Saturday, April 30, 2011

MONDAY'S AGENDA. MAY FIRST LOOK

A quick look  at Monday night's Council Agenda suggest that it will b ea busy meeting.

There is schedule an update on the "shared services agreement with the BOE' by IT Manager Chris Payne in addition to reports  from the Council's subcommittees.

There is a resolution submitted by the Mayor for appointments to serve as members of the PLAINFIELD HEALTH ADVISORY CONSORTIUM , including a physician who owns a health care business in Scotch Plains. I confess my ignorance  regarding the Consortium  and its function as an advisory organization. If I learn about it which I have been unable to find on Google I will comment over and above question why there is no Plainfield physician recommended.

The Resolution releasing Dornoch's performance guarantee which was tabled at t5he April meeting is back on the agenda. I presume that all questions have been satisfied. 

Any comments on other Resolutions will wait until I have a chance to read them. There is one peculiarity; A resolution authorizing a contract award for the South Ave Repavement , and an other one rejecting bids for the South Ave repavement. Confusing!

It is of interest that in the absence of a Director of Public Works all the road related resolutions are submitted by the Engineers.

Thursday, April 28, 2011

HEALTH CARE FILLER 4/29/11

This article from Medscape news is one more hair brain  reason why I am concerned on the impact of the new Health Care laws on the actual care the patient (YOU) will get. My comments are in italics.

April 28, 2011 — Nearly 120,000 clinicians who told Medicare how they did in 2009 on certain quality yardsticks such as conducting foot exams for adults with diabetes received a total of $234 million in bonuses in 2010 — more than twice the amount for 2008 — in the program's Physician Quality Reporting System (PQRS). Good old fashion medical practice when the MD had time would include that exam each office visit. To rely and pay a bonus for the physician to record, probably by a check mark in a computer entry is ridiculous; there is no proof the exam was done.

The average payment for 2009 performance was almost $2000 per qualifying clinician, according to a report released last week by the Centers for Medicare and Medicaid Services (CMS). Some 86,000 qualifying clinicians received about $92 million, or almost $1100 apiece, for their PQRS performance in 2008.
In addition, roughly 48,000 clinicians received $148 million, or almost $3100 each, in Medicare bonuses for electronically transmitting prescriptions to the pharmacy in 2009 — the year in which the incentive program went live. The physician will have a programmed list of prescriptions in his Android or I-phone will text patients name and punch the prescription number. The doc has another piece of "time saving equipment". Saves the pharmacist from picking up a phone call or reading a written Rx. This is supposed to reduce errors. Doubtful.

Both incentive programs are part of a CMS effort to compensate physicians and other providers for the quality, not the quantity, of the care they render, as is the case under traditional fee-for-service medicine.  I need proof that this will increase quality-good docs will practice good medicine, bad ones/ can the tiger change his stripes? However, the $382 million paid out under both programs combined for 2009 equals less than 1% of the $62.5 billion that Medicare spent on physician fee-schedule claims that year.
Physicians Can Choose the Measures to Report
In PQRS, which debuted in 2007 as the Physician Quality Reporting Initiative, clinicians report their performance on a handful of quality measures that they pick from a list issued by CMS. In 2009, clinicians could choose from 153 measures. The list has grown to 194 items in 2011, including:
  • The percentage of patients aged 18 through 75 years with diabetes whose most recent blood pressure was in control.
  • The percentage of patients aged 50 years and older who received a flu shot during the influenza season.
  • The percentage of adults screened for tobacco use at least once within 24 months and counseled on quitting if they were identified as tobacco users.
  • The percentage of seniors with a history of falls who had a risk assessment for falls completed within 12 months.
CMS classifies PQRS as a "pay-for-reporting" program, as clinicians do not need to meet a certain minimum in a particular measure. Reporting that only 5% of adults aged 50 years and older were immunized against influenza is good enough for that measure — for now.
Despite PQRS not setting performance thresholds within a measure, participating clinicians have nonetheless improved the quality of their care, at least in some areas. For example, the percentage of clinicians who reported that they had talked to patients with diabetes about eye-related complications rose from 52% in 2007 to 93% in 2009.

Clinicians can submit PQRS data on their chosen measures to CMS through a qualified electronic health record system, Medicare claims, or a qualified online registry. With the latter 2 methods, the reporting period can be either the entire year or just the last 6 months. With an electronic health record system, the reporting period must be the entire year. Some lamebrain expert in bureaucracy must have thought this  as helping patients and cutting costs.

Clinicians who successfully submitted their data for 2009 received a bonus equal to 2% of their estimated Medicare allowed charges during the reporting period. The bonus remained at 2% for 2010, and decreased to 1% for 2011. However, clinicians can earn an extra 0.5% this year for maintenance of certification, which requires year-round reporting, among other things.

The primary PQRS bonus will decrease to 0.5% in 2012, 2013, and 2014, and then disappear. The 0.5% maintenance of certification bonus continues through 2013.

Right now, participation in PQRS is voluntary. However, physicians who do not submit PQRS data beginning in 2015 will experience a 1.5% pay cut under the health care reform law called the Affordable Care Act. The penalty for nonparticipating increases to 2% in 2016 and beyond. Why should there be bonuses now and in  4years penalties? The idea is to force use of one of two  software systems.  The more rules and regulations there are it becomes impossible for a small two person practice to survive. The same number of Compliance individuals in a practice will work for the 2 man group and the big group. The bigger the group this individual has little impact on total net revenues.
For more information on the PQRS program, visit the CMS Web site.
E-Prescribing Must Start Before July to Avoid 2012 Penalty
Electronic prescribing used to be a quality measure in the PQRS program, but in 2009, it became the basis of its own incentive program under the Medicare Improvements for Patients and Providers Act of 2008.
Physicians who qualified in 2009 received a 2% Medicare bonus, which was also the carrot in 2010. The bonus decreases to 1% in 2011 and 2012, and then to 0.5% in 2013, the last year of the program.
As with PQRS, the e-prescribing program will shift into a penalty phase. Physicians who do not report a minimum of 10 electronic prescriptions in the first 6 months of 2011 on their Medicare claims will see their Medicare reimbursement cut by 1% in 2012. The penalty will increase to 1.5% in 2013, and to 2% in 2014 and beyond. Another report!!! What is the hidden agenda is another means of forcing physicians into a "Big Brother is Watching" situation and will also make it easier to monitor patients a privacy invasion.


If I did not keep reading the silliness that is supposed to bring about good health care to every one I would have time to write in length my opinion about the not to far impact on  the c are we all will receive.  Health care is being treated a s a commodity. Commodities costs money. If you reduce the amount of money-cutting costs- adjustments have to be made; either you reduce the amount or the quality. You can not get what you don't pay for.

We in Plainfield have already been a victim of the system through the loss of Muhlenberg. It was force to give care for which the State or Feds would not adequately reimburse.

BOARD ELECTION S THOUGHTS

In his blog about the results of  the BOE elections ,"e=mc2" wrote today "The People have Spoken".

Truer words have never been written. Unfortunately the interpretation is wrong. I do not dispute the overwhelming victory of the  "Slam" sponsored slate giving that association control for at least the next two years and probably three of the Board. In that respect those who voted have confirmed their justified dissatisfaction with the Board of the Gallon years.  Let the new Board and its successor use that mandate wisely.

But in all honesty, the people have spoken by their silence. If less then 1000 votes were cast on the budget that represents maybe 11% of the Plainfield electorate. In other words approximately 80plus% of voters in Plainfield do not care about educating the city's children. This is a failure of democracy, or more precise citizenship.

School board elections are notorious for the lack of public participation either as candidates or voters. Usually people do run for a seat if they have a child in the system and they have a personal agenda with the overall concerns being ancillary. That sentence should not be interpreted as being derogatory but rather as a compliment in that there are some who are concerned about their children's education.

It is significant that in districts  that have acknowledge better school systems, there were the following number of voters; Westfield (4000),Fanwood (800),Bernards(4178) ,Bridgewater-Raritan(4712). (data source the Courier). What persentage of voters in these communities  is represented I do not know but i am sure that it would fall somewhere between 20 &30%. That is significant.

If the present system of elected BOE members rather than an appointed board is a failure what alternatives do we have? In Plainfield the administrations track record on appointments and filling TOE positions is one that would make the appointed board even less than an acceptable option. That is coming from one who is an advocate of the appointed Board.

There is possibly workable alternative. The farce that the School Board elections are non political is a farce as demonstrated by the number of "slates" running in the past and some of the politicians remarks about membership. One solution for greater involvement would be to combine the school board elections with the general elections in November. In a one party town like Plainfield, the Primary election would perhaps be a better choice. Lets give this some thought and pressure our legislatures to make that possible..

BOE

Congratulations to the winners in the BOE elections.

Six of the sitting members of the Board will be from one affiliation. Having a secure majority for the next two years. we can hope that the Board will expedite the election of progressive Superintendent.

We look forward to at least two years of a program dedicated to delivering to student groups not to minimal test standards.  The K-8 configuration may allow at about the 3rd grade level a division into at least two groups; those that need more intense instruction and those that capable of benefiting by an advanced tract.

Just a suggestion by someone who knows little about education. However, who believes that edcuation must constantly challenge the child to keep him involved. Parents will recognize that and the urge to transfer out  or to attend charter schools will disappear.

Wednesday, April 27, 2011

ELECTIONS

Get out and vote today. There are only 4 candidates for  3 slots. Vote for individuals not a "slate". It is the number  of voters who turn out for a school board election that is the indication of the community's interest in providing quality education. If the community shows interest the next election will draw a greater number of  exceptional choices. In three years the character of the Board could be completely different.

TO THOSE WHO NEED AN APOLOGY

The other day I posted a blog relating  to the BOE elections. In that blog I needless made reference to the most popular radio program of the depression years which I had not  thought  about for years. It was never intended be any "racial slur" but  as groundwork for a spontaneous association  that popped into my head the first time I heard Dr. Gallon  address the Council.

By remarking that Gallon "was the Kingfish" was that Gallon turned out "conned" by being less than honest the BOE . the public  , and most recently a consulting  firm in Arizona. He seduced his listeners by his fondness for polysyllable words delivered in his commanding bass voice. He sounded good but had no direction except to "take care" of his Florida friends.

 I thought that by calling attention that programs of that type which all of America deemed acceptable due to the mores of the times would have no place in today's world.In today's reprint of the "offending" paragraphs I have bold faced the line that expresses my true feelings.

If I did inadvertently offend anyone I do sincerely apologize.

The "offending" paragraphs:
Before I get into the subject of today's blog let me recall a little history of the Great Depression. People needed laughs and the most popular show was one that today would rightly be barred from the airways  as being racially derogatory. Most Americans, white and blue collar, urban or rural, of those time were very insular and had no contact with African Americans so that the characters portrayed by the "Black face  Comedians" in Amos  and Andy filled a nationally popular erroneous concept of the Harlem population. Thus the situations they would get into were hilarious. Recent hit TV shows like 'Sandford and Son" or" George Lopez" which is of course a self parody"partially fill that ethnic comedy niche. *********************************************************************************
"One of the lead supporting characters in "Amos and Andy" was a local politician, lodge leader, con man called the 'Kingfish". His trademark was in his deep base voice the use of polysyllable erudite words when trying to take advantage of his less educated targets.


There was a reason for my opening story; when  I first heard Dr. Gallon address the Council at an Agenda setting session the minute he began to speak the memory of the Kingfish instantaneously came into my mind. I believe I so remarked in my blog However  then I did not realize that he was the "Kingfish.".  

There is one caveat; I can not apologize to the author of the comment which I refuse to post due to a reference to a Nazi symbol. That is particularly insensitive since this coming Saturday is for Jews a 'Day of Remembrance of the Holocaust"  If that person is a blogger there are no restrictions from posting their remarks there.If that person is a blogger there are no restrictions from posting their remarks there..

Ps: there may be a clue to who the anonymous writer is in this sentence from a comment at about 5pm Tuesday."I'll face you at the next Board meeting. Ok".

Tuesday, April 26, 2011

HEALTH CARE COSTS ITEM

I thought that this might be of interest from Medscapes "Internal Medicine News"

The 10 Most Prescribed Drugs
Daniel J. DeNoon
April 20, 2011 — The 10 most prescribed drugs in the U.S. aren't the drugs on which we spend the most, according to a report from the IMS Institute for Healthcare Informatics.
The institute is the public face of IMS, a pharmaceutical market intelligence firm. Its latest report provides a wealth of data on U.S. prescription drug use.
Continuing a major trend, IMS finds that 78% of the nearly 4 billion U.S. prescriptions written in 2010 were for generic drugs (both unbranded and those still sold under a brand name). In order of number of prescriptions written in 2010, the 10 most-prescribed drugs in the U.S. are:
  • Hydrocodone (combined with acetaminophen) -- 131.2 million prescriptions
  • Generic Zocor (simvastatin), a cholesterol-lowering statin drug -- 94.1 million prescriptions
  • Lisinopril (brand names include Prinivil and Zestril), a blood pressure drug -- 87.4 million prescriptions
  • Generic Synthroid (levothyroxine sodium), synthetic thyroid hormone -- 70.5 million prescriptions
  • Generic Norvasc (amlodipine besylate), an angina/blood pressure drug -- 57.2 million prescriptions
  • Generic Prilosec (omeprazole), an antacid drug -- 53.4 million prescriptions (does not include over-the-counter sales)
  • Azithromycin (brand names include Z-Pak and Zithromax), an antibiotic -- 52.6 million prescriptions
  • Amoxicillin (various brand names), an antibiotic -- 52.3 million prescriptions
  • Generic Glucophage (metformin), a diabetes drug -- 48.3 million prescriptions
  • Hydrochlorothiazide (various brand names), a water pill used to lower blood pressure -- 47.8 million prescriptions.
The 10 Best-Selling Drugs
It shouldn't be a surprise that these generic drugs are not the ones bringing in the big bucks for pharmaceutical companies. The drugs on which we spend the most money are those that are still new enough to be protected against generic competition.
The IMS reports that Americans spent $307 billion on prescription drugs in 2010. The 10 drugs on which we spent the most were:
  • Lipitor, a cholesterol-lowering statin drug -- $7.2 billion
  • Nexium, an antacid drug -- $6.3 billion
  • Plavix, a blood thinner -- $6.1 billion
  • Advair Diskus, an asthma inhaler -- $4.7 billion
  • Abilify, an antipsychotic drug -- $4.6 billion
  • Seroquel, an antipsychotic drug -- $4.4 billion
  • Singulair, an oral asthma drug -- $4.1 billion
  • Crestor, a cholesterol-lowering statin drug -- $3.8 billion
  • Actos, a diabetes drug -- $3.5 billion
  • Epogen, an injectable anemia drug -- $3.3 billion
U.S. Prescription Drug Use: 2010 Factoids
Who's paying for all these drugs? Commercial insurance helped pay for 63% of prescriptions, down from 66% five years ago. Federal government spending through Medicare Part D covered 22% of prescriptions.
For Americans covered by insurance, Medicare, or Medicaid, the average co-payment for a prescription was $10.73 -- down a bit from 2009 due to increased use of generic drugs. The average co-payment for branded drugs for which generic alternatives were available jumped 6% to $22.73.
Other facts from the 2010 IMS report:
  • Doctor visits were down 4.2% since 2009.
  • Patients filled more than half of their prescriptions -- 54% -- at chain drugstores, possibly because of discounts on generic drugs.
  • Brands that lost their protection from generic competition led to $12.6 billion less spending in 2010 than in 2009.
  • The price increase for drugs without generic competition led to $16.6 billion more spending in 2010 than in 2009.
  • Drug companies offered $4.5 billion in rebates to assist patients with the high cost of brand name drugs for which there was no generic alternative ( boldface mine)

ADDENDUM BOE

Upon reading Plaintalker II today about  a BOE proposal to rename the High School, I sent the following comment which I repeat because it is symptomatic  of the lack of real priorities in the BOE to even discuss such an idea.

There are many pioneers from various ethnic and religious backgrounds in America's scientific and professional fields today that are a tribute to what good educational opportunities are now available when provided. Changing the name of the school will not solve our educational problems. Better yet the BOE select a good superintendent and give him/her support and time to develop that system. The answer would lie in multi-tract curriculum from some level in K5-8-12 to even perhaps splitting the high school into smaller diverse schools with different education goals that would fill the needs of all students.

BOE ELECTIONS

Once again I am postponing a continuation of my new Health Care laws and the impact on you, the patient.

Before I get into the subject of today's blog let me recall a little history of the Great Depression. People needed laughs and the most popular show was one that today would rightly be barred from the airways  as being racially derogatory. Most Americans, white and blue collar, urban or rural, of those time were very insular and had no contact with African Americans so that the characters portrayed by the "Black face  Comedians" in Amos  and Andy filled a nationally popular erroneous concept of the Harlem population. Thus the situations they would get into were hilarious. Recent hit TV shows like 'Sandford and Son" or" George Lopez" which is of course a self parody"partially fill that ethnic comedy niche.

"One of the lead supporting characters in "Amos and Andy" was a local politician, lodge leader, con man called the 'Kingfish". His trademark was in his deep base voice the use of polysyllable erudite words when trying to take advantage of his less educated targets.

This day before the BOE elections and the vote on the school budget I am going to return to the BOE and in part to the Candidates. There are only three vacancies to be field and four seekers. One will have to be left out. I previously wrote that I would not make a recommendation and although I write positively but not enthusiastically about two whether you vote for them or not is your prerogative based on judgement.

There are three seats open, one at present held by Cathcart who is seeking reelection which we will return to later, one vacated by Edwards who was elected to fill a 1 year residual term as a member of the "SLAM" and the last one by Peterson who had years of administrative experience in the Edison system

Let us first focus on the District's Administrative and the supervising Board's records for the past decade:.; Since Leverett left in 2003 there have been including the present acting supervisor 6 individuals, some acting, filling that position; They were Melindo Persi, Paula Howard the only one who had a full appointment an d served less than 4 years. She was known for her expensive tastes at district expense such a s Gevalia Coffee. Shre was followed by Peter Carter (Interim),Bailley (Interim) and then Gallon. who was succeeded by the present acting Superintendent Anna Belin-Pyles. We have not even gone into the longevity of the school principals.

I would ask; How can any school district have any direction when there is a lack of continuity at the top administrative positions.. Without any knowledge of facts one would have to presume that this was a lack of cohesive purpose among Board membership during that period. The fact that there were multiple "tickets" at previous elections suggest political factions among the Board members with various agendas took precedent over understanding the role of a Board of Directors.

Be that as it may, two present sitting members of the BOE; Campbell and Barksdale were 2/3rds of the search committee that found Dr.Gallon. In their defense they did. use a known 'headhunter" and did do what they thought was due diligence by going to people where he was employed. One can not blame them for accepting 100% what they were told by those that must have wanted to rid themselves of that man. If they search the Internet for further information I do not know, but if they had something may have turned up.

Monday I received this comment to my post on the LWV forum from of course anonymous;"The slate that controls the BOE now got rid of Gallon, the incumbent supported every move Gallon made. That's all I need to know."

Sir you are in error;(1) A member of "The Slate" was part of the search committee that selected Gallon.(2) The BOE did not get rid of Gallon. They should have terminated him for cause when his improprieties led to an indictment. Or at least suspended without pay, but instead they finally reach a settlement after many months. What the total cost was including legal fees we will never be informed.

That Cathcart supported Gallon was not unique. If there is a record of anyone opposing the title changes and the employment of the Florida three let them show us the record. I will bet non exists. Thus you should not hold Cathcart's support of Gallon as a reason to not vote for him.

The choice should be who will be the best for the Board. Cathcart with his 9 years of experience and his avowed spot of expertise , or Mr Edache who was either evasive in his replies to the moderator's questions or only answered in generalities, or also a man who admitted that he had to learn the position. That would be OK but his part time affiliation as a real estate agent in a firm owned by Campbell's husband would cause me time for concerns.

When  at the LWV forum when the time came for the Candidates to make there opening statements; Mr Hurtt to the initiative to defend the 'slate" by admitting that although they are running as one they held to their individual thoughts  and would act accordingly.The question then becomes why did they need to be  a slate?

There was a reason for my opening story; when  I first heard Dr. Gallon address the Council at an Agenda setting session the minute he began to speak the memory of the Kingfish instantaneously came into my mind. I believe I so remarked in my blog However  then I did not realize that he was the "Kingfish.".

Monday, April 25, 2011

OUR NEW MEDICAL CARE SYSTEM

Before going into the practicalities involved in evolving new forms of health care, I would first like to review the subject of records. 

 In 1946 when I  took over my father's practice most physicians kept records if any on 3X5 cards. Obviously they were quick reminder notes only. I inherited more complete records on 5X8 cards but quickly switched to the innovative  letter size sheets of paper which were followed years later with printed forms that had  certain areas for proscribed information.

As this society became  a litigious one in which courts awarded outlandish amounts for supposed malpractice damage often based solely on what was not on the record. "If you did not write it down you did not do it" If you had a check sheet which you marked "done" or "OK" that inferred that you had asked or done it. In truth all it could mean in too many cases was that you had checked that line.  having to keep the paperwork on every test or xray even if normal the volume of the record would increase to actually be useless.

Physicians and hospitals had to keep such records to protect themselves from lawyers and a society that was more interested in what they 'can get" than in if they were victims of bad medicine. Doctors had to carry mal-practice insurance for their own protection because merits of a suit was a secondary consideration. There were times when no carrier would insure a doctor in New Jersey  because in cases that went to trial the awards were uniformly outlandish. Middlesex County's courts were notorious for their awards and therefore many lawyers would try to get the case heard in that County.After all the attorney would be paid from 33% to 50% plus expenses from the patient's award. "The coin drives the machine".

One of the troubles in  the past was that Specialists consultants would not communicate with the primary care physician . Patients began to bypass their "family doctor" and go directly to a specialist who felt no obligation to inform the one individual who could compile a valid information base.

Hospital records with the need to accommodate nursing reports, technicians reports, lab work, xrays etc. became a mess to dig through for valuable needed information. Often tests and xrays were repeated unnecessarily because the usable earlier data was missed.

Then along came the computer age first used  as a billing tool. In the 80's software for record keeping was first introduced. The quality and tools have greatly improved so that hospitals for instance have converted to a point where everything relating to a patient is in one file. WE now have the capability of sharing those files formerly by transfer of information but now by direct access.

Access to a file can be limited to those granted the privilege.At least that is the theory but in reality their is always the "Hacker". Irrespective of this the Computer Record can be a great improvement since i t c an b e easier to review in a compartmentalization manner, IE: All laboratory studies one place  xray reports another etc. But what is the value if the records consist of check sheet boxes not a record of personal observation. "Garbage in is Garbage out"

The computerized file can be a blessing in the hospital except to the doctor who never learned touch typing. It does mean a longer work period for the practitioner who  having been accustomed to making notes as he progressed on his rounds, now has to go to the terminal to enter into the records.

There are security firewalls for hospital records but they are not infallible, and it becomes easier for a person not involved in the patient's care to out of curiosity to access  the record.

However, the government has made my 8X11 sheet records obsolete by demanding the use of electronic records. As of this past week claims are going to be monitored and although reimbursement. has as yet not been cut, there will be bonuses for those that use electronic records. One can be sure that the insurance carriers and Medicaid will also demand that policy. The problem is that there are only two (2) proprietary software programs that are acceptable  and they are expensive.

The small individual or 2 man practice  has found it to be an economic burden to convert but they must do so. The alternative is to be absorbed into a large group practice or become an employee of a hospital sponsored group, a modality that is increasingly becoming the norm.

This is a major change in medicine delivery, one that I find to be a negative one. The patient has accepted being a consumer of health care and instead of seeing a physician who has a one to one relationship to him he now en trusts his care to a series of "providers" of various competencies. On a "routine visit" the only contact with a physician may be a very brief impersonal one.

For the doctor he will have become "9 to 5 worker" or whatever time slot assigned and once  off need not thin l about the cases he has  "treated" that day. The hospitals are employing physicians who see only  inpatients and the outside doctor no longer will treat them.once the patient is inside the hospital.

The tools for health care continue to advance but the all important human element will have disappeared. That may make no difference because the consumer is now accepting a commodity where price and efficiency is important.

This is from an recent article this past week on the first page of the Times about a family physician who is unable to cope with the above changes and wishes to retire but can't dispose of his practice:
"Sroka’s fate is emblematic of a transformation in American medicine. Doctors like him are being replaced by teams of rotating doctors and nurses who do not know their patients as well. The share of solo practices among members of the American Academy of Family Physicians fell to 18 percent by 2008 from 44 percent in 1986. And census figures show that in 2007, just 28 percent of doctors were self employed, compared with 58 percent in 1970. Many of the provisions of the new health care law are likely to accelerate these trends. “There’s not going to be any of us left,” Sroka said."





But

Sunday, April 24, 2011

WISHES

A  HAPPY EASTER TO ALL.

Saturday, April 23, 2011

About 2 Comments

Frustrated, although I had no intentions of writing a blog this weekend, checked  the" beautiful" weather this  Saturday and with the promise of a similar day on Easter. I checked the comments to my recent blog to see if any needed a reply.

To the two comments on yesterday's blog" Patients are not Consumers", I spent time twice writing a reply but not only would the site provider not post it but wiped it out.So out came Dragon Speak,Therefore I am using this blog as a means to reply to Nat and. Dottie:

Nat, you are correct, we are spending billions for the armed services that could probably be spent elsewhere however this money is being spent by us on because the United Nations has once again failed the world when it comes to human rights. Our operations in Afghanistan and Iraq are aimed at eliminating a narrow minded society which is without regards to individual rights. If only we could do that if Syria and the other Middle East totalitarian dictatorship. At least in Libya the European Union countries have also become involved not because they abhor dictatorship or terrorists but because this country is a major source of oil.

But where is the United Nations when it comes to the African nation such as the Ivory Coast, Liberia, Sudan, and the Congo as well as all other nations where genocide has been the rule and not the exception in the past few decades?

Certainly, are military expenditures may be more than all the other nations  combined, although I would like to see proof of that fact. This holy season perhaps we should chalk that up to religious righteousness.  is unfortunate that too many cases those in charge are in inept and in their arrogance. Treat those that we are supposed to be helping as inferiors.

I for one, a World War II veteran who in 1945 was able to walk on Hitler's bunker's ruins, do not regret any money we spent anywhere in this world to combat the repression of human rights. If only the rest of the world would also act for humanity.

Dottie, I have not forgotten you and I know that you are too wise to really believe that digital records such as those required in Medscape are free from being subject to violation by those who should have no access to them.  There are great concerns with the requirements for electronic records and their true value, which I shall go into in detail in another blog, I hope Monday.

Suffice to say the world is paved with ill advised good intentions by social day dreamers who would vision a practical but improbable answer to all problems. They are among those who believe  information technology is the answer to all problems. 

Friday, April 22, 2011

PATIENTS ARE NOT CONSUMERS

Last week I wrote that I was going to comment on today's an d the near future's health care picture. Today being Earth Day  besides the holy day< "Good Friday", it is time  to act on my  good intentions. This has been a  3 meeting week, two of which I did attend plus two sick 14 year old cats  has interfered with my resolve. Besides that  since we are closing in on the June Primary Time which is the most important election in local politics we have been supplied with more than enough material to write several post a day. hey would be more pertinent to Plainfield than one on Health C are.

Today (4/23/11) in the OP-Ed page of the New York Times there appeared a  column  by Paul Krugman           ( http://www.nytimes.com/2011/04/22/opinion/22krugman.html?_r=1&ref=opinion ) disputing the notion that patients are "Consumers". He rejects the concept that Health Care is a commodity like a loaf of bread. Only briefly does he mention  that Doctors and Hospitals and Nurse are "Providers" a term applicable to the Baker. We are not  dealing with a profession but instead  a service which many feel that it is a right.

That of course is the problem. Once the social planners and politicians decided that Health Care was an entitlement although nowhere in the Constitution or the Amendments is it so written then the relationship between Doctor and patient began to change as it became a business especially with the arrival of the HMO concept. The third party payers be it the insurance companies or the government began to limit payments and ease of access. The patient began to over use the system and available resources if the cost was not coming out of  his pocket.

The Third Part Payer if a non-government enterprise  (insurance company)  was in business to make money.  That could be done by reducing payments to "providers" (not physicians or hospitals) and limiting by various means deliverable services. The patient (consume r) did not care as long as it was costing him nothing. The insurers began  to assemble panels of physician who would  accept reduce payments and once the doctors  became dependent the carriers would squeeze them by reducing fees.

The hospitals also became victims of the Insurance companies. Muhlenberg for instance was denied a contract with Blue Cross although JFK was granted one. In part this was over payments. Many patients (consumers) accepted the fact that they no longer had a choice in who was delivering their care, as long as they did not have to pay for it

The day of doctor/patient relationship has past. To survive physicians need  to be in big groups and to delegate much of the care to assistants. Volume to provide profit not quality is the driving force of care. To reduce costs by what ever means can be use d is the goal of the Third Party Payers. Government sponsored  programs find that cost  have gone out of control. therefore they also go through methods  of limiting services
That we  go into in another article.

What  shape the reformation in Health Care will take  be it "Obama Care" or one  of the Republican voucher programs must wait until after the 2012 elections. This is on e of the provisions of the Obama Health Care legislation that  has just been cancelled.(http://www.medscape.com/viewarticle/740898?src=mpnews&spon=18 )
(to be continued)

This being a holiday weekend of major religious importance, reading blogs will be an unimportant pursuit.There will  be no posting until Monday unless there is a major  story.

LWV FORUM

It may have been a public lack of interest or that for the 3 BOE spots open there were only 4 candidates; Lenny Cathcart, the incumbent and the "slate of 3. Whatever, only about 20-30 individuals showed up

The least that can be said is that no one mad a fool of  themselves.  Of the "Slate of Three" Mr. Hurtt was the most erudite. Ms. Surgeon works in  a school system, position unknown. , Mr. Edache whose 's Nigerian accent  dominated his comments was difficult to follow at times because he is soft spoken and tended to speak away from his microphone. That said he and the rest pf the "Slate", came across as citizens  concerned with being involved in trying to rescue a school system that has become a catastrophe.

In his opening statement Mr. Cathcart admitted that he made a mistake in his support of Dr. Gallon, but that should not negate his  9 years of service. He felt that the most important task facing the BOE was finding a Superintendent who was honest and aware of Plainfield's problems but willing to come here not because  of a high salary, but to restore the system.

On  a question of the impact of the Charter Schools,Cathcart  felt that the profusion of such schools in  Plainfield was due to parents fear of sending children to the Middle Schools. The others all felt that if Plainfield Schools improved overall and offered quality education the Charter Schools would vanish. Mr. Edache felt that the parents  of children  going to the Charters look down upon the public schools. All agreed that the Charter schools took money out of the system.

On the matter of "School Safety" Mr. Cathcart felt that it had to start with the Superintendent's policies and filtered down through school administrator to properly trained security personnel. Mr. Hurtt felt that the problem was over blown and that "fights" were a common occurrence among school children everywhere. He felt that part of the problem was that when the children reached the 13 to15 year age range that the parents seemed to become less involved in the schools. All agreed that parents had to become more involved.

As to where their interests on the Board would best be served  Cathcart noted that the Board consisted of 9 individuals each with different expertise and his was directed to the Buildings and Grounds, Surgeon felt she would best be involved in curriculum, Hurtt because of his occupation either finances or technical changes. Edache  remarked that he would need to learn more about the duties of Board members through the offered courses but that he would  be completely involved  in whatever area he was assigned.

Despite any impression I may have given. my conclusion is that none of the four Candidates would be a detriment on the Board; that they are all running because they feel that they can do something to restore our school system to a well functioning efficient educational entity. The forum was an hour and half well spent.

Thursday, April 21, 2011

POTPOURRI 4/21/11

You would never know it. The City's posted Calender shows only a Planning Board meeting for tonight (4/21/11). Not listed is the LWV forum with the Candidates for the BOE. Not listed is a MCAQ meeting at the City Hall Library at 6:30pm. and of course NONE of the Council's Town Hall forums have been worthy of listing.

I was under the impression that the City has an IT division. I tried to look it up as to whom it is responsible but could not find it anywheres on  the list of City Departments etc. Interestingly a "Bibi Taylor" is listed as City Administrator. Under downloads there is a line City Charter/City Code with a note that it was updated 4/13/11. However although there is no problem loading the Charter I am unable to access the City Codes. I must be doing something wrong because the information says it is  on line. Help!

Tonight's LWV forum should not draw a large audience. There are only 4 Candidates for the  3 slots. One. Mr Cathcart is seeking his third term. If the performance  of the BOE in the past 8 years can be a criteria, his previous tenure can not be much of an recommendation.

That leaves a SLATE of 3. Supposedly the reason for an elected board was to make it non-political. That would suggest that each Candidate is running as an individual. A SLATE infers some kind of  binding among the Candidates Even without stated party political affiliations I would consider the presence of a slated to mean a group affiliation  which is contrary to the intent of the "Elected" Board.

Perhaps this gives credence to Assemblyman Green's statements" wherein there are some Republican connections on the BOE"All across the State, people recognize the fact that the Plainfield BOE is controlled by Republicans" (http://jerrygreenspage.blogspot.com/."--SDA/School Construction (4/19}}

The sad fact is that there is no evidence that this farce election will change anything on the BOE since there is a business connection with at least one of the Candidates with a present (Republican??) board member.

Non the less this is an opportunity to quiz our new Board members. Don't waste it. 

TOWN HALL MEETING WARD 3

Taxes, the PMUA and the Plainfield's Streets were the subjects st last night's Council's Town  Meeting in Cedarbrook School. Missing from the meeting were Councilor's Rivers and Reid as well as any member of the upper echelon of  Administration.

Since several 3rd Ward residents complained about inability to personally contact the Mayor by phone and  the Administration's ignoring of the Council's Town Hall Meetings  suggest that except at election time the public does not concern our Mayor.

Dorien Hurtt, a Candidate for the BOE questioned the lack of financing for Road Resurfacing and the Status of the 2005 Road Replacement Master plan after two residents complained  about the condition of Field and Ironbound Avenues while in their neighborhood a little  one block street was resurfaced.

Although Councilor Mapp pointed out that the City's ability to float bond issues for road  resurfacing was limited it was noted by a citizen that during the previous administration  and in the first years of this administration State Grants had made possible to do most of the roads. No explanation  why Grant money even before the Christie Administration had vanished.

Regarding pothole repairs Councilor Storch remarked that three pieces of equipment the city owns remains for the most part unused.

Perhaps the meeting's most startling moment came when  1st & 4th Ward Council Candidate Delois Dameron  charged a sitting Councilor for harassing her at her place of work.




Wednesday, April 20, 2011

2011 PRIM ARY

Once again Jerry Green has opened  the 2011 Democrat primary campaign against whom ever is running as a "New"Democrat opposite  his anointed candidate  with the old innuendo blast of wrong doing  by the administration that preceded the present disastrous one.

This time Cory Storch is the target.. At this point instead of emphasising  Tony Rucker's merits, the party leader is focusing on running another negative campaign.

At least the relationship between that of the Council President blasting  Roland Muhammad  and Assembly Candidate Green as well as the Mayor is out in the open. Muhammad has spoken about the money wasted on pipes as well as the  McWilliams administration having a "drinking party train" to Washington inferring that it was at public expense. How did this citizen who was only concerned with his Recreation Department sponsored baseball team have knowledge of these events? Has he become the unofficial voice of the Plainfield Democrat Leadership?

It is immaterial that before she became "Acting City Administrator", he (Muhammad) has sat next to the Mayor in active discussion  at Council Meetings. It may be only  coincident that once again Councilman Green has mentioned those matters in his  blog on April 19th. Non the less this uninformed citizen has the right to request Assemblyman Green to publicly supply all the information about that infamous train as well as tghe "pipes"..

The pipe issue  also needs clarification rather than innuendo. This of course has to do with the new Storm Sewer pipes  for the  East Second Street repavement project which WAS started while McWilliams was Mayor. To the best of my knowledge someone presumably as a result of old city engineering records  of the lines or the engineering plans had specified the wrong size concrete pipes. At the same time I believe that the contractor  ran into financial problems and the Bonding Company sent an engineer here to evaluate the situation.

What settlement was made was never made public and when I questioned it years ago no answer was given as it had been under litigation. The settlement was made during the present administration but I have no recall of ever seeing it  made public or accounted in any budget. That I may have missed .

But once again the Assemblyman is bringing up a charge to discredit an incumbent candidate. Green owes it to the voters to provide all the details.

Again references are made to real estate deals that have benefited Corey's family. If they were resulting from the Councilman's political position that would be improper and should be documented. However, he who accuses others of real estate malfeasance should also make public his own success in real estate. One instance would be the windfall from property in Rahway Linden. Does the Assemblyman invest in rental properties? Nothing wrong there unless his political position could have contributed to a profitable investment.   I have no knowledge of any such happening but raise the question because he himself  broached the subject so many years ago that I have forgotten the details.. 

I have written that I will not take a position of supporting any single candidate. I am not egotistical enough to believe that I could influence voters. However, I can not conceive either of the two 2nd Ward Candidates to be the type to indulge in a mud slinging campaign. Last year it backfired even though Councillor Burney never actively participated.

Charges made must be substantiated. The caliber of the candidates will be measured by their response to a campaign of unsupported charges and innuendos.

1:43pm Errata; The Street involved with the pipes was North Ave not East 2nd Street. Thanks to Jerry for posting the explanation from "Mrs. Fox" (sic). It seems that the city's utilities plans were  wrong. Also it is good to know the  owed $40,000.00 fees  from that administration. were to an engineering firm. Perhaps they were responsible for the error in North Ave Plans, or South Ave, or even the omission of curbs on Randolph Rd. when  Woodland was repaved.

DELAYED AGAIN.

The Armory, Sewer Pipes. a fabled train  to Washington, a missed BOE meeting, A blogger's updating contents of a letter posted by JG, a week until the PSD elections, about 6 weeks  to the important Local primary elections and  two cats that are better but still sick plus a Holy day resulted in too much material to have a blog ready this morning.

If interested look for something near noon time, however a service man's call this am may cause further delay.

Tuesday, April 19, 2011

cats

Two senior citizen cats that have been "barfing" all night are not conducive for writing a meaningful blog.Perhaps later today I may post something that I hope is not as controversial as yesterday's.

Just a brief comment about Tony's blog 2 days ago promoting computerizing programs for our fiscal matters. Computers and software will work well as long as there are people trained  to use them. In an Administration that has ignored the need to have qualified  personnel (CFO, Director of Administration and Finances) in financial positions repeatedly over the years the track record indicates that no one will be able to use the software or enforce good accounting practices.

The precedent has been set in Public Works where several years ago a machined to lay hot asphalt patches was purchased but remained  unused  since there was no one  who knew how to operate it.

Most appreciated were all those who wished me a happy Passover.  Thank you very much.

Monday, April 18, 2011

CONTEMPLATION

From the ridiculous to the sublime.
Monday April 18 is according to the morning news broadcasters either  or both "Nation al Anti-Stress Day" or/and "National Wear Your Pajamas to Work Day". It is also TAX DAY.

In the evening marks the start of the first day of Passover marked by the Jews with the first nights Seder Meal and with the more observant tomorrow night  the Second Seder will be celebrated. Traditionally the first night's Seder is a family holiday whereas in the Reformed and Conservative movements the Second Night is often a Communal Service.

At this same time, Christians are observing Holy Week. Which brings up the question; "Why are so many of the most devoted the least tolerant of others"?

Passover  should be respected by all. If it were not for the Exodus; Moses would not gave ascended the Mount and received the Ten Commandments. If God had not made the Covenant with the Israelites over the centuries Monotheism as we know it would never have evolved. The various interpretation of their religion among the Jews as later among Christians would not have existed. Nor would there have been those that listened to Jesus of Nazareth rather than the established cults  and spread his teachings.

This is the time when we should sit back and reflect on why we should respect the beliefs of all that do not worship exactly as we do. All religions preach "Love thy brother" but do we? 

If one can not honestly answer that question in the positive, then is not the professing of devotion a hypocrisy?

IN DEFENSE POTPOURRI

Dan Damon in his "Clips" facilitator blog on Friday remarked that Plainfied's  political boss* was attacking me in his blog. I did not consider it as a personal attack but rather  using my blog as a vehicle to  confront  those who would indirectly attack him through his politically anointed office holder. He has been put in a position as the local "Boss" to defend the Mayor and those in City Hall who may have been involved with the infamous "Scarlet Letter" or dump them by cutting all ties. That could not be a good move if  his control were to survive.

Assemblyman Green did write on April12 " I just feel that some people will try to make an issue that they have no proof as to who did or even where it was done, but will try to makes others feel guilty. Already, I see council members spending more time talking about investigation. Whether it is the $20,000 the Mayor spent, or other issues I feel are minor when compared to this year’s budget. They have already had three months to sit down with the Board of Education, where the council members and board members have joint meetings to see where they could consolidate services that will avoid negatively impacting the classroom and teaching staff."  The bold face is mine and I have crossed out the last sentence in the paragraph as being immaterial to the subject.

 On April 15 while "Cleaning up the local Potpourri"(http://jerrygreenspage.blogspot.com/2011/04/cleaning-up-local-potpourri.html) he wrote, (and I have inserted the link since I will be omitting part of a very long document ): "Reading Doc’s blog today, I would like to make myself VERY clear. Often when people read something they like to put spins on the content, and the spin they place on it makes no sense whatsoever.
When I mentioned the investigation regarding the Mayor and $20k, it would have been very simple on everyone’s part, the Council and even Doc yourself, to pick up the phone and call the Attorney General’s office to file a complaint as a taxpayer in the City of Plainfield. That office would have taken the appropriate steps to bring in professional investigators to investigate the matter. If anything criminal was to come out of it, it is obvious that the individuals involved would leave themselves wide open for criminal charges.
That is no different than the ‘Scarlet Letter’** matter; the same steps could have been taken. Leave that up to the professionals in law enforcement to investigate these matters. If anything criminal has been done, then it is up to them to use the system for these individuals to pay for their crime.
 What I see and hear is a lot of grand-standing, and Doc this what I mean when I say this is small when compared to the budget problems in which the City is facing."

Jerry, if I had sufficient indication that there was "criminal activity" I would try to involve the media, preferably the press to expand  documentation and hope the publicity might force the Attorney General or the US District Attorney, especially if Federal funds were involved, to take some action. You know that I as an "at least a 100 year old"  blogger would have little impact with either agency. The clock is ticking and why waste time.

But let us address the principles involved; If there is a question of an irregularity the City Charter delegates that right to investigate to the Council (2:8) with the right to subpoena witnesses including the ex-City Administrator and provides penalties including jail time for uncooperative witnesses. What the Council can not do is remove the Mayor or a Councilman from office. The Mayor does not have the power of investigating.  Therefore it is the council's DUTY to conduct an investigation when there is a question that funds designated for one purpose were diverted without authorization  to an other unrelated use. And, if this has happened then it is up to the Council to make a  report to legal authorities if the situation warrants charges of criminal action or recommend corrective action..

The  problem that frustrates the Council is the 3 vote veto power that exists in the Council as constituted. Next year there may be a reversal of the "power" in the Council or a super-majority. The voters will decide that in November.

We bloggers are not obstructing the governance of the City of Plainfield. Our function is to be when needed watchdogs for the people, their advocates against perversion of power. The one thing we do is not hide behind a veil of anonymity but take responsibility for what we write., as do you Assemblyman .


*"A boss, in politics, is a person who wields the power over a particular political region or constituency. Bosses may dictate voting patterns, control appointments, and wield considerable influence in other political processes. They do not necessarily hold public office themselves. In fact, most historical bosses did not." The recent Committee meeting to pick the  primary party slate by reports was run in an dictatorial not democratic manner.

** The Scarlet Letter was refered to the County Prosecutor. What is the status of the Mayor's own             'internal investigation" a report should have been given at the Council meeting?

Sunday, April 17, 2011

To Jerry

Sunday is not the best day to post serious discussions. I shall defer until Monday my reply to  that portion of Assemblyman's Green blog "Clearing Up the Local Potpourri" as related to the "Investigation".

I would not have considered Green's blog to be anything more than an excuse to attack his antagonists, except he could not resist one paragraph to take a swipe at me.  .If it were not for that personal attack I would also have  deferred an answer to the following irresponsible statement:'"So Doc, no disrespect, but I have yet to hear you talk about whether we are going to have to lay off police officers, are we going to have to cut services, or will the quality of life issues be negatively affected by the cuts in Trenton. Not one time have any of the bloggers brought to the attention of the Plainfield residents, like other towns have, how the unions are being crippled, the teachers being disrespected, people no longer receiving homestead rebate checks, how healthcare services are going to be cut back, how UEZs are going to be eliminated…"

First of all if you go back over the past years blogs you will  note that in the past I have referred to the Police Division's manpower deficiency as well as the impact of the several organizational restructuring. I even made comments in the blog and at the Council concerning what I considered ill thought out projects proposed by the Director of Public Safety and decried about the politics that have hampered the police division..

As to the unions being crippled I suppose you are referring to Christie's  efforts to change the  health care contracts and other perks that the public employee unions are holding on to. There is a relationship to what in Plainfield seems to have been a reluctance for the local unions to make any accommodation in this period of financial difficulty. The Unions are in danger of losing all that they have gained over the years if they and the politicians that support them in return for their votes do not understand that there will be an increased swing against them by the middle, not upper, class that have economically suffered in the past 3 years. 

Jerry, good teachers are not being disrespected. Christie may be right, that performance should take precedence over tenure. Doctors have to take continued education courses at their own expense to renew their biannual licenses. Do teachers have to renew their certificates of competency much less show proof of continued education?  When they do take courses the system subsidizes them.

As to the homestead check not only have you politicians in Trenton so fouled up our finances  so that the State has cut back but I myself ,who has been retired for 20 years does not receive one because I have had to go into our retirement savings which became taxable income to care for my wife when she was ill. That made our  income fall above the cut off level although our net worth was markedly decreased.

Why do you a future tense "health care is going to be cut back". Plainfield suffered a major cutback when the State and Corzine permitted the closure of MRMC.  This was at a time when the Democrats controlled  the Administration and Legislative bodies in the State as well as Congress. As to the what will be the future I intend to write about that,I hope this week if  time permits.

As to the UEZ you, being in Trenton, have more true knowledge of what is happening. I thought that I had heard  at the last Council meeting that the zones were going to be  maintained but the taxes which now go in some part to the municipality would all go to the State. I would  like your clarification on that point.  

I accept that  the paragraph concerned was not written to show "disrespect" of me, but rather as part of a reelection campaign by an astute esteem politician hardened by two decades of holding  a powerful office.

So if your column was part of your election campaign please instead enumerate everything you have accomplished in Trenton in the past two years that benefited Plainfield and its school system. Perhaps you may tell us why Cook School is overcrowded. Why did we lose the construction money while other communities still received theirs? .

Saturday, April 16, 2011

TONY RUCKER'S BLOG

Friday both City Democrat Party Chairman Green and 2nd Ward primary Candidate Tony Rucker favored us with significant posts. Both merit commentary but I shall turn to least disturbing one today.

Rucker in his blog ( http://www.theqcpblog.com/ )calls attention to the BOE elections scheduled for Wednesday April 27. That is less than two weeks away. Without this reminder the election would have caught me by surprise since I did not find any reference to it on the City site calender or on the BOE site.

Perhaps it is symptomatic of what is wrong with Plainfield that there is so little publicity and interest for this election. There are three (3) open seats to be filled and  4 candidates. One incumbent running for a third term and a slate of three.

Board member Renata as a private citizen in her blog has supplied a bio for each of the slate candidates. Without a true race it may be questionable if the LOWV will hold a Candidate's Forum. It may be that we will not have enough information about all four to vote intelligently.Without sufficient publicity and an election day of Wednesday it may be doubtful if even 12% of the electorate turn out if it were not for the fact that the Budget should be on the ballot.

Rucker who is the party selection to challenge incumbent Cory Storch as the Democrat nominee for the 2nd Ward Council seat also notes the overcrowding at Cook School which is in the 2nd year of a progression from  K-5 to K-8. He notes that Maxson School is one of the two underutilized Middle Schools and wonders why the conversion of Cook School should continue with its increasing space problems.

The plans to by pass the under performing Middle Schools by reverting to a K-8 format was one of Dr Gallon's better programs. That it was continued may have been poor judgement by a BOE and School District that for at least a decade has been dysfunctional with frequent changes in Administrative leadership.

I am sure that Tony knows that there were plans I believe even into architectural drawings for expansion of Cook School which the State shelved when the corrupt State Agency under the Democratic Administration failed due to misuse of funds.

Being outside the inner circle I have no knowledge what the long term plans if any the PSSD has. We seem to be wallowing in a lack of direction and yet have one of the highest costs per student in the area. If it is in part the impact of the multiple district Charter Schools which by their very presence is an indication of the failure of our District.

Mr. Rucker is right, the lack of advanced classes in the system is a disgrace.  It is an indication that the District is willing to settle for mediocrity at best. Ultimate blame falls on the electorate who chose the BOE.

The members of the BOE are well meaning and individually capable, but as a group do not seem to understand the nuances of their fiduciary responsibility as opposed to the tunnel visions of their own agendas. Until we can elect Candidates who have a combination of business administrative skills as well as educational competency the future for education in Plainfield will remain bleak.

Friday, April 15, 2011

THE INVESTIGATION

 "I don't give a damn if it was $10,It should be investigated.'' Quote from CN article 4/13/11 about the Council appointing a Special Investigator to conduct the investigation approved by the Council in 2010 to determine if there were an irregularities in the expenditure of $20,000.00 last year to radio station WBLS.

Actually the amount in question is $25,000.00 which cane from 3 different line items in the City's budget'
  • $2,500.00 charged to "General Imp (sic) Ordinance 1237."
  • $2,500.00  charged to "Outside Consulting Services." 
  • $20,000.00 charged to "Hardware & Software Maintenance." 
See link PlaintalkerII :Wed 4/13/11 http://ptalker2.blogspot.com/

It is obvious that there are individuals in Plainfield who do not believe that following proper procedures in allocating funds is of any importance;

  1. Resident  Roland Muhammad who has been a severe critic of four  of the Council's members asked; "Why is this (investigation) so important?''  "We were going out in the city to prevent crime ... so what was done, was that a bad thing?'' (CN 4/13/11)
  2. Assemblyman Green recently wrote "Already, I see council members spending more time talking about investigation. Whether it is the $20,000 the Mayor spent, or other issues I feel are minor when compared to this year’s budget"

Neither person or the Mayor seem to consider that the cavalier management of  the City's funds ,derived from our tax dollars, is of importance.  Six years of government with essential positions  designated in the City Charter were unfilled for prolonged periods of time despite the fact that they were important to maintain proper fiscal control suggests either a lack of understanding the financial operation of the municipality, or what could be worse, a desire to avoid accountability.

As citizen Darden has pointed out at Council meetings; the annual report by t he City's  Auditors point out the same deficiencies in financial control every year and there apparently is no effort to remedy the problem. It was only when the State threatened to fine the Mayor and Council  that a CFO was appointed.  Despite the fact that purchases were to be processed through the Purchasing Division that procedure was all too often bypassed.

This is in part why it makes no difference what the amount involved is, since even a small amount one time could ultimately lead to improper yes even criminal removal of funds from the City's account. The history of embezzlement from businesses often start with a "borrowing" of a small amount and gradually increasing to large sums. That is why if there were irregularities they should be eliminated and correct procedures followed through. If the incident involved should reveal a pattern of irregularity then of course the investigation should be expanded by a complete forensic audit.

 The latter is I believe the fear expressed by those who would negate this investigation. If funds were used improperly then punitive action would be indicated. This of course would be mitigated depending on the circumstances.











I

MEMO

Very much later

Thursday, April 14, 2011

MY MEMORIES

While in a mellow reminiscent mood I thought that I would share with you a little but personal story of the pleasant formative years of my life.
       
“Approximately three months prior to the end of my third year in college, some of my graduating friends were applying to medical school.  I had no intention to continue in medicine at Virginia, but hoped to go north to Columbia P&S, my brother's alma mater. 

However, this was still depression time, and concerned about wasting my folks’ money by just studying history. I decided to take a flyer and applied to the medical school. It was possible to combine the first-year medicine with the last year in college for a degree. 

All that I can remember of the interview with Dean Jordan was that we argued where my father had gone to medical school. (It was the Royal Academy of Medicine in England where he was living)
         
To my amazement and to the annoyance of friends, I was within days accepted into the medical school while all the others still had to wait for acceptance.

First year medical school was a “little” more work than college.  Anatomy constituted most of the first semester courses. The anatomy dissecting rooms were on the second floor of the Medical school. We worked as teams of four students. On our team, all the others thought that they were surgeons. 

One of these three was George Psimas who lived with his brother Gus, also a medical student, in the Cracker Box. They were Greek and their family had a restaurant in Portsmouth Virginia. One weekend George and I hitched hiked to his home. He had a beautiful Greek girlfriend, Stacia, who his family wanted him to marry. However, he fell in love and also against his family’s desires married, a classmate of Helen. A correspondence friendship and rare visits with them lasted until his death in the late 90s. 

Among those working in our dissecting room, which was the smaller of the two, were the class’s three women students. They and a male student were dissecting a buck male cadaver that was heavily endowed. These girls were well accepted as fellow students, thus some of the class jokers decided to insert a thin knitting needle down the penis, tying it down with dark thread.  One day when hard at work on their cadaver, the thread was released and much to the girls surprise, right before their eyes, their cadaver suddenly had an erection.  As you can imagine there was turmoil in that laboratory for a few minutes. 

There was of course the usual disrespectful treatment of the cadavers by medical students. I can assure the reader that the “disrespect” had nothing to do with racism or with the fact that they were once living human beings but rather a means to relieve some of the tensions that all were under. The cadaver was an “object” material and utterly impersonal.

The hospital operating suite at that time was directly across from the medical school second floor anatomy laboratory. The operating rooms were in a semi-circular area complete with skylights.  There was a covered walkway between the first floors of both buildings, and the roof acted as a bridge between the hall beyond the anatomy lab and the OR. There were “emergency” doors on both sides leading to the bridge. 

Senior student nurses were given a great deal of responsibility, often being in charge of a ward on the 11pm-7am shift. Helen frequently had that type assignment, plus her daytime class schedule.  During the semester that I had anatomy, she was assigned to the OR, for evening or night shift and often the only person on duty. We were able to do a great deal of courting on that bridge.

In Southern hospitals of that era, the patient wards were segregated not only by sex but also by race.  The wards were large and open and contained at least 20 beds. The male and female black wards were in the basement.  “F Ward” was the male “black” ward.  Helen often had the 11 to 7 shift for that ward. There was a rocking chair in the middle of the ward floor which one night began to move all by itself; nobody was in it!  You can imagine the consternation among the patients of F Ward and the charge nurse.
        
 In the second half of the first-year biochemistry seemed to be an easy subject resulting in a top grade. That was unfortunate inasmuch as the professors of biochemistry and physiology hated each other.  Therefore, if Dr. Britten thought that you were a favorite of Dr. Chanutin, it was difficult to get even a passing grade in his second year physiology course, so a better than average passing grade was greatly appreciated. 
        
 Sidney Britten was ahead of his time. He expounded the Adrenal glands as the most important gland in the body. However, he was focused on the wrong adrenal cortical hormone and it was not until 20 years later that the importance of cortisone was appreciated.

During the second year, Clinical Pathology-the study of diseased tissue- was a most important subject. 2/3rds of the final examination was a practical where we had to identify unknown stained tissue slides. I was able to identify all 20 slides correctly.  This was just a matter of lucky guessing but it certainly helped my grades.

AOA honors. I did not regret it.

As third-year students, we spent two weeks in Norfolk at the King’s Daughters’ Clinic that provided a home Obstetrical delivery program for the underprivileged. The medical student accompanied by a nurse, an African-American, almost always into a home without electricity, and delivered the baby either by candlelight or kerosene lamp. The patient did not receive anesthesia because ether is very explosive. Sometimes at a critical point the nurse would administer a few whiffs of chloroform.
   
Those of us who had the least bit of common sense knew to depend for advice, and coaching, upon the nurse, whose knowledge and experience base was extensive. If we were getting into trouble she called for an ambulance to take the patient to a hospital. This was a great experience and for the first time we felt like we were “real doctors”.

The surgical rotation (3rd year) was a most difficult one. The student was the third assistant at an operation and if lucky just held a retractor. If it was a pulmonary case, he often was under the drapes holding up a shoulder sometimes for hours.

Under close supervision of the residents, the Third and Fourth year medical students also staffed the outpatient clinics. It was this on hands training that made us good doctors. I spent part of my second year vacation doing a “clerkship” in the medical clinic.
   
After Pearl Harbor, the medical school program accelerated with the elimination of the summer vacation and we graduated in March of 1943.  


I am planning to once again post probably this coming week a series(?) on the Health Care we can expect and my fears about what we will we receive based on my experiences.