Our colleague, Claudio Schuftan passed along a link to the video below regarding wealth inequality in the US, a topic that has been re-introduced into the national debate by the Occupy Movement.
The issue of wealth inequality has enormous implications for health disparities. Johann Peter Frank’s classic paper , The People’s Misery: Mother of Diseases, (now available online) shows that physicians even in 1790 understood the connections between poverty and ill-health. Indeed, the statistical evidence linking poverty and disease (or health and wealth) was so strong that William Farr, considered by some as the father of medical statistics, remarked in 1839 that “diseases are the iron index of misery.”
The data on wealth disparities presented in this video poses a question: is it is possible to meaningfully address health disparities in the US without addressing these massive transfer of wealth from the rich to the poor that has taken place since the Reagan Revolution in the 1980’s? If we attend to the bulk of the evidence, the answer is probably no. But this leaves us with the question, how do we reduce wealth disparities when the Congress has become a club of millionaires?
Join Strike Debt for a Week of Action to Declare a Healthcare Emergency: It’s a Matter of “Life or Debt”
In the U.S., healthcare is a bankrupt system run on debt:
62% of personal bankruptcies are linked to medical bills. ¾ of people who declare bankruptcy due to medical bills had health insurance when they incurred those bills.
86% of doctors begin their professional lives with medical school debt. This debt limits medical school to the upper classes and forces even socially-minded young doctors to choose lucrative specialties. The restrictive cost of nursing school further reduces the availability and quality of primary care.
Community hospitals deemed “unprofitable” are being closed left and right because they have fallen too deeply into debt.
These debts are literally killing patients, students, providers and communities. They deepen the already entrenched inequalities that divide races, classes, and genders. Our healthcare system doesn’t make us well; it prolongs our illnesses in the name of profit.
In reaction to this system, Strike Debt’s Rolling Jubilee initiative will make a big announcement in March. We have bought and abolished a large amount of medical debt. Though this will provide real relief to thousands of people who need it, it is only crumbs in light of the 70 million who still owe money on medical bills.
We want to use the attention this buy will generate to highlight the profound inhumanity and inequality of our medical payment system and to create a vision of a world where healthcare is truly treated as a right. We demand the cancellation of all medical debts and a radically transformed healthcare system based on everybody’s need for wellness and not the 1%’s desire for wealth.
Strike Debt is calling for a week of education and organizing culminating in a day of action in New York City on March 23.
If you’ll be in New York, save the date. Stay tuned for updates.
If you won’t be in New York, join us in bringing this action everywhere! Wherever you are:
Protest a closed community hospital
Support a struggling community hospital
Protest a private insurance company
Protest a pharmaceutical company
Do a creative direct action!
Organize a healthcare or debt speak out
Organize a free health screening or health fair
Organize free legal advice and debt/financial guidance
Provide free education about debt and/or healthcare
Some helpful slogans and messages:
Healthcare: a Matter of Life or Debt
Debt on Arrival
End Medical Debt
Strike Medical Debt
Healthcare is a Human Right
Medical Knowledge Put Me into Debt
Medicare for All
Isn’t Being Sick Bad Enough?
Cause of Debt: [Heart Attack, Diabetes, Private Hospital]
Doctors for the 99% has finally launched! We borrowed the illuminator and illuminated three big hospitals in the City. We floated a banner above the Monte entrance, as part of a welcome for the new interns. We stamped napkins and changed homepages towww.doctorsforthe99.com. Slowly coming out with media of all this…
Street Medic Training Saturday, May 19th and Sunday, May 20th 8:45 AM – 6:30 PM
Street medics are a community of health workers who are specifically trained to respond to the health needs of people at demonstrations, in progressive social movements, and at encampments.
Street medics are called upon to deal with a wide variety of illness and injury: crowd-control, chemical weapons decontamination, weather and temperature-related illness, altered mental status, sexual assault, and handcuff injuries, all in resource-scare, unsecured environments. Street medics also provide preventative care and public health promotion in protester encampments. Street medic care is ethical, empowering, and do-no harm.
Those who already have advanced first aid or medical training will want to take this course as we cover many topics that are specific to protest healthcare. People with no healthcare background will learn valuable skills that can be used anywhere, not just at protests. In this highly participatory training, you will learn to use your skills in complex, high-tension, low-resource situations. Expect to have fun!
Location: Manhattan. Address and subway information emailed upon registration.
Cost: $50 with a sliding scale. No one will be turned away for lack of funds. Please explain your needs when registering. Payment in the form of cash or check can be made on the first day of training on May 19th.
For registration info, please email firstname.lastname@example.org.
Instructors from Common Ground Health Clinic, Latino Health Outreach Project, Medical Activists of New York, Black Cross Health Collective, Mutual Aid Street Medics, Katuah Earth First!, Mutual Aid Disaster Relief in Haiti, Mountain Justice 2005 Medics, and The Union of Palestinian Medical Relief Committees (Ramallah).
Note from the Editor: Pfizer offers a especially outrageous case of a company which committed massive crimes and did not face the full penalty. Here, briefly is the story:
In 2009 the US announced a $2.3 billion dollar settlement with Pfizer’s for the marketing practices related to several drugs including Bextra, a drug taken off the market in 2006 because of concerns over cardiovascular safety. In their statement on the case the FBI noted that Pfizer: “promoted the sale of Bextra for uses and at dosages the Food and Drug Administration (FDA) specifically declined to approve for safety reasons.” The settlement involved the largest criminal fine ever imposed in the US.
But the back story is not so simple. If a health care company is convicted of fraud it is automatically excluded from the Medicaid and Medicare programs for several years. This is the law. But CNN later reported that prosecutors felt an exclusion from Medicare and Medicaid would bankrupt Pfizer, a company they deemed “too big to fail.” So the Feds found a way to help Pfizer avoid this penalty. They allowed Pfizer to create a shell company – Pharmacia & Upjohn Co. Inc. – which would plead guilty to the fraud and be excluded from Medicare and Medicaid; for the rest of the company it was business as usual. It was – in the words of CNN – like having an imaginary friend who takes the rap for you when you do something wrong.
In short this was a “clear message” that when corporations are too big, they are above the law. When this happens something is very wrong with our democracy and it is time to take to the streets. For us in NYC the exact time is 2/29/2012 @ 10AM.
Protest against Pfizer’s profiteering and support for ALEC (American Legislative Exchange Council)
When: Wednesday, February 29, 10 AM
Where: Assemble at 42nd Street and First Avenue (Robert Moses Playground)
The two main targets in New York City are Bank of America and Pfizer, and Healthcare for the 99% is leading a protest at Pfizer, which sits on ALEC’s Board, to highlight how its business practices as well as its role in ALEC reveal excessive corporate greed at the expense of human needs.
This is in essence a march along 42nd Street from 1st Avenue to 6th Avenue:
Editor’s Note: Later today (1/6/2012) I will be talking about the work of Healthcare for the 99%. I want to thank Dr. Steve Auerbach who prepared this summary of our work over the past 3 months. Matt Anderson, MD
NYC’s “Healthcare for the 99%” Working Group of Occupy Wall Street
List of Events & Media Coverage
Many Thanks to Dr. Steve Auerbach who prepared this list.
October 26: Rally & March Against the Health Insurance Industry and for Single Payer:
This was the major rally of OWS that week, and it was organized by our healthcare working group with a health focus.
Over 3 blocks long at peak and over 1,000 people altogether. Our group’s biggest event to date.
Lot of prep work by lots of folks over several weeks with OWS/NYCGA & other working groups, Direct Action, etc.
Started at Zuccotti park, march to WellPoint (among the largest of the for-profit insurance companies; bought out former non-profit NY state’s “Empire” Blue Cross/Blue Shield); then on to WellCare (corrupt company involved in for-profit managed Medicare and Medicaid) and finally the site of closed St. Vincent’s hospital (example of mission oriented community hospital forced into bankruptcy and converted to luxury condominiums by broken healthcare financing system and corrupted political system).
Attended by 60 people to learn about the Vermont “Healthcare Is A Human Right Campaign” that was a major grassroots effort part of getting single-payer-like. Health reform passed in Vermont. How did they do it?
December 4: Health Access Rally & March for Health Professions Students, organized by AMSA
Well attended rally and march, featuring drop-in appearance by Rev. Jesse Jackson. Part of American Medical Students Association (AMSA) activism to get health professions students involved in Occupy movement nationwide.
Jan 11, 2012: People’s Power Breakfast and Speak-Out to Fix Healthcare in Brooklyn
The “People’s” answer to a $75-a-plate power-elite’s breakfast, where health industry and Wall Street insiders were guests of Crain’s NY (the local business publication whose readers are the 1%) to talk about how to “Solve Brooklyn’s Hospital Crisis”.
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).
Note from the Editor: Many health care professionals have expressed an interest in working with the Occupy movement. We prepared the following support guide in early November to provide a general orientation. We anticipate updating the guide in early 2012 and would welcome any feedback. Please send it to Matt Anderson, MD. You can download a PDF copy of the guide here.
Support Guidefor Health Care Personnel Interested in Workingwith the Occupy Wall Street Movement(version 1.0, dated 11/11/11)
What is the purpose of this guide?Many health care personnel have expressed an interest in supporting the Occupy Wall Street (OWS) movement but are unsure how they can best participate. The goal of this guide is to synthesize some of the historical experience of physicians working with social movements as well as our own experience with working with Occupy Wall Street in order to provide practical guidance to health care professionals. Anyone can participate in OWS activities as a citizen. This document, however, will discuss bringing professional medical expertise to OWS.This document has been prepared specifically for the US context, but some of the issues may be germane to other countries.Why might health care professionals want to support OWS?Many of us are profoundly dissatisfied with the current health care system. The 2009 health care reform law (P-PACA) essentially turned the health care system over to the insurance industry; many of us see the for-profit insurance industry as part of the problem, not the solution. Perfectly reasonable alternatives – Single Payer, Medicare for All – were simply dismissed by the political elites, forcing many doctors and nurses to resort to civil disobedience to get media attention for these proposals. Many of us feel that true health for the people of the United States cannot happen unless we address the profound social inequalities that are particularly characteristic of the US. We cannot have a healthy people if our environment is polluted, ours schools and communities degraded, and vast sectors of our population tied down in the military industrial and the prison industrial complexes. With the current recession and the political climate in Washington these social inequalities seem only likely to worsen.The Occupy Wall Street movement has shied away from making specific demands. But their emphasis on making the wealthy pay, on direct democracy, and on reducing income inequalities, speaks to many of the issues we are concerned about.
What are the general rules governing working with groups like OWS?First, do no harm. Make sure that you are contributing something that is needed and something you are able to do. Don’t practice outside of your area of expertise. Don’t do things you are not comfortable doing. Don’t do things that are unsafe or illegal. You should not place other individuals at risk, you should not jeopardize your license, and you should be mindful of the reputation of the Occupation.Be respectful and work with the occupiers. They are a diverse group of people working together to build a collective identity, and they are usually the best local experts on what they need. Do not underestimate their skills or make assumptions about their experience. Be patient and learn with them. If you can’t be respectful of the Occupation then you should not be involved.Always identify yourself and have proper ID. As a general rule you should always be willing to show any materials or documents you have (other than confidential patient charts).Know the local laws and regulations governing your professional work. (see below)How are the OWS sites organized?
Different sites are organized differently, but most, if not all, have daily meetings called General Assemblies (GA) to discuss issues and plan events. There are various working groups on logistical and thematic issues, e.g. outreach, direct action, media, sanitation, labor, people of color, health care, … etc. Everyone is welcome to participate in the GA or the working groups, not only the people who are staying there every night or most nights. If you are curious about OWS consider going to one of the GA.
How can you make contact with OWS occupiers?
The best way to communicate and build relationships with OWS occupiers is to make repeated visits to the sites and introduce yourself in person. Join the solidarity marches and participate in the general assemblies. If you’re in a city where health professionals’ groups have already made organized contact with OWS, then go through those groups. Don’t duplicate work that is already being done.
How do you build a relationship with the street medic team?
In the case of occupations, some of the street medic team members are occupiers or otherwise spend most of their time on-site, so they are the local experts with whom you should consistently consult. The street medic model of work is non-hierarchical. Patient communication is key. Since the team can consist of a large and revolving group of people, be prepared to have multiple, repeated discussions with various members. Do not assume one conversation with one person is sufficient. The street medic model also incorporates non-Western traditions, and biomedicine is not assumed to be the solution to many health problems that arise. Be sure to listen and discuss, and be willing to both accept as well as give helpful feedback. Be reliable and consistent, and offer your group or yourself as a resource and ally.What can you offer OWS?
There are a number of things that you can provide the occupiers. Each (except the first) is discussed in more detail below:1. Resources: Check on the OWS websites for a list of items which the sites are requesting. These can range from money to food. If they are asking for it, it’s probably worth providing. See also Peter Rothberg’s article in the Nation: http://www.thenation.com/blog/163749/how-support-occupywallstreet2. Medical accompaniment: The presence of medical personnel (you should be dressed professionally) can sometimes deflect police repression.3. Medical support at demonstrations: This involves knowledge of a specific set of medical problems and the ability to work on the streets.4. Medical care at the occupied sites: Many sites already have active medical tents typically staffed by street medics. In addition to providing care, you can offer to help coordinate a committee that may include street medics, nurses, doctors, public health experts and a lawyer. This committee can draw up protocols, anticipate problems, build connections to ERs and community health resources (including medical vans), and create an efficient structure for medical professionals to volunteer on-site. It can also manage a simple registration process to ensure volunteers are not misrepresenting their training. (PNHP-NY Metro has set up an online registration and scheduling process. Please contact email@example.com you’re interested in using a similar system.)5. Establishing longer-term health work in a given community: The current US community health center movement grew out of medical activists working during the civil right era with protesters in the South.
6. Expertise on health policy: You can play a role in helping the occupiers develop their ideas about health policy (as part of a democratic process.) Propose teach-ins to discuss concrete policies aimed to realize the foundation of what many protesters already believe in: health care as a right. Precede or combine teach-ins with speak-outs, to democratize the process and for people with different experiences to learn with each other.
Forms of Medical Solidarity
What is medical accompaniment?
We can provide a general answer to this question by quoting from a 1966 guide written by the Medical Committee for Human Rights for medical personnel participating in the civil rights movement:Just the presence of physicians and other health professional personnel has been found extraordinarily useful in allaying apprehensions about disease and injury in the Civil Rights workers — there is a certain security in knowing that even if they do get hurt, professional help is available. There also seems to be a preventive aspect to medical presence — actual violence seems to occur less often if it is known that medical professionals are present, particularly when Civil Rights workers are visited in jail at the time of imprisonment or thereafter regularly. In addition, medical personnel should anticipate violence in terms of specific projects and localities and to be present at the right place and at the right time. Thus, medical personnel should be in intimate contact with the Civil Rights organizations at all times, and to be aware of any immediate planned activities. Committee members should act mainly as observers who are ready to provide emergency aid at demonstrations. Committee members should strictly avoid getting arrested and going to jail whenever possible. (reference 1)This is a general statement which should be adapted to local needs and circumstances. We would add that to be effective in prevention, health care workers must be dressed professionally (usually white coats or scrubs) and clearly identified. Any accompaniment is best done in collaboration with lawyers; in some protests there are legal observers usually from the National Lawyers Guild (http://www.nlg.org/occupy/). If you plan to provide first aid at a demonstration you should have some preparation (see below). If you are at a demonstration as a medical observer, it does not make sense to get arrested.Documentation of injuries may be important for legal reasons, but is probably best done in an Emergency Room.Who are street medics?The street medic movement arose during anti-globalization protests in the late 1990’s and represents a largely lay response to the specific health problems raised by protests. A great deal of practical experience has been accumulated by street medics. There is an excellent street medic wiki at: http://medic.wikia.com/wiki/Main_Page. See also the following posting by Juliana Grant from which we have excerpted in this document: How to be a Street Medic.
Street medics come from a variety of health care backgrounds including herbalists, nurses, EMTs, NPs, health educators, physicians, medical students, and acupuncturists. In fact, a medical background is not actually necessary to be a street medic as most receive additional training in first aid, the management of activist-specific injuries, and such topics as scene control and pre-hospital assessment.
It is important to emphasize that physicians generally do not have training in pre-hospital medicine. Since you may encounter problems during a demonstration for which you have not received training, you should consider additional instruction, e.g. an EMT or first responders course. Street Medics often arrange training programs.
Being a street medic requires more than just medical knowledge. The ability to work in non-hierarchical affinity groups, value non-western medical knowledge, and work in stressful, and at times dangerous, situations are all equally important to street medic work. For many physicians and nurses, developing these skills will be the focus of their street medic experience.
What are some of the medical issues associated with demonstrations?
It is not possible for us to provide a primer on medical care during demonstrations. Here we can suggest some of the general issues:
Participants in demonstrations can become sick due to dehydration, sun exposure or pre-existing medical problems.
Handcuffs have been associated with nerve injury called Handcuff neuropathy. (reference #2)
Various irritating substances are used to disperse crowds. These include tear gas and Pepper Spray. Tear gas may be composed of several different substances. Among them are phenacyl chloride (“CN gas”, the active component in Mace), 2-chlorobenzalmalononitrile (“CS gas”), and dibenzoxazepine (“CR” gas).
Trauma from weapons: rubber bullets, live bullets, batons.
Physical trauma due to accidents or beatings. This may take the forms of: burns, cuts, orthopedic injuries.
Difficulty of working in or near the site of a demonstration. Of note, the police may not allow EMS into an area until they declare that it is safe.
There can also be important psychological sequelae of arrests and/or violence (see below).
Problems associated with incarceration; one of the major issues may be lack of medical attention in detention facilities.
While most of the work surrounding these issues has come from lay people, members of the Medical Committee on Human Rights and the District of Columbia Department of Public Health did produce a number of articles documenting their experiences in the late 60’s and early 70’s. These articles are particularly useful since they address the organizational implications of protests for the volunteers, the local health and law enforcement establishments, and for involved communities. (reference #3)
What are the issues involved in working with local jails?
Jails vary greatly based on the locality. People who are arrested often need access to health care because of injuries sustained during a protest or pre-existing medical conditions (such as diabetes or HIV). Mass arrests may overwhelm the facilities of the jail system and lead to unsanitary and unsafe conditions. Lawyers may call upon doctors to visit prisoners and/or document unsafe conditions in the jails.
What are issues involved with working at the occupied sites?
There are important precedents for providing health care services in occupied sites. In early 1968, as part of the Poor People’s Campaign, the National Parks Service allowed 3,000 people to occupy “Resurrection City,” a 15-acre area of the West Potomac Park. Health services were provided there by a coalition called the Health Service Coordinating Committee. (reference #4)
Some of the general issues arising in occupied sites include:
Providing Sub-acute Care: Many Occupy sites have medic groups that have set up an area where participants can seek care. The spectrum of care offered varies substantially among sites and depends a lot on who the medics are. Care offered might only include basic first aid /triage or extend primary health care services. Issues seen at these sites are typical of what one might see in an Emergency: trauma, hypothermia, acute infections (often respiratory), and acute exacerbation of chronic problems. Occupiers may prefer non-traditional medical traditions which are also offered at some site. Lack of health insurance may preclude people from filling prescriptions so you should be aware of local resources for free or low-cost medications.
Disease Prevention and Public Health: Occupy movements bring large numbers of people together in spaces that were not originally designed for an encampment. Disease prevention and public health activities supported by street medics can help keep participants healthy. These might include ensuring that hand sanitizer is available at all food stations and bathroom sites, arranging for free flu shot clinics, and working with logistics to help collect warm clothing for participants.
Mental Health & Substance Abuse: Being a victim of police brutality or misconduct is traumatic. Most of us will experience a heightened level of stress, anxiety or depression after an event. Some individuals might even develop long-term health problems, such as post-traumatic stress disorder. Mental health issues can also arise during regular Occupy activities simply due to the stress of being in a new and rapidly changing environment. Some Occupy participants have pre-existing mental health or substance abuse problems that are exacerbated by stressful situations. Street medics may offer mental health support to activists during or after an event. There is a great need for psychiatrists, and they are highly encouraged to take volunteer shifts at the medical tents. Psychologists and social workers may also be part of the team. Be aware that team members come from very different perspectives and may not all agree on recommendations for a patient. This is particularly important to bear in mind when working in a non-hierarchical context.
Off-site Referral: Occupation sites are not emergency rooms or primary care clinics, so it is important to have knowledge of and access to local health care institutions. Institutions with established outreach programs (as for homeless or SRO’s) may be able to share these resources with demonstrators or occupiers (flu vaccines, rapid HIV testing, counselling, etc.). On the other hand sometimes local facilities (e.g. ER’s) may not welcome protesters; others may have a policy of reporting undocumented workers to the government. Occupiers may have had bad experiences with “safety net” providers and are distrustful of traditional medicine. Sympathetic health care professionals can help build bridges between these two worlds.
How should you work with street medics and other lay health care workers?To quote from the 1966 Medical Committee on Human Rights guidance:When you arrive at the office of the Civil Rights group which will be your base of operation, do not expect to be received with open arms. There may be a brief period of social trial before you are accepted — and this period may be extended indefinitely by any evidence of a paternalistic or authoritarian attitude on your part. Do not make the mistake of telling them how to “run things” on the basis of the experience gathered in your brief stay. It is also important that you seek an appointment with the local people in the Civil Rights groups to discuss how you can repeat and possibly improve upon the services previously provided by the Committee Members who have preceded you. If you are the first one in your area, it is important that the best ways of meeting the prevalent needs within the limitations of what the MCHR offers be worked out in this discussion. Clarity at this point can be extremely helpful later.How should you work with lawyers at the sites or at demonstrations?The National Lawyers Guild has extensive experience working to defend protesters and has set up an infrastructure to help the Occupation Movement (http://www.nlg.org/occupy/). This site provides a hotline (24/7) for 18 major US cities and email addresses for 58 more. You should try to coordinate your work with them or another group of experienced lawyers. You may see NLG or other legal observers at demonstrations or at the occupied sites. Introduce yourself to them and discuss possible collaborations.The Guild encourages protesters who are likely to be arrested to write down the number of a lawyer on their body using indelible ink. If you are at risk for arrest you should consider knowing who you will call and having the number on your body. Generally speaking if you are acting as a professional you will not want to get arrested; the police, however, may not always respect your wish.
How should you work with the local Department of Health?
Depending on the local political context, it may be worthwhile to try to build a positive working relationship with the local DOH. In some cases, however, the relationship may be more defensive than collaborative, especially if the local government is trying to find ways to shut down the occupation. Keep in mind that the mission of a DOH is to protect the health of the public. In Washington DC in the late 1960’s the DOH saw it as part of their mission to protect the health of protesters.Are there long-term implications of providing care to OWS?We believe that there are. Physician involvement in the Civil Rights struggle in Mississippi played a role in the creation of the Mount Bayou community health center which became the model for federally-qualified community health centers in the United States; today there are over 1,000 such centers which provide much needed health care to the working class of the US.Local conditions will clearly dictate what types of possibilities are created by OWS for lasting collaborations. But consider your work with the occupiers within a larger framework.How can you contribute to policy debates within OWS?As with all your collaborations with the OWS movement, be respectful of the existing culture and rules. In cases where there are no agreed-upon rules, or such rules are not well communicated, propose a meeting with the street medics team and discuss. Some team members may feel that “political discussions” should not be mixed in with health care delivery on-site; others may wonder what defines a political position. E.g. “health care as a human right” may be accepted as apolitical, but specific policies, such as single payer, may be considered political.
In New York City, health professionals have played a central role in starting and building up “Healthcare for the 99%,” an official working group of OWS that advocates for universal health care. We have organized teach-ins, speak-outs and marches.
What are the legal issues for licensed professionals involved in working with a movement like OWS?This document cannot provide legal advice, which you should get from a lawyer. However, we will mention some of the legal issues involved with medical solidarity. They touch on several different areas of law: mass protest law, physician licensing, health law, public health law, and malpractice.Good Samaritan laws: Good Samaritan laws protect professionals who provide emergency care from medical liability unless they are grossly negligent. The details of these laws vary from state to state so you need to be familiar with local rules. These laws will not prevent you from being sued, although they should protect you from losing the case.Licensure requirements vary by state: Typically states require medical professionals to act within their competency (something you should always do) and maintain adequate records. In New York State you can lose you license for referring a patient for care to someone who is not appropriately licensed.Malpractice: Except for situations where Good Samaritan laws apply, any care provided will be subject to malpractice laws. You should check to see if you malpractice coverage will apply. This is another reason not to provide care outside of your professional expertise.Where can you go for specific legal advice as a health care professional?
Consider contacting the National Lawyers Guild or the legal counsel at your institution.
Who has prepared this guide and how can you help improve it?
This guide was prepared by members of the Montefiore Residency Program in Social Medicine and Physicians for a National Health Program-NY Metro Chapter. This document does not represent the official position of our organizations; they are provided for identification purposes only.
We intend to continue revising this document as we gain more experience with medical solidarity. We welcome your feedback which can be sent to either of the authors.
Residency Program in Social Medicine
Montefiore/Einstein Department of Family and Social Medicine
Physicians for a National Health Program-NY Metro Chapter
Frank A, Roth J, Wolfe S, Metzger H. Medical problems of civil disorders. Organization of a volunteer group of health professionals to provide medical services in a riot. N Engl J Med 1969 Jan 30;280(5):247-53. Despite it’s unfortunate title this article provides useful insight into MCHR’s approach. For example, they were able to get temporary licenses for physicians who were not licensed in the District of Columbia.
Schneider EL. The organization and delivery of medical care during the Mass Anti-War Demonstration at the Ellipse in Washington, D.C. on May 9, 1970. Am J Public Health 1971 Jul;61(7):1434-42. Available for free at: http://www.ncbi.nlm.nih.gov/pubmed/5563262
A contingent of about 40 doctors in crisp white coats, carrying signs that read “Bronx doctors for Wall Street Occupation” and “My patients need jobs, education, healthcare for all, not just prescriptions, definitely not bank bailouts,” joined the throngs of activists at the Occupy Wall Street protests at New York’s Times Square two weeks ago.
Members of the umbrella group “Healthcare for the 99 Percent,” they are one of a growing number of OWS constituencies that view their particular cause not as a stand-alone issue, but integrated with other social grievances represented by the movement.
These doctors care for the people who live in the poorest congressional district in the country: the South Bronx’s 16th district. They see large numbers of patients each day who are hungry, who don’t have jobs or stable homes, who can’t afford their prescriptions. Widespread poverty means that Motrin and Lipitor won’t do much to help these New Yorkers; their health problems have much deeper socioeconomic roots. Not surprisingly, the Bronx is the unhealthiest county in the state of New York, according to a recent University of Wisconsin study. Dr. Cameron Page, who completed his residency in the Bronx and now works at Manhattan’s Beth Israel Medical Center, says that what he calls “upstream problems” have to be addressed first, because by the time patients get to the exam room, “it’s too late.”
Many healthcare professionals see how social factors impact their patients’ health and ability to access health care. They have joined protests over the past weeks in NYC and around the world. Readers of the Portal are invited to participate in the following events organized by the group Healthcare for the 99%, the OWS healthcare working group:
Friday, October 21st 3:30pm, March on Verizon in solidarity with CWA and OWS! A group will meet at ZPark at 3:30 and will march to Verizon HQ at 140 West Street at 4pm to rally.
Sunday, October 23rd at 4pm, Healthcare Teach IN / Speak OUT at ZPARK. Bring your white coats and signs! Check out this powerful video from last week’s speak out at Washington Sq Park. Stay for our usual 5:30pm planning meeting right after.