Month: June 2020

June 21, 2020

[Ed. Previously published April 16, 2015.]

There are some things about which I know very little. This is not one of them.

As many in the press have been too quick to proclaim, this case does point out a serious problem with the policies that govern the behavior of the police in this country. But the press, impelled by the desire to be the first to sensationalize an event and fan the lucrative flames of racial hatred and civil discord, have it ass backwards. 

They immediately raised the alarm because the Tulsa County deputy was a 73-year-old man and a volunteer who also donates a lot of money and equipment to the department.

“Wealthy donor… who pays to play cop” is the way the RAWSTORY blog put it, and every other news outlet including CNN questions whether his age was a factor. 

NBC news referred to the usual “unarmed black man”, ignoring the fact that the man, a drug and gun dealer on PCP, was fleeing from the scene of a sting wherein he was recorded selling a pistol to an undercover cop. Caught after a chase, he was struggling with police, pinned prone on the ground. Under the circumstances the only safe assumption was that he was still armed, given that he had one hand under him in his waistband and was refusing to take it out to be handcuffed.

Yet the media story became about a volunteer deputy, “playing” cop, who was assumed to be untrained and incompetent, who grabbed the wrong tool and shot the “black man” who proved, after the fact, to be “unarmed”.

First let‘s stop and recall that the exact same scene played out in Oakland, California a few years ago. There, a Bay Area Rapid Transit (BART) cop tried to tase a black teen, resisting on the train platform as cops, pinning him on his belly, struggled to arrest him during a manhunt for several black youths who had immediately previously been using a pistol to intimidate train passengers. At the time his department foolishly didn’t specify that the service pistol and the taser were to be worn on opposite sides of the duty belt. In the heat of the struggle, the officer grabbed the wrong one and shot the teen in the back thinking he was tasing him.

In that case the narrative advanced by the press and the black community included the implication that the cop was young, inexperienced and likely undertrained. There was also, as there will surely be in this case, the assertion that he was careless because, to him, black lives did not matter. Never mind that this latter allegation was completely contrary to anything anyone knew or learned about the officer before or after the incident. When he was found guilty of involuntary manslaughter and not intentional murder, there was raging, rioting, looting, and arson in Oakland, resulting in the arrests of 80 people. 

Returning to the matter at hand, in the interest of full disclosure I must reveal that I have been a volunteer with the Sheriff’s Office for a few years each in two separate counties. I was a ham radio operator member of the Alameda County S.O. Communications Team, including the time of the Oakland shooting, and heard second-hand accounts on the very day of the incident from the deputies of the Special Response Unit (SRU) with whom I also volunteered on the Sheriff’s 85-foot, high-speed patrol boat. At the time I, too, was in my mid-seventies.

We ham operators who were part of the disaster and emergency communications team did not participate in any law enforcement duties, though it was a slightly different story on the patrol boat. That boat assisted the coast guard in dangerous cargo inspections of incoming freighters, including, on one occasion, escorting a captured Colombian drug ship carrying half a billion dollars worth of drugs. Because there were many similar port security circumstances in which our patrol boat and everyone on it could possibly have become engaged in a fire-fight, (think McHale’s Navy without the torpedoes, but with the machine guns). the civilian volunteer on the boat (that would be me) was required to have a Concealed Carry Weapon’s permit, rare as hen’s teeth in California and requiring eight hours of annual training in the classroom and at the pistol range. Moreover, in both counties in which I served, volunteers underwent the same F.B.I.-based background check as applicants for sworn deputy positions.

But the chance I would ever have to participate in combat in Alameda County was extremely remote, and my main duty, in addition to setting up and operating ham communications between the boat and the County Emergency Operations Center, was to help the chief engineer with engine maintenance and repairs.

Far different when I moved a few years later to the Phoenix area and joined the Maricopa County Sheriff’s Office Communications Posse. That county is larger (9,226 square miles) than five different states and the District of Columbia, while being home to just under four million people. The sheriff enforces the law with something under a thousand sworn deputies, augmented by a number of specialized “posses” totaling about 3500 men and women of all ages.

In Maricopa county there is an extensive training curriculum through which posse members can qualify to, for instance, direct traffic, use restraints, (cuffs), search and transport prisoners, and even carry and deploy tasers, pepper spray and firearms. It can take a couple of years to go through all the training. I know because I took about half the training: including engaging in hand-to-hand combat with criminals. That training was very illuminating to me, as I was at the time approaching 80, my age at the time of this writing. I was doing well enough on gym mats with classmates a third my age who were only engaging in mock combat with me. The only reason I didn’t complete the training and go on to the pistol range, where I am already more than proficient, is because there came a time when I had to repeat all the techniques I had just learned, but after being sprayed in the face with real pepper spray. That I could not allow. For one thing I’ve had both cataract and glaucoma surgery on both eyes. For another, I have extensive scarring in my lungs from a pneumonia I had ten years ago. I simply couldn’t allow myself to be sprayed in the face with and to breathe capsaicin. As it turned out, there was no possibility for a waiver, since a posse member’s life, and that of the deputy with whom he or she is working, might depend upon being able to fight and call on the radio for help after being sprayed with pepper spray. 

In Maricopa county a posse member may volunteer for patrol duties, riding with a deputy, or for transporting prisoners to jail from the point of arrest in cage-cars. Qualified, armed posse (QAP) members may volunteer to assist at DUI check-points or go out with task forces serving felony warrants.

I had a major epiphany as I underwent the training in the application of “less than lethal” force. Not only did I finally fully concede that I was a fat old man incapable of taking down a tattooed psychopath with muscles developed at a jailhouse “muscle beach”,  but it became clear to me at last what we actually ask our police men and women to do when they go to work each day. They are expected to chase down and wrestle physically with the scum of the underworld, without killing them or applying any force that some political activist sitting safe in an armchair with a permanent animosity towards cops will, after the fact, decide to call “unnecessary”.

In the back of my mind had been the illusion that it would be sufficient that while I might no longer be able to fight, I could still shoot the eye out of a gnat.

As a physician and surgeon, standing in the operating room for hours repairing actual consequences, I know that real fights are not like the movies or TV, where actors trade punches for several minutes, only suffering a smear of fake blood at the corner of the mouth when it is all over. In real fights a single punch can collapse the bones of the face like eggshells, resulting in several months of surgeries followed by only a partial restoration of function. Or a broken blood vessel in the brain can result in death within minutes. 

To me it is perfectly clear that someone who throws a simple punch at me is putting me in real danger of grievous bodily harm or death, justifying the use of deadly force in self- defense. But the segment of the public with inverted values doesn’t see it that way, and insists that the police who protect the community use, even at the risk of their own lives and in the heat of the moment, the least possible force, doing everything to avoid hurting the poor drugged out, drunk or insane psychopath coming at them. This bizarre combination of medical ignorance and belief in movie “fight mythology”, is compounded by racial politics when the criminal is black. 

In the black communities of the inner city the prevailing narrative has become that the police are to be mistrusted and reviled, and that black young men are “unarmed” and “innocent” even when engaged in serious crimes. It is as if many in the black community feel that on the basis of past mistreatment, blacks have “earned the right” to be criminals, and to flee from or fight with police when apprehended.

It seems reasonable to suspect that this inversion is somehow related to that which has been found in sociological studies in school systems. Whereas popularity seems to track along with academic accomplishment among white students, among black students popularity and esteem are bestowed in inverse proportion to academic ranking. Black students who do well in class and speak standard English become objects of contempt among other black students. Those who copy the speech, dress, behavior and values of their fathers and older brothers in street gangs and county lockup are the sub-cultural leaders. 

On the street in the inner cities, the cops are fair game and the cons are the folk heroes. According to my observation of what is reported in the media, this false narrative is shared, or at least exploited by anarchists, liberal activists, the media, academics and the liberal white establishment, who consistently minimize the significance of criminal values and behavior, and wildly exaggerate or wholly invent the misdeeds of the police. For the average street cop, most of whom, naturally, are assigned to patrol the areas of highest crime, the general adoption of this inversion of values, and concomitant restraints on police behavior has amounted to handicapping the good guys and giving the advantage to criminals. It is as if, “no good deed goes unpunished”.

In a world where one is expected to use Marquis of Queensbury rules while fighting with 250-pound street thugs, what of the aging officer, slower and fatter than when a youth? What of smaller officers? Outnumbered officers? What of women officers? Do we have the resources to pension police officers off like millionaire athletes when they begin to lose peak physical conditioning?  Or like movie stars when they begin to show a few wrinkles?

Now on the steepening downslope of senescence, when I was undergoing volunteer posse training I had little interest in elective courses in the use of pepper spray or tasers. Instinct told me that my only chance of surviving an assault by a younger, quicker, stronger attacker would be to shoot him dead. That, essentially, would be the “least possible force” I would be able to employ successfully.

Not a problem for me philosophically or morally. If some big guy comes at me with the expressed intent to throwing the old guy down and kicking him to death, he has just forfeited his right to live.

What my police training revealed to me, not in so many words but very clearly, was that shooting an attacker is not what the community expects of its police officers, and that in my present aged state I am not a good match for the job.
Even though I would not have volunteered for any of the overtly dangerous jobs, law enforcement volunteers in Maricopa County are advised that whenever they are wearing the uniform, indistinguishable for that of a sworn deputy save for the fine print on the shield, they should wear bulletproof vests, because the uniform is a target for bad guys. Predators seek out the defenseless. 

At 2 pm on New Year’s Eve in 2013, an Arizona police officer was in pursuit of several men fleeing in a car from the scene of an armed robbery. When they crashed at an intersection the officer jumped out of his car and approached the suspect vehicle. To prevent them from driving off again, he ordered the men witnesses said looked like NFL line-backers, out of the car. Immediately the men grappled with the officer, trying to get his gun.

A 63-year-old Sheriff’s volunteer posse member in civilian clothes, having been stopped in the intersection because of the collision, jumped from his truck and ran to assist the police officer, just as one robber gained control of the officer’s pistol. The felon shot first at the man running to help the officer, hitting him in the center of mass. The bullet exploded his stomach and fractured his liver and one kidney. Then the bad guy shot the officer. Both survived, but the posse member just barely. All but ruined financially by months of hospital bills, the posse volunteer was refused the usual workers compensation medical coverage because he was not under a deputy’s orders at the time he ran to help the city cop.

Was he too old to try to help?

In my own late seventies I had decided even before my training that I would never volunteer for duties that involved backing up a deputy on patrol. Bad enough if I were not able to assist him or her fully. It would have been even worse, I reasoned, if in a dangerous situation the deputy, in addition to everything else, also had to worry about my safety. It would defeat the whole purpose of volunteering. My original intention in joining the posse was to help my community by using ham communications to back up county radios during time of disaster or emergency.  As I mentioned, I only took the more advanced training because I would only have felt safe while wearing the required deputy’s uniform if I had been armed. 

Regardless: when did it become acceptable for a criminal to attack any deputy, regardless of age? When did we turn our sympathies and our support upside down, and give them to the criminal instead of the lawman? This is an idea so absurd and indefensible that the only way to argue for it is with racial demagoguery and rioting. It is because there is no reasonable argument to be made that supporters of a false narrative turn to bullying and intimidation. 

The outcome I fear is that there will an outcry by the usual advocates of racial anarchy, one of whom, in 2015 at the time of this writing, is an advisor on racial policy to the President. Moreover, I expect an inquiry may be pursued by the federal Department of Justice under its racially biased leadership, to attack the policy of using volunteers in local policing. While both the national and the local Tulsa County issues are worthy of close review, deliberations should not be contaminated by the present atmosphere of racist animosity against the police. In my experience, there is a lot more good about the institution of police volunteerism than there is bad. 

END 

June 21, 2020

[Ed. Previously published August 4, 2019.]

This will be a a discussion about the factors that allowed Andreas Lubitz, young Germanwings co-pilot, to crash an airliner into the French Alps at 700 miles per hour, killing himself and 149 others, without anyone who knew of his mental instability preventing him from continuing on active flight status.  These are some of the reasons why it could happen in Germany why its is much less likely to happen in the Unite4d States.

After 17 years of practice as a Family Physician, I worked for the decade of the 1980’s as an Occupational and Environmental physician, heading up the SFO regional medical department of a major airline.

Following World War I, when it had been discovered that about as many pilots were lost to accidents caused by their own ill health as were shot down by the enemy, the military established the position of Flight Surgeon, and gave medical officers with that designation the power to determine pilot fitness for duty, and even the power to overrule the orders of line commanders regarding flight status. By the 1980’s, several airlines had full-service medical departments dealing with employment health and injuries. Their Flight Surgeons worked closely with the FAA’s Aeromedical Certification Branch in Oklahoma City, and had primary lines of responsibility to flight safety, the employees and the airline itself.
When I was an airline’s regional flight surgeon at SFO, which included our maintenance base, we served 25,000 local employees, of which a couple of thousand were pilots.

Not every airline had a medical department, and the jobs of my staff of 20 were constantly in jeopardy during the decade of the ‘80s, when hostile takeovers were rampant and “deregulation” had struck the aviation industry, resulting in dozens of little start-up airlines with no debt or pension load. The start-ups undercut prices severely, and the established airlines struggled to cut costs in order to compete.
Management debated year after year regarding whether to shut down the company medical department and rely upon outside contractors to provide “occupational medicine” support.

As one of the first in the company to be issued an IBM personal computer in about 1983, a departure from the corporate practice of doing everything on a huge mainframe, my hobby interest in computing had led me to write a very large relational database program on my PC that tracked demographic, medical and disability data resulting from the more than 2,000 visits per months to our medical department. Before it was over I had collected data on more than 100,000 consecutive visits to the medical department. As a result, my monthly reports were able to show that while it cost about a million dollars a year to fund my regional medical department, if the company had outsourced only the federally mandated exams, less than half our workload, to outside occupational medical clinics, it would have cost twice our department’s annual budget.

Our regional facility did pre-employment exams, with drug testing, on all employees except pilots, who were hired and drug tested by a special team at the airline’s training center in Denver. We saw all work injuries and did “fitness for duty” or return-to-work determinations on all employees, including pilots. In my experience over the years, outside doctors rarely if ever had the slightest idea what the various jobs of our employees entailed. They didn’t know, for instance, that pilots were forbidden from taking any of dozens of common medications, including any sedatives, depressants, anti-depressants, anti-seizure medications, anti-histamines, etc, etc, etc. Which is why any flight crew return-to-duty order by an outside doctor had to be rechecked by my staff of two other flight surgeons, two nurse practitioners and myself. 

The FAA requires an annual or six-month physical for pilots. It is cursory, but covers certain critical things, like eye exams and an EKG. In addition to those exams, we also did a very comprehensive annual physical on our pilots,
which covered every aspect of life and health. Always including an inquiry into alcohol consumption and medications and a question about street drugs and nicotine use.

The general rule in aviation is that no pilot may resume flying if suffering from any condition which could cause “sudden or insidious incapacitation” in the cockpit.
It should be understood that the best defense against cryptic illness or drug use was the integrity of the pilot himself or herself, who was obligated by law to report any significant change in health. It was, and is still the case that any significant adverse change in health, reported or not, automatically voids the pilot’s official federal medical certificate, and with it his or her license to fly.

In the hiring process each pilot was administered a full battery of psychological tests, administered by psychologists, and was interviewed by our full-time company MD-psychiatrist.

The company also had a very active Employee Assistance Program (EAP), and participated as a founding member, along with the Airline Pilot’s Association (ALPA) and the FAA, of the Human Intervention and Motivation Study (HIMS).
Our EAP, medical, and union reps all participated in week- long annual trainings in intervention, evaluation and monitoring of pilots with alcohol or related substance abuse, dependency or mental health problems.

We did group interventions, with employer union and family members present, upon pilots who were brought to our attention by family or fellow pilots, or who showed abnormalities in, for instance, liver function tests. 

After a 28-day inpatient program and a couple of months of successful and whole-hearted participation in a 12-step program, it was my responsibility to decide whether it was safe to return the pilot to the cockpit. Upon my recommendation to the FAA chief psychiatrist in Washington, the pilot’s license was restored and he returned to work while being monitored by my group for an additional few months. Following which he or she was questioned extensively during the annual physical. 

The HIMS program was the first of its kind and was the pattern for ones now used for physicians, and people in other jobs where public safety is key. The recovery rate for pilots during the 80’s was 96%. This past year some addiction specialists have questioned whether my assertion of that recovery rate is credible. There are few records or reports still available on-line, but those that remain confirm that it was in that range, and that number is my personal recollection regarding a program in which I was deeply involved. 

Pilots who were not detected before committing a firing offense, like showing up in the cockpit drunk, were fired, then invited to use their full medical benefits to undergo several months of treatment and AA follow-up.

Not all airlines participated in the HIMS program. Some maintained, “We don’t have any alcoholic pilots”.  Yeah. Right.

During the years I worked for the airline, three other airlines closed their medical departments and relied solely upon the exams done by FAA Aviation Medical Examiners, (AME’s), private physicians designated by the FAA to do physical exams on pilots.

My impression is that at this point in the US very few airlines have their own medical department, though they may have a “medical director’ and contract with clinic groups who by now have become as knowledgeable about FAA requirements and flight safety as we were at my airline. 

On the other hand, perhaps because of the extensive spying that was done upon citizens in East Germany and the egregious misuse of private information thus obtained, at the time of the crash of Germanwings Flight 9525m Germant had very strict laws regarding the privacy of mental health issues.  The laws were so strict that they prevented the flow of information from several mental health professionals aware of Lubitz’ suicidal nature, from ever reaching management decision-makers at Germanwings. 

In the U.S. we have a similar problem regarding the reporting of dangerous mental conditions to those who maintain the National Instant Criminal Background System (NICS), in order to prevent certain mentally ill people from obtaining firearms. According to my most recent look at the numbers, only about 46 states require reporting. Of those, many do not forward the reports from the responsible state agency to the FBI for inclusion in the NICS database. While states require hospitals and institutions to report, and may include mandatory reporting for judicial determinations of mental illness or incompetence, there is rarely a requirement for treating physicians or clinicians to report mental illness, in the way that reporting is required for obvious reasons of public safety for venereal disease or infectious diseases like measles.

In the U.S., when there is a full airline medical department, the employer has an in-house expert who can evaluate outside medical information and pass real-time judgment on fitness for duty. Privacy insulation comes from the fact that the in-house medical team passes only a disability status recommendation to management, and not any specific medical information. At the same time management is able to be absolutely sure that company physician recommendations will conform to flight safety requirements, and that an airline doctor understands precisely what they are and what is at stake. That confidence also descends from the federal government.  At my airline we were actually also designated as Senior AME’s by the FAA, as FAA Medical Sponsors in the HIMS program and as drug test Medical Review Officers (MRO) for the Department of Transportation, so we had a strong line of responsibility to the federal government and public safety, as well as one to the company. 

The Germanwings crash triggered a debate regarding the withholding of information by mental health practitioners from the company medical staff.  And Even such information as was communicated to company medical officers was not given to managers in charge of pilot assignments.  Even then, medical and aviation officials argues against relaxing the confidentiality rules.  A year after the crash, investigators recommended allowing physicians to report known dangers to authorities.  Years afterward the problem has been addressed in some countries and remains unresolved in others.

END

June 18,2020

[Previously published October 4, 2018]

OK,  now this is pretty funny.

I think it has to do with the idea of Richard Dawkins’ memes, which definition I find it difficult to keep in mind.  But in this case it is a TV meme rather than an internet one, although there is crossover in that many people obtain their news videos on various websites.

Anyhow, back to the word, used a zillion times this week in relation to the Kavanaugh confirmation hearings.  The actual word, or perhaps I should say the word up until now, has been corroborate.  From the Latin prefix: co (cor), together, and robarare, to strengthen.

Note that there are no “w”’s in the word.

There is, however, a very common and well-known Elmer Fudd speech impediment, where he refers to Bugs Bunny as “that Wascally Wabbit!”, also exploited by the scientist character in “The Big Bang Theory” called Barry Kripke.  He refers to himself as “Bawwy”, and pronounces every r as a w.

In this day and age, when to mock a disability is a mortal sin, it is hard for me  to understand how anyone can get away with making fun of a speech impediment, but there you have it.

There is, and I wish I could remember who it is, a news reporter  who has a mild form of this speech impediment, and manages a sound that is half-way between the r and the w.  I think I recall that Barbara Walters had a touch of it as well.  But this week there have also been several non-lawyer senators and others, who, even initially, used the Elmer Fudd pronunciation.

Almost everyone with legal training has learned how to pronounce corroborate properly because it is such an important idea in the law, that testimony often requires corroboration in order to become credible.  But the countervailing influence in this case is the tendency for any repeated usage to become a meme by simple mimicry.  In the case of TV news, one can hear a linguistic error, uttered by one newscaster early in the morning, spread to several others, even on other channels or in other countries, by the end of the day.

By my count, about 40% of the people using the word corroborate, after just over a week of the Christine Ford controversy, are saying “cowwoborate”.  Strangely, they morph the first two r’s into w, then leave the last r unchanged.  Proving this is clearly a meme rather than a contagious speech impediment.

Watching the news just now, I found myself yelling, “IT’S CORROBORATE!” at the images on the screen.  They didn’t care a bit.  Within a decade sixth-grade teachers will be teaching: “cowwoborate, c-o-w-w-o-b-o-r-a-t-e, cowwoborate”.

And now you will know why.

END

June 13, 2020

[Previously published January 13, 2020.]

Given that the number one topic this week is impeachment, I thought it would be useful to consider what the word means and how it is used in the modern world in less extraordinary circumstances.

The first step for me in understanding the idea conveyed by a word is always to look at the derivation of the word, which usually means its Latin or Greek origins.

In this case the Latin origin is from “impedicare”, to catch or entangle, which is based in turn on, “pedica”, to fetter, which is based in turn on “pes, pedis”, meaning foot.   

Unbeknownst to those who are employing impeachment at the moment, this meaning, to trip someone up, reveals what may be their basic agenda.

The thesaurus gives us these synonyms for impeachment: to challenge, question, disparage, criticize, call into question, raise doubts about, cast aspersions on.  Thinking about the actions described by those verbs, it is clear that they could be called “pre” (or ‘extra’) legal, insofar as all they require is a naked, or even a false accusation, or a mere innuendo, that may or may not provide sufficient probable cause to take to a grand jury or court to obtain an indictment.  That is to say, that impeachment, by linguistic definition alone, does not set any evidentiary or procedural standards, nor insist upon any legal protections for the accused.  Which may explain why Trump’s political enemies may have chosen to employ this process and have thus far denied him the protections of our laws, and of our highest law, the Constitution.

Yet far more common than impeachment of a president, or even another such government official, the process of challenging, questioning, disparaging, criticizing, calling into question, raising doubts about, or casting aspersions upon is used thousands of times every day in courts, when advocates attempt to discredit witnesses in order to encourage the trier of fact not to trust their testimony.  In these cases, however, there is a referee from the get-go — the judge —  to make sure the attempt to impeach the witness is done according to legal rules of fairness.  

In another example of the basic, underlying process, politicians make a profession out of impeaching the credibility of an opponent.  Again, mere accusation is enough, even innuendo, but there is no criminal sanction that applies to the impeached, only that he or she is not believed or trusted and may lose election.  Therefore there are no legal protections to protect the maligned — not even the meager protection of slander or libel sanctions because the victims are public figures.

However, whenever there is a criminal liability that may befall the impeached, he or she must first be convicted in a court of law of the crimes charged, and all of the protections due to a citizen of the United States must be applied to that process.

Until the minute the charges are filed (with the U.S. Senate or with a court of jurisdiction) the accusations are not evidence, and until the triers of fact and law consider all the admissible evidence and arrive at their verdict, the accused is legally presumed to be innocent.

As a tactical matter, it fulfills an acknowledged strategic goal of the Democrat members of congress to, as the Old English definition of “impeachment” has it, to “hinder and prevent” the Administration, by catching, entangling and fettering its feet, tripping it up; breaking its rhythm, breaking its stride.  This evening on the news, a video shows Speaker Pelosi responding to the question of what possible benefit or satisfaction was to be gained by bringing Articles of Impeachment to the senate that have disregarded so many rules of evidence and process that they are bound to be dismissed out of hand, perhaps even in a pre-trial motion to dismiss.  After fumbling and sputtering, her mouth formed itself into a sanctimonious pout as she uttered the final truth:  “Because then he will have been impeached, forever!”

This is true because no matter what happens, whether a summary dismissal or a long trial that completely exonerates President Trump, that will never remove the indelible stain upon his name, that as President, he was impeached.  On one American in a hundred understands that an impeachment is only an accusation.  Even fewer care.  For Trump it will remain a deep wound to his narcissism, never healing.  As Speaker Pelosi said, FOREVER.

Once the Articles of Impeachment reach the Senate, the tactic fails, because none of the so-called “evidence” elicited by the House thus far will meet the standard of proof required in a trial.  The presiding judge will be the Chief Justice, not as easily bamboozled as the public and the press. 

It is not unlikely that upon reading the Articles, the Senate will pass a directed verdict to dismiss, on the basis that the evidence to impeach was inadequate (anonymous sources, hearsay) in the first place.  This will, of course, engender an eruption of political theater, a melodramatic calamity in several acts.

What you will see then is the Democrat house immediately returning to impeachment on the basis of “new” innuendo.  Because even baseless charges entangle the feet of the accused and distract him or her from the business at hand. 

END

June 10, 2020

[Previously published July 15, 2019]

For the better part of a century at least, it had been the usual practice to work graduate doctors undergoing specialty training  continuously for three to five years on a duty-cycle typified by 36-hours on, 12-hours off, and every other weekend on duty.

In a recent article in the online medical  magazine, Medscape, a study was reported that showed that capping the work hours of medical residents at 80 per week and 30 in any single shift in 2003, had not resulted in any increase in hospital mortality, readmissions or cost of health care for hospital patients.

From my perspective at 84, and retired for  almost 20 years from a three-phase practice — family practice, board certified 17 years; Occupational and Environmental medicine for 11; then a psych residency and ten years of state hospital forensic psychiatry, I am inclined to view what has been the standard model for residency training as a cycle of (inner) child abuse, perpetuated by those who were themselves abused.

Following a year of “rotating internship” and the first of three years of an orthopedic residency I was just beginning my second orthopedic year with a rotation at a San Francisco hospital less than five minutes door-to-door from my home hospital, where my wife and three kids were living in a hospital-provided apartment. In addition to the apartment my pay was $3,000 per year.

In the first week of the rotation another ortho resident, who lived across the city, had been reluctant to come in to the hospital at 3 am for some relatively trivial problem, so the duty staff orthopedist made the rule that residents would remain in the hospital whenever on call.  No matter that the rotation hospital was smallish and calls were few and far between.

However, this meant that the next time I was on weekend call, beginning at 6 pm on Friday, I would not see my family from Friday morning to Monday evening after work.  Call was every other weekend.

The ortho Chief at that hospital was out of town.  The orthopedist who made the rule was unyielding.  Two weeks later my wife called on Sunday to tell me that she was putting the kids in the car and leaving.

Instead, I called the Chief of the residency and resigned on the spot, thinking I was “finished in this town” for doing so.  Instead, on Monday morning, my Chief recommended me for a job in a local group practice, saying that when he was young he had faced the same choice, and that he had made the opposite choice, which he later came to believe was the wrong one, due to the resulting estrangement from his family.

A few years later that brilliant orthopedic surgeon, though I know nothing more of the details, sat down against the trunk of a eucalyptus in the park at Presidio San Francisco and shot himself to death. 

I believe very strongly in the value of continuity of care and good medical training.  I do NOT believe that we need to keep young doctors on duty constantly in order to achieve it to a sufficient degree.

I believe that if more experience is needed to teach a skill, then we might keep people in training longer WITH REASONABLE AND LIVABLE PAY AND ACCOMMODATIONS in order for them to acquire it.  And at the same time give them sufficient time each day to rest and recharge in the bosom of family.

To any who object that such a scheme would be unaffordable, I say that how we allocate resources is a choice a community makes.  For too long, corporate pirates and government kleptocrats have exploited the benevolence and high ethical standards of physicians  to maintain a level of excellence in medical care for which they have never been willing to pay fair value.

And physicians, upon repeatedly experiencing that no good deed goes unpunished, have sunk in to the sadness of children long betrayed and abused.  They suffer a very high burnout rate and the highest suicide rate of any employment group

I weep for my colleagues, who will not, it seems, make use of the power they possess to regain control of their profession.

There is a very interesting theme common to the arguments of those who favor residents working virtually unlimited hours.  It manifests the logical fallacy of the excluded middle:  “Either residents must work unlimited hours or they won’t learn anything and there will be no continuity of care for patients”.

This reminds me of the way individuals with Cluster B Personality disorders tend to see the world in polarized, over-simplified, all-or-nothing terms.  Looked at from a slightly different angle, denying residents, (trainee-doctors), a healthy emotional and family life also resembles the “pervasive pattern of disregard for the rights of others”.  

Seen from that perspective, the system at its worst has been flagrantly antisocial towards its victims, however willing those victims may have been.  Residents have been like the abused spouse who is pathologically unable to set a boundary with the abuser, much less leave him or her.  Like other victims of abuse, residents still believe that if THEY can just do everything right, everything will be OK.

I have recently arrived at a theory about the state of our government, which seems unable to resolve a single problem because of the incessant need of its representatives to fight with one another and for each to prove their opponents incapable of proper parenting.  I’m thinking that we have managed to elect a “critical mass”, pun intended, of Borderline Personality Disordered persons.  It doesn’t take many Borderlines to paralyze any human community or organization.

It is depressing to think that our own profession has had so little insight into the pathological origins of its flawed teaching methods that it sees no other choice but to persevere in them.

Having ended forty years of medical practice and three separate medical specialty board certifications with a final decade of training and practice of psychiatry, and having continued to read the journals for an additional 20 years in retirement, I am more than ever convinced of a lack of congruity between the way the brain learns and the organization of medical education.  Learning and memory formation not only benefit greatly from periods of rest and sleep, they utterly depend upon them.  There is reason to suspect that we have become learned doctors DESPITE some of the ways in which we have been taught.

Since it is obvious that no resident could possibly attend every patient continuously from the beginning to the end of every episode of ill health, and, because of this, perfect “continuity of care” by an individual is impossible anyway, therefore it seems to me that a need for compromises should be acknowledged, such that, say, a TEAM could insure continuity, while its individual members were able to get enough rest and sleep, and were able to be with their families in a healthy way. 

Personally, I think that for senior members to give up the systematic exploitation of younger members would  only enhance our profession.  As for scavengers like the hospitals, insurance companies and government, shame on us for having allowed them to feast on the minds and bodies of our young.

In the 1970’s, what had been called the medical care system was suddenly called the health care DELIVERY system, as though anyone could “deliver” it. Soon thereafter cheaper substitute personnel were employed to “deliver” it and physicians were devalued.

The thing that defeats physicians is that they are so ethical that they can’t figure out a way to withhold services in a group action.  In which they have also been impaired by the laws against collective action by individual practitioners.   When California Medical Association (CMA) physicians plotted out the relative value of services in order to help docs figure out what each service and procedure was worth, it was called the Relative Value System (RVS).  The federal Fair Trade Commission charged the CMA with “conspiracy in restraint of trade”.  With no funds for legal defense the CMA agreed to recall all the RVS books.   The categorization number for each service and procedure, developed for the RVS, became the basis for the Current Procedural Terminology (CPT) system, and was afterwards required to be specified for each charge to any insurance program, including Medicaid and Medicare.  One set of actual relative value charges, calculated by multiplying each service’s relative value by a modest dollar dollar conversion factor, was hijacked by the California workers’ comp system, which set that price list as the minimum charges for those services.  Then, a couple of years later, those minimum fees were set by the state to be the MAXIMUM charges a physician could bill the state system.  Thus in California, the physicians’ useful ideas were stolen by government agencies who then turned them against doctors after forbidding doctors to use them for their own benefit and convenience.

Aside from the use of force, the only power any person or group has over another, is to withhold its labor, knowledge and services.  If physicians were able to do that in concert at strategic junctures, it wouldn’t take long before they were back in charge of every aspect of medical care where medical ethics, knowledge and training are essential.  Ironically, doctors are “hoist on their own petard” of conscience and benevolence. Modified strikes could even be accomplished without withholding critical medical services to patients, though some elective services might need to be curtailed from time to time.

But organizing docs is like trying to herd cats.  The very characteristics that cause them to accept the abuse heaped upon them by the system — the need for love and approval, or the converse, the abhorrence of the slightest disapproval — will likely prevent them ever from saving their profession from ruin through thoroughly unscrupulous political and economic contamination.

There is no evidence that the abusive aspects of residency training serves any useful purpose beyond the very limited lesson that perseverance in the face of fatigue and adversity is possible.

END