Plastic Surgeon General

Salon’s Dr.Ayala has a post on the weird assertion that the Surgeon General of the United States is not qualified because she is not a babe. What do they want, an aerobics instructor? Never mind that the first name that comes to mind for most Americans when you say ‘Surgeon General’ is the substantial C. Everett Koop. We remember Dr.Koop because he showed leadership in the AIDS crisis, and has dedicated himself to health promotion since.

President Bush’s Anthony Carmona was rather studly, so he served that function well, but hardly a peep out of him in all his tenure. He was rumored to have a habit of yelling at nurses, but his mild reproof of the tobacco industry was saved for just before the door hit him on the way out. I have a thing for David Satcher, he was quietly effective and a strong advocate for mental health parity, but not a publicity seeker and did not become a media star.

I have high hopes for Dr.Benjamin. I will be very happy if she speaks out about the ‘Lack of Aid’ crisis we are suffering now, when a large section of our population cannot access primary and preventive medical care. Dr. Benjamin, I wish you good health and won’t gripe if you schedule some time at the gym. But we need you to put in long hours and breathe life into an office that has been left empty too long. Beauty is as beauty does.

It’s About Time

The Senate has confirmed Dr. Regina Benjamin as our new Surgeon General.

Highly qualified, and much needed, Dr. Benjamin has been kept waiting while politics held up what should have been a quick confirmation. With a flu crisis ongoing, and much work to be done to improve the health of our nation, Dr. Benjamin will be one of our more active and visible public leaders. Good luck to you Doctor, we’re glad you’re on board.

UPDATE: Doctor Nancy puts the role of the Surgeon General in perspective.

AND MORE: Keeping a qualified doctor from serving the American people in a time of crisis was a strategy on behalf of a big insurer. Shocking.

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.

Highly Qualified

The nominee for Surgeon General looks very good–

WASHINGTON – President Barack Obama turned to the Deep South for the next surgeon general, choosing a rural Alabama family physician who made headlines with fierce determination to rebuild her nonprofit medical clinic in the wake of Hurricane Katrina.

Dr. Regina Benjamin is known along Alabama’s impoverished Gulf Coast as a country doctor who makes house calls and doesn’t turn away patients who can’t pay — even as she’s had to find the money to rebuild a clinic repeatedly destroyed by hurricanes and once even fire.

If you can’t recall who the heck was filling the post for the last eight years there’s a reason. A recap of the former Surgeon General’s elusive career is here.

Dr. Carmona wasn’t a hard act to follow, but Dr. Benjamin is facing health care reform, flu season and a recession. We need someone in office, I hope she starts soon.

Help Wanted- Surgeon General. Must Be a Team Player.

August 2, 2006

Today, the news is full of the nation’s spontaneous outpouring of regret, as we bid goodbye to our beloved Surgeon General Dr. Richard Carmona. What, you never heard of him?

When he was confirmed by Congress four years ago, Dr.Carmona, described by a colleague as a ‘charismatic cowboy,’ seemed like the can-do, ‘hell with the bureaucracy’ kind of guy our President likes; a tough-talking emergency room physician who jumped out of helicopters. A man who took out a gun-wielding felon in a confrontation on the highway. A man’s man. He had a reputation for a hot temper, for being difficult to work with. Which makes it all the stranger that during his tenure there was barely a peep out of him.

Compare his career with Surgeon General C. Everett Koop. You probably still remember him from the Reagan years. That’s because he took the politically risky, but admirable course of warning the public about the dangers of HIV/AIDS while advocating for effective prevention and treatment. This good doctor won respect from all points on the political spectrum because he put people ahead of politics

Then there was Dr. Joycelyn Elders. She was a pediatrician who had devoted her career to public health. The religious right had it in for her from the beginning, labeling her ‘The Condom Queen.’ I guess if you’re a Black woman who speaks out, being called a queen is a risk you have to accept. Dr. Elders was at a public forum on sex education, when a questioner asked her if a sex education program would teach young people anything about masturbation. She said that it would be mentioned as one of the topics discussed in teaching human sexuality. All hell broke loose. Now Dr. Elders was portrayed as being on a mission to teach masturbation techniques to the nation’s youth. In case they hadn’t figured it out themselves. President Clinton, showing the style of leadership characteristic of his administration, tossed her overboard.

She was succeeded by Dr. David Satcher,, a family physician, college president, and, like Dr. Elders, an African-American who grew up poor in the South. I admit I had a major crush on him. He came to Rhode Island to speak about health care for the mentally ill, a very under-served population. He was surrounded by a group of cool D.C. professionals, one of whom called the present administration, ‘amazing’. He was so suave it was impossible to tell if he was amazed at the pace of change, or amazed that these nimrods got elected, though I suspect the latter. Dr. Satcher was soft-spoken but politically brave. He supported needle exchange to help reduce the spread of AIDS and Hepatitis. And he set a ten-year plan called ‘Healthy People 2010’, a plan whose goal is to — Increase Quality and Years of Healthy Life and To Eliminate Health Disparities! Is that cool or what? I’m not betting on us eliminating health disparities by 2010, but you have to set the goal. What if President Kennedy told NASA to aim, ‘kind of near the moon’? How far would that get us?

So Dr.Carmona could have just kept the momentum going, but his tenure was marked by what is tactfully called, ‘a low profile’. I suspect that his profile was low because the Bush administration was sitting on his head. We have an administration that is so one-sided, that no one dares to go against the President. Congress should have asked many more hard questions about Dr.Carmona before confirming him, but they are afraid of seeming cranky. The flip side of this is that if Dr.Carmona disagreed with the administration on any issue, there wasn’t anyone likely to stand up for him. (I heard some researchers are working on a way to grow backbones for Democrats.)

What passes for political bravery today is Dr.Carmona’s parting shot, a report that second-hand smoke is bad for you. Who would have thought? This has actually ticked off the tobacco people though, so I should give him credit for doing at least that much.

Was it any loss to have the office fairly inactive for four years? You bet. During that time we had the SARS crisis, a flu vaccine shortage in 2004, and a supply problem in 2005 that had the elderly panicked and public confidence damaged. We continued to have large numbers of Americans unable to access health care, and a Bird Flu threat that may or may not happen. In any case we are totally unprepared. We had people quitting the Food and Drug Administration because politics was suppressing science in the evaluation of the ‘morning after pill’. We have a cervical cancer vaccine that could save lives, but we waste time debating whether it’s moral to use it. We had Hurricane Katrina. Is New Orleans prepared to handle another hurricane? Governor Blanco declared a day of prayer. (I’m praying that some of our politicians are ready to take responsibility for doing their jobs). We have a health care system that spends more money and gets worse outcomes than other developed nations, and it’s not getting better.

I wish Dr. Satcher would apply for the Surgeon General position, or Dr. Elders, or Dr. Koop, although he’s pretty old now. We need a really good, honest and fearless advocate for the nation’s health, and a Congress with the political courage to back them up. I’m not holding my breath.’