Stephen Berger, Investment Banker & Chair of Cuomo's Medicaid Resign Work Group

Doctors for the 99% will be out on Wednesday morning (1/15/2012) at 7AM to provide a people’s answer to a $75-a-plate power breakfast inside the Brooklyn Marriott.  Health industry and Wall Street insiders will be guests of Crain’s NY (the local business publication whose readers ARE the 1%) to talk about how to “Solve Brooklyn’s Hospital Crisis”.

Why a demonstration?

This protest is a response to Gov. Cuomo’s special work group on Brooklyn hospitals (chaired by Stephen Berger a Wall St. financier) which has recommended changing NY law to allow investors to own or operate hospitals that are in financial trouble. They also recommend that the state be given power to dismiss hospitals’ management and boards. Together, these changes will allow Wall St. to take over health care even more than they already have.

It is amazing that in an attempt to save money, the State would turn Brooklyn hospitals over to for-profit companies.  There is extensive evidence that privatizing health services results in increased costs, poorer quality, and increased health disparities.  The people who will profit are the for-profit companies.  The people who will pay? The taxpayers of New York and the patients who will lose access to safety-net institutions.

Changes to our health care should be made transparently and democratically. These life and death decisions should be made by the communities who will be affected, not by the bankers who caused our problems in the first place.

This is a classic example of using a “crisis” to push through unpopular policies that will benefit only the rich.

What is the background?

• 20% of Brooklyn residents live in poverty. 40% of Brooklyn residents have Medicaid as their health insurance, and another 20% have no health insurance at all.
• One-third of all Brooklyn residents lack a regular doctor, so they use emergency rooms (ERs) when they get sick. 46% percent of all ER visits in Brooklyn could be better treated in the community.
• 6 of Brooklyn’s 14 hospitals are almost out of money and in danger of closing: Brookdale (Brownsville), Brooklyn Hospital (Ft. Greene), Interfaith (Bedford-Stuyvesant), Kingsbrook Jewish (East Flatbush), Long Island College (Cobble Hill), and Wyckoff (Bushwick). These hospitals serve low-income communities, where most people have Medicaid or no insurance, and many are immigrants and people of color.
• Gov. Cuomo appointed a special workgroup chaired by an investment banker to suggest fixes for Brooklyn’s troubled hospitals. They suggested letting private investors come in to “save” these hospitals.
• Brooklyn is fighting to keep hospitals open in low-income neighborhoods. Meanwhile, the wealthy east side of Manhattan is stuffed with well connected hospitals that grab public money, but give little care to low income communities of color.

What are the details of the demonstration?

We will be meeting Wednesday 11 January @ 7 am outside the Brooklyn Marriott, 333 Adams St (near Borough Hall / Jay St / MetroTech in downtown Brooklyn).

For more information visit: http://owshealthcare.wordpress.com or contact: owshealthcare@gmail.com

HELP US STOP A DRAMATIC AND AVOIDABLE HUMANITARIAN CRISIS IN PUERTO RICO

Julia Burgos Latino Cultural Center – (1680 Lexington Ave, between 105 and 106 streets) -Thursday, November 10, 2011 – 6pm to 12am

Education + Access = Power

The AIDS crisis in Puerto Rico is out of control. Over 35,000 people live with HIV/AIDS and at least 50% of these are due to the (avoidable) sharing of contaminated drug injection. It has been proven that when free sterile syringes are made available to injection drug users (IDU), they stop sharing syringes and HIV infection rates go down dramatically. Moreover, HIV and Hepatitis C (HCV) infections are the direct result of the lack of syringe availability. Despite the epidemiological crisis in the island, the needs of these populations continue to be overlooked. While a syringe that literally costs cents can save hundreds of thousands of dollars in HIV and HCV medication treatments and unnecessary human pain, there are almost no monetary allocations to decelerate the progress of these epidemics. In fact, while HCV treatment is virtually nonexistent in Puerto Rico, studies have found that over half of PR IDU may be infected with HCV. This governmental negligence has caused a major and unprecedented human rights’ crisis. We are determined to take matters into our own hands by bringing life-saving services to PR IDU via activism and philanthropy. But we need you. Puerto Rico needs you.

Concerned NYC-based activists are asking you to support El Punto en la Montaña, a rural Syringe Exchange Program (SEP) that operates in the municipalities of Cayey, Cidra, Comerio and Aguas Buenas. While the HIV/AIDS epidemic is island-wide, drug users in rural municipalities have even less access to drug treatment services and sterile injection supplies than those IDU living in metropolitan areas, where syringe exchange, methadone treatment and other services are (somewhat) available. This is what makes El Punto unique. Since 2007, with a yearly budget of approximately $40,000, it has provided access to sterile injection supplies, education and nutritional services to over 600 rural IDU. 98% of these IDU had never received these services in their lifetimes prior to El Punto.

El Punto has been able to operate thanks to funding from private foundations such as TIDES, National AIDS Fund-now AIDS United, NASEN and MAC AIDS Fund. CitiWide Harm Reduction (a Bronx-based SEP) and the Harm Reduction Coalition have also supported this program administratively, and with trainings and supplies. While these funders and institutions have helped El Punto throughout the past 4 years, the financial panorama for 2012 is grim. We need to raise $30,000 to guarantee full program operation during 2012.

Join our efforts to face an unprecedented humanitarian crisis. Join as at the fundraiser PUERTO RICO´S HUMANITARIAN CALL to be held on Thursday, November 10 at the Julia Burgos Latino Cultural Center (1680 Lexington Ave, between 105 and 106 streets). You can also send check donations by mail to 226 East 144^th Street, Bronx, NY 10451. Please make checks payable to “CitiWide Harm Reduction/El Punto en la Montaña”.

Questions? Contact El Punto Chair Camila Gelpí-Acosta at 718-581-3983 or camilagelpi@gmail.com

What is a Doula?

The word doula is an ancient Greek term that translates to “caregiver.” A doula provides emotional support, pain management and relaxation techniques, and information to her clients as needed.

Birth – A Birth Doula will provide all of the above throughout a client””s labor and delivery, as well as the immediate postpartum period (about two hours after the baby has been born). The doula meets with clients prenatally to talk about birthing preferences, the creation of a birth plan, and to practice different positions and relaxation techniques for labor. Additionally, a birth doula provides a postpartum visit to review the client’s birth experience and refer them to any resources they may need. Birth doulas are on call for their clients for three weeks.

Abortion- An Abortion Doula will provide all of the above to clients who are choosing to terminate the pregnancy. The doula will stay with the client throughout her procedure, as well as part of the recovery period, and will remain in touch with the client as she desires thereafter.

About The Doula Project:

The Doula Project is a pro-choice New York City-based organization that was started in 2007 to provide free services to lower-income individuals across the spectrum of pregnancy. It was founded by pro-choice doulas and reproductive justice activists, two of whom currently serve as the Project Co-Coordinators. The Project is a volunteer led and run organization that trains and manages its own doula base. We currently have 3 programs that serve the greater NYC area:

1) To provide doula care to people facing abortion, miscarriage, and stillbirth (in partnership with a Manhattan Public Hospital and Planned Parenthood Brooklyn). You do not have to be a birth doula to serve as an abortion doula. We train our own volunteers on this component of care.

2) To provide doula care to people choosing adoption (in partnership with Spence Chapin Adoption Agency). Please be a trained birth doula to apply. We do not require a lot of experience, only a formal training with an established doula certifying program.

3) To provide doula care on a case by case basis to lower-income individuals who are not affiliated with either of our partner organizations. Please be a trained birth doula to apply. We do not require a lot of experience, only a formal training with an established doula certifying program.

We are recruiting doulas for all components of our mission, though priority is given to those who are interested in being both Birth and Abortion Doulas. While you are not required to serve as a doula for all components, you are expected to support the mission and values of the entire project and the work each individual doula engages in. You are also expected to attend all components of our training. We encourage you to apply for all components of our work!

Abortion Doulas:

We are looking for people interested in training as abortion doulas to work with clients in NYC clinics and hospitals. Doulas will be present and provide emotional support to clients before, during and after abortions. We are looking for people who can work at least 2 weekdays a month as well as complete 40 hours of training, provided by The Doula Project, in the summer of 2011. Trained birth doulas are particularly encouraged to apply, though we are excited to bring on reproductive health and justice activists who have no prior doula training.

Job description:

• Report to the assigned hospital/clinic each workday
• Meet with clients in the clinic/hospital before abortion and answer any questions/concerns, help fill out paperwork, and provide pre-abortion counseling
• Provide client with emotional support during abortion (includes 1st and 2nd trimester and laminaria placements). Please note: This means you will be expected to be in the operating room with the client as needed.
• Provide clients with your number to call you anytime to talk after abortion.
• Meet with clients anytime if desired after abortion

Commitment:

• Commit to two 5- 8-hour weekdays per month (Monday – Friday 9-5PM)
• Commit to meeting with the client outside of clinic setting after abortion, if desired
• Provide personal number to client as desired
• Attend monthly abortion doula meetings
• Attend 40 hours of training in the summer of 2011 (includes 25 hours classroom over the course of one week/15hours clinic over the course of three to four weekdays)
• At least one-year commitment to project
• When working in hospital/clinic settings, become hospital/clinic volunteer and go through volunteer training

Adoption and Birth Doulas:

We are looking for previously trained birth doulas to work with birth moms who may be choosing adoption and with clients who cannot otherwise afford doula care. We partner with Spence-Chapin to provide doula support to their clients and support low-income clients who sign up through our website, free of charge. You do not have to have a lot of experience as a doula and will work as part of a two-person doula team. A back-up doula will always be provided for every birth.

Job description:

• Coordinate with your partner doula to ensure that at least one of you will be available at all times during your five-week on-call period.
• Meet with clients, for a minimum of two prenatal visits as desired by the client and as time allows
• Assist client in the creation of a birth plan
• Answer questions and provide resources per client””s request
• Remain in constant contact with client before and during the on-call period, and after, as client desires
• Provide continuous support at the time of the client””s labor and delivery
• Meet with clients for a minimum of one postpartum visit after the birth, as the client desires

Commitments:

• Participate in adoption training with Spence-Chapin (part of larger training we provide)
• Commit to one (1) birth every 6 weeks
• Commit to a minimum of two prenatal visits and two postpartum visits
• Commit to the five-week on-call period with your partner doula. At least one of you must be available at all times during the on-call period.
• Provide personal cell phone or pager number to clients
• At least one-year commitment to the project
• Adhere to Doula Project and Spence-Chapin policies and protocols.

Doula training will take place the weekend of June 18th and 19th (9am-5pm). In order to offset some of the cost of the training workshops, we will be asking each applicant accepted to the Doula Project to pay $25 on the first day of training. We recognize that this may be difficult for some of us; if this is the case for you, please just drop us a line. We will waive the workshop fee, no questions asked.

How to apply:

People with experience in doula work, reproductive health, rights and justice work, abortion counseling or health services are encouraged to apply. People under 30, people of color, queer and trans people and Spanish speakers are strongly desired. People with flexible/free weekdays are ideal. While we are willing to negotiate for the right person, priority will be given to those who can commit to at least two weekdays a month.

Abortion doulas and births doulas who take births through our website will serve in an unpaid volunteer capacity. Adoption doulas will receive small stipends through the adoption agency. We realize this is a big time commitment and will do everything possible to take care of our doulas and work within your schedules.*

You can get our application at www.doulaproject.org.

If you are interested in working with us, we are accepting applications now through April 25th. Please send completed applications at apply@doulaproject.org

Low-cost acupuncture treatments

For several years, Manhattan’s Swedish Institute (226 W 26th St.) was the place to go for low-cost acupuncture treatment in New York City.  The Institute’s teaching clinics offer both acupuncture and Swedish massage.  A 13 week course of acupuncture cost $360 ($150 for seniors).

Earlier this week we ran into a colleague,  Dr. Ben Kligler, co-author of Integrative Medicine: Principles for Practice, who informed us that the Swedish Institute has been purchased by the Pacific College of Oriental Medicine.  He recommended the PCOM teaching clinic where acupuncture is provided by interns at somewhat higher prices than the Swedish Institute; see the details on their website. The address of the PCOM is 915 Broadway, 3rd floor.

Both the Swedish Institute and PCOM have interesting websites.  Here is the Swedish Institute’s explanation of what it’s like to experience an acupuncture session.

Advanced Directives

A recent article in The Teaching Physician (a publication of the Society of Teachers of Family Medicine) discussed a new (free) initiative to make it easier for people to both make – and retrieve – advanced directives.  “Information Technology and Teaching in the Office: Advance Directives Online” by Richard P. Usatine, MD, and Craig M. Klugman, PhD, University of Texas Health Science Center at San Antonio was published in the October 2009 edition and discusses Caring Connections (http://www.caringinfo.org/).

Caring Connections was developed by the  National Hospice and Palliative Care Organization (NHPCO) with support from the Robert Wood Johnson Foundation.  The website offers a number of resources for people considering end-of-life care.  The one highlighted in the article was the ability to create and store advanced directives on line.

As noted on the site: “Advance directives allow you to document your end-of-life wishes in the event that you are terminally ill and unable to talk or communicate. ” They generally take two forms. In a living will someone specifies what kind of care he or she would like in future.  A health care proxy is someone who can make decisions for a patient if he or she is incapacitated.

As a practicing clinician I find that there are several problems with Advanced Directives.  First, people don’t fill them out. No one likes to think about their own death. Second, people often turn to lawyers who charge money to complete these forms. This is really not necessary.  The forms in New York State can easily be completed by a family.  [The specifics of advanced directives, however, vary by state.] Finally, there’s no logical, single place to put Advanced Directives so that they are easily retrievable in an emergency.

The Caring Connections site deals with both problems. State specific forms are available for downloading.  The forms come with very detailed instructions.  Once they have been completed users are encouraged to scan them and upload them to a Google Health Profile. This profile can then be shared with the key people who need access to the advanced directives.

One is always a bit reluctant to further promote the Google monopoly on the web, but this is a useful free service.  It is, however, only available in English, a true limitation in an ever more diverse United States.

More free stuff in NYC – medical and not

The Swedish Institute is mentioned in a wonderful book sent to us by a reader entitled The Cheap Bastard’s Guide to New York City. Interested readers of the portal should consider getting a copy at the New York Public Library (of course).

posted by Matt Anderson, MD

Shah M, Edmonds-Myles S, Anderson M, Shapiro ME, Chu C. The Impact of Mass Incarceration on Outpatients in the Bronx: A Card Study. Journal of Health Care for the Poor and Underserved, Volume 20, Number 4, November 2009, pp. 1049-1059.

2009 marks the 400th anniversary of Henry Hudson’s voyage (let’s not say discovery) up the the river that now bears his name. There will be many celebrations marking this anniversary, but perhaps none as imaginative as the paired conferences organized by the public health communities in Amsterdam and New York City. The first conference was held on April 6th in Amsterdam, the second conference will take place on September 10th in New York. These dates mark Hudson’s departure from Amsterdam and entrance into the Hudson River, respectively.

The joint conferences are entitled the Hudson Year Urban Health Conference in Amsterdam and New York: a Tale of Two Cities in 2009.   We have posted the conference brochure at this link.  As readers can see there is a social medicine focus to the presentations. Here is a description of the conference from the brochure:

Henry Hudson Year
When Henry Hudson set foot in what would become New York, Amsterdam was already a flourishing city. Trade, culture, and social emancipation were the cornerstones of society. The city thrived because immigrants brought their skills and work. Tolerance for diverse religious and cultural backgrounds was born in Amsterdam and was important for the development of New York. In some ways, New York became what Amsterdam once was. Yet both cities have many vulnerable citizens that need care. In this conference, we will take a closer look at the similarities and differences in how they meet this major challenge.

A Tale of Two Cities in 2009
The Hudson Year Urban Health Conference (HYUHC) is a one-day program planned for Monday, April 6, 2009, in Amsterdam and repeated on Thursday, September 10, 2009, in New York. The Amsterdam site is De Duif, Prinsengracht 756, 1017 LD Amsterdam, The Netherlands. The New York site is Columbia University, Department of Psychiatry, 1051 Riverside Drive, first floor auditorium, New York, NY 10032. The two programs will be largely identical, with a local emphasis for each city. After morning workshops for health experts, afternoon lectures will be open to all persons interested in urban health, followed by a reception.  The HYUHC will be organized by the Public Health Service of Amsterdam (GGD) in co-operation with Care and Community Services of Amsterdam (DZS), Columbia University, the Montefiore Hospital of NYC, and the NYC Department of Health and Mental Hygiene.

Themes and Topics
Big cities are inhabited by many groups of marginalized people. The mental illnesses, addiction, and other health problems from which they suffer have an impact on the individual and on society as a whole. Our conference goal is to introduce these problems and to show a broad audience the progress made and the continuing attempts to find solutions. An important purpose is to raise more understanding and tolerance among the people living in these cities.  Each afternoon speaker will present a controversial statement to discuss with the audience. At the morning workshops, health experts will meet and share knowledge to strengthen the already existing work relations between New York and Amsterdam.

At both HYUHC sites, the Dutch photographer Annaleen Louwes will present a series of photographs concerning urban health care in Amsterdam and New York. This visual display will highlight the similarities and differences between the two cities. The organization Niet-Normaal, the Netherlands (www.nietnormaal.com), will invite contemporary artists from Amsterdam and New York to enforce the message of this conference by showing video art works.

Two abstracts

To provide readers of the Portal with  a sense of the conference’s content, here are two  abstracts, one from New York City, the other from Amsterdam:

Chinazo Cunningham, Montefiore Medical Center and Albert Einstein College of Medicine. Title: Sketches from the Bronx–what we see and what we do!

Dr. Cunningham will present two innovative programs that aim to improve access to care among HIV-infected, opioid-addicted, and unstably housed individuals. One program involves close collaboration between an academic medical center and a community-based organization, medical outreach to hotels (that serve as temporary emergency housing), and the delivery of health care outside of traditional medical settings. The other program provides opioid addiction treatment with buprenorphine outside of a traditional drug treatment program. Dr. Cunningham will describe the evolution and sustainability of these programs and present results of program evaluations.

Udi Davidovich, GGD Amsterdam.  Public education on HIV/AIDS by the GGD
Online public campaigning for sexual health: the role of Internet  interventions, their potential and current achievements. Online prevention interventions have been increasingly used by the Amsterdam Health Services to influence health-seeking behaviour and sexual behaviour among different risk groups for HIV and other STD’s. In this presentation we will discuss the present targets, present achievements and the potential of online interventions. The presentation will be illustrated by three ongoing targeted campaigns: an online intervention for the promotion of safe sex among gay steady partners (in www.mantotman.nl), an online internet intervention for the promotion of safe sex and HIV testing among heterosexual youth: www.vrijlekker.nl, and an internet tool for the facilitation of STD screening among gay men (in www.mantotman.nl).

Further Details:

The New York Conference will take place on September 10th, 2009 at  Columbia Presbyterian, 1051 Riverside Drive (& 168th St), Auditorium, first floor, NY, NY 10032.  The morning program (small groups sessions) will run from 8:30-12:00 and the afternoon program (lectures) from 2-5:00. A reception will be held from 5-6:30 PM.  The cost is free. To register visit this website: www.nynjaetc.org

For more information on the NY400 week and the many planned events, check out the official website.

Posted by Matt Anderson, MD

Riker's Island

The June 2009 edition of the American Journal of Public Health contains an article entitled: From Public to Private Care The Historical Trajectory of Medical Services in a New York City Jail” written by Noga Shalev, MD. Dr. Shalev is a graduate of the Residency Program in Social Medicine and this work developed from her 2006 Social Medicine Project. The article describes the evolution of health care services at Riker’s Island.

The Riker’s Island Penitentiary sits in New York City’s East River between Queens and the Bronx, just to west of La Guardia Airport.  Riker’s is quite literally an island,  connected to the Borough of Queens by a single bridge. It is one of the world’s largest correctional facilities with an average daily census of about 13,000 prisoners.  Administratively, the facility houses ten jails that sit on the island and the Vernon C. Bain Center, an 800 person facility located on a barge just off of Hunts Point in the Bronx.

Vernon C. Bain Prison Barge

Dr. Shalev divides the history of health care at Rikers into three periods.  From the opening of the prison in 1932 until 1973 medical services were provided by various New York City agencies.    During this period numerous reports documented the poor quality of care provided to inmates.   It seems clear that the Department of Correction’s concern for security trumped attempts to provide medical care to inmates.  As noted in a 1958 report: “The Department of Correction is not now in background, equipment, or personnel capable of giving modern medical care—whether preventative or therapeutic—to the prisoner.”

Attempts to remedy this situation made little progress until the early 1970′s when a series of prison revolts including those at the upstate Attica prison and the Manhattan House of Detention (commonly known as “the Tombs”) led to reforms.   This resulted in the second period of medical care at Rikers.  From 1973 to 1996 Montefiore Medical Center provided health care under an affiliation agreement with the City.  Health care on the island improved and the service was “the first correctional medical program in the country to be accredited by the Joint Commission on Accreditation of Healthcare Organizations” (JCAHO).  However this period also coincided with the HIV epidemic and in its wake a resurgence of tuberculosis; prisoners were particularly affected by these twin epidemics.  Costs for medical care increased substantially and in 1996 the Giuliani Administration decided to turn health care at the island over to a private contactor. The initial agreement with St. Barnabus Hospital was generally recognized as a failure.  Costs did not decrease and there were ongoing concerns about the quality of care.  Currently, care on the island is provided by the private, for-profit Prison Health Service, Incorporated.  Concerns over costs and quality of care remain.  Dr.  Shalev characterizes this final period from 1996 to the present as one of “managed care” and the overarching theme of her paper is that health services at Riker’s have moved from public hands (the city) into private hands (for-profit corporations).

Dr. Shalev’s careful historical research, butressed by interviews with Montefiore staff, tell the story of a particular and certainly unique experience in incarceration.  But the unique story of Riker’s illustrates the larger themes of how corrections have come to be seen as one more commodity on which profit can be made. And this gives powerful players a vested interests in keeping jails full.  The result is a system described by some as a prison-industrial complex, by others as a penal state.

Here is the abstract of Dr. Shalev’s paper:

Over the past 25 years, incarceration rates in the United States have more than tripled. Providing health care services for this growing number of inmates poses immense medical and public health challenges. Focusing on the administrative and financial shifts in health care delivery, I examined the history of medical services in one of the nation’s largest correctional facilities, Rikers Island in New York City. Over time, medical services at Rikers have become increasingly privatized. This trend toward privatization is mirrored nationwide and coincides with the rising prevalence of incarceration.

posted by Matt Anderson, MD

Today at the Interchurch Center in Morningside Heights, Senator Kirsten Gillibrand (D-NY) met with a diverse group of community activists, labor leaders, and health care professionals to discuss priorities for health care reform. The demands of the group were simple – quality affordable health care we all can count on – and Senator Gillibrand’s response, which included overwhelming support for inclusion of a public health insurance option in any legislation on health care reform, suggested that she will be a strong advocate for health care reform in the near future.

The round table discussion was organized by Health Care for America Now! (HCAN), a coalition of 850 member organizations committed to common principles for health care reform. In attendance were representatives from 1199 SEIU, AFL-CIO, ACORN, Citizen Action of New York, the New York Immigration Coalition, NYC for Change and about 20 other local and national organizations. In addition to Senator Gillibrand, NYC Councilman Daniel O’Donnell and a staff member from Congressman Ed Towns’s office were also in attendance. As a practicing physician, and a representative of the National Physicians Alliance, it was heartening for me to see so many people committed to fixing our broken health care system.

The meeting began with a welcome from Paula Mayo, Director of the Interchurch Center, and introductory remarks by Dr. L. Toni Lewis, president of the Committee of Interns and Residents. Dr. Lewis shared an example of the tenuous nature of health care delivery in our communities – the hospitals in which she trained, Mary Immaculate and St. John’s, have both recently closed leaving patients in an already underserved area of Queens in flux. She also introduced HCAN’s policy priorities: enacting legislation in 2009 that would guarantee the option of a public health insurance plan and working toward equal access to quality care in communities of color and low income areas.

The most compelling speaker at the round table, a young woman named Kelly Cuvar, shared an extremely personal story of her battles with both cancer and her private health insurance company. Diagnosed with cancer at 19, she described how every major life decision she has made since has been framed by the need to maintain health insurance coverage. Never in full remission despite treatment, her “prior condition” and her ongoing need for doctor visits and treatment has made every interaction with the insurance company a source of stress. “Everything was fight,” but at least as a 19 year old student, her father could do the battling with the insurance company. Now 10 years later, after losing her job last year and needing to pay for her coverage through COBRA, she is petrified that her coverage will run out, “I am frightened and it is all that I think about.” In arguing for an affordable public health insurance plan without restrictions on prior conditions, she made the heart breaking plea that she is hard working, she has bravely battled her cancer, but our convoluted system of health care is failing her and has left her uncertain about her future care.

Other speakers included Sherriann Cumberbatch, a small business owner from Staten Island who cannot afford health insurance for her employees or even her own family; Elisabeth Benjamin of the Community Service Society who questioned why private health insurance premiums in New York have been increasing at 81% – a rate seven times greater than increases in wages; Ralph Palladino of AFSCME DC 37 who argued that a public health insurance plan would introduce competition, stability, efficiency, and innovation into markets where the private insurance industry has failed to do so; and Theo Oshiro of Make the Road New York who emphasized that immigrant families pay taxes and contribute to the economy and should not be barred from public health insurance plans.

In response, Senator Gillibrand only spoke for a few minutes, but immediately affirmed her support for including a public health insurance plan in any health care legislation. She also acknowledged support for a House budget resolution that would allow the Senate to pass health care reform with a simple majority vote avoiding filibuster. She was clearly moved by Ms. Culver’s comments and spoke directly to the young woman telling her that the stress and strain that her family went through is unacceptable. In a flurry of powerful statements, Senator Gillibrand emphasized that a not for profit public plan must be affordable (no more than 5% of a family’s income and less for those who can afford less), easy to enroll in (suggesting a check box on tax forms for enrollment), allowed to negotiate for discount prices with pharmaceutical companies (similar to the VA), and should offer coverage to everyone. To her, health care is right, not a privilege. The junior Senator from New York is clearly going to be a champion for progressive health care reform…now what can we expect from Mr. Schumer…

Aaron Fox, MD

Tuesday, March 24, 2009 brought Dr. Martin Donohoe to Social Medicine Rounds at Montefiore.  Dr. Donohoe, a Portland internist, is an Adjunct Associate Professor Department of Community Health, Portland State University. He is also a prolific writer and the editor of the Public Health & Justice Website (phsj.org).  PHSJ contains a rich variety of materials on health topics such as Activism and Education, Women’s Health,  Beauty, Body Modification, Cosmetic Surgery, & Obesity and Unnecessary Testing, Scams. A previous posting on the Social Medicine Portal discussed his critique of the diamond, gold, and flowers industry (See Alternative Valentine’s Day: No gold, No diamonds, No flowers?)

Tuesday’s talk examined “Corporate Control of Public Health: Case Studies and Call to Action.”  Dr. Donohoe has made the slides available on PHSJ.  In this posting we wanted to discuss one of his cases studies: Bringing Bad Things to Life:  The Alliance between GE Medical Systems and New York Presbyterian Hospital.  This case study is available as a slideshow on the PHSJ website or as an article published in the journal Synthesis/Regeneration.  (A slightly longer version of the article is also posted on PHSJ.org)

The Agreement

On September 8 , 2003, General Electric and New York-Presbyterian Hospital announced “a historic multi-year, several hundred million dollar partnership” between GE Medical Systems and the hospital.  As per the GE press release:

An integral aspect of the engagement will have NewYork-Presbyterian Hospital adopting GE’s acclaimed management development and performance improvement methods. This will help build upon NewYork-Presbyterian Hospital’s strong leadership team and employee base to deliver superior patient care well into the future. NewYork-Presbyterian Hospital will implement leading edge tools for improving management, service quality and operational effectiveness. Employees will be trained in GE’s quality and process improvement programs. This balanced approach is comprised of Six Sigma statistical methodologies, change-management strategies (Change Acceleration Process) and team-based problem solving techniques (Work-Out™).

The GE/NYP deal raised concerns about the corporatization of medicine that were voiced in 2004 in the New England Journal of Medicine by Dr. A. M. Garber (Business and Medicine: Corporate Treatment for the Ills of Academic Medicine).  Garber noted the agreement – said to last ten years and involve $500 million dollars – offered a series of discounts and financing for  GE products that would create an effective lock-in for GE medical equipment.   While noting potentially positive aspects of this relationship, Gerber questioned the wisdom of such a lock-in.  He also noted the potential conflicts of interest arising from  GE’s dual role as management consultant and provider of equipment.  Finally Dr. Garber raised concerns about the multiple ways in which corporate consultants might deal with economic pressures facing hospitals.  He painted an elegant picture of the ways in which corporate thinking can undermine the social mission of the hospital:

But any consultant could also help a hospital’s financial performance by pursuing strategies that do not benefit the public. Many academic hospitals could improve their bottom lines by cutting the amount of uncompensated care they provide and eliminating unprofitable services. They might also promote excessive use of high-margin services. For example, to the extent that physicians induce demand, any hospital that owns a scanner — and any physician who earns fees by interpreting scans — can raise revenues by performing scans for less critical or even dubious indications. Similarly, well-reported phenomena such as “DRG creep,” “upcoding,” and “unbundling” can increase health care expenditures without benefiting patients. Such practices may seem innocuous from the individual patient’s point of view, if they merely raise health expenditures generally. But a physician or hospital that takes advantage of reimbursement anomalies can also jeopardize patients’ health. Physicians and hospitals can be reimbursed more if a candidate for the placement of multiple coronary stents has the procedure divided among two or more hospital admissions than if they are placed as part of a single complex procedure. Is it plausible that clinical needs alone explain why so many patients have stents placed as part of multiple admissions?

Concerns about the deal were also raised in an article in the New York Times entitled:  The Conglomerate Will See You Now; Is What’s Good for G.E. Good for Health Care? which asked:

IMAGINE a small town where one person not only owns the hardware store, but is also the banker and the doctor’s most trusted adviser. In a sense, General Electric is trying to play such a role in the nation’s $2 trillion health care industry.

The New York Times article discussed the possibility that the agreement would foster the use of expensive technology, a major factor in rising health care costs. As noted by Gerber above, expensive diagnostic machines often generate their own demand.

New York Presyterian’s Dr. Herbert Pardes responded to the Garber article in a two paragraph Letter to the Editor (published in February 2005). Pardes stated:  “Our collaboration with GE Medical Systems is based on having access to business skills and cutting-edge equipment that, in our judgment, will benefit our patients and increase our ability to provide cost-effective, high-quality care. We purchase from GE only technology that the hospital deems to be in the best interest of its patients. We will never delegate to a third party any decisions regarding our patients and the manner or method of our delivery of health care.”

Swimming with Sharks

Dr. Pardes’ reassurances ring far less convincing when we know a bit more about General Electric; this is the main topic of Dr. Donohoe’s article.  General Electric is the world’s largest company by market share. In 2007 it had revenues of $168 billion and profits of $21 billion. For a bit of perspective GE’s revenues are larger than the GDP of over 2/3 of the UN member states. The corporation is built upon a diverse set of products and services including media (NBC, Universal Studios, Telemundo), consumer appliances, power, aircraft engines, insurance, transportation, business systems, and medical services/equipment (see the Columbia Journalism Review website).  Through GE Power, the company is a major force in nuclear power.

General Electric does not have a stellar history as a corporate citizen.  GE’s history of corporate malfesance is discussed Dr. Donohoe’s article and also in a 2001 article in The Multinational Monitor entitled “GE: Decades of Misdeeds and Wrongdoing.”

Rather than review this history in detail, we will focus on one of these misdeeds that is particularly close to our home: the pollution of the Hudson River with 1.3 million pounds of polychlorinated biphenyls (PCBs). These PCB’s were released between 1947 and 1977 from two of GE  capacitor manufacturing plants and became a major focus of organizing along the river (discussed in a slideshow from Clearwater and a series of FAQ from Riverkeeper).  Thanks to GE, two hundred miles of the Hudson River are now the EPA’ largest Superfund site (see http://www.epa.gov/hudson/).  Of note this is just of of several GE superfund sites.

PCB’s are good neither for the environment, nor for health.  The EPA states: “PCBs are considered probable human carcinogens and are linked to other adverse health effects such as low birth weight, thyroid disease, and learning, memory, and immune system disorders.“  General Electric has devoted tremendous resources into evading responsibility for the cleanup (see Richard Pollock’s Is GE Mightier Than the Hudson?)  For GI’s side of this story, see their website.

Crade to Grave Care?

Dr. Donohoe closes his article on GE with the following reflection:

It is abhorrent to imagine GE profiting from New York-Presbyterian Hospital requiring that a patient’s developmental anomaly or environmentally-induced cancer (a result of exposure to GE toxins) be diagnosed by a GE scanner and treated with GE-manufactured therapeutic devices. This is a macabre twist on the concept of cradle-to-grave health care.

The question then is whether we should be looking to or partnering with corporations like GE for models on how to run health care.

Posted by Matt Anderson, MD

Anyone who has driven across the Whitestone Bridge more than once or twice has probably noticed the large brick building located just east of the highway on the Bronx side.  This is the home of the St. Joseph’s School for the Deaf, a school founded in 1869 and which moved to its 10-acre campus in the Bronx in 1913.  St. Joseph’s is is one of eleven New York State 4201 schools which are supported by the state to provide educational services to children who are deaf, blind or physically challenged.  Social Medicine Rounds last Tuesday (2/10/2009) took us to the School to learn something about deaf culture.

We were greeted by Patricia Martin, Noreen Collins and Roxana Aguilo who were gracious enough to spend nearly 90 minutes talking to us about the school and about the meaning of deafness. Dr. Martin is the Executive Director of St. Joseph’s and has been with the school for seventeen years.  Ms. Collins in responsible for pupil personnel services and is the person to call (718.828.9000) for assistance with referrals .  Ms. Aguilo is a former student at the school who works there now as a teacher’s assistant.  Since she is deaf, she participated in the Rounds through the able translating abilities of Dr. Martin and Ms. Collins.

Dr. Martin began by distinguishing two definitions of deafness.  Deafness can be seen as a pathology; this is what we could the “medical model.”  In this model the important questions are why it occurred, how severe it is and how it can be fixed.  But deafness can also be seen as a culture. From this perspective to have deafness is not to be dis-abled, but rather to be differently abled.  To emphasize the reality of deaf culture, Dr. Martin read a poem entitled “Being Deaf” by Dianne Kinnee:

“What is it like to be deaf?”
People have asked me.
Deaf? Oh, hmm… how do I explain that?
Simple: I can’t hear.

No, wait… it is much more than that.
It is similar to a goldfish in a bowl,
Always observing things going on.
People talking at all times.
It is like a man on his own island
Among foreigners.

Isolation is no stranger to me.
Relatives say hi and bye
But I sit for 5 hours among them
Taking great pleasure at amusing babies
Or being amused by TV.
Reading books, resting, helping out with food.

Natural curiosity perks up
Upon seeing great laughter, crying, anger.
Inquiring only to meet with a “Never mind” or
“Oh, it’s not important”.
Getting a summarized statement
Of the whole day.

I’m supposed to smile to show my happiness.
Little do they know how truly miserable I am.
People are in control of language usage,
I am at loss and really uncomfortable!

Always feeling like an outsider
Among the hearing people,
Even though it was not their intention.

Always assuming that I am part of them
By my physical presence, not understanding
The importance of communication.

Facing the choice between Deaf Event weekend
or a family reunion.
Facing the choice between the family commitment
And Deaf friends.
I must make the choices constantly,
Any wonder why I choose Deaf friends???

I get such great pleasure at the Deaf clubs,
Before I realize it, it is already 2:00 am,
Whereas I anxiously look at the clock
Every few minutes at the Family Reunion.

With Deaf people, I feel so normal,
Our communication flows back and forth.
Catch up with little trivials, our daily life,
Our frustration in the bigger world,
Seeking the mutual understanding,
Contented smiles and laughter are musical.
So magical to me,
So attuned to each other’s feelings.

True happiness is so important.
I feel more at home with Deaf people
Of various color, religion, short or tall.
Than I do among my own hearing relatives.
And you wonder why?
Our language is common.
We understand each other.

Being at loss of control
Of the environment that is communication,
People panic and retreat to avoid
Deaf people like the plague.

But Deaf people are still human beings
With dreams, desires, and needs
To belong, just like everyone else.

–Dianne Kinnee (Switras)

Dr. Martin went on to describe their work in the school. She pointed out that about 95%of deaf children are born into hearing families.  If hearing parents don’t learn sign language, as often happens, this can be very isolating for the deaf child. This is a particular problem in Bronx where many parents don’t speak English. For immigrant parents learning American Sign Language involves communicating in a doubly foreign language.  [A universal sign language does not exist; each spoken language has its own way of signing].  The result of this is that even when deafness is identified early on deaf children may not receive a great deal of language stimulation at home.

The school has responded to this challenge by providing programs in which parents can bring their children to the school as early as 8 months of age.  Children come to the school on their own starting at age 3 and stay through the 8th grade.  The school also offers a 10 session class on Thursday evenings for people interested in learning how to sign. The cost is $50.

Ms. Aguilo then spoke at length about her personal experience. She had been born in the Dominican Republic where there were no services for the deaf.  Her mother brought her to the Bronx and she had been diagnosed as deaf at Jacobi Hospital. This was a great blow for her mother.  Fortunately, they had a Spanish-speaking counselor at Jacobi who was able to explain the situation in a language her mother could understand.  Her mother found learning sign language difficult and so Ms. Aguilo had great difficulty in communicating with her Mom.  Ms.  Collins mentioned that often parents came to the school requesting that the school tell children about the death of relative or a pet.  In these cases the school asked the parent to come in and the school provided translation services.

Ms. Aguilo had been a student at St. Joseph’s and later enrolled at Rochester Institute of Technology where she majored in fashion design.  But she was homesick for the Bronx and returned after only a year and a half. Now she was working as a teacher’s assistant.  She has three children of her own (“and all of them hear”) and has taught them ASL.  Her kids are tri-lingual, speaking English, Spanish (with the abuela) and ASL (with Mom).

The topic of kids lead to a discussion of their use as interpreters.  Ms. Aguilo spoke in forceful terms that the American Disability Act gives deaf people a right to a translator and this right should be respected. “Don’t write”, she said.  “Don’t ignore our rights.  It only makes us angry.”  The use of children as interpreter has also been an issue with our southeast Asian patients.  For a list of translation resources, see the end of this post.  Ms. Aguil0 also spoke about the coverage limitations imposed by SSI particularly in terms of cost-sharing for hearing aids.

Ms. Aguilo noted to us that deaf people can drive cars.  Deaf persons had initially experienced difficulty getting auto insurance so they formed their own company.  Accident rates are lower for deaf drivers than for hearing drivers.

Finally we touched on the controversy surrounding cochlear implants.  A 2005 Scientific American Frontiers program provides an introduction to this topic.   The program included a fascinating website that allows one the hear the evolution of CI technology.

To some cochlear implants are the latest medical miracle.  But many in the deaf community see it as an attempt by the medical community to eradicate deaf culture.  Ms. Aguilo was blunt: “I like being deaf. And cochlear implants say to me that I am not ok.”   She did not think they were appropriate for children born deaf. But they were an option for hearing people who were becoming deaf.  Dr. Martin stated that the school was neutral with respect to implants.

Interpreting Services

New York Society for the Deaf: 212 366-0075 (9AM-5PM)

Mill Neck Manor School for Deaf Children: 516 512-6222

Deaf & Hard of Hearing Interpreting Services, Inc.: 212 647-1092 (8AM – 5PM, requests for interpreting by appointment; call same number after 5PM for emergency interpreting)

Video Relay Service (VRS): Sorenson VRS 866 327-8877.  You need to have either the video number or the IP address for the Deaf person to call in addition to calling VRS.

posted by: Matt Anderson, MD