RARITAN VALLEY HOSPITAL

Instead of dwelling on this country's political stupidity which like it or not involves both parties; I thought today I would recount the tale of Raritan Valley Hospital written from a personal view.

In the early '60s there was an extraordinary population explosion within areas around Plainfield. There was pressure for building a new hospital in Edison and also to replace the antiquated and condemned privately owned Bound Brook Hospital. Both objectives were completed by the end of the decade. The Edison hospital ultimately became the controlling partner in a union with Muhlenberg in the late 90s.

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

Unhappily, for unknown reasons, the new hospital, Raritan Valley Hospital was built on land within the Green Brook flood plain and could only be two-story high building.

I felt that I should have a second Hospital as a back up in case conditions became unsatisfactory at Muhlenberg. There was now a choice to selecting either one as the secondary hospital, and, unfortunately as it turned out, I chose Raritan Valley.

Although I did not like the fact that only a select five full-time employed physicians would have the sole power to act for the medical staff, there were many positive reasons for that choice. I had a substantial practice from the Dunellen and Middlesex area. I was particularly impressed with four of the full time doctors, who not only were extremely competent but also decent human beings.

In my 45+ years in practice I can remember only one other Radiologist who I held in as high regard as Raritan Valley’s. The Internist, a qualified Cardiologist, was a warm and friendly individual who fortunately retained his position at NYU. The Pathologist was most knowledgeable and after leaving this hospital became professor of Pathology at a southern medical school. The Anesthesiologist was extremely competent.

Although there was always a great camaraderie among Muhlenberg’s physicians, the doctor’s lunch facility was often overcrowded. I enjoyed escaping to RVH and having lunch with the “chiefs” and physicians from the Bound Brook-Somerville area.

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

Ultimately, the other four members of the executive committee called for an open but informal staff meeting to discuss the problem. In the middle of that meeting, the chairman of the board entered the meeting room. He interrupted the discussion and said “This meeting is illegal. I will not have a hanging jury destroyed this brilliant young man. You are to leave at once."

The reaction from the nearly 100 doctors present what was one that could have been anticipated. No one left but immediately called for a rump meeting to discuss the matter. Some of them turned to me and said "Yood, you are the oldest here.” Please conduct this meeting".

The result was that a volunteer medical staff organization was set up and I was elected president. I was of course not flattered by being called the oldest because I was in my early mid 40s. An Obstetrician from Bound Brook/ Somerville was made Vice President and a steering committee appointed.

For the only time in my medical career 100 percent of the physicians on the hospital staff contributed $100 to pay for legal action. We employed a lawyer recommended for his hospital expertise. Unfortunately we had little help from the State Society. We met several times with the executive committee of the board and almost had straightened out for the problems when one of our steering committee members, a surgeon who had spent years in the army, unexpectedly spoke up saying "I charge this board was deliberately trying to sabotage the medical staff."

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

There would be no future talks. Soon after that episode, all four quality members of the medical executive committee resigned. Their replacements were second rate at best.

The successor Radiologist had been fired from his Philadelphia Hospital, and there were X-rays that were misread. I was reluctant to trust his reports.

The Pathologist was adequate but did not compare either in personality or person with his predecessor.

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

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

After the new Chief of Staff arrived, both the Obstetrician and I were called before the Board of Governors who was going to suspend our privileges. I thought I was innovative by appearing with my attorney and a tape recorder. Initially the lawyer on their board sputtered about the recorder, but yielded to our recording the meeting. Which was very short and terminated without action or comment? The next day I learned that the other doctor at his conference with them the day before had upstaged me by appearing not only with his attorney but also with a court reporter to record the meeting. 

Needless to say the result of those hearings was no action by the BOG.

Fortunately all members of the “Volunteer Medical Staff” could admit patients to other area hospitals, and proceeded to admit all but emergency cases to their primary institution.

The patient census fell below 50%. . What was never publicized was to all intents and purposes the first time, to my knowledge; physicians had literally boycotted a hospital. This ultimately ended with the hospital becoming bankrupt.

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

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

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

Ultimately the medical school abandoned the hospital for one of the New Brunswick hospitals. The facility which had been taken over by the state became a substance and mental rehabilitation center.

ON DEBT AND SHUTDOWNS

I will spend some time in the next 10 days again noting why I think Obama Care may defeat the purpose for which it was intended. I will also comment on fiscal management. Do you think that we have a good innovative fiscal manager in our city who we could send to help Congress sort things out.

Just two articles from Wikipedia that will make interpretation of yesterday’s table meaningful.

The United States public debt is the amount owed at any point of time by the federal government of the United States. The measure of the public debt is the value of the Treasury securities that have been issued by the Treasury and other federal government agencies and which are outstanding at that point of time. There are two types of United States Treasury securities on issue:^[1]

• Debt held by the public, such as Treasury securities held by investors outside the federal government, including that held by individuals, corporations, the Federal Reserve System and foreign, state and local governments.
• Debt held by government accounts or intragovernmental debt, such as non-marketable Treasury securities held in accounts administered by the federal government that are owed to program beneficiaries, such as the Social Security Trust Fund. Debt held by government accounts represents the cumulative surpluses, including interest earnings, of these accounts that have been invested in Treasury securities.

Public debt increases as a result of government spending and decreases as a result of government tax or other receipts.^[2]

Historically, the US public debt as a share of GDP increased during wars and recessions, and subsequently declined. For example, debt held by the public as a share of GDP peaked just after World War II (113% of GDP in 1945), but then fell over the following 30 years. In recent decades, however, large budget deficits and the resulting increases in debt have led to concern about the long-term sustainability of the federal government's fiscal policies.^[3]

On April 2, 2013, debt held by the public was approximately $11.959 trillion or about 75% of GDP. Intragovernmental holdings stood at $4.846 trillion, giving a combined total public debt of $16.805 trillion.^[4][5][5][6] As of January 2013, $5.6 trillion or approximately 47% of the debt held by the public was owned by foreign investors, the largest of which were the People's Republic of China and Japan at just over $1.1 trillion each.^[7]

In U.S. politics, a government shutdown is a situation in which Congress fails to pass authorization for sufficient funds for government operations. Typically, the government stops providing all but "essential" services at first, but since Congress must authorize all expenditures, there is no law protecting any government service from stoppage. Federal services that may continue for a time after a shutdown include the National Weather Service and its parent agencies, medical services at federal facilities, armed forces, air traffic management, and corrections (the penal system).

During the Ford and Carter administrations, there were 6 partial government shutdowns that affected only the departments of Labor and Health, Education, and Welfare. These partial shutdowns lasted from 8 to 18 days and the primary issue of dispute was federal funding for abortion. During the Reagan administration, there were 8 full government shutdowns that lasted only 1 to 3 days apiece, primarily over the issue of the United States budget deficit. There was a similar 4-day shutdown during the first Bush administration.

During the Clinton administration, after conservatives made massive congressional gains in the 1994 Republican Revolution, there were two full government shutdowns lasting 5 and 21 days apiece, the second of which was by far the longest of its kind to that date. The primary issue was again the United States budget deficit.

The United States federal government shutdown of 2013 is ongoing, having begun on 1 October 2013. The primary issue of dispute between the Republican-controlled House of Representatives and the Democrat-controlled Senate (the latter supported by President Obama) is the Republicans' desire to delay implementation of the Affordable Care Act, signed into law in 2010.

# We will have the Council's Agenda session Monday night as an interlude for perhaps two weeks. In the interim this country will run out of money to pay its bills. 

## I am fideling with a new computer and a different version of Foxfire as well as windows. All seem to have minds of their own; like a puppy.

ECONOMIC FAILURE

One factor that is most disturbing is the increase in the National Debt for almost a century. The important numbers are the Debt/GDP ratio,which have only been higher in the post WWII recession years 1945,46,and47.  There was  a fairly stable rate in the 50-68% range from the end of the Korean War (63) until 2009. The big increase to near the entire GDP seems to be a result of the ARRA (Stimulus Act). In actual percentages this years debt is about 12% higher than in 09.

The only way that we can prevent massive inflation is to reduce the debt especially when related to the GDP. That will mean that two things mus5t happen;(1) Government income must increase. To do this Taxes must be raised and the rates for the true wealth should increase materially. The Republicans must be willing to yield on this. (2) Government expense must decrease.The military expenses although significant have not been the only major factor. The ARRA had a great impact as had the  increase in entitlement programs. The Democrats will not consider a review and scaling back.

Both parties not one are responsible for the mess that we are in. Until the self-centered idiots that we send to Congress and the social dreamers in Washington accept reality we are headed for an economic  crisis greater than any we have ever seen. The dollar will be worthless,savings will be  useless, and unemployment will lead to anarchy.

We the people must demand responsibility in Washington.

National Debt by Year Since 1929 Compared to Nominal GDP and Major Events

End of Fiscal Year	Debt (in billions)	GDP (in billions)	Debt/GDP Ratio	Event
2012	$16,066	$16,356	98%
2011	$14,790	$15,612	95%	Obama Stimulus Act (ARRA) spent $120 billion.
2010	$13,562	$15,050	90%	ARRA budgeted $400 billion.
2009	$11,910	$14,384	83%	Economy contracted 8.9% in Q4 '08, 6.7% in Q1 '09. ARRA spent $241.9 billion. War on Terror cost $79 billion. Fed funds rate lowered to 0%.
2008	$10,025	$14,844	68%	Economy contracted 3.7% in Q3 '08, 1.8% in Q1 '08. War on Terror cost $197.6 billion, Bank Bailout Bill cost $350 billion.
2007	$9,008	$14,572	62%	War on Terror cost $173.6 billion.
2006	$8,507	$13,911	61%	Katrina clean-up was $24.7 billion, swine flu added $6 billion, War on Terror cost $120.4 billion.
2005	$7,933	$13,207	60%	War on Terror cost $107.6 billion.
2004	$7,379	$12,369	60%	War on Terror was $94 billion.
2003	$6,783	$11,628	58%	Unemployment still at 6%. War on Terror cost $53 billion.
2002	$6,228	$11,040	56%	War on Terror added $33.8 billion.
2001	$5,807	$10,644	55%	2001 recession and 9/11 Attack
2000	$5,674	$10,364	55%
1999	$5,656	$9,719	58%
1998	$5,526	$9,147	60%
1997	$5,413	$8,692	62%
1996	$5,225	$8,159	64%
1995	$4,974	$7,707	65%
1994	$4,693	$7,352	64%
1993	$4,411	$6,904	64%
1992	$4,065	$6,587	62%
1991	$3,665	$6,218	59%	1991 recession.
1990	$3,233	$6,030	54%	Desert Storm.
1989	$2,857	$5,712	50%	Savings and Loan Crisis cost $125 billion.
1988	$2,602	$5,300	49%
1987	$2,350	$4,901	48%
1986	$2,125	$4,620	46%	President Reagan lowered tax rates.
1985	$1,828	$4,395	42%
1984	$1,572	$4,087	38%
1983	$1,377	$3,692	37%	Unemployment from the 1982 recession peaked at 10.8%.
1982	$1,142	$3,367	34%	1982 recession, GDP fell 6.4% in Q1 '82.
1981	$998	$3,261	31%	Beginning of 1982 recession.
1980	$908	$2,860	32%	1980 recession, Iran oil embargo, GDP fell 7.9% in Q2 '80.
1979	$827	$2,670	31%	Volcker became Fed Chair, increasing Fed funds rate to 20% to combat inflation.
1978	$772	$2,399	32%
1977	$699	$2,122	33%
1976	$620	$1,891	33%
1975	$533	$1,714	31%	Unemployment from 1973-75 recession peaked at 9% in May, GDP was down 4.8% in Q1 '75.
1974	$475	$1,563	30%	Wage-price controls worsened recession.
1973	$458	$1,437	32%	OPEC raised oil prices, Nixon went off gold standard, tripling inflation rate to 9.7%.
1972	$427	$1,294	33%
1971	$398	$1,180	34%	GDP down 4.2% in Q4 '70. Unemployment from 1970 recession peaked at 6.1% in Dec.
1970	$371	$1,089	34%
1969	$354	$1,032	34%
1968	$348	$952	36%
1967	$326	$867	38%
1966	$320	$821	39%
1965	$317	$750	42%	Vietnam War starts, total cost will be $111 billion.
1964	$312	$693	45%
1963	$306	$645	47%
1962	$299	$610	49%
1961	$289	$568	51%	GDP fell 4.2% in Q4 '60. Unemployment peaked at 6.1% in Dec.
1960	$286	$546	52%	1960 recession started.
1959	$285	$525	54%
1958	$276	$487	57%	GDP fell 4.2% in Q4 '57, and another 10.4% in Q1 '58. Unemployment peaked at 7.1% in Sep '58.
1957	$271	$480	56%
1956	$273	$452	60%
1955	$274	$431	64%
1954	$271	$392	69%	Recession follows end of Korean War.
1953	$266	$392	68%	Korean War ends, total war cost $30 billion.
1952	$259	$368	70%
1951	$255	$352	73%
1950	$257	$309	83%	Korean War starts.
1949	$253	$273	92%	1949 recession.
1948	$252	$280	90%
1947	$258	$250	103%
1946	$269	$228	113%	GDP fell 11%.
1945	$259	$228	116%	1945 recession due to end of WWII. War cost $296 billion.
1944	$201	$225	89%
1943	$137	$203	67%
1942	$72	$166	44%
1941	$49	$129	38%	Attack on Pearl Harbor, US entered WWII, ending the Great Depression.
1940	$43	$103	42%
1939	$40	$94	43%
1938	$37	$87	43%
1937	$36	$93	39%
1936	$34	$85	40%
1935	$29	$74	39%
1934	$27	$67	40%	World trade is down 66% from start of Depression.
1933	$23	$57	39%	Roosevelt took office, New Deal signed. Unemployment peaked at 25%.
1932	$19	$60	33%	Hoover worsened depression by raising taxes to balance budget.
1931	$17	$77	22%
1930	$16	$92	18%	Stock Market Crash of 1929. Congress passed Smoot-Hawley Tariffs.
1929	$17	$105	16%	Hoover maintained high wage controls. Fed raised discount rate to defend gold standard, creating deflation. Combination forces bankruptcies on businesses.

I regret that I have lost for the moment the source of the table.