Ebola -- Or why Medicaid Expansion matters.

Summary:

It seems obvious to me that the Hospital turned away on September 25 2014 Thomas Eric Duncan because of his insurance and because Texas Health Presbyterian Hospital is part of a medical system that refused the Medicaid expansion and doesn't make money from indigent patients. The medicaid expansion matters because it will make a dent in this inequitable and dangerous system. Because that is part of the purpose of medicaid and the medicaid expansion -- to ensure that doctors get paid for treating sick patients, including ones who might be infectious and otherwise make others sick.

Discussion

NBC article titled "Texas Hospital Makes Changes After Patient Turned Away" the Hospital admitted that the Nurse documented his disclosure he'd come from Liberia in the Electronic Medical Record at the Hospital. This puts the lie to the usual official first response of the Hospital that it was "The Nurses Fault" (anyone who knows Doctors, Nurses and Hospitals know that many Doctors always blame Nurses for their inattention, arrogance and mistakes). They admit:

"The nurse who took Thomas Eric Duncan’s medical history did the job correctly, the hospital said. “However, we have identified a flaw in the way the physician and nursing portions of our electronic health records (EHR) interacted in this specific case,” it added."

Thomas E Duncan didn't get treated until his relatives called the CDC and alerted them multiple times. Anyone ask why? Here's what his neighbor said:

"That was the day "I called CDC to get some actions taken, because I was concerned for his life and he wasn't getting the appropriate care," Duncan's nephew, Josephus Weeks, told NBC News on Wednesday night. "I feared other people might also get infected if he wasn't taken care of, and so I called them to ask them why is it a patient that might be suspected of this disease was not getting appropriate care?"

But you have to go outside the major news media to even get the "elephant in the Room" -- Insurance and the fact that Texas is refusing the medicaid expansion and that Hospitals around the country are either turning away patients or closing on account of that:

Charles D. Ellison rightly notes that:

"Did Duncan get initially turned away because he is black and, possibly, uninsured?"

Of course the Supreme Court says racism is dead in the USA and uses that to justify striking down laws intended to stop racist policies. So who wants to talk about this? He continues:

"We may never know for sure and it’s unclear if Duncan had insurance or not (it’s unlikely considering he’s a Liberian national on a U.S. visa)."

It's not hard to find out. A reporter should have asked him, or his relatives. Or the Hospital. But none of them seem to have asked this basic question.

“I was stunned,” Walks told The Root. “You could put [Duncan’s] picture in the dictionary under what you look for when responding to Ebola. How do you miss that guy?”

The Hospital had to notice. But I really don't think they missed this disclosure, what they missed was an even more important set of facts; the hospital wasn't focusing on where he was coming from. The Hospital was focusing on his insurance card and his ability to pay. Anyone who's been to a hospital recently with less than perfect insurance has found that out. In 2010 I went to a hospital after breaking my arm, spent 4 hours in the emergency room, only to be put in a cab to a clinic in Bethesda. Why? They said because they didn't have anyone on the staff who could set a broken arm. That wasn't true, the Hospital didn't have any doctors who would treat my broken arm under my insurance so I rode a cab. I suspect he was sent away because the Hospital didn't want to lose money on Thomas Eric Duncan by treating him under his substandard insurance if he had any. Texas has blocked the medicaid expansion. He likely didn't have insurance and the State wasn't going to reimburse him for the expense, they thought. I'm Sure the Federal Government is paying for his care now, but that is probably what really happened. Is anyone verifying this? I doubt it. Will it get investigated? Will the gross negligence of the hospital be punished? Will the Gross Negligence of Governors like Rick Perry who won't take the Medicaid expansion get punished? I doubt it. They'll prosecute Thomas instead. Ellison notes:

"That’s where factors such as Duncan’s race and level of insurance could have influenced the hospital’s first decision in either subtle or not-so-subtle ways. “There is a lot of research showing that different people get turned away in different places,” argues Walks. “So, if they turned him away at first because he’s an African with no insurance that would not be inconsistent with what we’ve seen over the years.”

Ellison also notes, quoting Walks:

"Walks draws on lessons from a similar event in October 2001 when the D.C. area was struck by multiple anthrax attacks which hit postal facilities particularly hard. When two black Brentwood facility postal workers – Thomas Morris, Jr. and Joseph Curseen - dropped by Maryland hospitals complaining of anthrax-triggered symptoms, the same time news of the attack and Brentwood as a focus of investigation was plastered on every cable channel, they were sent home and died soon after."

Our Hospital system has never been kind to minorities, but it has a duty to treat all people who show at the emergency room and it has an even more important duty to protect public health.

For further reading I suggest you read Ellison's report. He covers it pretty thoroughly in his article in the Root:

http://www.theroot.com/articles/culture/2014/10/where_ebola_meets_concerns_over_race_class_and_the_uninsured.html

References:

NBC Report on Hospital "Texas Hospital Makes Changes After Patient Turned Away":

http://www.nbcnews.com/storyline/ebola-virus-outbreak/texas-hospital-makes-changes-after-ebola-patient-turned-away-n217296

Same Report from Dallas, with more detail: http://www.dallasnews.com/news/metro/20141004-dallas-hospital-under-fire-as-accounts-of-ebola-patients-initial-release-change.ece

Report on his Brother:

http://www.nbcnews.com/storyline/ebola-virus-outbreak/ebola-patient-thomas-eric-duncans-nephew-i-had-call-cdc-n216326

We know he lied on his entry papers. But he didn't lie the first time he showed up at the hospital

http://www.nytimes.com/2014/10/03/world/africa/dallas-ebola-patient-thomas-duncan-airport-screening.html?_r=0

Fact is our hospitals need to employ a virtuous and uniform (just) standard of care, and they don't.

The home left Behind

I was homesick for a home I left behind.

When I wandered over the horizon long ago.

I was homesick til I found a home in a dale,

where the babies cried and fat tongues wagged,

and I went out each day to make my way.

 

And then one day I sat and thought,

I'm surrounded by friends, I'm not alone.

I might be here. I might be there.

But my heart is still and I am home.

Christopher H. Holte

The Day the USA Marines invaded Savage, Md

I forget the exact date, but I lived in or near, Savage Maryland off and on from about 1971 to about 1988. And while I was in College at the University of Maryland in the late 70's I worked at the Savage IGA, which was where the WAWA is now off of Main Street. It was run by a nice man who's name I can't recall and I was there part time stocking his shelves, cleaning and sometimes helping the Butcher. I remember his wife, who filled in for him on weekends so he could go to Shul. And his daughter who he put through college so she wouldn't have to run a grocery store. I also remember his butcher, a man named Izzy who seemed old as sin to me and had numbers on his arm, at the time, but was probably actually younger than I am now. Anyway I still remember one weekend day working there as clear as a bell. It was the Weekend Savage got invaded by the Marines.

It was a beautiful day. Not super hot. The kind of day when people came to Savage to take advantage of the mild rapids in the town where the water moved fast enough to avoid leaches and bugs, but was safe enough so that people could swim with a relative lack of fear. People came from miles around to swim there and party. It was a hangout for redneck and hippy type alike. And also got some pretty wild people. But that day I wasn't enjoying the water, but a few local marines were. They went down to the Little Patuxent that we affectionately called "The Savage River" to swim. Parked their jeeps and went into the water.

Apparently a few of the local bullies harrassed and attacked them. I don't know which bullies they were but I can guess as I had a few run ins with them myself. The bullies beat up one of these three marines and they beat a retreat back to Fort Meade. We all knew that Fort Meade contained the National Security Agency and were proud of our non-existent agency and it's mission to keep us safe from the evil Communist menace, and I was too. So were the Marines who then provided the NSA security detail.

The three came back with a small army. I don't know how many jeeps, but they came in with a battallian strength hunting for the bullies who attacked that Marine. One Jeep pulled up to the Store and a few tough looking and angry looking guys asked me if I knew what was going on. I didn't, and they kept on going. I hear they caught the three guys who'd attacked one of their own a few minutes later. I don't recall how the administrative justice went. But I don't feel sorry for the guys who attacked the marines.

I actually thought the whole thing was funny. To me it will always be "the day the Marines invaded Savage."

The Marines eventually were replaced with Federal Protective Service officers. And eventually the existence of Fort Meade was hidden behind new roads, bypasses and the relocation of soldiers to other bases unless they were involved directly in NSA operations. But I was thinking of the story because today is a beautiful day like that, and I wanted to write the story down. Savage is normally a peaceful place, but there were a few wild people and most of them aren't around anymore or would like people to forget they once thought they were bad arses.

This is me around that time

The Fire

Forged in fire, bent and annealed

broken assunder, reforged and healed.

Heated and beaten, beaten and healed.

This is a good sword, created and forged.

 

The fire tests us, sometimes bests us,

as we struggle just to live,

The ineffable, Lord of the Firmament

Tests our metal,

Tests our willingness to forgive.

 

The Lord of Creation;

A word spreading over the ocean

born, reborn, winds and eternal waves

Is defined, redefined, we participate in creation

like a drop of water in the ocean

waves spreading from first contact.

We define the ineffable, we create our image;

In our hubris or blasphemy, we imagine what the divine is all about

and our delusions are crushed

and burned in fire.

 

And we can pray that waves will spread from each point of light,

that we can heal the world, and make it right.

For We either teach and learn,

Or we taste the fire, and are beaten and healed.

Or are broken and discarded.

What do we bequeath?

I will be home one day. And home for to stay.

Deep in a hole in the ground, where the soil is good.

The world will get us, and get us it will.

And we will depart this world....

as will our children....

as will our children....

 

My own fate, bothers me little.

But the fate of my grandchildren...

and the fate of the children of my loves...

that bothers me more than the fears of the day.

We all will one day depart this world...

as will our children....

Sadly, as will our children.

 

What monstrous eggs have we planted in the ground?

That rise up to haunt us, Monstrous and cavernous.

Taking our children, before they should.

We planted glowing dragon's teeth.

And what will we reap?

What have we taught them?

What do we bequeath?

 

Deep in the ground, where the soil is deep.

At the end of my days, sleeping for good.

The world will get us yet into it's maw.

And what do we leave our children,

when they depart too?

What do we reap?

Why do we weep?

Christopher H. Holte

The companion of a mirror

I say good night to I in the mirror,

and the mirror says good night right back.

It's companionship couldn't be clearer

I enjoy the company of my creaking house,

and the odd sounds in the night.

The House talks to me when no one is around.

and I talk to it in turn.

And when I think of loved ones who passed,

I set a candle in my window to burn.

 

Oh, my little dog is companion enough,

and I am companion to my self.

And, I've friends who lend a hand when it's tough,

I am grateful to them for my mental health.

 

No man is an Island, a Rock, Dunn said,

But I think he understood we are more like a ship instead.

We need our ports and we need our journeys,

We need our trials and we need to rest and be repaired.

I am lonely for missing dear friends long gone,

And sometimes I sing that despairing song.

But their voices are alive within my mind

And I hold onto them tightly in my heart.

Christopher H. Holte

The Arrogant Monkeys

Once there was a tribe of monkeys who thought they were so clever. God saw them and wanted to warn them, so he cut off their beautiful tails. They being the arrogant monkeys they were just congratulated themselves on how fine they looked without tails and what fine monkeys they were. They didn't learn anything. But learned to hang from branches with their hands and race through the trees.

So God punished them by taking away their trees and surrounding them with lions, panthers and bears. And now they were very afraid because monkeys without trees have nowhere to run when the predators come. So they banded together and stood up all the time to watch for the predators and learned to throw rocks at them. They learned to fight off predators with sticks and stones and after a while they started congratulating themselves on how tall and strong they were and were even more arrogant at being able to stand straight and look far away for enemies. They hadn't learned a thing.

So God punished them by giving them all scabies and taking away their fur. So they learned to use their sticks to kill animals and wear their skins or build shelters from them. And they began killing things for sport and taking animals and making them do their work for them. Once again they hadn't learned a thing.

So God sent fire to them to burn their huts and burn their food. But the clever monkeys took the fire and kept it and even learned how to make fire from rocks and sticks. They started cooking food and eating it. And they lived like locusts on the land eating what they chose and using the fires to keep predators from eating them. They congratulated each other on their wisdom and learned to sit around the fires jabbering at each other and to call that talking. They became very dangerous. Not just to themselves but to all the animals and plants of the world. At that point they began calling themselves humans.

God next tried flood. But one of them built a giant boat and brought his livestock and goods on it. And after this the strange monkeys got even more arrogant.

God had tried fire, and rain, flood and earthquake, but at length after all these punishments God showed them a poisonous rock. And told them never to gather all those rocks in one place. Being the arrogant monkeys they were the monkeys of course gathered the rocks in one place and they called it Fukushima. Naturally the rocks grew very hot and melted and killed all the monkeys. And God was very sad and he wasn't sure what to do because they killed everything else too.

Shana Tova.