angeles Times Staff Writer
May 29, 2008
Centinela Hospital Medical Center in Inglewood has been a key healthcare provider to nearby residents for nearly a century. Now some patients and activists in South Los Angeles worry that recent cuts and other changes are diminishing its role in the community.

Since taking over the hospital late last year, its new owner has shuttered departments, laid off 13% of its 1,700 staffers and canceled most private insurance contracts, hospital officials say. As a result, many residents say they've had to seek treatment elsewhere.

Victorville-based Prime Healthcare Services Inc. said that it made the changes to keep the medical center financially viable and that access to healthcare in the Inglewood area had not suffered.

State data show that Centinela has been unprofitable for years. The hospital's previous owner considered closing the facility in the fall, before Prime bought it sight unseen.

To the disproportionately low-income and uninsured residents of South Los Angeles and other nearby communities, the recent changes at Centinela are yet another blow after a long spate of hospital cutbacks and closures throughout the area.

Robert F. Kennedy Medical Center in Hawthorne closed in 2004. Last year, Martin Luther King Jr.-Harbor Hospital near Watts shut down. Brotman Medical Center in Culver City recently filed for bankruptcy protection. Other area hospitals such as Downey Regional Medical Center have said they aren't certain how much longer they can remain open.

The closings have left the local healthcare system in its most threatened state in decades, experts say.

"This is a system, and an area in particular, that can't take many more hits," said Liz Forer, chief executive of the Venice Family Clinic, which provides free healthcare to the uninsured.

Forer said her clinic had seen a 15% increase in patients from Inglewood in recent years as more hospitals in the area failed.

"At some point, you have to ask what is too much" for the area to withstand, said Lark Galloway-Gilliam, executive director of Community Health Councils Inc., a health advocacy group.

In recent years, Prime Healthcare and its chairman, Dr. Prem Reddy, have launched an aggressive expansion program in Southern California, often buying up struggling hospitals at risk of closure.

Prime Healthcare owns nine area hospitals -- eight of them bought in the last four years -- including Sherman Oaks Hospital and Huntington Beach Hospital.

As the company has grown, its operations have come under increased scrutiny by state officials, healthcare advocates and patients.

When Prime Healthcare takes over a hospital, it typically cancels the facility's private insurance contracts. That means many Prime Healthcare patients arrive through the emergency room -- which is open to everyone, regardless of financial status -- and, if needed, are admitted for longer stays.

Because its hospitals are not bound by insurance contracts, Prime Healthcare often is able to collect steeply higher reimbursements from insurers for such patients.

Prime has also suspended some services at its hospitals -- including chemotherapy treatments, mental health care and birthing centers -- that provide relatively little income. The company tries to reduce how many days that patients remain in the hospital, although data show patients' length of stay at Prime Healthcare hospitals remains in line with national averages.

Such measures are key to what company executives say is a profit margin of as much as 15% per hospital -- far above the industry average.

Centinela still busy

The company says it has cut only services that are rarely needed and can be obtained at other facilities nearby. And Centinela remains busy. Last year it treated 140,000 people, and it has one of the most active emergency rooms in Southern California.

State and federal data show the company's hospitals score above average on surveys that measure patient safety and the outcomes of treatment.

Even so, some residents say that the recent changes have made it harder to get the care they need.

After James Mock of El Segundo was found to have advanced colon cancer a year ago, his doctor put him on a chemotherapy regimen that requires two days of continuous treatment twice a month. On alternate weekends, he had been checking into Centinela on Thursday and staying until Saturday so nurses could monitor his care.

Because the hospital no longer has a contract with his insurance carrier, Mock is caring for himself -- at home. He visits his oncologist every other week, and an assistant hooks a catheter to a vein through his chest.

Mock gets his first 22 hours' worth of chemotherapy in an IV bag, drives home and sleeps most of the day. The next morning, he drives back to his doctor, gets a new IV bag and repeats the process. "It's a little crazy, but what choice do I have?" the 52-year-old engineer asked.

Prime Healthcare has closed seven of Centinela's 13 operating rooms, according to hospital executives.

Dozens of longtime nurses and doctors have quit in recent months, hospital staff members said. Among them: Dr. Lawrence Dorr, founder of the hospital's prestigious Dorr Arthritis Institute, which treated 1,500 patients each year. Dorr, who declined to be interviewed, and his arthritis center are now affiliated with Good Samaritan Hospital in Los Angeles.

"This is very frightening," said Dr. Doris Lyonga, a hematologist who has practiced at Centinela for more than 20 years. "First, Robert Kennedy closed. Then Martin Luther King. Clinic after clinic has closed. Centinela is a shell of itself. Where exactly are people to go?"

Centinela's chief executive, Von Crockett, said the community's access to care had not decreased as a result of Prime's acquisition of Centinela and that the changes were needed for the hospital to survive.

"Our new owners are the only reason this hospital is open," he said. "They saved us."

The number of patients visiting the ER has grown about 10%, he added, and wait times in the emergency room have fallen to an average of 15 minutes and 12 seconds from one hour and 38 minutes last year.

Crockett said the medical center's new owner was investing millions of dollars this year to replace long-neglected equipment and had increased care to the uninsured. He added that some recent changes, including the closing of operating rooms, could be reversed if needed.

"Prime Healthcare Services has increased access to care for the community members at Centinela as evidenced by an increase in the number of inpatient admissions, decreased waiting times for both patients and emergency medical personnel in the Emergency Department," Crockett said in a follow-up e-mail.

Accreditation status

Crockett noted that the hospital had received a "conditional accreditation" in the fall from a national accreditation organization, the Joint Commission, after surveyors found several safety issues during a surprise inspection. (The accreditation status of hospitals is available to the public at jointcommission.org, but the details of such reports are not.)

Late last month, he said, the hospital received its full accreditation after making systemwide improvements.

Others are less upbeat about Centinela's recent transformation.

Vivian Swan, who suffered a stroke a year ago, was attending rehabilitation classes twice weekly at Daniel Freeman Medical Center nearby to help regain lost motion in her hands. Swan, 71, worked as a hairstylist before her stroke but can no longer hold scissors and hasn't returned to work.

She stopped treatment this year, when Daniel Freeman suspended services. When Prime Healthcare bought Centinela, it explored the option of transferring the rehabilitation and radiation therapy programs from Daniel Freeman to its new property, Crockett said. It declined, citing lack of adequate bed space.

"They say people can go somewhere else, but that's not easy," the Marina del Rey resident said.

Prime executives said they were interested in buying more hospitals in the near future, although they didn't name specific facilities. In April, Prime Healthcare bought the majority of Brotman Medical Center's loans from its primary lender.

The Culver City hospital entered bankruptcy in the fall and has been looking for investors. It has spurned overtures from Prime, hospital executives said, out of concern about some of the company's business practices.

Brotman may soon have no choice in the matter. If the hospital can't pay its debts, the Bankruptcy Court could decide it should be sold by public auction. That decision could come within the next several weeks, Brotman executives said.

Although anyone could bid for Brotman, Prime would be in a strong position to acquire it because the debt the company recently purchased has most of the hospital's assets attached as collateral, bankruptcy attorneys said.

PRIMARYS JUNE 3rd Part 1

This is part 1 of 2 or3 parts reflecting my thoughts about Tuesday’s elections. Locally and for the US Senate every vote will be important. Part 1 concerns the Presidency. Part 2 will be devoted to Local, County, and if space permits, the US Senate and Congress elections.

PRESIDENTIAL ELECTION

2008 is a Presidential election year. Too often in the past by the first week in June the successful candidate had piled up an insurmountable lead, and New Jersey was denied the chance to play a significant role in the process. This year with the early special Presidential Primary every vote counted. While the General Election is
not until November, it is not too early to start evaluating the candidates as part of an ongoing process.

I for one am far from deciding who I wish to vote for. I do know that as usual I will not be tied down by Party affiliation. Instead I must judge which candidate has the most pertinent pros and least cons for the office and cast my vote accordingly.

All three remaining candidates come with much baggage.

McCain the Republican has taken a firm view on the continuing presence of troops in Iraq. This is a position I agree with. I served under fire in Europe during WWII. I understand that troops facing disabling injury or death need the country’s support. For whatever reason we are there, we did disrupt the Iraq’s political infrastructure. We must show the guts and ability to restore it. We did destroy Saddam a murderous genocidal tyrant. His replacement must be unique to that nation’s culture. Personal and religious freedom is not incompatible with that goal. We have the responsibility to see that it is achieved.

But I am scared by McCain’s convictions on issues such as the separation of Church and State. Will he follow the present administration’s cow-towing to the Religious Right? Will his government surreptitiously continuing directing Federal funds to blatant evangelistic organizations? Will his personal views on abortion lead to further legislation restricting the right of personal choice? What will his stand be on the illegal immigrants? How will he address the ills facing Social Security and Health Care with a legislature controlled by the opposite party?

The Democratic Candidate will most likely be Obama, not Clinton.

Senator Clinton is probably the strongest willed candidate of the three. She can be ruthless in trying to achieve her goals. On the other hand she is political wise and will have the least problem with congress. Will she revisit her prior impractical and ill fated Health Care reformation attempt? Can she function on her own or will she be an extension of the Bill Clinton Presidency? Does she plan a rapid retreat from Iraq? Where does she stand on the Near East issues? Is she trying too much to be all things for all groups?

Obama could or could not be the proverbial “White Knight” (an interesting phrase) of politics. The big question for the party is can he carry the “Red Neck” States as well as Florida. Their last two candidates could n ot.

There are still major questions remaining about his personal discriminatory status. How could he not have opposed his former minister and friend’s bigoted out bursts? He could not have been unaware. How will he handle his naivety in international affairs? Where does he stand on issues such as the Hispanic illegals and the “Right to Life” versus “Personal Choice”? He has yet to clarify his health care plans. Will he too implement the Democratic line of an early and prompt disengagement from Iraq?

Time will give us better insight as to the character of these candidates. Of great importance in this election will not only be their party’s choice for Vice Presidency, but also whom they favor for Cabinet appointments.

Tuesday, May 27, 2008

MEMORIAL DAY REVISITED.

Perhaps you may find the following controversal. Your non vitrolic comments are welcomed.

May 25th was Memorial Day, a day in we give homage to those who have died in the service of their country.

Wars are never popular. War is hell for those in combat and those who have loved ones at risk. However, to demand withdrawal of troops from a combat area before the goal has been accomplished besmirches the memory of all who have died or received disabling wounds in that conflict as well as all the preceding wars in our history.

The Viet Nam soldiers were so disrespected by many in this country that their post service life was a disaster. That war, even more than this one in Iraq, became such a political and moral issue that it was impossible to be properly fought.

Even today few have a handle on the reason we were fighting there. The casualty rates were high, and there was an absurdly disproportion of draftees from the minority segments of society. The military were given an impossible task; fight a war by humanitarian rules. What an oxymoron!

We must accept the fact that no civilized rule is valid in modern warfare. Wars are not a game. The aim is to kill, maim or disable as many of the “enemy” as possible. Maiming or injuring the enemy’s forces is preferable to killing since it requires resources and personnel for their care. The dead only need to be buried. The destruction of his infrastructure is a necessity. Collateral damage, ie: non combatant’s death is an acceptable risk. It may even be desirable. Civilian casualties were high in the last major war and I believe that they will be astronomical in the next.

We memorialized the dead of the Civil War, the bloodiest highest casualty war in history and the first modern war. Also those who perished in the Spanish-American War, the pre WW I Mexican campaign, WWI itself as well as the adventures in Panama, Granada, Somalia and the Gulf War. We seem to have forgotten the Korean War where General McArthur’s egomania cost thousands of American lives.

How many lives both civilian and military could have been spared is unknown. The war in the Pacific was inevitable. Perhaps if the Pacifists and Isolationists among us had not delayed our intervention the Nazis would not have had the freedom to kill millions. Those among us who criticize Truman for dropping the “bomb” cannot conceive how many lives were saved in the aborting an invasion of Japan.

Yes, Iraq today is unpopular. Like Viet Nam it has become a political toy. Grandstanding politicians and egotistical Presidential advisers as well as some arrogant generals have botched the war’s conduct. We should not let politicians or rabble rousers or legitimate ill advised do-gooders make the sacrifices of our troops worthless.

Instead, we must assure that the military leadership is competent, not impressed by its own ignorance. I know that that is difficult but is possible. Then we should whole heartily finish this episode, which has accomplished one great objective. We have rid the world of a tyrant and mass murderer.

Finally, we must understand, which this administration has been incapable, that no matter what our idealistic wishes are, we cannot impose our perception of Democracy on cultures that have a different mores. We should stick having them adopt acceptable civil and religious liberties. The form in which this takes is immaterial.

If the UN could be a functioning force, the ideal solution would be cohesive action in destroying all repressive murderous governments like those that exist in Burma (Myanmar), Sudan or Zimbabwe. There should be no condoning nations that deny human freedoms. North Korea and Iran as well as the autocratic Arab nations are among those in this group. Dream on! I have not mentioned China since it appears that economic forces are cracking the steel grip.

Basically it is for that fundamental idea of the individual’s right of personal freedom in an organized civil society that Americans have died. That is what we should hold in memorial.

to atgness mclean

Without an email address I would have to reply in the blog. I have no experience with cobalt therapy. that is in the province of the Therapeutic Radiologist. I don't believe your mother was treated in the Plainfield area since I knew of no facility private or hospital in the area who had the capability early 50s. I would suspect treatment was for metastases, and must have been debilitating. You could contact either the American Cancer Society, or The American College of Radiology for more info, Incidentally, Cancer of the Cervix can be a preventable disease with the use of the now recommended vaccine,

GOOD AND BAD GAS

Without the technology changes in anesthesia in the two decades after WWII, none of the present day remarkable surgical triumphs would be possible. Operations such as, Organ transplants, extensive tumor removing procedures, separating Siamese Twins require long and stable anesthesia.

The available agents in 1946 were Chloroform, Nitrous oxide, Ether, and Ethyl chloride.

Ethyl Chloride was a volatile liquid which rapidly vaporized and could be used as an inhalant when sprayed on a nose mask. Although it produced rapid unconsciousness it was a very dangerous substance that could cause cardiac or respiratory arrest.

Chloroform was one of the oldest anesthetics. It too was a liquid which was inhaled when applied to a nose mask. It was non explosive and could be used where there was open flame. My earliest experience with it occurred in 1942 when as a 3rd year medical student I had a rotation for several weeks at the Kings Daughters Clinic in Norfolk, Va. They provided a home delivery service for the needy using a medical student and thank goodness a very capable nurse who would give whiffs of Chloroform if needed. And of more importance, advice to the nervous “doctor”.

Nitrous Oxide, know as Laughing Gas, was the first anesthetic discovered and had been in use for years. It was also the pot of its day and was used improperly to get high. It worked by displacing oxygen in the blood causing anoxia. It did not create a deep level of unconsciousness when properly used and if not watched could result in asphyxiation.

Ether was a very volatile and explosive agent. It was initially used by dropping small amounts on a nose cone or mask. By the time of WW II more efficient methods of administration had been developed. One was the Heidbrink machine. This was a single tube semi closed system that had a yoke that held two oxygen tanks on one side and two Nitrous Oxide tanks on the other, thus the gas flow could be regulated. The mixture was passed over an Ether container and through the hose to a mask over the patients nose and mouth. The mask had to be tight. There was a re breathing bag and a valve to relieve any excessive pressure into the air and of course into the Anesthetist’s face.

With the development of this machine major and prolong complicated operations were possible. However there were problems; induction to a deep enough level was slow. During the slow recovery patients would vomit so there was a danger of aspirating into the lungs. This could cause a fatal pneumonia, if not immediate asphyxiation.
Another problem of the times was one of carelessness. The yokes and fittings for the gas tanks were all the same size. It was possible to place the wrong tank on a yolk so if the anesthesiologist was not alert the patient could be receiving 100% Nitrous oxide and be asphyxiated.

In the early 50s, there was a great advancement. First with the development of the closed system two tube techniques and with the introduction of Cyclo-propane. With this gas induction was rapid, and recovery was equally fast. Nitrous Oxide was no longer required. The danger of aspiration was nearly eliminated. It was safer to now have anesthesia under emergency unprepared conditions.

However, Cyclopropane was a very volatile and explosive gas. There were frequent incidents of explosions. In a closed system, that could destroy the patient's lungs. Fortunately other safer inhalation gases with little risk of explosion shortly followed.

The use of intravenous drugs to produce an anesthetic state or make the induction by a respiratory gas easier is a postwar (that is WWII) blessing. Among the earliest were barbiturate drugs such as Pentothal. These were followed by great number of chemicals some of the antidepressants or anti psychotic drugs. Also the use of intravenous muscle relaxants derived from curare type drugs have made the surgeons life easier.

I must confess that I had a personal interest in anesthesia , having put the mothers of many of Plainfield's Baby Boomers to sleep during the late 40s and early 50s. Cyclopropane was the last agent I used. During that period we received from $5.00 to $15.00 per case and "ward" deliveries were pro bono. Oh for the good old days.

Monday, May 26, 2008

A break from R&R.

I must post a comment from "Anonymous" about my " Gloom and Doom".

"I am tired of having to pay my way and having to pay the ways for many that have abused charity care. Plainfield is doomed only if you beleive it. Since this is your belief you should leave, if not immediately. Your comments are no solution.
My solution is to vote out all politicans that currently hold office and replace them with those who have a vision and passion for the city and NJ. Then keep them in line with the views and concerns of the people. OUT WITH THE OLD AND IN WITH THE NEW!!!"
May 25, 2008 10:06 PM

Obviously this individual did not understand my comments. I apologize if it was vague. I thought I was referring to the Muhlenberg situation, not the city. Anonymous your solution for the city and state is correct. Are you actively exercising your right as a citizen to accomplish that goal?

Sunday, May 25, 2008

R&R day. Read today's Courier for amusement.

Saturday, May 24, 2008

GLOOM AND DOOM

No R&R yet. I read the articles in today's papers (Star Ledger & Courier) regarding the $142 mil cut in hospital's charity aid. Remarkably Trinitas in Elizabeth is to get an increase of $8mil! That takes care of Union County's benefits. Could Lesniak's influence have had an impact? Does this affect Green's and Stender's hands off policy?

Obviously there is NO HOPE for Plainfield.

So much for our Democrat's claim that all should be able to receive health care. Perhaps that is meant to mean all politicians and affluent individuals.

Should it not be time to recall all elected state officials? Replace them with the political naive, We could not be worse off.

I would even entertain the Governorship except (1) I am not a super multi- millionaire,(2)or I do not have other elected or appointed pension generating governmental positions, and (3) least important, I am way too old. I can not qualify.

Back to R&R

MRC QUESTIONS 5/24/08

After the 1997 merger of MRC into the newly formed Solaris organization, The Muhlenberg Board of Governors continued to exist. What was its function under the Merger Agreement? Did it have a responsibility regarding Muhlenberg’s operations? Was it allocated any fiduciary accountability? Or as it seems, was it just a social club created to satisfy egos?

We are entitled to answers to these questions. If Solaris has acted unilaterally in the disposing of MRC assets or in proceeding with its plan to close the hospital were these actions legitimate under the merger agreement. If not is the Muhlenberg Board of Governors legally liable for failing to exercise its fiduciary obligation?

If there is “Board” liability is it for the group, or individuals, or both? If Solaris acted improperly what is its liability?

If there is any question of legal liability, who is the damaged party, and able to collect compensation? What is the community’s interest? Could there be a basis for a “Group” action?

Before the CN is implemented, I would like answers to the above questions. Wouldn’t you?

On a practical track, I would like to have the data for admissions in 2006 &2007: the number of admissions, the diagnosis of each admission, the age group, and the reimbursement grouping. The latter would include self pay, insurance paid at listed rates, HMO’s admissions which could be broken down into carrier contracts, Medicare, Medicaid, Casualty (auto and workman’s compensation), and uninsured uncompensated.

Similar data on ICU and CCU admissions and days stayed is of great importance. All of this should be obtainable, may need a court order.

This data would be of value in (a) determining what kind of a facility can be supported, and (b) if there was a change in patterns in the two years that was detrimental to the hospital.

Unless there is some earthshaking event, the next two days will be devoted to R & R. Have a great holiday weekend

Friday, May 23, 2008

MRC # XXXX

Both Star Ledger and Courier have items relating to MRC in today's paper. The Courier's Editorial calls for positive action by the State. Solaris will oppose because of the money drain and the loss os immediate financial gain through property sales. All acute and critical care units must be kept fully operational until a new management takes control.

The Ledgers news item is of course a rehash of the Wednesday night meeting. Interestingly this article notes that six months ago Piscatelli had met with Solaris presenting the proposal he and Green claim is new. Senior Citizen housing was part of the earlier presentation. Another potential drain on resources that will not be available.

Thursday, May 22, 2008

TODAY'S FILLER


(Photo reproduced from Wikepedia the Internet Free Encyclopedia.)
THE CRNJ JERSEY CITY TERMINAL restored as the Visitors and Exhibit Center for the Liberty State Park. The bright colored ferry slips are for the Ellis Island and Statue of Liberty boats. The dark slips in the background are where the large Hudson River ferries docked. There was a double deck ferry boat shed that extended from the front of the terminal building to the docks and bridges were lowered to the boat for upper deck passengers.

With the completion of the Elmora interchange the terminal was closed circa 1967

Prior to the Lehigh Valley trains being routed via the Pennsylvania RR from Newark to NYC they terminated adjacent to the CNJ yards on Communipaw Ave and had their own ferry.

A great scenic inexpensive trip is a ride on the Staten Island Ferry to and from Battery Park.

NOT A WHITE KNIGHT

According to today’s Courier News, Gerry Green’s grey knight, Drew Piscatelli, said he's willing to resuscitate an ailing hospital. He offered nothing new. It was not a plan that would preserve Plainfield’s acute care needs. Who would benefit? Does our Assemblyman have a conflict of interest?

In Wednesday’s “Save Muhlenberg” blog, Dan Damon referred to a comment I had posted to the Courier’s article on Green’s plan to buy Muhlenberg. I presume that it was the following which was part of a retort to an individual who was “dissing” those who are legitimately trying to save our acute care facility.

“Accept that Health Care is not an individual’s god given right. Instead it is Society's obligation for its own safety and welfare to assure that high quality health care is available to all irrespective of ethnic, religious, or even legal status. We cannot talk about"$50,000 a day" since we do not have accurate numbers. I cannot accept figures produced by a party with a specific agenda. Federal and State Governments have not only been remiss in their obligation but have cut even more every year. Charity no longer makes up the shortfall. The term "tithe" as a charitable -not just church- factor has long been forgotten. Do not deride as "children" those who will find a livable solution -not Jerry Green's- to the MRC drama.”

Now-a-days “Charity” plays a minor role in our materialistic litigious society. Bureaucratic agencies have assumed the functions that were once the province of charitable nonprofit entities. Most are underfunded and inefficient for the role that they have been designated to fill. Many are riddled with nepotism or political appointees incapable of adequate performance including judgment. By their nature all preclude private donations to relieve their shortfalls.

The only remedy is the allocation of sufficient funds. Unfortunately, that is not possible in our political system which gives lip service to the control of pork barrel projects. Increased taxation means political death for advocating legis-
lators. Therefore, we are caught “between the proverbial rock and a hard place” until public pressure is sufficient to mandate legislative action.

Thus the problem is how we can convince the Stenders and Greens in our legislatures to accept society’s obligations at the expense of their agendas. Who has answers?

Wednesday, May 21, 2008

GOOD OLD DAYS


The "John Wilkes" perhaps in Wilkes Barre 1930s

More Muhlenberg

The Muhlenberg saga rolls on.

Today Solaris opened its counter offensive with a two page advertisement in the Courier in which McGee presents nothing but a reiteration of his previous statements;
*There will be an ER, which can be no different than the “Medimerge” in Greenbrook. It will not be in the classical terminology a site to treat acute medical emergencies. The MICU units stationed there when not on a long trip to an admitting facility will at least reduce time for critical interval help to reach the scene.
*The Harold B. & Dorothy A. Snyder Schools of Nursing, Medical Imaging, and Therapeutic Services is a separately endowed facility which occupies a newly constructed building. I am sure this building is among the $50 million that Solaris is supposed to have invested in the MRC site.
*The DaVita Healthcare Dialysis Center rents space in a freestanding building that was renovated to accommodate the facility. This profitable unit was one of money making services sold by Solaris in the past ten years.
*Home Health Care Services by their nature can be just as easily be delivered from the JFK campus as from MRC site. In fact, for years blood sampling is done by JFK based technicians.
*The degree of Imaging and Laboratory Serviced that will be provided will in a short time become only those needed for ER support. Ambulatory imaging will continue to be referred to the independent offices.

Thus, he offers nothing. Solaris however gains by ridding itself of uninsured and Medicaid care and from the disposal of the multiple plots that it recently subdivided from the Muhlenberg campus.

I am not privy to the “Green” proposal. I remain skeptical about a proposal in which an entrepreneur is involved. I cannot conceive a “Medical Mall” as being anything more than a collection of individual sites for various specialties in addition to the walk in center. This is not an acute care substitute. There must be some other planned usage for the present structure.

Likewise, I cannot conceive a consortium of twelve communities operating the hospital. Even if Solaris ‘spun off” the hospital, will the townspeople be able to pay the increase in taxes that must result. Even a separate “Authority” must raise money.

The only workable solution would probably come from a commercial hospital group assuming the hospitals operation. Whether there has or has not been a legitimate interest is open to conjecture.

Unfortunately, without the State providing adequate financial aid to a needed “Safety Net Hospital”, Plainfield is going to be left with an acute health care void.

Tuesday, May 20, 2008

COUNCIL MEETING Monday 5/19

For a professional report on this meeting I would refer you to Bernice's http://plaintalker.blogspot.com/

The agenda was short,all items except for the "movie" were as usual on the consent agenda. However two items were removed upon request for public or council members discussions which were brief and the passed. One was to allow Councilwoman Carter to abstain on a awarding of a contract to a company in which she felt that there could have been a remote possibility of a conflict of interest. The other was to clarify the transfer of $180,000.00 from one budget line to another.The explanation was adequate.

Of greater interest was the discussion during the public comment session re: MRC's fate. For the first time I learned that Solaris is willing to enter in to an agreement to sell Muhlenberg to a consort ion involving the concerned municipalities and either Somerset Medical Center or Solaris itself! I hope we can have time to review in depth the proposal. The term "streamlined acute care facility" bothers me,I would like clarification. There is n o question that at least 50% of the present beds should be closed, but it is important that MRC be a full service facility. All specialized skilled procedures that Muhlenberg does with great success should be retained not transferred.

Are there any other legitimate interest parties?

I regret that I have commitments that will prevent me from attending this Wednesday's 6pm meeting at the Washington School. I hope someone will provide me with complete details.

Sunday, May 18, 2008

Monday AM--Nothing World Shaking

When I reread yesterday's posting I saw "budje t" Obviously my one finger hunt and peck typing and two spelling checkers failed me. Nothing new, as a sight reader I never looked at all the letters in a word. I could read and absorb paragraphs fast, but spell-no way. In fact I am ashamed to say that I never passed freshman (9th grade) English in High School. On the other hand I graduated as the second youngest member of the 1936 class. Some day I will write about the award I received and the one I did not get. Suffice to say that $15.00 in those days equals about $300.00 today.

That said, I get 3 newspapers every morning. All are for different reasons and I do not always read every part of each paper but do scan each section:

The Times because it is the TIMES. It is not the paper it used to be and all too often tends to editorialize in its news reporting.

The Courier News for what little local news and of course for the Obituary notices. The first is scant, and most of the names I would recognize in the obits have either already been published or gone to Florida. Anyhow I am always relieved that I do not see my own name. Incidentally, since the Courier and the Home News merged it is again beginning to resemble a newspaper and not the rag that it had become in the last few years.

The Star Ledger,New Jersey's newspaper, for its broad news coverage, the best sports section in the country, and enjoyable comics. However, I am disturbed that this paper has given no editorial attention or even published any letters about the Solaris plan with apparent State pre-approval to close Muhlenberg. I would think that someone would be concerned about the lack of interest for this area's inhabitant's health.

Saturday, May 17, 2008

CNJ R R

This is the first day of probably a two day sabbatical. Tomorrow night (Monday ) last Council; meeting for a month.One item from the Agenda setting meeting has to do with transfer of $150,000.00 in the budget from one line to another. One specific sum is interesting! I would think that a budje t passed 8 months late in the fiscal year could account for all except an unexpected contingency. I am sure that there will be at least one resolution not publicly disscussed last week on the agenda.

This is a followup from yesterdays 'Trains"

Central Railroad of New Jersey
From Wikipedia, the free encyclopedia
A CNJ camelback locomotive built by Baldwin in the 1920s.

The Central Railroad of New Jersey, more commonly known as the Jersey Central Lines or CNJ, was a regional railroad with origins in the 1830s, lasting until 1976 when it was absorbed into Conrail with the other bankrupt railroads of the Northeastern United States. Its main line ran from a terminal at Jersey City west through New Jersey to Phillipsburg and across the Delaware River to Easton and Scranton in Pennsylvania. Branches also stretched into southern New Jersey to Delaware Bay.

The CNJ was acquired by the Philadelphia and Reading Railway in 1883. Though that was later canceled, the Reading continued to exert a major influence over the CNJ, and used it for its New York City-area terminal.

Liberty State Park in Jersey City, New Jersey includes the site of the CNJ's terminal.

The Elizabethtown and Somerville Railroad was chartered on February 9, 1831 to build from Elizabeth on the Newark Bay (with a steamboat transfer to New York City) west to Somerville. The line to Plainfield was completed in March 1839, connecting to the New Jersey Rail Road in Elizabeth. Extensions took it west to Dunellen in 1840, just east of Bound Brook in 1841 and the rest of the way to Somerville in 1842.

The Somerville and Easton Railroad was chartered February 26, 1847 to continue the line west to Easton. The first extension, to Whitehouse, opened in 1848 and was leased to the Elizabethtown and Somerville Railroad. On February 11, 1849 the Elizabethtown and Somerville Railroad bought the Somerville and Easton Railroad, and on February 26 the two companies were consolidated as the Central Railroad of New Jersey.

The rest of the line to Phillipsburg opened in 1852, and on September 8, 1855 the upper level of the Lehigh Valley Railroad's Easton Bridge over the Delaware River, taking the CNJ to Easton. At that time, Lehigh Valley coal trains began running over the CNJ to Elizabeth. A similar operation with the Delaware, Lackawanna and Western Railroad, joining at Hampton, began May 27, 1856. This required the addition of a third rail to join the broad gauge DL&W onto the standard gauge CNJ.

On December 1, 1859 the CNJ arranged to run over the New Jersey Rail Road to the latter's terminal in Jersey City. That operation began December 19, and included a third rail for DL&W trains.

The South Branch Railroad, controlled by the CNJ, opened July 1, 1864 as a branch from Somerville to Flemington. The CNJ's extension to their new terminal in Jersey City, including the first CRRNJ Newark Bay Bridge, opened on July 29, 1864, with a ferry transfer to Cortlandt Street in New York City, ending operations over the NJRR. On July 23, 1869, the Newark and New York Railroad opened, providing a straight route from downtown Newark to the CNJ's Jersey City terminal. The Newark Branch, running north from Elizabethport to the N&NY in Newark, opened June 7, 1872.

On October 6, 1873 the CNJ leased the New York and Long Branch Railroad, which was in the process of building from Perth Amboy southeast to Long Branch. At the same time the Perth Amboy and Elizabethport Railroad was building from Elizabethport on the CNJ south to Perth Amboy. Hostilities at the crossing of the Pennsylvania Railroad's Perth Amboy and Woodbridge Railroad in April 1872 led to an injunction against the PRR interfering with the construction. The CNJ bought the PA&E later that year. The full line to Long Branch opened September 7, 1875, and was later extended south, reaching Bay Head in 1881 by acquiring other companies. In 1882 the CNJ and Pennsylvania Railroad agreed to use the line jointly, with trackage rights granted to the PRR over the Perth Amboy and Elizabethport between the Perth Amboy and Woodbridge crossing and its south end at the Raritan River bridge.

In 1929, the CNJ began operating its most famous train, The Blue Comet, which ran from the Jersey City terminal to Atlantic City. Service ran until 1941. The route was via the shore line past South Amboy and the a southeast branch through Lakehurst to join the Readings Atlantic City Line.


The first commercially successful diesel-electric locomotive manufactured by Alco in 1924 was built for the Central Railroad of New Jersey.

Paralleling the Lehigh Valley Railroad from the Hudson River to Scranton, the CNJ was a fierce competitor for anthracite coal and freight traffic. With heavy commuter traffic and short freight hauls, the company was in and out of bankruptcy throughout its history. In 1967, bankruptcy was declared for the last time. In 1972 all Pennsylvania operations ceased and the Lehigh Valley Railroad took over the remaining Pennsylvania trackage. The CNJ was merged into Conrail on April 1, 1976.

PLAINFIELD'S TRAINS

Prior to WWII passenger rail traffic from the Plainfields left little to be desired.Commuter service was frequent and on time unless the Newark Bay bridge was raised. Air conditioning was nonexistent on the CRNJ trains. The locomotives were anthracite (hard) coal burners and had over sized fireboxes. To give the engineer visibility, the cab was draped over the boiler.

There was frequent freight traffic on the line, including long coal carrying trains bound for the Jersey City terminal. Area homes were covered with soot and grime.

Of the four stations along the four track CRNJ main line in Plainfield; Clinton Ave, Grant Ave, and Netherwood served commuter riders as well as local passengers. 99.9 % of all CRNJ trains, as well as Reading and B&O passenger trains stopped at the downtown station between Park and Watching Avenues.

Commuter trains ran from The Somerville-Manville-Bound Brook area to the Jersey City waterfront. However there was passenger service to High Bridge and Phillips burg. The train-ferry shed was adjacent to what is now Liberty Park.

Once in the large train shed. The commuter boarded a large ferry boat which was also one of the main vehicular modalities to reach NYC. There were two lines from that station, most went to the downtown dock at Christopher/ Dey Streets and walked a long block to the Westside subway station or farther to the Canal Street Station of the Lexington Avenue line.

If you traveled on the upper deck of the ferry you could cross the very broad West Street on a covered bridge and then descend to street level. This was of course a two way route. These ferries ran at frequent intervals and during the rush hour the wait was no more than 5 to 19 minutes.

The ferry ride was an extremely pleasant interlude in good weather, but in winter or rain storm the walk between dock and subway station could be most unpleasant
The other car carrying ferry went up river to 23rd St. passing ocean vessel piers.

From Plainfield one could change trains at Elizabethport for one of the shoreline trains headed into the Broad St station in Newark. Shore Line trains also joined the main tracks there to reach the ferry depot.

CRNJ trains also ran to Scranton and Mauch Chunk as well as Williamsport and one to Harrisburg. The Reading trains diverting at Bound Brook crossed the Delaware River at Trenton Junction and terminated at Reading Terminal in Philadelphia There one could take a train to Western Pennsylvania or north through Reading and the coal fields.

The B&O trains after stopping in Elizabeth and Plainfield (to pickup or discharge passengers only) ran on the Reading tracks to just outside of Philadelphia to their own station and on to Washington DC. Most continued on to either Chicago or St Louis.

The Lehigh Valley RR ran through South Plainfield. It did not consider itself as a commuter line but did run several passenger trains that stopped at the South Plainfield Station.

The most famous was the Black Diamond from Buffalo.Others trains included the “Asa Packer," which ran between New York and Mauch Chunk, Pa. In the 30s, the John Wilkes’s streamlined engine powered a train of one baggage-express car, one mail-baggage car, four coaches, one club car, one diner, and one Pullman chair car daily both ways between New York and Wilkes-Barre

In the twenties this railroad’s New York terminal was adjacent to the CRNJ in Jersey City and had its own ferry service. In the 30s a connection was made for the passenger trains to use the Pennsylvania tracks just before Newark Penn Station. There engines were switched for electric locomotors into the 34th street station.

Many non commuters would take advantage of the direct trip into NYC. I believe that passenger service ended in 1969.

Friday, May 16, 2008

POTPOURRI THOUGHTS

Since I could not be tied down to a specific format I felt that if I produced a blog it should be Pot Pourri. Some definitions are; hodgepodge, miscellany, conglomeration, jumble, odds and ends etc. In other words a mixture as to content and form.

Other definitions relate to fragrances such as “sachet” or “scent box” or in music specifically a melody. These references will never apply to this blog, although some may rightly think the blog stinks.

Occasionally, I may become contentious, but unless they are offensive, all comments will be published.

This leads into my thoughts on the flack being raised by the Democrats on Bush’s remarks in Israel. My initial reaction was that some in the party were being very thin skinned, and perhaps with a degree of guilt. That should be another day’s subject in depth.

No Democrat speaks out when Carter, except for Nixon one of the worst Presidents in history, independently tries to broker a settlement with Syria and Hamas over Israel.

We should cringe. It is inconceivable to concede to two political entities that have
vowed to destroy Israel. Doesn’t anyone remember that the harvest from Chamberlain’s Munich sacrifice of Czechoslovakia to Hitler for “Peace in our time” was the horror of WWI I and the Holocaust”.

When Bush speaks about continuing the war against terrorism the venue in which the speech is made is of little importance. Rather it is an affirmation of a role that America has previously played despite the willingness of the European nations to pay blackmail.

At the end of the 18th Century into the 19th Century the Barbary pirate Nations led by Algiers in 1785,declared war, seizing two American vessels and imprisoning 21 people.

A "treaty" with Algiers in 1795 cost the United States nearly $1 million--at a time when national revenues totaled just $7 million. A treaty with Tripoli the next year cost $56,000 and one with Tunis about twice as much. In 1801 Tripoli demanded to renegotiate an existing treaty for more tribute, Jefferson sent four newly built warships instead.

Congress and the public supported the action and rallied under the slogan "Millions for defense, not a penny for tribute!" No quick victory came to the navy. In 1805 U.S. Marines, working with Muslim insurgents, traveled 520 miles across the desert from Egypt to capture the pirate port of Derna, east of Tripoli. Tripoli quickly negotiated a new treaty that did not require tribute. (The event still gets mentioned in the Marines' Hymn: "From the halls of Montezuma / To the shores of Tripoli, / We fight our country's battles / In the air, on land, and sea.")

The United States had trouble with--and paid tribute to--the other Barbary States for 10 more years. Finally, in 1815, a 10-ship squadron sent to Algiers by President James Madison forced it to release all American captives and to accept a treaty abolishing any sort of protection money. Madison wrote "It is a principle incorporated into the settled policy of America, that as peace is better than war, war is better than tribute."

That twenty year venture cost over 2000 American lives, a very significant amount considering the population.

The righteousness or legality of our present policy is not a subject here today. I submit that it is consistent with that of the early 19th Century.

Thursday, May 15, 2008

MEDICINE'S GOLDEN AGE-II

When Penicillin was first introduced it had to be administered in a water based solution by injection. Since it was in short supply efforts were made to recycle the drug by trying to extract it from the urine.

WWII occurred just when penicillin was beginning to be produced in commercial amounts, so the military received most of the supplies. It was effective in treating venereal diseases especially gonorrhea and the early stages of syphilis. In Europe a black market rapidly developed immediately after war’s end.


In Berlin we could not treat GC, even though there was no clinical problem in diagnosing the disease, without a confirmed laboratory diagnosis from a smear.

The change in the treatment for syphilis was even more remarkable. No longer did we have to rely on toxic intravenous injections of an arsenic compound plus gluteal (in the butt) injections of Bismuth for treatment, now a course of penicillin treatment resulted in complete cure of primary and secondary syphilis. While in Berlin attached to the 82nd, I had the good fortune to have 6 weeks of duty as chief of the venereal disease service attached to the only American Army hospital inside Paris. But that is another story which I might relate from my war memoirs some other time.

After the war the drug companies put efforts into finding better ways of administering the available penicillin other than by the frequent intravenous route The form then available was destroyed by the stomach acids so could not be given orally. Moreover the frequency of the dosage was a problem.

One of the earliest “ solutions” was the Romansky formula. This was penicillin in a beeswax media for intramuscular gluteal injection. Because the beeswax was slow to be absorbed one injection a day was sufficient. There were certain problems. The most serious if some was accidentally injected into a blood vein it cause a pneumonia that was indistinct from sarcoid disease.

Another was technical, the mixture was not very viscous and if too cold could not be drawn up from the sterile vial into the syringe. Syringes were glass and not disposable. They were sterilized by boiling or in autoclaves. Often when trying to inject this ungodly substance if too much pressure was applied to push it through the large bore needle, the glass syringe would explode sending wax particles onto patient and therapist’s clothes.

However, progress was fairly rapid. In a few years oral penicillin compounds were developed. At the same time slow absorbent formulations were produced for inter muscular injection. The Romansky quickly became an unregretted anachronism.

There was some other new weird combinations with penicillin that had a short clinical life. One was a tablet combination of penicillin with one of the newer “sulfa” drugs. The real problem was that there existed a high degree of allergy to both drugs. If during a treat course with one of these compounds a patient developed an allergic reaction the offending agent could not be identified and because of the probably of a fatal anaphalactic reaction in the future neither medication would be available.

Penicillin was soon followed by Streptomycin and Chloromycin, Erythromycin, the Tetracycline’s, Cephalosporin’s, Quinolones and other antibacterial and anti-viral drugs. Some had severe side effects. One Chloromycine could depress blood cell production and cause aplastic anemia resulting in death. Some others damaged the Liver or the Kidneys with life threatening results.

The overall effect was the ability t o treat all and any bacterial infection regardless of etiology. The down side was one of evolution. Certain bacteria rapidly developed resistant forms to various antibiotics and newer ones had to be constantly developed to produce cures.

One of the major benefits of the development of antibiotics was the treatment of Pheumonias. There were over twenty different strains of the pneumonia bacteria. By the late thirties early forties we were able to treat many of them by the intravenous injection of antiserum. These were antibody horse blood serum products, but were specific for a single strain. To know which one to use, sputum had to be obtained and tested against each one. In the hospitals at that time this was done by a technician in the day time but unfortunately fell upon the house officer (intern) at night. It was a time consuming process. Also many pneumonias were cause by bacteria that were not of the pneumoccocus strains. They were usually fatal. The coming of the antibiotics changed all of that for the better.

Blood stream infections, septicemias, could now be treated and not be fatal. Likewise the frequently occurring ruptured appendicitis was no longer a death sentence.

Thus ends antibiotics, subject- to be continued.

Wednesday, May 14, 2008

Elections

Just a grim thought. The magnitude of Clinton's victory in red neck West Virginia is a disturbing portend for the November elections. Will this be a pattern in middle America? Perhaps we should hope, I trust not in vain, that McCain is not reincarnation of Cheney/Rumsfeld.

PICTURES FROM ISRAEL 1973&1981

These photos were taken many years ago and the quality of the slides have deteriorated. I am trying to post them as a follow up of Israel at 60

The Temple Mount-The Western Wall and The Dome of the Rock
View from the Golan Heights the pale light area is the farm lands of Galilee
Haifa from MT. Carmel
.
The Western Wall
Entrance to The C hurch of the Holy Sepuchler
Roman Catholic Sanctuary
Entrance to Manger-Church of the Nativity

Tuesday, May 13, 2008

Yesterday in her blog, Bernice questioned a Resolution listed on the Council's agenda setting session regarding the transfer of $180,000.00 between theFY2008 Appropriations General Fund. Council members did question this before approval for inclusion for the next Monday's meeting. The explanation included an amount listed as $150,000.00 from "Salary Adjustment to various other departments for "S&W". My impression that these were funds that were budgeted for positions that had been eliminated and were now available for "S&W" in other divisions. Supposedly routine transfers. Since this budget had not been approed in time for first quarter tax payments and most of the 2008 position changes had been administrately completed, the validity of the entire budget process is questionable. If I understood an explanation of the $85,000.00 to the Dir.PW&UD , a unspecified portion is owed to PMUA! I hope we get information on what and why before this resolution is adopted. I think that there was also some mention that funds were owed as far back as 2005.

Monday, May 12, 2008

ISRAEL AT 60

On May 14 Israel will celebrate the 60th anniversary of its independence.

Having visited there twice, once shortly after the Yom Kippur war, I am convinced that once in their lifetime every Muslim, Christian, or Jew should,if humanly possible, make the pilgrimage.

Israel and the West Bank compose an area,of historical and emotional significance for all three of the world's religions based on the Old Testament.It offers a poignant experience, which no one even the agnostic can miss.

Jerusalem has been the holiest city in Judaism and the spiritual center of the Jewish people since the 10th century BCE.The city contains a number of significant ancient Christian sites and is widely considered the third-holiest city in Islam.

The walled area of Jerusalem, which constituted the entire city until the 1860s, is now called the Old City, and was added to the List of World Heritage Sites in danger in 1982. The Old City has been traditionally divided into four quarters, although the names used today—the Armenian, Christian, Jewish, and Muslim Quarters—were only introduced in the early 19th century. Despite having an area of only 0.9 square kilometer (0.35 square mile), the Old City is home to several sites of key religious importance.

Jerusalem is sacred to Jews, Christians and Muslims.

The Jews pray at; the Temple Mount’s Western (Wailing) Wall, the remnant of the Second Temple built after the return from the Babylonian exile.

Orthodox, Armenian, and Catholic Christians worship in the Church of the Holy Sepulcher, with its many separate chapels as the sites of worship for different Christian faiths.

Not far away lays Bethlehem and the Church of the Nativity, probably one of the oldest churches in the world. The first basilica on this site was completed in 333. It was burnt down in the Samaritan Revolt of 529. The current basilica was rebuilt in its present form in 565 by the Emperor Justinian I. Greek Orthodox, Roman Catholic, and Armenian Apostolic authorities jointly maintain the church but with separate sites for the manger. All three traditions maintain monastic communities on the site.

As a political expediency the Balfour Declaration of 1917 (dated November 2, 1917) was a classified formal statement of policy by the British government stating that the British government "view with favor" the establishment in Palestine of "a national home for the Jewish people" on the conditions that "nothing shall be done which may prejudice the civil and religious rights of existing non-Jewish communities in Palestine" or "the rights and political status enjoyed by Jews in any other country..

Unfortunately, when the British received the Mandate over Palestine as a WWI war spoil, they promptly reneged on the Balfour intent.

After the end of WWII the British were forcefully denying entry to Jewish refugees who had survived the Holocaust. After 1945 the United Kingdom became embroiled in an increasingly violent conflict with the Jews.

In 1947, the British government stated that it was unable to arrive at a solution acceptable to both Arabs and Jews. The newly-created United Nations approved the UN Partition Plan (United Nations General Assembly Resolution 181) on November 29, 1947, dividing the country into two states, one Arab and one Jewish. Jerusalem was to be designated an international city – a corpus separatum – administered by the UN to avoid conflict over its status.[51] The Jewish community accepted the plan, but the Arab League and Arab Higher Committee rejected it.

In 1948 the British decided to abdicate its Mandate on May 14, 1948, the Jewish provisional government declared Israel's independence. Both Soviet Russia and the USA recognized Israel as a sovereign nation the next day. Jordan immediately seized and annexed the West Bank and the Jerusalem areas. The Egyptians seized the Gaza strip. Subsequently the Arab Nations united on a war to drive the Jews out of Palestine and create “a United State of Palestine.

After almost a year of fighting, a ceasefire was declared and temporary borders, known as the Green Line, were instituted. Jordan annexed what became known as the West Bank and East Jerusalem, and Egypt took control of the Gaza Strip. Israel was admitted as a member of the United Nations on May 11, 1949.. During the war 711,000 Arabs, according to UN estimates, or about 80% of the previous Arab population, fled the country. The fate of the Palestinian refugees today is a major point of contention in the Israeli-Palestinian conflict, but it must be noted that none of the Arab countries were willing to absorb any of the refugees.

Religious freedom had existed under the Turkish rule and the British Mandate, but after Jordan seized the West Bank and the old city , Jewish Synagogues were destroyed and the Western Wall denied to them.

In 1967, Egypt, Jordan, and Syria massed troops close to Israeli borders, expelled UN peacekeepers and blocked Israel's access to the Red Sea. Israel saw these actions as a casus belli for a pre-emptive strike that launched the Six-Day War, during which it captured the West Bank, Gaza Strip, Sinai Peninsula and Golan Heights.

In the early 1970s, Palestinian groups launched a wave of attacks against Israeli targets around the world, including a massacre of Israeli athletes at the 1972 Summer Olympics.

On October 6, 1973, Yom Kippur, the holiest day in the Jewish calendar, the Egyptian and Syrian armies launched a surprise attack against Israel. The war ended on October 26 with Israel successfully repelling Egyptian and Syrian forces

In 1977, Egyptian President Anwar El Sadat made a trip to Israel and spoke before the Knesset in what was the first recognition of Israel by an Arab head of state. In the two years that followed, Sadat and Menachem Begin signed the Camp David Accords and the Treaty. Israel withdrew from the Sinai Peninsula and agreed to enter negotiations over autonomy for Palestinians across the Green Line, a plan which was never implemented.

We were in Egypt shortly after the peace. One of our guides was a young Christian Egyptian girl who spontaneously commented that “thank god we now have peace. There will be no more needless deaths”. Regrettably that has not been true and one of them was Anwar El Sadat.

Subsequently, Jordan signed a peace treaty with Israel. Jordan forcibly stopped a Palestine Arab attempt to seize power.

Peace between Israel and Syria has not occurred, although there has been many attempts by the Israelis to negotiate one. The Israelis will not give back to Syria, the entire Golan Heights which commands the entire fertile Galilee plane. Before the Six Day War the Syrian terrorized the Israel settlements below.

We, who live here in Central Jersey, should visualize an enemy, complete with howitzers and mortars standing on Washington rock and overlooking the Plainfields, Dunellen, Middlesex Green Brook. The residents of these communities could be under constant fire from the guns overlooking.

Unfortunately, despite many attempts there has been no honest effort of the Palestinian leaders to recognize Israel l as a country. Instead terrorism has increased and Israel’s efforts to counter the bombings and the shelling have been strongly criticized by China, Russia, France, and the rest of the Western World




I have taken the liberty to excerpt part of the above from the Wikepedia Encyclopedia.

CLARINET

As long as I can remember I have been uncomfortable when someone told an ethnic type joke. I may have been polite and laughed but I find any form of bigotry to be unacceptable.

Instead, I have always maintained that the best and funniest stories you can tell are the ones you, yourself, are the butt.

For this story I have to set the scene; after I had returned from service, my father had retired and I took over his practice and office which was in our house on the southeast corner of 4th and Grant.

The configuration of the office could be compared to a railroad flat. If anyone doesn’t know what one was, please ask and I will explain. There was an enclosed entry on 4th St. into a small 6x10 area where there was to the left of the door a small desk for my nurse, a RN who also was lady of all trades. My records were stored in a large side sliding 5 drawer record file. To the right of the entry door was the waiting room, which had been converted from an enclosed porch area. To the left passing the nurse’s desk was a doorway leading into the consultation room, probably 10x20 but perpendicular to the entry foyer. At the far end a door led into what was a small central hall shut off from the restr of the house by doors. On entering this hallway a left turn brought you into the treatment/examing room. Beyond that was a small washroom and a rear enterance. The sequence was Waiting room-door- entry foyer-door-consultation room-door-hall-door-treatment room-door-door-john.

By the early 50s we were able to treat some pneumonias as out-patients. One day I told a young Afro-American that his pneumonia was cured and he could resume a normal life. Clem then left and since there were no other patients, I started to read a medical journal, leaving the door to my nurse’s station slightly ajar.

Shortly after that, I heard the outside door open and the following dialogue ensued:

Clem in a not too quiet voice to the nurse, “I forgot to ask the doctor if now I could play the clarinet”.
Me through the parftially opened door. “Of course you can, I told you that you were free to do all activities”.
Rejoinder “That’s great, I never could play one before.”


Hook, line, and sinker, I had bitten.

For many years we have laughed over that episode whenever we met. Clem and his family were valued patients until I retired. Since then whenever we met I have retold this story.

Barbara Wilson who had been working in the obstetrical delivery room was my first nurse. She earned $45.00 a week, with no fringe benefits. Please be advised that was not slave wages, and an office visit was$3.00 to $4.00, a house call $5.00. How times have changed.

Sunday, May 11, 2008

FYI-COURIER EDITORIAL 5/11/08

Open minds needed on Muhlenberg closure



The State Health Planning Board has a responsibility to recommend action on Solaris Health System’s plan to close Muhlenberg Regional Medical Center.
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And yet when the board conducted a public hearing on the plan at Plainfield High School last week, only four of its 11 members showed up. And it only bothered to allot two hours for the entire meeting, despite knowing the hearing would draw a large and passionate crowd.

That’s pitiful. State health officials owe Plainfield and its surrounding communities better than that.

In a crowd of 1,200, only a third of the 90 people who signed up to speak at the session got their chance. Board members listened, but asked no questions. The hearing, in short, did nothing to dispel the notion that this entire closure process is nothing more than a rubber-stamp exercise; the board will approve the basic proposal, the health commissioner will agree, and Muhlenberg’s acute-care hospital will be history.

A second public hearing is in the works, which is the least the health board can do at this stage. But some things had better change this time around. More board members should show up, and display more interest in what they’re hearing. The meeting should be open-ended to allow everyone who wishes a chance to speak, regardless of how long it runs. A little inconvenience isn’t too much to ask to address the future of a hospital that has been serving its community for more than 130 years.

Muhlenberg’s fate should not yet be sealed. But the state health board has traditionally done little more than tweak these sorts of hospital closure applications. And Health Commissioner Heather Howard has already publicly supported shutting Muhlenberg’s doors, suggesting that the move will help strengthen other hospitals.
It is reasonable to expect an open mind from the people who will make the final decision on Muhlenberg. But we haven’t seen that yet. And time is running out.

OUR POSITION:
The State Health Planning Board’s approach to a public hearing on the proposed closing of Muhlenberg Regional Medical Center was an insult to affected communities.

Day off

No words of wisdom, intrigue or nostalgia today. Today's Courier News' editorial hits the spot. To bad the major area media are asleep.

To all the mothers "You have earned it" from Grump and GG

Saturday, May 10, 2008

Addendum "How far we have come"

In the following paragraph from yesterday's post I was trying to explain why I chose a career in medicine.

My father opened his practice in Plainfield in 1910-11.My brother also became a physician.I became a doctor not because I had an overwhelming desire to care for people but because I could not contemplate any other adulthood.

As my son Andrew, a psychiatrist living in NYC, pointed out, he is the third generation physician of my lifetime.

I am proud that although Andy did not influence my choice, he unlike so many other physicians' sons decided to select that career. I must have made an unrealized impact!

Life for the children of doctors in the post war years was not easy. Their fathers were often absent parents due to prolong office hours, working evenings as well as day times, and for most a 24/7 availability. The workloads began to ease up in the 50's with the establishment of formal coverage groups.We could now take time for a family life with the knowledge that our patients were provided for.

I established one of the first groups in Plainfield with my juniors,Dick Sharret and Nancy Davis who had been my coverage. We shortly included Dabney Moon in this very congenial group.

Trolley Times

With all the concern registered about public access to MRC's replacements,I thought a brief and likely inaccurate essay would be appropriate.

In the twenties the local public transportation was provided by the trolley lines. The Public Service Transportation line ran from Bound Brook to Newark. It may have started in Somerville but I have no recollection of its exact route.

In Plainfield the tracks ran from the Dunellen border down Front St. to Watchung Ave. turned south to Fifth Street. The route continued east to Richmond St. then under the RR tracks to Third St. (I don’t believe it was Second but 60-70 years was a long long time ago.) and east to the city line.

After crossing Terrill Road, the tracks used a private “cross country” dirt right of way, finally entering Westfield on North Ave. The Jolly Trolley is so named because of the tracks that ran down the Street. I can’t recall where the tracks again ran south of the railroad, but between Garwood and Cranford there was again a private right of way south of the road.

In Elizabeth after passing under the Pennsylvania RR tracks into downtown Elizabeth the cars merged with “the main line tracks into Newark and Penn Station.

Sometime in the 30s the trolleys were replaced by ecological friendly ‘Trolley-Busses”. They ran on electricity from the overhead wires, and could manipulate as vehicles do today. Of course the tracks were abandoned or paved over. The Scotch Plains right of way became Midway Avenue. Many of the tracks were torn up for the steel during WWII.

There were two local lines serviced by “Toonverville Trolley"** like cars. Unlike the interurban vehicles of the main line (29) these cars did not have double trucks for wheels. The 4th Street line went from beyond Clinton Ave ( Evona???) to join the Public Service line at Watchung Ave and terminated its run downtown perhaps in New Street.

The other line I remember ran down Somerset Street in North Plainfield, then via the 4th St. route from Front Street to Arlington Ave, down Randolph to Park, past the Hospital, to South End Parkway, terminating at Hillside Cemetery.

We had a “Heinz Hound”, Rex, who was every child’s delight, and the Lothario of the West End as well as the Adirondacks. On warm days, Rex like to lie-down in the middle of 4th. St. on the tracks and absorb the sun. Obviously auto traffic was much less than it is today so he was never in real danger. The trolley operator would stop, clank the car’s bell and Rex would amble off to the side until the street was clear.

In as much as my memory is faulty on some matters, as allways, I would appreciate comments from anyone who has a better recall

** a comic strip.

Friday, May 9, 2008

THANK YOU

Belatedly, I wish to publicly express my gratitude to Rev. Colvin for ceding her 3 minutes to me at Tuesday' Public Hearing on MRC's closing. I hope I justified her action. It was obvious that none of the physicians who had registered to speak were going to be part of the "random selection". We are all indebted to Nancy Piowar for brokering the time for those who did get to address the panel, and to those that gave up their slot. For those who were not there, Nancy's presentation was one of the strongest submitted, I would hope that she would make it public via the media.

HOW FAR WE HAVE COME

With little better to do, because of the Muhlenberg Hosital issue, I have had time to reflect upon my life time involvement in Medicine.

My father opened his practice in Plainfield in 1910-11.My brother also became a physician.I became a doctor not because I had an overwhelming desire to care for people but because I could not contemplate any other adulthood.

Someday I may expand on the Yood's Medical Careers, but not now. I wish to relate what has happened to our society over the last 80+ years. This will take several installments of various lengths. They will not be posted consecutively.

I was fortunate that my career coincided with the truly golden age of medicine. this was a time when Doctors could be patient advocates and friends, not skilled technicians subjected to the constrictions imposed by governmental agencies, third party payers, and a litigious society,

As a medical student, in 1939, when I first entered medical school, there was only one bactericidal medication available, sulfanilamide. This was a German drug that Bayer had developed from a chemical dye. A few other more effective compounds were rapidly developed. However, some like sulfathiazole had severe side effects; among them was loud ringing in the ears which could become unbearable. One could correlate the effects of that drug to today’s unlawful torture interrogation processes. Other side effects included destruction of the bodies ability to make blood cells, aplastic anemias which were incompatible with life.

Sulfadiazine was the best tolerated and most effective of the sulfas and is still used. By the time I had retired in 2001, there were multiple generations of antibiotics as well as some available anti-viral drugs,

Tuberculosis was synonymous with the sanatorium, where it was hope that the disease could be arrested by exposing patients to fresh and often cold air. Being spread by close contact especially in the presence of those who were coughing, it was a leading killer of not only the poor but the affluent.

Among the treatments were operations to remove ribs and collapse part of the chest wall and lung in an effort to close and seal the cavities that were the focus of infection.

Locally Runnells, known then as Bonnie Burns, was the local sanatorium. The ones at Lake Placid and Saranac NY were world famous. Today they are all history or converted for other uses.

Poliomyelitis was a feared disease. The worse complication was not only varying degrees of peripheral paralysis, but the involvement of the respiratory muscles including the diaphragm. When this occurred, life could only be maintained by the use of the ‘iron lung” a steel tank equipped with bellows to expand and contract the lungs. Patients lay on their back with only the head protruding through a rubber diaphragm outside the tank. If the power or pump failed they were doomed to death by asphyxiation.

Today, Polio has been eradicated almost everywhere in the world. However there are still small loci in Africa and Asia of unprotected populations and if we let our guard down this scourge like others could resurface.

Rheumatic fever and the contagions cut short many a youngster’s life. Rheumatic fever, a streptococcus infection damaged the heart valves leading to heart failure. Septicemia, including sub-acute bacterial endocarditis, a streptococcus infection which had settled on a damaged heart valve, was inevitable fatal.

By today’s standards the treatment for sub-acute bacterial endocarditis was witch craft. Intravenous injections of killed typhoid bacteria or even milk were routine in an endeavor to great an extremely high fever, 105 or better in the belief that would destroy the bacteria.

Fortunately in the early 40s Penicillin was discovered, and its potentiality against certain bacteria realized. While an intern at Syracuse University Medical Center in 1943 we were able to obtain 20,000 units of Penicillin to treat intravenously a young girl with SBE. To the best of our knowledge we cured her.

If you comprehend that today a single tablet of penicillin contains a minimum of 250.000 units, more than10 times what we had available, you can understand how great a miracle that was.

I intend this to be, if you are willing to read, the first of many periodic but intermittent postings on the change in health care in the last 60 to100years.

Wednesday, May 7, 2008

VILLAIN SOLARIS ROLLS ON

(This is Thursday's Posting- the date/time stamp represents that at the blog's site)
GOOD/BAD NEWS
According to the Courier/Home News web site the State will hold another public hearing about Solaris's request for a CN. That is the good news. The bad news is that the McGeeites are continuing with the process of making MRC worthless. Rumor has it that the Colon-Rectal Group is terminating its 40+ years affiliation with MRC for a promised dedicated floor at JFK.

This is a continuation from my complete document submission to the State Board.
IMPACT OF CANNIBALIZATION
The sale of the busy Surgicare Center in Watchung to 27 physicians who were big users of MRC’s same day surgery unit and the insurance carrier’s preference for patients using free standing facilities, the Hospital effectively lost that source of income.

The sale of a busy dialysis unit to a profitable commercial entity who maintains their site on the MRC campus also had a negative effect on MRC’s balance sheet. I am sure that the proceeds of these sales were not used for MRC’s benefit.

The transfer to JFK of the Wound Care Center as well as combing at JFK and eliminating of essential patient care services such as physiotherapy, occupational therapy, speech therapy, diagnostic and clinical laboratory procedures from those offered at MRC created an unsatisfactory and unsafe atmosphere for the Orthopedic , Neurosurgery, Colon Rectal groups. and the Vascular Surgeons resulting in their abandonment of MRC for the JFK site. This loss of inpatient occupancy was catastrophic.

The Home Care Services provided by MRC are delivered by JFK

The relocation of the Diabetes Center from MRC to a freestanding site on Talmadge Rd.,Edison, deprives Plainfield’s ethnic populations who have a high incidence of that disease of appropriate care. No public trans available

The Bariatric Center will be lost to the MRC core area.

The life saving elective Angioplasty facility its site certified and cannot be transferred. However , Today I became aware of this press release. Solaris is continuing to try to eiminate MRC as a desirable hospital

Solaris Health System Inks New Agreement
By Martin C. Daks
2/19/2008
Solaris Health System today announced it has retained MedCath Partners, LLC, to manage the catheterization laboratories of its two acute care hospitals, JFK Medical Center and Muhlenberg Regional Medical Center.
Edison-based Solaris, local cardiologists, and Charlotte, N.C.-based MedCath will own equal shares of the management company. MedCath will contribute about $1 million to the venture; the other participants will make pro rata capital contributions.
JFK Medical Center in Edison comprises a 399-bed teaching hospital and the adjacent 94-bed JFK Johnson Rehabilitation Institute. Muhlenberg Regional Medical Center is a 396-bed facility in Plainfield that provides inpatient and outpatient services.
The Solaris system includes acute care hospitals, inpatient and outpatient rehabilitation centers, nursing and convalescent facilities and specialized treatment programs. MedCath Partners' primary focus is working with health care organizations to form joint ventures to manage hospital-based cardiac catheterization laboratories. It is a subsidiary of MedCath Corp., a health care provider focused on the diagnosis and treatment of cardiovascular disease and other illnesses
.

What JFK did not count on is the non transferability of the Internal Medicine Residency program at Muhlenberg which not only will be lost but the physicians who signed contracts for training there are now left out in the cold with nowhere to go.

Is the public aware that Solaris received permission from Plainfield's Planing Board to devide the Muhlenberg campus into multiple parcels that can be sould seperately?



ARGUMENTS CON CLOSURE
There can be no ignoring the fact that Muhlenberg, in conformity with the criteria noted in the Commission on Rationalizing Health Care Resources’ report, fully qualifies as an Essentially Necessary Hospital.
Many of services provided at present by Muhlenberg are not available elsewhere in its service area.
• There exists no easily accessible or adequate public transportation from the Muhlenbergs Service area to any of the other adjacent hospitals. Public transportation to JF K, and Overlook the 2 suggested relief hospitals involve a tain or bus to Penn Station Newark then for JFK. Train to Menlo Park and Bus to Hospital. For Overlook a transfer to another RR station and train to Summit then Shankls Mare. Work out the logistics.
• With the potential lack of access, any one without available car transportation can not receive adequate health care.
• The proposed ER at the Muhlenberg campus will be nothing more than another walk-in urgent care clinic. Rescue squads will go to a facility with acute care capabilities. I am under the impression that JFK has only guaranteed to maintain an ER at the Muhlenberg site for 3 years. What will happen after it is closed?
• ER patients needing hospital admission or specialized emergency procedures would first have to wait for the ultimate arrival of an ambulance and then face at a minimum another 15 minutes transportation time to an available hospital. This can create an absolutely life threatening crisis, which I believe no one in the Department of Health could find acceptable.
• The impact on the local economics will be devastating if 800 employees out of 1100 will be terminated. This does not include the additional cost to the State for unemployment and welfare benefits, including a further drain on Medicaid funds.
• JFK offers no acute psychiatric care. Of the four other so called available hospitals, Overlook and Somerville normally run at near capacity. Raritan Bay and Trinitas are more than 12 miles away and well over 30 minutes by car. Neither can be reached by direct public transportation if at al.
Although we have heard otherwise, we can only surmise that Solaris has acted in good faith despite its inability to find a buyer for Muhlenberg. Does it have another agenda involving the substantial closing funds it has requested? The fact that both Muhlenberg and Solaris are running a deficit operation could possibly be related to poor management. I give two examples:
• Seven years ago Solaris sold its busy but money losing Surgery Center to a group of physicians.. It has been very profitable since
• Two decades ago Muhlenberg, terminated a partnership with a group of Staff Physicians and sold three walk in clinics at a distress price. I am aware of at least one is still a successful enterprise.