Monthly Archives: December, 2007

Kmareka’s Top Hits of 2007

Some topics covered on Kmareka have garnered more attention and seem to be part of a larger change in communication sweeping the world. Online communication, activism, and blogging are steadily gaining credibility and beginning to influence public policy and the direction of social change. People are coming to understand local, national, and global issues in different ways by reading about them and discussing them online where they can cite sources and bring better information into the discussion.

There is a way in which the “collective unconscious” — as defined as the collective reservoir of human experience, knowledge, and ideas — is stumbling toward progress in the many blogs of significance online. It is not just coincidence that more discussion of medicating children is taking place in the mainstream media. Nor is it just coincidence that America is now more aware of its growing discontent with the movement conservatives who have governed our country for the past 7 years. At Kmareka, we strive to be part of the collective unconscious on these issues in that we are helping to bring them out of the realm of the repressed and into the light of day where they can be examined and acted upon. In bringing these issues into the open, we are helping in the collective effort to actualize.

As technology and communication online evolve, we also begin to experience more of each other emotionally online. I now feel connected to many people whom I’ve never seen in the flesh — not because they are famous, but because they bring their distinctive voices and ideas, from the absurd to the angry to the funny to the grieved, to Kmareka. One of our commenters, Donald Wolberg, is a paleontologist with a keen voice for politics, and a mind full of science and history. He first showed up on Kmareka to argue about climate change and has since returned to discuss issues as diverse as medicating children and the similarities of Dick Cheney to an overfed game pheasant. When he emailed me about a difficult loss this past year, I felt a deep sorrow for him. Somehow now we are connected, he and I, although I’ve never met him.

I’ve also gotten to know members of my real community better through blogging. By attending community events related to health, education and the environment, I have met many local elected officials and have also become a familiar face to our U.S. Senate delegation. So while the money for blogging is not big (and most of it is shared with my co-bloggers) the pay-off in terms of learning, and being part of an engaging world, is huge.

So, here’s to 2008 and here’s to the hits, and may they keep on coming…

Kiersten’s Top Hits:

Medicating Children: The Risks We are Taking: This post looks at the increasing use of psychiatric medication for children and provides links to scientific studies on the health risks associated witht he major categories of psychiatric drugs. As a practitioner in the field of adolescent psychiatry, I see teenagers being put on medications every day. I continue to struggle with fears that overmedicating is a growing trend. However, I am also congnizant that some adolescents respond well to medication as part of their treatment plan. I believe we should all continue to weigh the short-term positives of using psychiatric medication on children against concerns for long-term deleterious effects such as increased weight gain, diabetes, and tardive dyskinesia. If you are pondering these questions as a parent, a practitioner, or a consumer, you can begin your research by reading some of the 46 posts in our Medicating Children category.

Open Space: Our blog posts on the proposed development of Mulligan’s Island into a big-box shopping plaza were some of our most commented-on, and helped identify a community of local activists who convinced Churchill & Banks to take their proposal elsewhere. The first post I did on the topic, which includes some of my personal history, received 67 comments, while another post on the topic, which got off-topic into the still-mysterious identity of “Jesse of Cranston,” received 113 comments.

The History of The Concrete Plant: We have done 41 posts on the concrete plant which is now nearing a settlement in favor of the residents. From powerful letters written by residents to a post connecting the concrete plant controversy to larger issues of citizen activism in a culture that encourages apathy, the posts in the “Cranston Concrete Plant” category are a testament to the way that online discussion helps to bolster community involvement. The costs of this controversy are good reason to investigate the way the Cullion permit was processed and revise zoning procedures so that the community is better informed and protected from industrial encroachment.

David’s Top Hits

Will I Spend Eternity in Hell? Wherein David ponders the nature of the physical and spiritual universes and the likelihood of his burning in hell because he is not a Christian. You can cast your vote for or against his eternal damnation.

The Sound of Neglect: This is a poem by David which he later read at a service on the theme of political action held by the Unitarian Society of Northampton.

Letter to a Fallen Soldier: David pays tribute to the sacrifices made by our country’s soldiers and places their loss in the larger context of the need for political leadership that can bring more peace and justice to the world.

Nancy’s Top Hits

Hummers for Sick Children: Nancy has some funny, insightful, and provocative things to say about Hummers making their way into hospitals as the vehicle of choice for the ride to the surgery room. Many Hummer devotees came by to share their own views.

Bill O’Reilly Needs to Get Out More: This post got picked up by Media Matters to be included in their page of posts about Bill O’Reilly’s strange comments after visiting a Harlem diner.

Desperately Selling a Kidney: This post attracted some intense discussion (including a rebuttal from the spouse of an organ donor) about the medical ethics of organ donation.

Financial Triage

I saw a screaming headline on Raw Story, ‘Insurance Company to Starve Toddler.’ I thought it would be some heartrending situation where a baby was on a feeding tube and life support with a dispute between the family and the insurer and the hospital, etc. As I mentioned in the last post, ‘Desperately Fighting Big Insurance’, universal health care would not mean that everyone gets every treatment. There is a limit on resources. I was expecting to read the article with a sense of resignation to that fact. I never expected this…

YORKTOWN — Three-year-old Hannah Devane is allergic to food. Not the kind that makes kids spit out their broccoli; the kind that can kill.

The Yorktown preschooler has a condition called eosinophilic esophagitis, a severe food allergy that causes a type of white blood cell to congregate in the esophagus, the tube that carries food from the mouth to the stomach, damaging the tissue when she eats.

A doctor-prescribed formula has allowed Hannah to grow to a robust 40 pounds, a normal weight for a child her age. Without it, Hannah could wind up with a feeding tube.

But the insurance program that covers her family through her father’s job as a New York City police lieutenant has stopped paying for the formula, which costs $1,200 a month. Food supplements and other over-the-counter items are not covered under the family’s insurance, the prescription plan administrator said.

This is so FUBAR. I know that $1200 a month is a lot of money, but that money is keeping a child nourished and healthy. To force a child who can take nutrition by mouth to undergo surgery to insert a feeding tube is medically unjustified, and there’s no guarantee it would not be more expensive in the long run. You’d have surgery, hospitalization, follow-ups, treatment for complications and still have to buy formula. It costs about twice as much to keep someone in a nursing home for a month, to put the cost in perspective. And the parents are doing all they can do…

Since early November, when Hannah’s last case of insurance-covered formula ran out, her parents have spent about $300 a week on Elecare.

Michael Devane works a second job as a security guard to cover expenses. Jessie Devane works three times a week as a temporary nurse. Hannah can’t take her formula to day care. She is only permitted to drink water and eat the rice and pears her mother prepares for her. She is ravenous when she gets home, her mother said.

The family had been getting coverage for Elecare because of an error, said Helen Sweeny, the administrator of the self-insured medical benefits fund run by the Superior Officers Council.

“The program would be broke if we tried to cover food,” said Sweeny, who has run the program for 32 years.

My suggestion to Ms. Sweeny is to stick a label on the Elecare can that says…I don’t know… Ritalin or Viagra or Oxycontin or something. Then they can call it a drug and cover it.

I wish this was an aberration, but I regularly see patients who are getting sicker because their insurance doesn’t cover essential meds, and I’ve been trying to make sense of the maze of Medicare drug plans so my mother can get coverage at all.

When we finally get universal health insurance in this country, as we must, we will need to write in enough flexibility to cover the costs of keeping a child healthy, invest in the care that will lead to long-term savings, and not create illness because the system won’t change.

Proposed Settlement with Cullion Concrete

Mayor Michael Napolitano will be holding a press conference today at 11:45 am at Cranston City Hall to announce a proposed settlement to end the Cullion concrete plant controversy that has been going on in Cranston for over a year. Cranston Citizens for Responsible Zoning and Development (CCRZD) is asking its members to attend the press conference and bring their “Stop the Concrete Plant” signs. They stated in an email that they are not for or against the proposed settlement, since they were not included in the discussions.

We will provide an update after the press conference with more information about the proposed settlement.

UPDATE: The projo article provided the following details:

In October, The Providence Journal reported that the Pawtuxet River Authority & Watershed Council, a state-chartered agency that serves as steward of the river, has targeted the land as the centerpiece for a sprawling waterside park.

The concept has won broad support from the mayor, City Council and the city’s delegation to the General Assembly.

With that in mind, Napolitano said yesterday that he would press the state and federal governments for funding to cover at least a portion of the $1.9-million settlement.

Failing that, the mayor said he will seek approval from the Democratic-dominated City Council for a city bond to be paid off by the taxpayers.

Council President Aram G. Garabedian, a Democrat and staunch opponent of the plant, has voiced deep reservations in recent months about paying Cullion anything for the land.

But he declined to comment last night, saying he wanted to review the details of the agreement first.

Sounds like there will be due diligence on this from the city council. Congratulations to the residents of Eden Park who fought to protect their neighborhood. Your work and perseverence paid off.

UPDATE #2: CCRZD has provided this statement from spokesman Howie Barte:

CCRZD Expresses Initial Unease To Mayor Napolitano’s Proposed “Settlement” With Cullion Over Cranston Concrete Plant

Cranston Mayor Michael Napolitano today informed the Cranston Citizens for Responsible Zoning & Development (CCRZD) regarding the disputed concrete plant in Cranston, “I settled the deal�.

CCRZD’s initial reaction is that $1.9 million offer by the Mayor to buy out Cullion is probably too high. It must be noted that this Mayor has cost the taxpayers a tremendous amount of taxpayer dollars because he refused to investigate and pull the permit from the beginning when it would have most likely been much cheaper to do so. It’s a known fact that a municipality under Rhode Island Law is only liable up to a $100,000 cap.

CCRZD continues to watch closely as developments occur. A continued area of concern not yet addressed is that assurance have yet to be issued guaranteeing that this land will be maintained in accordance the 1992 Comprehensive Plan which was has been in affect, but ignored, for fifteen years. And, of course, CCRZD has yet to see the detailed of the purported deal. So far, it seems more questions have been raised than answers provided.

UPDATE #3: Activist and resident Suzanne Arena sent a letter to the Cranston City Council expressing concern about the size of the settlement for Cullion. A part of her letter reads as follows:

I am appealing to you because $1.9 million is on the high side. We have determined the cost of land to be $240,000 with an assessed value of approximately $310,000 and an estimated fair market value of $700,000 in the extreme. Adding a conservative $100,000 for legal fee concessions leaves $1.1 million. What does number this entail? We fully expected that Cullion would take back the equipment so that this would not become part of the settlement.

Further, I expect that there would be an Environmental Site Assessment as part of the agreement and in the eventuality that hazardous waste is discovered, I would expect that the cost of removal would be borne by the owner, Cullion / Karleetor. In order to establish due diligence, another appraisal by City Council should be obtained.

If the fair market value of the property is determined to be substantially higher than the assessed value of the property, there should be a determination with respect to the City’s Right of Recourse against the seller for back taxes based on the current $300,000 assessment.

Ms. Arena received a response from Council member Jeff Barone, which is as follows:

Suzanne,

First, I must say, we finally agree on something. The only difference is that the “deal” is about $1.8m too high. The city should just give Cullion $100,000.00 that was expended prior to our stop order. What ever monies they have expended after that point should not be the responsibility of the city.

You and you association feel that you should have been part of the negotiation of this “deal”. The City Council was not even part of it, what makes you think you should be?

By the way, your Mayor told the press before the Council of this deal, why do you think he’ll tell you first.

This is maybe the worst “deal” he has ever come up with. More than the Valley settlement or the Providence Water settlement. I’ll bet you didn’t know about those.

Where does he think he is going to get the money to pay for this. I know where, you the taxpayer. Don’t forget, we have a $2.5m settlement with Valley, a $1.5m settlement with Providence, a possible $4m Carullo action and now this. That will all come out of the Rainy day fund. He said he will get state aid, they are not going to give Cranston $1.9 million for 20.2 acres of flood land. He will tell you that but let’s get real.

When he goes to knock on doors to get re-elected, his new “promise ” will be that he will continue to support the people. Wait for next year’s tax increase.

All the other costs you mentioned earlier will be absorbed by the city. I hope you and your association let him know how you feel.

Thanks,

Councilman Barone

Benazir Bhutto, Leader and Patriot

Today the world extends its condolences to the Pakistani people for their loss. Benazir Bhutto gave her life to her country, opposing violence and extremism, bravely standing up for democracy.

Today I recalled the shock and grief of the years when we lost President Kennedy, Robert Kennedy and Martin Luther King Jr. to assassin’s bullets. You can kill a person, but you can’t kill an ideal. Benazir Bhutto will live in every person who fights for justice, every person who loves their country, every act of courage and sacrifice.

For a beautiful tribute to her life, see this from The Washington Post headlined on Buzzflash.

Season’s Greetings

[direct link]

Salvation for Nematodes

David Jaffe has written eloquently about the plight of nematodes [As the Worm Turns] who are afflicted with manic depression. Fortunately, medical science is making progress in bringing the benefits of psychiatry to a previously overlooked population, lengthening their lifespan and improving their quality of life.

But up until now, who has been thinking of their spiritual needs? A great leap, or crawl, forward comes from the nanotechnology experts at the Technion institute in Haifa.

Israeli scientists have inscribed the entire Hebrew text of the Jewish Bible onto a space less than half the size of a grain of sugar…

“It took us about an hour to etch the 300,000 words of the Bible onto a tiny silicon surface,” Ohad Zohar, the university’s scientific adviser for educational programs, told the Associated Press… The tiny Bible appears to be the world’s smallest.

They must have intended it for nematodes, because I have trouble reading the KJV even with my glasses, never mind turning those tissue-thin pages. I hope the nematodes will eschew fundamentalism, and get into the deeper meaning. Shalom, little guys.

Curmudgeon’s Christmas

This is turning out to be the happiest Christmas season I’ve had in years, and I wish you all a good one too. After coming out as a curmudgeon, or curmudgeonette, I decided that the war on Christmas was over and I would sit back and enjoy the peace. I opted out of accepting any mandatory shopping obligations or feeling guilty about anything.

Instead of running myself ragged, like in previous years, to get cheesy items for co-workers, I just did something I really wanted to do and picked up gifts I wanted to give. The fact that my current job doesn’t pressure anyone to be jolly had a lot to do with my good mood.

As usual, by Saturday I had not started my Christmas shopping, and the Mall gives me hives, but I just cruised around and stopped in a few small local stores and ended up with way better stuff than I expected to find. Then I went to a Solstice party.

Last year on Christmas Eve I went with a group who sing Christmas Carols at the ACI. It was freezing, but there was a full moon, and the women opened the windows and called out requests. Then I went to see Fishel Bressler and his Klezmer band. They were awesome. I plan to see them again this year.

It took a long time to stop feeling guilty for not getting into the collective shopping and sugar frenzy, but I can finally enjoy a bright day in a dark season. I have a feeling I’m not the only one who declared a separate peace. How are you celebrating the holidays?

I’m Glad I don’t Live in the Burbs

My feeling about the burbs, and more so about the gated community, is that it’s where people like me go after they die if they’ve been very, very bad. The burbs are full of people who want to get away from all the problems of the city or escape the wildness of the country. They want everything to be nice. And square. And mowed.

Often when they get behind the gate they discover that their neighbors are not nice. And then they’re stuck. So they have to sue someone or call the cops. This is a pretty extreme case of calling in the authorities…

An 86-year-old man jailed for a week for not mowing high grass or cleaning trash from his yard has gotten help from prison staff hoping to keep him from going to the slammer again.

John Allen was sent to prison after being convicted of violating a Union Township law stating private property must be clear of junk, rubbish, garbage or unruly grass.

Union Township Police Chief Joseph Lombardo said Allen did not heed warnings to clean up his property, which neighbors complained was an eyesore. Allen also refused help from others in the neighborhood and from a group that assists the elderly, Lombardo said.

“I don’t want local people in my house,” Allen told the New Castle News when asked why he had turned down the help of friends and neighbors. “Ordinarily, I wouldn’t let you through the front door.”

I would have let the poor guy alone, I mean, how much longer would he have been a problem? But where the good neighbor policy failed, the prison guards knew what to do…

So, about a dozen corrections officers spent several days this week at the elderly man’s house. Working on their own time, they filled a garbage bin to the brim with old furniture and other household goods. They plan to get to the yard — including mowing the high grass — once the recent snow melts.

Allen, a World War II veteran who worked in the airline industry in California, praised the prison staff for treating him well when he was behind bars and for helping him stay out of more trouble.

So wishing all a Merry Christmas, and that’s my heartwarming story for this year.

Desperately Fighting Big Insurance

Sally Satel’s New York Times story about her search for a kidney donor and her conclusion that we should set up a process for selling organs led to a fascinating debate. (Check out the ‘comments’ section for ‘Desperately Selling a Kidney’.) Ms. Satel never addressed the role of health insurance, or lack of it.

Today’s ABC News brings a story of a young woman who had a matching donor for a liver transplant, had the medical team, and had insurance.

Nataline Sarkisyan, a 17-year-old from Glendale, Calif., died Thursday just a few hours after her insurer, CIGNA HealthCare, approved a procedure it had previously described as “too experimental.”

Nataline’s supporters, including a good number of nurses, took it public, which seems to have influenced the insurance company to change its decision.

Geri Jenkins of the California Nurses Association said the Sarkisyans had insurance, and medical providers felt comfortable performing the medical procedure. In that situation, the insurer should defer to medical experts, she said.

“They have insurance, and there’s no reason that the doctors’ judgment should be overrided by a bean counter sitting there in an insurance office,” Jenkins said.
Doctors at the UCLA Medical Center actually signed a letter urging CIGNA to review its decision.

Whether the delay was the cause of her death will probably be established in court.

In a free market you try to get the best deal, and the seller tries to get the best price. That’s fine when you’re shopping for a pair of shoes. When you’re sick your bargaining power is zip, and making critically ill people fight with insurance is a disgrace.

However, there is no perfect system. I agree with the nurses that the insurer should have let the doctors judge whether the transplant had a chance of success. A girl is dead because CIGNA denied, and then granted coverage when the publicity became an embarrassment. But there is no system we can construct that won’t have to use some form of triage.

Right now we cannot claim that we have a health care system that offers fairness and transparency. It’s a hopeless bureaucratic maze with multiple vendors all trying to make a buck and millions left with inadequate, or no coverage. Denying service brings rewards, promoting health is not a priority. It’s a screwed-up system that steers normally decent people into inhumane, immoral behavior.

Some of the people who oppose universal health insurance warn that we would lose ‘choice’ and that there would be ‘rationing’. Well, there already is rationing, and it’s not done on a fair or medically defensible basis. The Sarkisyan family paid their insurance and thought they had coverage, but found they had no recourse when time was of the essence. Nataline Sarkisyan was not the first and won’t be the last young person to die while we argue about how to make a health care system that works.

The Buck Stops There

I’m only a humble nurse, sitting here in my scrubs, with saggy white support hose on my legs and a cap shaped like a cupcake on my head. It may be presumptuous of me to say anything at all about the Governor’s chain of command. But what the heck…

When you come onto a unit to take charge there is a standard procedure. You and the nurse leaving the unit count the narcotics to be sure every pill is accounted for. Then you get the keys. Then you get a report on what happened to all the patients on the previous shift. The passing of the keys is an almost ritualistic passing of authority and responsibility. Any nurse who walks off shift with the keys in her pocket (it does happen) will be called at home and expected to return them right away. A good nurse doesn’t even leave the unit to eat lunch without passing the keys to another nurse. Everyone knows things can happen unexpectedly.

So why did the Governor leave the unit, I mean state, without informing the Lt. Governor? He did not give her report. He walked out with the keys in his pocket. Here’s from today’s Providence Journal

Although Roberts had pressed Carcieri’s staff to open the emergency operations center — where top officials from various agencies could have worked together and informed the public of their response — she said the governor’s staff turned her down. Gen. Bray also did not want to open the emergency operations center, said spokesman Lt. Col. Denis Riel.

If Donald Carcieri were a nurse he would have been written up.

This would have been his second write-up for the same mistake.

Nearly five years ago, there was another lieutenant governor in that position. When a major winter storm was predicted over President’s Day weekend in 2003, then-Lt. Gov. Charles Fogarty returned from a conference in Washington, D.C. Carcieri, a new governor, remained in Florida.

Fogarty said then-Adjutant Gen. Reginald Centracchio told him that the governor’s staff didn’t want to open the emergency operations center because they didn’t want to panic anyone. Fogarty said he called Carcieri to insist, and the governor agreed. The EOC opened…

After that, Fogarty said, Carcieri rarely told him when he’d be out of the state.

What is Carciei’s problem with handing over the keys? If he were a nurse he would have been expected to take responsibility, but he’s a Governor, so he tossed his emergency management executive director overboard instead…

Robert J. Warren’s firing from the $74,700-a-year job was immediate, according to a terse news release. The governor’s spokesman declined comment.

Maybe the Governor was doing a heckuva job and it was all Robert Warren’s fault, especially since the Governor was far from the scene of the debacle.

Carcieri said he was flying from Kuwait to Afghanistan and probably sleeping as the storm bore down on Rhode Island.

Maybe Warren was a lunkhead and we’ll be better of with Major General Robert T. Bray, the guy who refused to open the emergency operations center when the Lt. Gov. asked him to. But look at this…

Warren had been the first EMA chief with public safety experience in at least 20 years. He had retired as Cranston fire chief after 27 years with the department and 6 as the city’s EMA chief, when he’d been awarded EMA director of the year.

Carcieri tapped him to head the state EMA in August 2005, as Hurricane Katrina devastated the Gulf Coast. Under Warren, the state EMA produced its first hurricane plan within several months, its first statewide evacuation routes, and established an interoperable radio communications system meant to help officials from various state and local agencies communicate in a disaster. Warren restructured the agency, which had been used as a political dumping ground, and he used federal money to hire planners to work with the municipalities to improve their emergency response.

How did a good firefighter go bad? Was it because no one told him where the keys were?

Eventually it will emerge that there were many mistakes and failures among those who should have been responsible, you don’t have this big a mess without plenty of blame to go around. Lt. Governor Elizabeth Roberts has some very commonsense proposals for a meeting on Jan. 22, so let’s see if we come out with this with some organization and accountability, from the top down, so that we keep the state together when a real emergency comes.

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