Cost Effective to Treat the World's Poor?

A great article was written by Darshak Sanghavi this month--Wrong Number. It is a must read.

Take home messages from this article:

1. Don't pit the poor against the poor.

2. QALY's dont count if YOU are sick. (Read the article to find out what QALY's really are.)

3. Farmer proved that treating poor Haitians with AIDS is reasonable, rational, and the right thing to do.

4. One's economic paradigm powerfully influences what can be done locally.

5. Haitian Hearts met with Dr. Aldo Castaneda several years ago in Guatamala. He was considered the best pediatric heart surgeon in the world. Dr. Castaneda accepted a Haitian child for cardiac surgery in Guatamala and will accept more. Dr. Castaneda and the Haitian child's mom don't care about QALY's either.

Haiti is Number One Again

The International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) estimated that nearly 80% of cervical cancer cases occur in developing countries.

In 2003, a Pan American Health Organization supported report said that well-organized programs can save lives of many women in the Caribbean, a region that suffers one of the world's highest rates of cervical cancer.

Cervical cancer is the leading cause of female deaths in Haiti. "At 94 deaths per 100,000 population, the estimated age-standardized incidence in Haiti is by far the highest in the world," according to the report.

The study also reported that most of the resulting health costs, suffering and deaths resulting from cervical cancer in Haiti, other countries in the Caribbean, and Africa are avoidable.

Cervical cancer is intertwined with poverty in Haiti. Risk factors for cervical cancer are more common in impoverished women and women in the lower socio-economic groups are less likely to be screened.

The poverty cycle is perpertuated when young and middle-aged women die of this cancer and leave orphaned children.

Up-To-Date is a medical search engine and has a section on cervical cancer in Africa. Below is an excerpt and if one substitutes "Haiti" for "Africa", the Haitian situation is very accurately described:

"While cervical cancer is a classic example of a neoplastic disease that has thrived in African women due to lack of access to screening, treatment, and care facilities, in reality the process is much more complex. In Africa, cervical cancer is a disease that occurs in women who frequently live within a social context where their human rights are severely restricted, employment is non-existent, malnutrition is rampant, clean water is a rare commodity and sewer systems and electricity are not commonplace.

"Theoretically, cervical cancer is almost entirely preventable. However, insufficient commitments on the part of local governments, operational difficulties, the absence of a sound healthcare delivery infrastructure, shortages in human resources and failure to address the social context in which the disease occurs have resulted in a failure to control cervical cancer in resource-limited settings in Africa and elsewhere.

"Any major advancement in cervical cancer control will require inter-sectoral collaboration and unflinching commitments on the part of researchers, clinicians, program managers, politicians and policy makers to make this a priority.

"Each case of cervical cancer thus represents one of the greatest public health failures of our times."

Mauricio Accepted !

Good news!!

Mauricio, the seven month old baby boy in Port-au-Prince with congenital heart disease, was accepted yesterday into a major children's medical center for heart surgery.

Also, two other Haitian children were accepted yesterday by another children's medical center, for surgical repair of their heart defects.

And a fourth baby, who is six months old, is very close to acceptance in the U.S. by yet another medical center. E mails have been flying back and forth between Haiti and the United States.

The childrens' families are very happy.

I would like to divulge the names of these generous medical centers, but won't at this time, to prevent anyone from attempting to stop these miracles from happening.

Luke and OSF

As documented in previous posts, our four year old son Luke has been intermittently urinating blood. With a sonogram, we found that he has a large kidney stone in his right kidney. The stone needs to be removed to protect his right kidney function and to protect him from infection that could occur with an obstructed kidney.

Today (7/20/2007) I called the pediatric urology office at OSF-Children’s Hospital of Illinois (CHOI) and told the office nurse that after much thought we have decided not to have Luke treated at OSF-CHOI. We arrived at this decision based on the following:

Luke has been on antibiotics daily for about two months. It has been approximately seven weeks since Luke was first evaluated by a pediatric urologist and it has been five weeks since he underwent a general anesthetic in the operating room at OSF to look at his kidney anatomy.

Since Luke’s general anesthetic and procedure five weeks ago, no meetings have been arranged to discuss options to remove his kidney stone. My wife and I have been to the pediatric urology office or contacted the office six times.

Why has there been such a delay? Why have their been no formal discussions regarding treatment options with the physicians that need to be involved in removing the kidney stone?

When I talked to an employee of CHOI and described the above time scenario to this person, he replied that he would be “concerned” if Luke were his child.

I am “concerned” also and do not feel our son has been treated appropriately by CHOI. Several years ago my Haitian Hearts patient’s cardiac surgeries were delayed, so this is nothing new to me.

If OSF were asked about the delay, I would think OSF and their attorney would have well thought out reasons why Luke has not been treated.

What happened to Luke is disappointing but not surprising. The Community Advisory Board at OSF is unaware of Luke's situation, but what would they do if they knew? What did this Advisory Board do to prevent the deaths of Haitian children denied care at OSF?

What about the Pediatric Resource Center at OSF? Would they intervene to help kids marginalized by OSF? My e mails to OSF are blocked.

Also, based on my past experiences, there is not an impartial ethics committee at OSF or in the Catholic Diocese of Peoria to present this problem. All of my ethics consults at OSF over the past six years have been ignored. When I told Monsignor Rohlfs about a Haitian Hearts baby that suffered an outpatient arrest before his cardiac surgery, Rohlf's reply was, "Let me know if it happens again." Our family has no one to go to.

There is no real self accountability at OSF or at the Diocesan level.

When I spoke with the nurse in the office today, I reiterated to her that it was not her fault that Luke did not receive appropriate care. I told her that I thought OSF-SFMC, the largest hospital in downstate Illinois, had 5,000 good employees, and that the real problem with OSF is their leadership.

Until these leaders are replaced with Catholic hospital leaders that are encouraged by an unafraid Bishop Jenky to respect and follow the Ethical and Religious Directives for Health Care at OSF, nothing will change.

Common Good

The common good may be defined as the sum total of those conditions of social living whereby citizens are enabled more fully and more readily to achieve their own perfection. Most social evils and injustices are the result of the exclusion of some persons from the common good in which they have a right to share.

Jesus, moreover, taught an ethics that clearly went beyond even this demand for distributive justice based on merit (i.e., each receives in proportion as he or she contributes). Jesus proclaimed the coming of the Kingdom of God (Mk 1:15), which was not merely a heavenly kingdom but was also the fulfillment of the Old Testament prophecies of the Reign of God on the earth.

The Beatitudes (Lk 6:20-22;Mt 5:3-11) are the joyful announcement to the poor (i.e., those excluded from the common good) that at last they are to be included in this common good, not only economically, but also spiritually (“the poor have the good news preached to them”; Lk 7-22). Consequently, the principle of the early church was “from according to his (or her) ability, to each according to his (or her) needs,” a principle Karl Marx borrowed from the Acts of the Apostles (32-35). Thus the common good requires love and mercy and the distribution of possessions according to need. The mark of all Jesus’s work was his concern for the neglected, the outcast, the leper, the prostitute, the Samaritan heretic, and the pagan unbeliever.

A Christian ethics of health care allocation must be based not on merit, and certainly not on the ability to pay, but on need, because the needy are the most neglected. In this sense, health care is a right. Moreover, social oppression is the chief cause of illness. Hence those who are helpless by reason of poverty, disease, defect, or age (the unborn or the senile) should be the first to be considered under any health plan.

Yet all persons should contribute to the plan according to their ability. Thus the social responsibility for health care falls first on those who have the ability to heal, the health care professionals, and second on those who have the ability to pay, that is, those who have profited the most financially from society. For such affluent individuals to claim that they have made their wealth simply by their own efforts is an absurdity. They may have worked hard, but their wealth would not have been possible without the existence of the society of which they are a part. Consequently, their debt to the common good is in proportion to the wealth they have received from it.

Ethics of Health Care, Third Edition
Benedict M. Ashley, O.P.
Kevin D. O'Rourke, O.P.

Mud Pies in Soleil

The incidence of childhood obesity is rapidly rising throughout the resource-rich world.

In just two decades, the prevalence of overweight doubled for U.S. children ages 6 to 11--and tripled for American teenagers. About one-third of U.S. children are overweight or at risk of becoming overweight. In total, about 25 million U.S. children and adolescents are overweight or nearly overweight.

The obesity epidemic is evident in the United States just 90 minutes from where there is no childhood obesity epidemic. Haiti is not plagued with this problem.

The mud pies above are baking in the sun in Cite Soleil. These mud pies will be consumed to quench hunger pains. The boy pictured on his homemade scooter, and his playmates in the slum of Soleil, should not have to depend on mud to calm their hunger.

Go to National FilmBoard of Canada website "Citizenshift" to see work done by photojournalist Darren Ell regarding many unjust circumstances for the people of Soleil.

Also, see this Miami Herald article and State of Denial on this blog.

Physician as Witness

At the end of Camus' The Plague, the main character--a physician named Rieux--reflects on his role throughout the plague epidemic. He realizes that, along with providing care that had to be given "by all who...strive...to be healers," he bore witness to patients' suffering. Physicians surely have the duty to fight disease in most circumstances, but physicians always have the still greater duty to see patients and survivors through their suffering and thereby to bear witness to it. Perhaps that greater duty lifts medicine from a mere occupation to a true profession.

Annals of Internal Medicine Volume 147, Number 1

Charity Assistance at OSF

The OSF Healthcare system has a site on www.osfhealthcare.org. It is signed by "The Sisters of the Third Order of St. Francis".

The site states the following--

"Dear Patient:

The Philosophy of OSF HealthCare is that all people have a right to receive needed health care. Our doors are open to persons of every faith and ethnic background regardless of their ability to pay."

Why would the Sisters sign this when OSF-SFMC attorney Doug Marshall has made it very clear that OSF will not take care of my dying Haitian Hearts patients?

Also, the Ethical and Religious Directives for Catholic Health Care Services, which OSF Corporate Ethicist Joe Piccione recently quoted in the Catholic Post, lists the following directive:

Directive #3-- "In accord with its mission, Catholic health care should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination: the poor; the uninsured and the underinsured; children and the unborn; single parnts; the elderly; those with incurable diseases and chemical dependencies; racial minorities; immigrants and refugees. In particular, the person with mental or physical disabilities, regardless of the cause or severity, must be treated as unique person of incomparable worth, with the same right to life and to adequate health care as all other persons."

The Haitian children and their families are in extreme distress. Why are the OSF Sisters, Bishop Jenky, and the OSF Board of Directors and Ethics committees ignoring Directive #3 regarding Haitian children?

Catholics, Capitalism, and the Gold Shovel

Several days ago in Peoria, OSF broke ground for its new $234 million dollar hospital expansion. (The article and comments that appeared in the Journal Star are located at the bottom of this post).

It is interesting to contrast the three paragraphs below from “Ethics of Health Care” by Ashley and O’Rourke with the Journal Star article and the reality of the “ethics of health care at OSF”.

While OSF “looks to the future” to treat “those who need it most”, they are allowing Haitian Hearts patients to suffer and die. OSF’s philosophy of respect for life does not seem to include Haitian lives.

Three quick, important, and potentially threatening ethics paragraphs from Ashley and O'Rourke:

“Many Catholics are under the impression that the Catholic Church, because it opposes communism, favors capitalism. They are unacquainted with the fully developed social teaching of recent popes, which must be considered in any Catholic approach to today’s ethical problems, including those in the medical field. The popes urge us to work for a world community based on spiritual goods or values and economic cooperation. They link human health and world poverty as the most fundamental ethical problems of our time, problems that in the United States are often ignored by ethicists and health care professionals…

“Thus the Kingdom of God begins here on earth with social justice, as modern popes have constantly preached, and no one will gain heaven who has neglected to work for social justice on earth. Jesus said, “I was hungry and you never gave me food…insofar as you neglected to do this to one of the least of these, you neglected to do it to me” (Mt 25:31-46). In the parable of Lazarus and the rich man (Lk 16:19-31), he taught the same lesson.

“Consequently, genuine Christian ethics cannot be conceived from the viewpoint of the status quo, which in a sinful world tends to reflect the materialistic spirit of domination and possessiveness. It must also view the world from the side of the oppressed, whose needs have been ignored and neglected. Thus, Jesus pointed to his preaching of the Gospel to the poor as the best sign of the authenticity of his own mission (Mt 11:5). A Christian politics of health care must then be based on an option for the poor.”


Hospital Looks to Future
OSF Saint Francis Medical Center embarks on largest private building project in Peoria's history with $235 million facility

Friday, July 13, 2007

BY JOHN SHARP
OF THE JOURNAL STAR

PEORIA - What started with "humble" origins inside a small house on Southwest Adams Street 130 years ago will blossom in 2010 into what OSF Saint Francis Medical Center officials claim will be one of the premiere facilities for pediatric care in the Midwest.

The $234 million Milestone Project will add an eight-story, 440,000-square-foot building to a hospital complex that is much more than 1 million square feet, further enhancing the mission of the Sisters of the Third Order of Saint Francis to serve people with "the greatest love and care."

"This is simply the largest undertaking we've ever done at OSF," Sister Judith Ann Duvall, chairwoman of OSF Healthcare System, said Thursday during a ceremony to officially begin construction on the largest private building project in Peoria's history. "It's been made for the right reasons . . . so we can be here to help the people who need it most."

Thirty-three dignitaries, including the sisters, local politicians, hospital physicians, patients and administrators, picked up gold shovels outside the future home of the Milestone Project and ceremoniously tossed dirt to officially start what will be a three-year project.

"We really believe this will take health care in Peoria to a whole new level," hospital CEO Keith Steffen said, who, along with other dignitaries, praised the sisters for the hospital's founding and dedication to helping it evolve.
The project, which will be paid for primarily through hospital debt, is a modernization and expansion of the medical center and the Children's Hospital of Illinois.

Three floors of the new building will be solely dedicated to the Children's Hospital, with one floor serving adult cardiac patients. The other four floors will contain services for both adults and children.

Derrick Brown, 13, of Peoria, a longtime Children's Hospital patient, said he looks forward to coming to a much larger facility.
"It's going to be great," said Brown, who has been treated for sickle cell anemia for years and who will be a freshman at Richwoods High School this year.

The St. Jude Midwest Affiliate will also move to the new building. The affiliate's wing will be named in honor of former Peoria Mayor Jim Maloof. Maloof, who still is recovering from the effects of an automobile crash last year, attended the ceremony and praised it as something other communities simply cannot offer.

Though planning for the Milestone Project began about two years ago, Maloof said having a strong St. Jude affiliate was something considered during a June 1966 visit by Danny Thomas, founder of St. Jude Children's Research Hospital.

"He said, 'someday we should have an affiliate,'" Maloof said. "Little did we dream it would be this facility."

Minneapolis-based M.A. Mortenson Co., a specialist in health-care construction, is the project manager for the Milestone Project. Steffen said the project will attract 600 to 650 construction-related jobs to Peoria for the next three years.

In addition, once the facility is completed, between 250 to 300 new positions will be added at St. Francis, Steffen said. St. Francis already is the largest hospital in downstate Illinois, with approximately 5,200 employees, and is the only Level 1 trauma center in the area.

A private fundraising campaign is expected to begin soon, but there is no timetable or goal set for raising money to help offset hospital debt. Already, the hospital has announced a $5 million donation from Jerry and Helen Stephens and a $500,000 gift from Lynn and Susan McPheeters.

Activities on the hospital campus over the past year have prepared the area for the new building. Those included construction of a new parking deck, a new helipad for LifeFlight and the demolition of a 900-vehicle parking deck.

John Sharp can be reached at 686-3234 or jsharp@pjstar.com.

Comments:

Pat
July 14, 2007 - 07:00
Subject:

Dear TT
OSF has a for profit and a non-profit interest. The hospital and all these interests are owned by a huge corporation. Do you think their huge insurance industry doesn't have stock holders? The main hospital, which is non-profit, operates at state minimum standards. They are under staffed and their help is over worked. Patients are told they can't find enough employees so how are they going to staff this huge expansion? Go read Dr. John Carroll's web site. He was one of OSF's best emergency room physicians. Disagree all you want but keep a wary eye if you are ever a patient at OSF. I personally know a case of hospital error that killed a young patient. These things never make the paper, settlements are based on the grounds nothing is ever made public. People here telling you the facts are in the profession or have first hand inside knowledge of the situation. OSF depends on the gullible to shovel dollars into their pockets by playing on an image of honesty and charity that no longer contols the organization. The Sisters don't run the place, but their image brings in big bucks. Yes they do good, yes they have saved lives. What good they do is in direct line with the patient's ability to pay or ability to qualify for tax payer funded programs. Too much of their money is funneled back into the for profit portion and into the pockets of people who have had nothing to do with patient care.



Nancy Bovee
July 14, 2007 - 06:35
Subject:
How lucky Peoria is to have 3 wonderful hospitals! I am sure we Peorians are the envy of many other cities - many residennts of whom come here to use the fine services provided by fine physicians. We should all thank hospitals when they expand and offer us more. Who knows when we might be the ones using ths state-of-the- art facilities?



johnson drake – Peoria
July 14, 2007 - 05:56
Subject:
I like to know if a venture like this will decrease any future healthcare expenses I have. Will it? Or will it increase them? I'm sure the increased revs will get at least one or two doctors membership into the Country Club of.



monkfellow
July 13, 2007 - 16:54
Subject:
Subject:
Monkfellow is living in a dream world. St. Francis and its chain of hospitals is one of the most crooked organizations I have ever been privy regarding. I saw the inside at very high levels. If you look real deep into the background ( go back to Bloomington) of their current leadership you will find deception and crookedness to the extreme. People who give to that organization to perpetuate its modus apparenda have more money than brains.--
--
care to put any validity to this pack of lies??????????
You have privvy to NOTHING...and you're fortunate you can besmirch this wonderful organization.



KAG
July 13, 2007 - 15:51
Subject:
Congratulations to OSF St. Francis and to Children's Hospital of Central Illinois. My son was very ill when he was born and the wonderful, caring staff at St. Francis and Children's Hospital saved my life and my son's life. I'm thrilled that the Children's Hospital is expanding and their NICU will be able to save even more children -- this is such wonderful news!



Mr. Johnson
July 13, 2007 - 15:30
Subject:
Why don't we take care of the sick Americans first? I would prefer that we take care of "our" business first before we give foreign people free medical care.





John A. Carroll, MD
July 13, 2007 - 13:19
Subject: Gold Shovels

As OSF looks to the future with their 234 million dollar campus renovation, the largest medical center in downstate Illinois is turning its back on suffering and dying Haitian Hearts patients. Even Haitian patients that have been treated in the past at OSF, and need surgery to stay alive, are being refused further care at OSF with full and partial charges offered for their care.

Why doesn’t OSF’s “respect for life” philosophy include Haitian lives?

Sister Judith Ann said the new project “could help people that need it most”. The hypocrisy in the air as the dignitaries’ gold shovels broke ground must have been stifling.



Cudos to Pat
July 13, 2007 - 08:03
Subject:
Monkfellow is living in a dream world. St. Francis and its chain of hospitals is one of the most crooked organizations I have ever been privy regarding. I saw the inside at very high levels. If you look real deep into the background ( go back to Bloomington) of their current leadership you will find deception and crookedness to the extreme. People who give to that organization to perpetuate its modus apparenda have more money than brains.



monkfellow
July 13, 2007 - 06:57
Subject:
Congratulations, again, to the Sisters of the Third Order of St. Francis, and the members of the health care community at OSF St. Francis for all their hard work and care throughout this area.
I hope the Catholic-haters note patient payment for services WILL NOT be used to build this complex(and the weak complaints about "high-paid" staff or health care executives shows the hidden contempt for the good in this institution-since they have so little to offer themselves they revert to anti-Catholic rhetoric which, in another arena, could be considered hate speech).
We are fortunate to have all our health care institutions. Kudos, too,to Methodist for its expansion plans.



Reply to monkfellow
Pat
July 13, 2007 - 07:13
Subject:
The Sisters have very little to do with OSF, it is ran by a corporation. I've never heard anything about high paid staff, the bulk of their employees are eligible for public assistance programs. The real winners in this expansion will be the stock holders, it should bring in a lot more revenue. I can't help but wonder exactly how they plan to hire so many new people when, by their own admission, they can't find enough applicants to staff the exsisting hospital. The era of "Catholic haters" is past. The ones who criticize OSF actually are those who work in the profession, or have inside knowledge of it's management. This expansion should go a long way to keeping the fund raising portion of their operation non-profit. We do have a lot of good dedicated doctors in the area. As long as they are willing to make money for the corporation they will practice at OSF. There isn't much room at OSF for those who put patient well being over bottom line.

The Leavings of the Powerful

My reading of “basic health care” ethics continues:

“In our contemporary world, there are two predominant views about the relation of a person to community, and they are in constant competition. One is collectivism, which is characteristic of communist governments…Generally, collectivism favors an economic system in which the state closely regulates the production and distribution of wealth. Collectivism teaches that the welfare of individual persons must be strictly subordinated to the welfare of the total community, and thus the rights of persons can be sacrificed to the interests of the nation.

“The other theory, individualism, begets a system that is characteristic of democracies in the Western world. We often hear individualism called the “democratic way of life”.

"Many argue that the goal of government is to protect maximum individual freedoms from the influence of collectivism, so that any restrictions on freedom, including any regulation of the economy, are believed to be an attack on the survival of the nation.

“The Christian point of view, which also has support in many other religions and philosophies of life, rejects both collectivism and individualism. Christianity repudiates collectivism, because the community should exit to serve persons and not persons to serve the community as if the community were a superperson. Christianity also renounces individualism, because Christianity teaches that the highest and most important goods of the person are not private property but spiritual goods, which can be achieved and fully enjoyed only by sharing with others. Because modern states, both collectivistic and individualistic, are oriented to maximizing material goods and economic power rather than maximizing spiritual goods, the struggle between person and community has become chronic.

“The Christian point of view is neither idealistic nor altruistic. The words of Jesus are “Treat others in the way you would have them treat you; this sums up the law and the prophets” (Mt 7:12) and “You shall love your neighbor as yourself” (Mt 22:39). According to this teaching, we are not asked to love our neighbor and not love ourself, but to love our neighbor as ourself. In other words, if we really love ourself—not selfishly, but intelligently—we will realize that we cannot be happy in isolation, because we were created as social beings. We can be truly happy only by sharing in a community of happy people, and that means that we each must not only respect the rights of others in a negative sense, but must be actively concerned to promote each other’s welfare.

“The social teaching of the Catholic Church, which is derived from the teaching of Jesus, insists therefore that the human community, including its governments, must be actively concerned to promote the health and welfare of every one of its members, so that each member can contribute to the common good. This concern cannot be a matter of a mere trickle down by which the weak live on the leavings of the powerful, but must be aimed directly at enabling the weak to share in the goods of life.”

Ethics of Health Care, Third Edition
Benedict M. Ashley, O.P.
Kevin D. O’Rourke, O.P.

Human Dignity

“The root cause of all unjust discrimination is the failure to understand that human dignity is not based on physical or mental health, any more than it is upon money or education, but upon the single fact that a human person is made in the image of God. Once this principle is firmly held, there is no shame or personal inferiority in being blind, crippled, homosexually oriented, poor, or illiterate. All are equally persons, have the same human rights, and have the same claim to justice and dignity. Thus, it is contrary to the Gospel to refuse to respect the rights of others because of their nationality, race, sex, age, or physical or mental impairment. The health care professions, in their best tradition, have always sought to help people on the basis of need, not because of social status.

“Jesus said, “Treat others they way you would have them treat you: this sums up the law and the prophets” (Mt 7:12). Thus, we formulate the principle of human dignity as follows: All ethical decisions in health care must aim at human dignity, that is, the maximal integrated satisfaction of the innate and cultural needs—biological, psychological, ethical, and spiritual—of all human persons, as individuals and as members of both their national communities and the world community.”


(From Ethics of Health Care, Third Edition
Benedict M. Ashley, O.P., Kevin D. O’Rourke, O.P.)

Ethics 101

Yesterday morning I spent some time in the OSF-SFMC medical library catching up on some journals. The library is a quiet peaceful place on Sunday mornings.

One of the new books on display in the library is “Ethics of Health Care” by Benedict M. Ashley, O.P. and Kevin D. O’Rourke, O.P. It is an introductory textbook regarding Catholic ethics in the health care field.

On the first page of the Introduction, the authors state that the Catholic tradition in ethics or morality has something important to contribute to the dialogue regarding “health care ethics”. Interestingly, the authors also state that the Ethical and Religious Directives for Catholic Health Care Facilities (National Conference of Catholic Bishops 2001) is the main compendium of Catholic teaching for Catholic health care institutions and professionals in the United States.

I do not believe that OSF-SFMC has followed the Ethical and Religious Directives(ERD) established by the U.S. Catholic Bishops. Yet, this book on Catholic health care ethics is based on the ERD and is prominently displayed in the OSF-SFMC library. There seems to be a gap between theory on quiet Sunday mornings and reality during the week at the very busy Catholic medical center in Peoria.

Haitian children are being ignored by OSF-SFMC and they are dying slow painful deaths from reversible cardiac problems.

Regarding Principles of Christian Love, “Ethics of Health Care” state:

“The principles of love related to health care are threefold: (1) Every person must be valued as a unique, irreplaceable member of the human community (the principle of human dignity). (2) Every person must be encouraged to play a part in the human community and fully share in its benefits (the principle of common good, sometimes called the principle of participation in community). (3) All persons must be helped to realize their full potential (the principle of the totality and integrity of the human person).

Dishonesty in the Diocese

The July 1, 2007 issue of The Catholic Post in Peoria has an article: “Bishop Reestablishes Diocesan Health Care Committee”.

The article begins:

“As the culture moves further from Catholic moral teachings in the field of health care, strengthening the Catholic identity of our health care institutions is more important than ever.

“That is the primary mission of the Diocesan Health Care Committee, co-chaired by Father Mark Merdian, pastor of St. Matthew’s Parish in Champaign, and Lynn Grandon, director of the diocesan Office of Respect Life and Human Dignity.”

Father Merdian asked Bishop Daniel R. Jenky to revive what was formerly called the Diocesan Ethics Committee.

“The ethics committee had gone dormant when the chairman, Msgr. Steven Rohlfs, became rector of Mount St. Mary’s Seminary in Emmitsburg, Md, more than two years ago.

“Father Merdian, along with OSF HealthCare corporate ethicist Joseph Piccione, had served on that committee.

“The reconstituted and renamed committee, which meets quarterly, currently has 26 active members. Father Merdian, Grandon, Piccione and Sister Judith Ann Duvall, OSF, chairperson of OSF Healthcare System, serve together on the Diocesan Health Care Committee’s planning committee.

“The other members include hospital administrators, doctors, priests and deacons who serve as heads of pastoral care committees at hospitals, and ethics committee members from different hospitals.

“Bishop Jenky agreed with Father Merdian’s request to reestablish the committee, according to Grandon, because he saw the need to keep up communications between the bishop and the diocese's health care institution, and to help them make sure they adhere to Catholic moral teaching.

“It’s such an exciting group to be a part of. I’m so glad the bishop is letting us do this,” Grandon said.

“Bishop Jenky understands, Grandon explained, that advancing respect for life isn’t just about fighting abortion. That is just one important thread in the fabric of Catholic moral teaching and medical ethics, she said.

Piccione agreed. “We have a biblical mandate to care for the poor,” he said. “The first right, which is the right to life, includes adequate health care. It says that in the Ethical and Religious Directives for Catholic Health Care Services, from the Catholic bishops of the U.S., so it really has the level of a church teaching.”

The church’s concern for the sick, Piccione said, is “rooted in the lived example of our Lord, but also the experience of the apostles in the early church.”

Health care ministry “is ancient in the church’s experience, and it’s to be applied to our experience in the 21st century,” he said.

“Among the responsibilities of the Diocesan Health Care Committee are assisting and advising diocesan health care institutions with matters of medical ethics. The committee also offers guidance regarding competition with other health care institutions and financial and marketing issues, said Father Merdian.

“According to Grandon, the committee is also planning to create a questionnaire and an audit system to ensure diocesan health care institutions are adhering to and are effectively teaching the church’s religious and ethical directives.”

My comments regarding The Catholic Post article:

The article is shameless. If I would have read this article a few years ago, I would have thought how worthwhile this idea was. Now I have a hard time believing that our Catholic leaders will actually do the right thing. I've seen too much damage and watched local Catholic leaders threaten, ignore, and hide.

I have extensively documented my thoughts regarding the Catholic Diocese of Peoria and OSF in Peoria on Peoria’s Medical Mafia, PMM Daily, Dying in Haiti, and John Carroll’s Posts. Both institutions have shown little respect for young Haitians that need to return to Peoria for heart surgery.

I would like to believe that the new Health Care Committee will make a difference. I think that Fr. Merdian’s hopes and goals are sincere. However, he has many obstacles in his way.

Joe Piccione was hired by OSF in the mid 1990’s to find a way, with the collaboration of the Catholic Diocese of Peoria, to allow OSF to better compete in the local medical market regarding prescribing oral contraceptives and constructing a “firewall” for sterilization procedeures. Joe, the Diocese, and OSF were successful.

Joe, who is extensively quoted in the article above, is currently on the International Committee at OSF-Children's Hospital of Illinois, to select or deny kids needing surgery at OSF-Children's Hospital of Illinois. Haitian Hearts patients, that were operated at OSF several years ago, are now dying in Haiti. OSF refuses to accept them back even with full and partial charges offered by Haitian Hearts for their care.

Other medical centers don’t want to accept these OSF patients for a multiplicity of reasons. Other medical center physicians and administrators believe that OSF is acting negligently.

Where have Joe’s public statements been supporting these kids returning to OSF for their care? Joe states that it is a “biblical mandate” to care for the poor. He even states that the Ethical and Religious Directives of the Catholic Bishops regarding health care are at the level of church teaching. Does Joe Piccione really believe that OSF needs to follow these Directives? Remember, OSF signs his paycheck.

I believe that if the Diocese and OSF, with the help of their Catholic ethicists, Monsignor Rohlfs, Piccione, and a few others, could so adeptly deal with the local oral contraceptive issue at OSF, then they can easily dismiss Haitian kids to early deaths.

Will the new Committee have any ability to have creative discussions or dissent? Will the Committee use the Ethical and Religious Directives as "church teaching" and evidence to convince OSF and Bishop Jenky that the Directives need to be followed and that respect for life includes Haitians? Will the Committee mainly be “yes” people from the Diocese and the OSF System that will maintain the status quo regarding respect for life issues at OSF?

A July 5, 2007 article in the New England Journal of Medicine mentioned ethics committees:

“Whereas the judicial system assures Americans of having a “jury of peers", hospital ethics committees are not held to this standard. Although it is true that most committees include one or two members of the community (often grateful patients of the hospital), most members are physicians, nurses, and other clinicians from the hospital staff. Without in any way calling into question their motivations or intentions, we must recognize that they are unavoidably “insiders,” completely acculturated to the clinical world and its attendant values.

“Of course we could do better. Some have suggested setting up ad hoc ethics committees with a membership that truly represents the diversity of the local population, without any financial or social ties to the hospitals they serve, specifically to offer a more legitimate sounding board for difficult cases in which the hospital ethics committee could be seen as having a conflict of interest or a biased perspective.”

I worry that the new Diocesan Committee will have a "biased perspective".

Until Bishop Jenky takes control, dismisses his fear of OSF, and insists that the Ethical and Religious Directives be followed at OSF, Haitian children will continue to die.

Father Merdian has his work cut out for him.

Luke--Part III

Luke’s OSF Bill

I received Luke’s itemized bill from OSF a couple of days ago.

The bill was for his outpatient tests done on June 15, 2007 in the operating room with a general anesthesia. No surgery was performed.

Below is the itemized bill. (I tried to scan his original bill, but I couldn’t get it to scan and paste on this post.)

June 15, 2007—

1. Pulse Oximeter--$81.00
The pulse oximeter is a non invasive technique to measure oxygen level in the blood. A piece of disposable tape with a sensor is wrapped around a digit and attached to the pulse oximeter.

2.Retrograde Urogram--$481.00
The urologist injected dye up Luke’s ureters to better deliniate his anatomy.

3. Acetaminophen 650 mg.--$3.25
Acetaminophen is generic Tylenol. I called a local pharmacy. If #12 650 mg acetaminophen suppositories are purchased, each suppository is 21 cents.

4. Dexamethasone 10 mg.—$19.40

5. Ondansetron--$22.45

6. Fentanyl--$17.50

7. Cefazolin--$64.80

8. Gentamicin 40mg/ml--$63.40
Gentamicin is an antibiotic that is commonly used for kidney infections. It is given IV or IM. If I were to buy the same amount of Gentamicin from a local pharmacy in Peoria, it would have cost me 40 cents, not $63.40.

9. Sodium Chloride 0.9% IVSL--$82.10
This is sterile salt water in an IV bag.

10. SFMC-OR-Conray 60% 30 ml vial--$33.00

11. SFMC-OR-Basin-Sterile-All sizes--$19.00

12. Drape:Proc Pack/Kit/Tray:Urology--$45.00

13. Surgery, 1st 30 minutes Level II--$1,771.00
This charge is for the first 30 minutes in the operating room.

14. Surgery, Each Additional 30 minutes Level II--$856.00

15. Anesthesia Services, 0-30 minutes--$1,873.00
This was the first 30 minutes after Luke was given the general anesthetic.

16. Anesthesia Services, Each Additional 30 minutes--$575.00

17. PACU Phase 10-30 minutes--$842.00
This was for Recovery immediately after coming out of the OR.

18. PACU Phase 2 0-30 minutes--$156.00

19. PACU Phase 2 Each Additional 15 minutes--$182.00

Total owed to OSF: $7,204.35. (I did not add this up.)

Luke entered the OR at 9 AM and was discharged to home at 11:10 AM.

The doctors’ bills are not included.


Luke’s medical care was excellent. However, the charges at OSF are obviously exorbitant.

The nurses and transports are the people carrying out the OSF mission philosophy while OSF Administration and OSF Corporate leaders make the big salaries and plan 500 million dollar OSF campus expansions.

Once You See It, You Cannot Unsee It...by Tanya Sneed

why

why is it
i wonder
a child's problem
to figure out
how to survive
the streets
why do adults like me
let children sleep there
why do kids
have to negotiate
the horrors of such a life
when i go to haiti
i sleep in a bed with a pillow
while little kids, even 3-year-olds, have
no place to lie
their heads
why do i
let it be that way
why is it their problem
and not my problem



haiti

everywhere i go
i see her
the little girl, in tattered, filthy clothes
begging for a gourde*
outside our car window
everywhere i go
i see the man without a leg
begging through the fence
the hungry used to swarm us
at the airport
but now they have to beg
from afar
everywhere i go
i see the old woman
emaciated and desperate
imploring us to give her some food
anything
everywhere i go
i see the toddler
sitting there
in the dark
a rat scurrying by
everywhere i go
i see the man's blank stare
standing there
in the slums
holding a baby
the consequence of
a long history of
oppression
everywhere i go
i see them
no matter how much i try to forget
everywhere i go
they are there
pleading for
mercy


More thoughts. . .

Last night, a coworker was asking me on the phone, do I really enjoy going to Haiti? I imagined out loud that, sure, I might be happier basking in the sun on a beach at some resort, and she insisted I wouldn't, and, after further reflection, I decided that maybe she's right, because I wouldn't want anyone to see my white flabby legs (ha!). Still, it seems like an odd thing to say, that I enjoy going to one of the most hellish places in the western hemisphere. If I say it's a pleasure to visit a place where there is untold suffering, it feels like I must be exploiting it on some level. And maybe I am. I am always open to the possibility that this is more about me than it is about them, that my selfishness, as it often does, reigns supreme. But I say that if someone feeds the poor, it doesn't matter at all to the hungry person the motive of the one who gives. Whether he or she is altruistic or narcissistic, what does it matter to the person whose belly gets full? And so I won't use my self-centeredness as an excuse to not do anything, but I want it out there, in front of me, right there on the table, for all to see, so that I don't get too full of myself, thinking I'm good when I know all too well that my goodness is a mockery of goodness. I know the truth about me, and I'm OK with exposing it. In the meantime, there are people crying out for justice, and we must hear them, no matter how complicated and convoluted and downright wrong our reasons for listening and responding.

I'll close with some of my favorite Arundhati Roy quotes:

To love. To be loved. To never forget your own insignificance. To never get used to the unspeakable violence and the vulgar disparity of life around you. To seek joy in the saddest places. To pursue beauty to its lair. To never simplify what is complicated or complicate what is simple. To respect strength, never power. Above all, to watch. To try and understand. To never look away. And never, never, to forget.

You have come to a stage where you almost have to work on yourself. You know, on finding some tranquility with which to respond to these things, because I realize that the biggest risk that many of us run is beginning to get inured to the horrors.

Another world is not only possible, she is on her way. On a quiet day, I can hear her breathing.

We don't want to be like good middle-class Germans in the 1930s, who drove their children to piano classes and never noticed the concentration camps springing up around them--or do we?

The trouble is that once you see it, you can't unsee it. And once you've seen it, keeping quiet, saying nothing, becomes as political an act as speaking out. There's no innocence. Either way, you're accountable.


Haitian proverb: Wòch nan dlo pa konnen doulè wòch nan soley.
The rocks in the water do not know the suffering of the rocks in the
sun.

(The baby pictured above weighs 10 pounds and is one year old. Photo from malnutrition clinic in Cite Soleil, May 2007.)