Protecting the Vote in Florida

If Katherine Harris were dead she would be rolling in her grave. Check this out…

Florida’s election supervisors announced their decision Friday evening to stop the controversial effort of Governor Rick Scott’s (R) administration removing names off the state’s voter rolls, according to The Palm Beach Post.

Spurred by the Department of Justice delivered a letter to Florida Secretary of State Ken Detzner that the name purging was illegal, the state’s Supervisors of Elections president Vicki Davis acknowledged the numerous mistakes located in purging eligible voters off the rolls.

“There are just too many variables with this entire process at this time for supervisors to continue,” David said.

The Miami Herald ran an editorial Sunday urging Florida to Purge the Purge List.

The Marietta Daily Journal calls this ‘voter supression’…

But here’s the problem. It’s not just Florida. The Sunshine State is just one of more than 20 states, led by Republican governors, where so-called “voter reform” laws — in reality, voter suppression laws — have been enacted within the last year. Based on model legislation provided by the Koch Brothers-funded American Legislative Exchange Council (ALEC), they target seniors, students, the poor and racial minorities by restricting voting rights in several different ways. Many states, collectively accounting for 171 out of 270 electoral votes needed to win the presidency, now require an official government photo ID. Early voting is eliminated or curtailed. No more registering to vote on Election Day. Voting on the Sunday before the election, when black churches drive “souls to the polls,” no longer permitted.

Republicans justify attempts to suppress the vote by warning about massive voter fraud — of which there is simply zero evidence. A 2011 survey by the Brennan Center for Justice found voter fraud “extremely rare.” Washington state, for example, reported a fraud rate of 0.0009 percent; Ohio, only 0.00004 percent. You’re more likely to be struck by lightning.

In living memory, Americans risked injury and death at the the hands of domestic terrorists such as the Ku Klux Klan to exercise their right to vote. Women have had the vote for less than a hundred years, and it was hard-earned by the efforts of Suffragists over lifetimes. Now the anti-suffragists are eroding our rights on the margins, a little at a time, counting on complacency, ignorance and hopelessness to persuade Americans that our vote doesn’t count.

We’re not the Koch Brothers, but the 99% has them outnumbered. Get your civics and spread the word. Knowledge is power.

Take This Cup and…

After about 20 years in nursing I’ve learned to take a methodical approach to certain things. Lab tests, for instance– why not test for everything all the time? That way you won’t miss anything?

It doesn’t work that way. My experience with community screening for diseases like diabetes only reinforces the principle that you need a reason to do a test. Targeted screening is good, random sometimes worse than useless. Wasteful, raising anxiety in people at low risk, missing the ones who need it and scaring people with false positives.

Before testing at all, it’s important to ask what will be done with the results. The ‘Women’s Cancer Screening Program’ for instance, swiftly learned that you don’t say to a patient–‘You have a spot on your mammogram. Have a nice day.’ Nope. You have to refer uninsured women to doctors and hospitals that will provide treatment, and that takes more funding. The ‘Women’s Cancer Screening Program’ saves lives and engages many volunteers and providers to carry out their mission. It’s not as simple as free mammograms.

Testing without a good reason and plan for dealing with the results does more harm than good.

I thought of these things when I got this email from my cousin–

THANK you FLORIDA and KENTUCKY!! Florida and Kentucky are the first states that will require drug testing when applying for welfare, effective July 1st. Some people are crying this is unconstitutional. How is this unconstitutional? Its OK to drug test people who work for their money but not those who don’t (and live off the people who do)? Re-post this if you’d like to see this done in all 50 states.
I didn’t verify it but I’m all for it!!!

Well, it doesn’t exactly verify. Kentucky, according to, has this in the legislature, but not passed. Florida just passed a bill this year and is working out implementation

Is the welfare population especially at risk for drug abuse? Who are they, anyway?

I put ‘Rhode Island welfare’ into Google and got the site of the Rhode Island Department of Human Services. Here’s the menu bar…

Families with Children
Children with Special Needs
Adults with Disabilities

I work with the elder population, and I doubt the benefit of testing all the grandmothers in the high rise buildings. I don’t know if the public wants to cut off benefits for veterans if they have a substance abuse problem– this would seem to call for drug treatment instead. Maybe they are thinking of adults on General Public Assistance…


Rhode Island residents who are between 19 and 64 years old can apply for GPA. To be eligible a person must-

have an illness, injury or medical condition that is expected to last 30 days or more and prevents a person from working
have a monthly income of $327 or less
have resources of less than $400
have only one automobile with an value of less than $4,650
cannot be eligible for other Federal assistance programs, although it is okay to receive SNAP benefits (food stamps)
cannot have a child under 18 living with the applicant
cannot be pregnant

Covered Benefits

The GPA program covers primary care doctors’ office visits/ health centers visits and most generic prescription medications.

When I worked in a primary health clinic there were people who went on public assistance to get coverage for drug treatment. SSTAR detox and drug treatment, for example, accepts Medicare and Medicaide. I can understand the frustration that someone who wrecks their health with drugs can get disability while so many pay a huge chunk of their paycheck for insurance. It is better for society to support drug treatment than to build more prisons, but until we have universal health insurance these inequalities will be a flashpoint for public anger.

Drug tests cost money. Florida’s law requires people applying for public assistance to pay out of pocket for drug tests– if they pass they are reimbursed, if they fail they lose benefits. Since mothers with children are a large percentage of people on public assistance Florida law has a procedure. From the Miami Herald…

• Parents who fail drug tests can get benefits for their children by naming a state-approved designee to collect the money. That designee must also pass a drug test.

This looks messy. It’s not that drug-using parents are okay, but this system seems thrown together and probably unfunded. Who’s going to approve the designee? What happens when there is a dispute?

There are many unanswered questions. What happens with a false positive test? What happens when a prescription drug affects the result? Who evaluates a positive in that case? Which labs will be authorized to do the tests and what will they be allowed to charge? Who guarantees the quality and accuracy of the tests? Governor Scott has a financial interest in a chain of clinics that does drug testing. Does this pass the ethics test?

One of hottest topics in Florida politics these days is Gov. Rick Scott’s plan to start randomly drug testing existing state employees. With estimates of as many as 100,000 tests a year, there would be a lot of money in it for the company that gets to do the testing.

Perhaps not surprisingly, that stirred up talk about Scott’s major investments in Solantic, an urgent-care chain that provides drug-testing services. (During the campaign, he cited its worth as $62 million, deciding to transfer the holdings to his wife’s name after he was elected.)

So, it’s okay I guess.

The new law may not pass the Constitution test. Lawsuits are pending.

A final word about mass screening. You have to look at cost vs benefit.

The most deadly addictive drugs in our country are tobacco and alcohol. They are widely used everywhere. Florida might do more public good with a stop-smoking campaign and a crackdown on drunk driving. The welfare drug test doesn’t cover drinking and smoking.

Another cost, less tangible, is the cost to human dignity. The chain email mentions drug testing ‘people who work for their money’. I don’t think we should accept the idea that our privacy is traded for our paycheck. Some jobs should screen–pilots and truck drivers, for instance. But should everyone get handed a cup, even if they sit at a desk? And there is no problem with their work performance? Does an employer have to have a reason, or is this just the new normal?

Is mass-screening people on public assistance intended to fight drug abuse, or is it a way to please the base, and make a few bucks for some clinics? Are there good options for dealing with the people who test positive, or will they drop off the welfare rolls and end up in the prisons, or in the hospitals at greater expense? Should we institute mandatory testing of politicians? They are responsible to the public, they live on our tax dollars and there is some evidence of substance abuse in that population.

I hope this idea won’t fly in Rhode Island. The best way to solve our social problems is to get our unemployment rate down, and I hope our politicians are keeping their heads clear and working on job creation.

Drug abuse is not limited to the poor, but poor people have not got much opportunity to get help. They can’t just check into the Betty Ford Center. The way to help people beat addiction is to engage them in services, not cut off aid. Too bad Florida did not first build a network of addiction treatment centers, then start a public health outreach. But that would cost money and would not be politically popular.

AND ANOTHER THING: Shockingly, there are people with mental illness and emotional distress who use drugs. Who would have imagined such a thing was possible? It’s called dual diagnosis. Some of the people I’ve worked with who had this problem were military veterans with physical and emotional wounds from war. We are just starting to recognize the damage of traumatic brain injury– the signature wound of the Iraq War. It’s not going to get easier, as long as we damage people faster than we heal them.

THE ICKY PART: Friend Kathryn suggested that our political leaders be the ones who handle the pee cups. That gave me flashbacks to a bathroom with the sink and toilets sealed off, and having to get closer to some grouchy guys than I would prefer. I did a few drug tests when I worked for a walk-in. It’s time-consuming, paperwork-intensive and stressful, because some truck driver’s job depends on the results. I handled the cups, at least I didn’t have to observe the source, as I believe some nurses are required to do. Hey, Florida nurses, thank your governor when the waiting room fills up with sick people while you maintain chain of custody on yellow cups.

From a Fat Old Nurse

Home with a cold, nothing to do but scan the news, and blog about how to fix this health care mess…

Part I– Money Corrupts

Congressman Patrick Kennedy has many faults, but I’ll always appreciate that he helped hold off Columbia HCA from buying Roger Williams Hospital in the late ‘90’s because by the end of the decade Columbia was paying huge fines for Medicare fraud and Roger Williams has had a little staff turnover.

The state law covering hospital mergers, the Hospital Conversion Act, prescribes many specific criteria that the attorney general and Department of Health director must use to determine if a transaction is appropriate under Rhode Island law and standards, including: whether patients — especially in traditionally underserved communities — can access affordable health care; whether essential medical services would remain available for safe and adequate treatment, appropriate access, and balanced health-care delivery; how much of the hospital market the new entity would control and whether the hospitals would continue to safeguard the public trust.

The law was first created when Columbia HCA — a large, for-profit hospital corporation with a less-than-stellar reputation — proposed buying Roger Williams Hospital, and permanently altering the voluntary nonprofit nature of our hospital system. Thankfully, this never happened. Nurses and other health-care workers, professional and labor organizations, and community-based health-care advocates worked together to win the passage of the Hospital Conversion Act, and Columbia HCA backed down.

That’s a local case of money corrupting health care. The Columbia connection comes back again in this story of how to grow an astroturf movement…

After six months and lots of money, Scott, founder of Conservatives for Patients’ Rights (and an ally of McKalip), has finally seen the fruits of his multimillion-dollar campaign against reform. Scott, a millionaire healthcare entrepreneur, predicted that when Congress reconvened this September the public option would be dead. “While Victory is near, we must not rest,” Scott crowed on CPR’s Web site. Scott himself never rested. He met with lawmakers, coordinated conference calls with conservative activists, wrote opinion pieces and spoke to the faithful about the evils of socialized medicine. Conservatives for Patients’ Rights targeted elected officials in 11 states with TV ads hoping constituents would pressure the lawmakers to oppose proposed changes. Sure enough, when the public option failed in the Senate Finance Committee Tuesday, Scott took credit in this video.

Scott came to the fight with a background in the business of healthcare; in the 1990s he was the CEO of the country’s largest chain of hospitals, until that company, Columbia/HCA, pleaded guilty to defrauding the government in 1997 and Scott was ousted (he was never charged in the fraud). Determined to reclaim some of his lost clout in the healthcare field and rehabilitate his image, in 2001 he started a chain of walk-in clinics in Florida called Solantic.

Walk-in clinics are one way people can access health care, and if they’re done right they can be a useful part of health reform. Where it gets dumb is when politicians claim that walk-ins and emergency rooms are adequate coverage. They’re good for dealing with the immediate problem, but without primary care they are just a revolving door.

Part II– Image is Everything

The Salon article gets really interesting regarding the weird hiring practices of Solantic…

Yet even before it was fully operational Solantic executives were accused of a pattern of serial discrimination in hiring, a pattern supposedly initiated by Scott himself. The suits alleged a standing policy not to hire overweight women, Hispanics with strong accents, older women and black women.

“One of the first things we needed was an R.N. [registered nurse] to help oversee the clinical part with me,” [Doctor] Yarian recalls. “There was this great young individual who had a lot of experience with clinic start-ups. She interviewed with me, and then with Karen. We both loved her. When I got on the phone with Rick, the first thing he says is, ‘What does she look like?'”

Yarian says he began describing her to Scott, at one point mentioning that “She’s a little bit overweight.”

“Immediately Rick says to me, ‘Fat people can’t work at our centers.’ And that sort of set the trend,” Yarian says. “I’d be interviewing someone and his first concern was what they looked like. He was always sending e-mails that people had to be fit and attractive. And no one was hired without his approval.”

Part III– Sisters Without Mercy, Newport, Rhode Island

Salve Regina University knew Sharon Russell was fat when they accepted her. They knew she was fat when they cashed her tuition checks. They refused to graduate her because she was fat. What were they thinking?

In April of 1988 Russell confronted the five nursing instructors from the college again. “It’s hard to explain how much fear they inspired in me. I had called another fat girl who attended Salve with me and asked her to testify. She had refused because she had been afraid to see those women again. And she had already graduated and had been practicing for two years! There was a great amount of fear. The class started out with sixty students; the drop-out rate was half.”

With the fear came anger, too. “I had paid big bucks for their abuse. My parents weren’t rich. Student loans and scholarships paid my tuition.” By the time of the trial in 1988, Russell had already completed a nursing program at St. Joseph’s in Hartford, Connecticut, and had a position at a hospital in Florida. “I had been working in the real world. No patient cares if you’re fat or not. They care about your skills.”

Part IV–Fit to Serve

What is the role of the Surgeon General anyway, and is Dr. Regina Benjamin qualified?

“I think it [her weight] is an issue, but then the president is said to still smoke cigarettes,” said Dr. Marcia Angell, former editor of The New England Journal of Medicine who is now a senior lecturer at Harvard University Medical School. “It tends to undermine her credibility.”

“We don’t know how much she weighs and just looking at her I would not say she is grotesquely obese or even overweight enough to affect her health,” Angell told

“But I do think at a time when a lot of public health concern is about the national epidemic of obesity, having a surgeon general who is noticeably overweight raises questions in people’s minds,” she added.

Will this answer the questions…

Benjamin founded the Bayou La Batre Rural Health Clinic in 1990 in the fishing village of Bayou La Batre, Alabama, and has served as its CEO since.

Like many of her patients, the clinic has suffered its own life-threatening challenges. It was heavily damaged by Hurricane Georges in 1998 and Hurricane Katrina in 2005. It also burned to the ground several years ago. But Benjamin rebuilt it after each setback and has continued to offer medical care to the village’s 2,500 residents.

Her commitment to them has meant making house calls during the rebuilding, mortgaging her house and maxing out her credit cards, Obama said.

“Regina Benjamin has refused to give up; her patients have refused to give up,” he said.

Many of her family practice patients are immigrants from Vietnam, Cambodia and Laos who make up a third of Bayou La Batre’s population, and many of them are uninsured.

Benjamin’s expertise goes beyond medicine; she earned a master’s in business administration in 1991 from Tulane University. But her focus has not been on making money for herself, she said.

“My priority has always been the needs of my patients,” she said. “I decided to treat patients regardless of their ability to pay.”

This practice of caring for poor people might be the real reason that Dr. Benjamin is being attacked. When Dr. C. Everett Koop, who was neither young nor slim, served as Surgeon General, he was greatly respected, and very popular for his leadership in public health. The post has become a more precarious and politicized place since Dr. Koop filled it, and Dr. Benjamin can expect to have every aspect of her life and career judged and misjudged.

But what qualities do we want in the nation’s doctor? Good looks and fitness? There’s lots of actors who qualify. Compassion and experience? I’d choose Dr. Benjamin for that. She has a fine resume and if the congressional process shows her to be who she seems to be she should be confirmed.

Part V– Looking the Part

The average nurse is middle-aged. We are an older workforce on average. Part of the problem is retention. Nursing is a high burn-out occupation. Part of the burn-out, I’m convinced, is the relentless corruption of patient care by the profit motive. Labor costs are minimized by stretching staff to the breaking point.

Stress leads to health problems in the people who provide health care, and not a few of us grab a cig or a donut when we shouldn’t. We’re all in it together. Health care workers have the same problems as other workers.

My doctor is lean and fit. He took time to talk to me about diet and exercise. I appreciate that, and that he supports health care reform.

My dentist is not as lean as my doctor. I go to her because of her competence and gentleness. If you want to keep your teeth, she’s the one to see.

If you ever need to check out a nursing home, don’t stop at the front lobby. That’s where they have the chandeliers and mahogany paneling and the fresh flowers. Don’t stop at the private rooms. Go all the way to the top floor where the sickest and neediest patients stay, and see how they are treated. See how the staff behave. Are they all having headaches, or do they take time to talk to the residents?

Glossy, for-profit clinics with buff-looking staff and a high profit margin are there for you right now, if you have the coverage. Rich doctors and attractive drug reps are making a good living.

You could almost forget that this is about sickness and health, life and death.

When the chips are down, I want to be able to count on people who have competence and compassion. I really don’t care what they look like. I want to know what they can do.