Part 2 of 4 of the series When Life and Death is “A Matter of Policy”
Annnnnnnnnd we’re back… in part one of this series, I detailed one policy driven by No Discernable Medical Purpose (NDMP), and that’s the “no foreign ventilator” policy hospitals have, affecting me in the past and maybe at points in the future.
In the past, I blogged about paramedics not wanting to move a dude suffering cardiac arrest “because liability,” No Discernable Medical Purpose (NDMP).
Here in the NY metro area especially, paramedics have been in the spotlight lately… not for good reasons, but in connection with the death of Staten Island gentle giant Eric Garner. Garner, known in his neighborhood as “Big E,” was murdered in broad daylight by an illegal NYPD chokehold for talking back to cops who were harassing him for a past pattern of selling “loosies” (single cigarettes). Garner, who wasn’t even selling anything that day, said “this stops today!” and “please just leave me alone,” among similar things, which apparently constituted resisting arrest and justified initiating force against him—an unarmed man—straight up police brutality. Here in NY, Garner’s murder has occupied conversations, newsprint, blogprint, radio and TV, and the role of the paramedics who seemed to make no effort to resuscitate him was/is being investigated, and the EMS team involved was suspended pending the investigation.
It’s evident from the horrifying footage of Garner’s death that none of the normal medical protocols were followed, and all nurses and doctors who have talked about it on the record (see Eyewitness News 7 report) are unanimously flummoxed and dismayed at the unusually lackadaisical approach EMS took. The New York Times spoke to Dr. Alexander Kuehl, who led Emergency Medical Services in New York City during the ’80s. “She certainly didn’t do her job,” he said of the paramedic girl on the infamous cell phone video of the Garner killing.
“She’s totally overawed by the cops. She doesn’t do her assessment at all. There was something very peculiar about her approach.” (full NYT article)
We may never know the full story. It’s apparent from the horrendous footage that the cops waylaid EMS, saying “not yet,” and also telling the crowd Garner was fine and still breathing in order to avert the whole neighborhood going into full-on rioting (crowd control). But that two EMTs + two paramedics took the NYPD assailant’s word for it and didn’t intervene in any of the usual ways is more than a little discouraging. The decisions made, whether directed by the NYPD on the scene, or driven by weird liability fear-related policies, or the EMS supervisor, or all of the above, self-evidently do not reflect advocating for your patient or serving Any Discernable Medical Purpose.
Recently an EMS-related surreal hospital policy also grabbed headlines (in conjunction with the increased scrutiny around the VA scandal) when the policy directing staff anywhere outside of the main buildings to CALL 911 if a patient collapses was followed, and killed a Vietnam veteran who, through unlucky happenstance, had a heart attack in the hospital cafeteria.
The AP reported:
ALBUQUERQUE, N.M. (AP) — A veteran who collapsed in an Albuquerque Veteran Affairs hospital cafeteria — 500 yards from the emergency room — died after waiting around 20 minutes for an ambulance, officials confirmed Thursday.
It took between 15 and 20 minutes for the ambulance to be dispatched and take the man from one building to the other, which is about a five-minute walk, officials at the hospital said.
Kirtland Air Force Medical Group personnel performed CPR until the ambulance arrived, VA spokeswoman Sonja Brown said.
Staff followed policy in calling 911 when the man collapsed on Monday, she said. “Our policy is under expedited review,” Brown said.
Sadly, this is yet another instance of “No Discernable Medical Purpose” (NDMP). The best medical treatment for this veteran easily WAS NOT waiting for an outside ambulance, after all “every second counts” with a heart attack. What he needed was heroic action by the staff hoofin’ it to get him to the Emergency Room with all possible rapidity, where cardiac crises are something U.S. medicine is set up to handle really well. If their Emergency Dept. has no one who can rapid response with a gurney to code blues in adjacent buildings, that is a matter of leadership and policy too, NDMP as it was not serving a legit medical goal.
Deference to whacked-out policies is baffling, especially in the United States, where you’d expect a bit more spunk and middle-finger wielding to authority figures from the descendants of rebellious colonists who sparked a revolution over the British effort to inhibit their tea smuggling and rum running (among other things). Here, that meek obedience—maybe even “willful blindness“—the higher-ups like to cultivate led to horrible consequences. Sometimes disobedience is needed, even essential, as I also discussed in the post Law and Order: When Is It Wrong to Follow The Law?
In Part 3, I’ll look at the psychology behind the tendency to OBEY, bad incentives at the VA, and how these problems can be ameliorated.
2/4 Series When Life and Death is “A Matter of Policy”
Note: the respect I have for the staff and bond felt with the other patients is very real, and though these diaries vent frustration and the heat felt at the time, their intent is to shed light not heat and to educate about the real world conditions and actual lived experience of disability in public long-term care hospitals. Please understand that I blame policies not people. I want to give Love to the human beings within the surreal constructs I’ve described.
In addition, you should know that the unit A13 I describe and the hospital Coler-Goldwater itself no longer exist in the forms I encountered, having closed/dramatically shifted at the end-of-2013 without the best transition plan for the people there…
I collected everything here for convenient access for readers who’d like an intimate look “on the inside.”
For more information on the mega-crane used to erect the Freedom Tower’s 70-ton “jumbo” steel columns that support the perimeter, click this interview with Quentin Brathwaite, the Port Authority’s assistant director of WTC Construction.
These photos thanks to friend Aaron Auslender; he took them on the way to visit me near-by.
We want that first tower up ASAP! (first dubbed the “Freedom Tower,” then changed back to the original “One World Trade Center” name, for what I think were specific marketing reasons).
It would be a wonderful thing aesthetically, economically, and amazing for morale here in Lower Manhattan and the U.S. in general. It’ll be a great day when we can finally say “enemies knocked it down and we rebuilt it right back even better!”
The important WTC reconstruction is controlled by The Port Authority and lease-holder Silverstein Properties, Inc.. The numerous delays in the reconstruction have been caused by, fundamentally, the conflict between the market and government (Silverstein Properties, Inc., vs. the Port Authority). Silverstein doesn’t want to build any towers unless there’s market demand sufficient to make each one profitable (i.e. corporate anchor tenants who promise to occupy a good part of the building) whereas the Port Authority, a government agency immune from market pressures but under enormous political pressure to get towers built ASAP, just wants the WTC reconstruction completed for the public good, but sucks at getting things done because it’s an unwieldy bureaucracy run by committee. The process has been complicated by the acrimony between the parties; instead of just restating that he doesn’t have the necessary market demand, Mr. Silverstein has often sniped at the Port Authority (a bloated and inefficient bureaucracy trying to turn around an ocean liner and build skyscrapers makes a VERY easy target) and the Port Authority has often attacked Silverstein’s endless delays, even suing him for not beginning construction on every tower as he’d promised. The many snags in planning and financing the new towers (5/6 of them yet to be completed) have made the two sides look like petty, squabbling children, and the mayor and governor occasionally step in to make them play nice “or I’ll stop this car! I swear it! don’t you make me stop this car!”
This year, an “agreement” was reached that ceded complete control over One World Trade Center (“Freedom Tower”) construction and Tower Five construction to the Port Authority, in exchange for total control for Silverstein over the remaining 3 towers. The Port Authority now has One World Trade Center built to about a third of its expected height, with construction crews working 7 days a week. Silverstein Properties, Inc. began building 150 Greenwich Street (Tower Four) in earnest after the deal, and it’s rising quickly, similar to the new 7 World Trade Center that Silverstein completed in ’06, the first (and, so far, only) one rebuilt.
The construction on the other towers isn’t visible above ground level yet. According to Mr. Silverstein himself, Tower Two may not be in the cards in the foreseeable future; the new agreement calls for important underground parts to be finished, leveled off at street level and just left that way until Silverstein decides “market conditions” justify building Tower Two. Given the fact that owners of existing office buildings can’t sell their office space at current prices (almost 15% class-A commercial office space vacancy in Downtown Manhattan) and would rather suffer abnormally high vacancy rates than bring their rent prices down to sane, reasonable levels, the future looks bleak for the beautiful Tower Two design. Real estate moguls are already panicking that just the space added by One World Trade Center/Freedom Tower, expected completed in Q2 2013 and open for business in Q4 2013, will push the downtown vacancy rate for class-A office space to 20.6% (hat tip, New York Observer). That’s just Tower One, the impact of Tower Two is inconceivable for downtown money lords, who want prices to “recover” to the ridiculous heights seen during the last bubble. In short, the “invisible hand of the market” gives the finger to building Tower Two because of the manipulation of the INVISIBLE FIST; it doesn’t want any more vacant office space that could put downward pressure on rents and result in fairer prices. They want to keep supply low so rip-off prices can continue. I think that SUCKS. The Tower Two design is such a stunning, gorgeous centerpiece to the whole WTC block, an essential counter to the Statue of Liberty-inspired “Freedom Tower,” that I can’t imagine the WTC without it! See models and CGI renderings of it here. We need Tower Two!
The WTC site just doesn’t make sense without Tower Two. We need Tower Two! If people don’t want commercial office space, they could convert it to recreation space (a movie theater!) and/or a performing arts center and/or a hotel, or even apartments! it doesn’t have to be 100% office space! Lower Manhattan has great needs for more facilities and services; Tower Two should not be scrapped!
Speak out, comment below! Should the “invisible fist” decide? Or should government override “market conditions” and build the entire WTC site, all 5 planned new towers, as (awesomely) designed by Daniel Libeskind and David Childs?
Here are some great links if you want to learn about the new WTC towers planned for construction.
I’m that guy in the neighborhood. Believe it or not, we live in an apartment only 6-8 blocks or so north of the disputed Park51 site, so this is about MY NEIGHBORHOOD and I feel I’m a direct stakeholder in this controversy, so I should weigh in.
Knowledge of the neighborhood, and of the culture and dynamics of New York City itself, is badly missing from this “debate.” Most of the opposition never frequents these parts of Lower Manhattan; they come from other places, often hundreds of miles away or farther, to protest.
I know that New Yorkers do view the 16 acre (65,000 m2) superblock where the World Trade Center buildings stood as hallowed ground. New Yorkers have been very offended by the petty squabbles between The Port Authority, WTC lease-holder Larry Silverstein and various insurers that delayed any work on rebuilding until April 27, 2006. The planned permanent memorial and visitor center isn’t completed despite promises it would be. The September 11 Families’ Association has often decried the crass commercial activity surrounding the site, with illegal vendors yelling to sell tourists tacky Chinese-made 9/11 memorabilia like Twin Towers snowglobes and bad commemorative booklets with inaccurate Engrish text and pirated photographs, for absurdly high prices. See Hawking History and Cutting Corners for details about the situation.
The fact that the site has shameless vendors hawking tasteless souvenirs but not the promised memorial is a festering wound for a lot of New Yorkers. THAT offends us living in Lower Manhattan, not an Islamic YMCA that might be built two full blocks north (conservatives respond: you’re not offended by this in your neighborhood! we’ll be offended x1000 FOR YOU!)
Insensitive out-of-towners asking everybody on the bus “how do I get to Ground Zero?!” like it’s just another tourist attraction and go to buy those tacky knickknacks is pretty offensive though, and many of us connect those clueless tourists with the clueless out-of-towners (who often take after the willful ignorance satirized here in The Onion) pouring into the city to protest in a neighborhood they’ve never frequented and don’t remotely understand. A recent Marist poll confirms what I’m saying, only 31% of Manhattan residents say the Cordoba House offends them, whereas opposition goes up the further away from the area they poll (53% against if you count all five boroughs, 68% if you ask people in all 50 states). Misunderstanding the situation and hating this is “roughly proportional to distance” from it (from a great Hendrik Hertzberg op-ed).
Yes, the actual World Trade Center site (can we stop calling it Ground Zero, a misused term from douchebag news anchors, please???) is hallowed ground, but the surrounding area? Those surrounding blocks are no different than the rest of this Lower Manhattan neighborhood. It’s a place constantly changing, lots of run down buildings waiting for redevelopment beside gleaming corporate towers, Wall Street titans, tons of office space, churches, mosques, old stores, tacky souvenirs, “adult entertainment,” and more, as market forces (self-interest, competition and supply and demand: AKA the invisible hand of the market) continually puts businesses and other facilities in the city, and because it’s NYC, everything is right next to everything (placed to serve the concentrated demand in such a tight, concentrated space of real estate). That’s right, the blocks surrounding the WTC have STRIP CLUBS, Burger Kings, everything–NOT “hallowed ground.”
I heard a host on NPR asking an outspoken opponent of Park51 what about the (actually a mosque) mosques also near the WTC, and he said “well, that preexisted 9/11 so they’re grandfathered in” but there should be no FURTHER mosques constructed in the area. When told that the Park51 project is modeled after the 92nd St Y, and is, by no definition (in Islam nor in the dictionary) “a mosque,” this guy brushed it off, disbelieving. What would he have said if told of the strippers, gambling and other low-brow establishments even closer to the WTC site? “How dare you say strip clubs aren’t sacred ground!!!”?? It’s like the opponents of this REALLY BELIEVE that this project (construction not slated to begin until 2015 or later) will be some huge domed mosque with minarets towering over “Ground Zero” and the muezzin’s call to prayer echoing off rubble and skeleton fragments as Taliban wield rifle butts to corral women in burqas. Nothing but fiction!!! It seems NOTHING can penetrate this fictitious narrative that the Right clings to, NOTHING. The machine (political/media machines) must have an enemy. The beast must be fed red meat to survive. The age-old bread and circus to distract the masses. The machine is all that matters–founding principles, the Constitution, even the physical safety of a religious minority BE DAMNED!
And it’s primarily fueled by lies and distortions ginned up by the shameless, ratings whores in cable news.
Violence is escalating now. A Bangladeshi cab driver was asked if he was Muslim and then brutally stabbed in midtown. Five teens were arrested in Waterport, upstate NY for firing at a mosque and disrupting a religious service. This has grown and grown beyond just a media distraction to threaten the peace and stability of our country, as well as our Constitutional principles and national soul.
Is religious freedom and the right of private property trumped by angry mobs ginned up by hate and fear? Are we at war with Islam itself and reject anything related to Islam on U.S. soil? (anti-Islam forces are battling Muslims trying to build on their own private property in Staten Island, Brooklyn, Tennessee, Kentucky, Florida, California…and arsonists attacked the construction in Tennessee.) Are we already at war with 1.5 BILLION believers? if so, time for a draft. What are we at war with? How can we win over Iraq and Afghanistan, which hinges on “hearts and minds,” if we paint all Muslims as terrorists hell-bent on destruction? IT’S DECISION TIME!
Amid all this turmoil, the mainstream media wall-to-wall hate speech, countrymen set against each other, friends de-friending each other on facebook, what should those of us who want a teaching moment about religious liberty, private property and anti-violence DO?
I made the video blog below, my response to the right-wing talking heads on your TVs and internets about this project, really a Y to be built in a disused Burlington Coat Factory IN MY NEIGHBORHOOD! SuperAleja edited in captions for the Nick impaired.
My main points: the Burlington Coat Factory isn’t hallowed ground. Park51 is not a mosque and it is not at “Ground Zero,” and Islam is not evil.
Warning: the clips of right-wing talking heads spewing hate speech I use may be offensive and difficult to watch. Dick Morris paints all Muslims as radical enemies and says “all the other (mosques)” are “command centers for terrorism,” Newt Gingrich calls the people behind the Park51 project “radical Islamists” and compares the building to “a Nazi sign in front of the Holocaust museum” and self-described Christian conservatives are shown burning the Koran. I cringe seeing these clips, but we must recognize the bigotry in this country in order to squelch it and lower the heat of this issue.
Transcript of the video blog:
Hello, this is Nick Dupree for nickscrusade.org. And because I live only 4 or 5 blocks from this proposed Islamic community Center that has consumed all of American politics, I thought I should comment.
All the arguments against this thing rely on the idea that Islam is somehow related to 9/11. And it would be like putting a statue of Hitler next to a Holocaust memorial; it would be like building a Robert Oppenheim school of nuclear science at Hiroshima. All these arguments are pure crap. Islam has nothing to do with 9/11, any more than Christianity has to do with the KKK. By the same logic, we couldn’t build a church near Atlanta’s Millennium Park because of the Christian extremists who bombed it. Or they say, it’s “hallowed ground”.
Oh no, you must not build on this hallowed ground! Okay, come on. It’s two blocks, two full city blocks, away from the World Trade Center. City blocks in New York City are huge, and there’s an entire culture in each city block different from the other ones. The city blocks around the World Trade Center already have everything–there’s already mosques, there are churches, there are strip clubs, there’s adult bookstores, there’s everything already in the surrounding blocks. And the place that they want to put this thing, is in a disused Burlington Coat Factory, for pete’s sake.
[Burlington Coat Factory commercial]
[NYC landmark commission unanimously ruling that there’s no reason to make the old Burlington Coat Factory an untouchable city landmark]
Come on! Stop telling me that the Burlington freaking Coat Factory is hallowed ground! It’s not on the site of the World Trade Center, and, it’s not a mosque, it’s an old Burlington Coat Factory. It’s going to be a community center like a YMCA, you know, with a gym, and a swimming pool, a culinary school, a food court, classrooms….. only a tiny part of it is going to be for prayer. And what’s so wrong about prayer? Don’t we have freedom of prayer, freedom of religion, and our very Constitution?
It’s not a mosque, there’s no minarets towering over the city. There’s no muezzin calling for prayer. It’s a crap argument. It shouldn’t even be a story, it’s a YMCA, for all intents and purposes. And they have the freedom to build what they want on their own property. It’s property rights, and a municipal land-use issue. It should be decided by those in the neighborhood, like myself.
Not the worst bigots in the country from a crazy church that wants to burn the Koran. [local Jacksonville news clip about this church’s “Burn A Koran” day]
Pat Robertson [clip of Robertson talking about “Cordoba mosque” (sic) on the 700 Club]
Dick Morris, [clip of O’Reilly interviewing Morris]
Newt Gingrich, [clip of Gingrich spewing hate speech on the Fox News morning show]
should these bigots decide what goes in my neighborhood, or should I decide it? Really it’s a no-brainer. Angry bigots, thousands of miles away, should not be deciding this. I, and the rest of the neighborhood, should decide it. There’s nothing dangerous, there’s nothing sinister, about the people that are behind this project, who are moderates. And they’re being painted, along with the entire religion of Islam, as evil. If we’re going to paint an entire religion of a billion and a half people with the same brush, then why would they make peace with us, why would anything change? So, the hate that we’re hearing all over the media… friends de-friending each other on Facebook over this, it really needs to stop. It’s a YMCA. Please, let the neighborhood decide this.
Please spread this blog post and video. Truth, justice and the American way will only exist to the extent we make it exist.
This is the 1337th post on nickscrusade.org. 1337!!!
On September 10, 2009, Nick Dupree was able to leave the rehab hospital in New York City where he had been living for approx. 378 days after moving from Mobile Alabama (well after his previous crusade), while waiting to get services and supports established to live in the community.
It’s a wait that’s shorter than many others, but longer than he’d expected or hoped would be the case. Luckily he is now home, and working on next steps, next battles to be fought.
To all those listening, supporting, and watching along the way, he gives thanks. He’ll continue to write and fight about things that are just and unjust as he adjusts to a new standard of living.
So, the U.S. has now signed on to the historic UN Convention on the Rights of People with Disabilities (CRPD). People are saying this is wonderful, the ACLU is saying that it marks America’s return as a world human rights leader (by the way, the Senate has yet to ratify the treaty). I’m concerned that this is largely happy talk, just more lip service while meanwhile we’re badlybehind in enforcing the Rehab Act, the ADA, Olmstead, and the other disability rights legislation we’ve fought so hard for. Will the CRPA become yet another unenforced law on top of that growing pile? Particularly grating to me was this commentary on AAPD’s Justice For All blog, which closes with this:
The US can engage in meaningful partnerships across sectors and help developing nations with the construction of accessible infrastructure, expanding inclusive education and vocational training opportunities. By signing the Convention the US is dedicated to these efforts. Can we make a different, “Yes We Can!”
Wut?? The U.S. is going to be like the Peace Corps for accessibility of the third-world’s infrastructure or some $#!T?! PLEASE!! We can’t even implement our own disability rights laws! As we speak, the feds are moving against ENTIRE TOWNS that are inaccessible and violating the ADA! Don’t send the Accessibility Corps to Africa or India; first send them to renovate the Mobile Public Schools! First send them to Ann St. in Lower Manhattan, where most of the businesses are inaccessible, and all over the five boroughs, where inaccessible pre-war buildings seem to be the rule, not the exception. Where’s the US’ “meaningful partnerships across sectors” to address this inaccessible McDonald’s on 429 7th Ave. off W 34th, which is a major tourist area?
We weren’t looking for some McDs yesterday, we were searching for pizza. The Spinelli’s pizza next door was accessible. When a locally-owned pizzeria tops a mega-giant multi-national chain in basic accessibility, that gigantic corporation needs to do some rethinking. As a special double bird to the elderly and disabled, this particular McDonald’s location has accessible entrances on either side of the stairs…that only open from the INSIDE, and only lead to stairs for the basement, staff confirmed. That leaves the middle stairs as the only access point for this location. Well done 7th Ave. McDonald’s, that’s some top-notch FAIL!
The U.S. has a lot of changes to make before we are a disability rights leader, an example to follow.
Any idea of when I’ll be able to access currently INACCESSIBLE public businesses? Maybe for the ADA’s 29th anniversary? 39th? Dammit, where’s the enforcement? We have no room to finger-wag and advise other countries about disability rights!
Nadina LaSpina (NYC ADAPT) gives a powerful, stirring speech about how far disability rights has yet to go, and Elaine Kolb sings an insightful song about the medical-institutional complex at the 19th ADA Anniversary Event in Central Park, July 26, 2009.
Dr. Jen Gunter
OB/GYN Jen Gunter wields the lasso of truth, reining in issues of women’s health, reproductive care and the insanities of American health care.
Health Care Renewal
Dr. Roy Poses blogs fearlessly against the corruption and lies in the halls of power of the medical industry.
Under the tagline “Thoughts from the Front Line of Physician Leadership,” Dr. Hein runs down the true issues in U.S. health care beyond the headlines and press releases.
Not Running a Hospital
Paul Levy deserves not only an award for blog activism against “preventable harm”-ing patients, but an award for blog journalism, as he expertly collects the facts on what health care corps are really doing…