(Like this diary, this piece was originally written for a local paper, about local outrages, but it was then suggested that it might also travel to other people, in other places.)
A town the size of Chico, it could use a hospital. More than 100,000 people in the Chico "urban area," according to those signs on the fringes of town. That’s a lot of people. Life’s a parlous undertaking, and the corporeal container is a fragile thing. Needs some binding and soothing, now and again. A hospital’s good for that.
Some might say that Chico already has a hospital. But they would be wrong. It is true that spreading all over this town, like some sort of murderous metastasizing cancer, is a huge gluttonous money-making machine calling itself "Enloe Medical Center." But this is no more a "hospital" than Tom DeLay was a "public servant." Enloe Medical Center is a butcher shop. A cash mad cow that cares no more for its patients or workers than DeLay cared for the American people.
Besides, Enloe’s closing. Not right away, but--trust me--Enloe, like DeLay, is finished. It’ll take some years, maybe many years, for all the cases to wind through the courts, but eventually Enloe will go under, crushed beneath the weight of the massive damages it will be forced to pay as penalty for, out of penury and spite, hiring as an anesthesiology "team" a clown car of malpractitioners who planted in graves people from throughout the north state.
The Gang That Couldn’t Gas Straight wheeled out dead three people that we know of, but that number is sure to rise, as the lawyers fan out searching for additional victims. Then there are those who were "merely" maimed or injured. I know one of those people. A legal secretary, who once worked in this office, and who entered Enloe ("Enloe" now an acronym for "Enter Now, Leave Once Expired") for non-emergency gall-bladder surgery. As she was coming out of the gas, a member of The Gashouse Gang managed to give her a heart attack.
Sure, surgery’s surgery, and anesthesia is inherently risky, but this woman was under 30, in good health, and the surgery otherwise uneventful. And the anesthesiologists who passed gas at Enloe before the hospital booted them out in favor of the clown car managed to go decades without performing pratfalls like these.
So why were the artists offed, in favor of the buffoons? Money. Enloe in recent years has shamelessly shoveled millions upon millions of dollars to scabby union-busting consultants and corporate lawyers, as part of its despicable jihad to prevent disgruntled employees from successfully attaining union representation. But it primly drew the line at paying money to anesthesiologists who could ensure that people left the hospital on something other than a slab.
You don’t want to screw around, in any way, with anesthesia. For centuries, the measure of whether someone was alive was whether s/he drew breath. By that measure, an anesthesiologist’s job is basically to temporarily kill the patient. The anesthesiologist first shuts down the patient’s breathing, then breathes for the patient throughout the procedure, then returns breathing control to the patient. Would you want that sort of responsibility? Not I. I have nothing but respect for these people. Would you want to go under the gas, knowing that the person who’ll, for some hours, be responsible for your very life, was hired to "save money"? Not me. I’m off the table and out the door. Would anyone but an utter imbecile, or a conscienceless hardheart right out of A Christmas Carol, hire anesthesiologists based not on competence, but on dollars? Answer, thy name is Enloe.
Again: Enloe doesn’t give a shit, for either its patients or workers. The first lesson of the history of labor relations in this country is that employees who are happy in their work do not unionize. Nurses and staff at Enloe unionized--over tremendous opposition, and outright intimidation. Even once the votes came in, Enloe fought and fought and fought, until, most recently, its feeble filing was literally laughed out of court in Washington DC. In the meantime, of course, with the election held in suspension, Enloe managed to fire hundreds of union supporters. I have absolutely no doubt that the hospital’s next move will be to seek to invalidate the union election on the grounds that the eligible membership pool has significantly changed--as a result of its own firings.
Doctors, like criminal-defense lawyers, are the last of the lone wolves, and attempting to corral them in a room to agree on anything is generally as futile as herding cats. But the doctors who labor at Enloe voted last year 116-16 to publicly express "no confidence" in Enloe. In the face of this unprecedented outburst of communism, Enloe threw overboard CEO Dan Neumeister and a couple of his enablers. Then, even as word began to seep out about the deadly slapstick of The Gashouse Gang--which seems to have begun when a public official, admirably, balked at accepting a death certificate for one of the Gang’s victims that smelled to high heaven of bad fish--Enloe sought for some replacement Queeg to take the helm of the Titanic. Now, with this new Ahab on board, we’re supposed to believe that all is wunderbar, that a savior has arrived who will right the sinking ship.
Don’t think so. I have here before me the April 5 edition of the Chico News & Review, containing the most recent somnambulant Newspeak from Enloe apologist Robert Speer. Trees died so that we might learn that new Enloe CEO Debi Yancer "is a cheerful woman who makes small talk easily and is quick to laugh," who "fell in love with Chico the first day she was here." From her "light-filled room whose floor-to-ceiling windows provide a soothing view of the flowering plants and shrubs on the hospital’s east side," Yancer drones on about Enloe as if it were staffed by robots: "a collection of interdependent units . . . when any of them is dysfunctional, the others are affected."
Speer, who used to string words together for Enloe’s in-house magazine, somehow brings himself to allow that the hospital’s penchant for killing people is "one of the more troubling matters facing Enloe." But Yancer will have none of that. People killed by a hospital, you see, are but "sentinel events." And "‘[a]ll hospitals in America have sentinel events,’ Yancer said. ‘It’s what you do with them that counts.’" So, not to worry. "A full assessment [will] be done." And, like George II, Yancer has a plan: "I always have a plan. I’m a planning person."
That’s nice. I hope she has a plan for getting out of town fast, because I don’t think that someone who refers to dead people as "sentinel events" is going to be too welcome here. For more than thirty years I’ve made a living from working with the English language, and I’ll be fucked if I can figure out how killing people for profit can sanely be described as "a sentinel event." A "sentinel event" is the unearthed monolith in 2001: A Space Odyssey broadcasting a signal to Iapetus. It is not hiring Daffy Duck as an anesthesiologist, chortling in glee over the ducats you saved, then bumblingly inscribing lies on official documents when Daffy shoves a tube down the wrong hole and the patient leaves the place in a box.
The CN&R’s coverage of Enloe in recent years has been disgraceful, for the same reason that Enloe’s conduct has itself been disgraceful: money. Even before Tom Gascoyne was offed from out of the paper to escape officious editorial intermeddling, CN&R Obergruppenfuhrer Jeff von Kaenel approached Enloe administrators to assure them that there would be no more coverage of Enloe labor issues in his paper. A lot of money there, in Enloe advertising.
Enloe bullies this town through its economic clout, the immoral amounts of money it expends on public relations, the lay populace’s fear and ignorance of medical matters, and its monopoly status. Who wants to attack the place when you might find yourself next week staring up at some steely-eyed guy with a knife? I have no doubt that as soon as this piece hits print, I’ll suffer some sort of "coronary event." That’s why I’ve fashioned this cardboard Medic-Alert-style bracelet I’ve slipped on my wrist, reading: ANYWHERE BUT ENLOE.
The "progressives" on the Chico City Council have demonstrated that they don’t much care about the non-human living creatures in their domain (see "Can I Pet The Nice Park, Daddy?," Chico Beat, 03/02/07). But decent health care, that’s a hot "progressive" issue, isn’t it? Good. Then the Chico City Council can set about implementing a plan to bring Chico a new hospital . . . .
*
Enloe Hospital is a morally bankrupt institution. It cares less for its patients and its workers than it does for money. Because its single-minded pursuit of gain results in death and injury to human beings, it stands as a particularly malodorous example of the inherent malignancy of "profit." As the poet Lew Welch succinctly put it: "‘Profit motive’ means very simply: you give less than you take. If you give less than you take, you grow mean and stingy. Everybody suffers. Morality is totally impossible."
The coffers of gold upended to award mercenaries dispatched to bash as rabble employees seeking to unionize, primly pinching pennies to hire an on-the-cheap clown car to blearily administer anesthesia—these are only the most recent, deadly, and public manifestations of the sort of slack and shoddy decision-making that has become depressingly routine at Enloe. Debi "Sentinel Event" Yancer, Enloe’s new mouthpiece, cannot yet bring herself to admit even that her hospital seriously fubared in hiring to pass gas a clot of bewildered ignorami--ur-physicians from out of the days of leeches, bleeding, and "the four humours." Yet this decision is, in truth, nowhere near the last instance of profit-driven doltishness that she, and her successors, will eventually have to answer for.
I mentioned earlier that a former co-worker of mine had been subjected to a heart attack by The Gashouse Gang as she came out of gall-bladder surgery. Yet she is but one of three women, who have worked here in this small office over the past five years, to be wronged by Enloe.
The second woman one morning developed all the classic symptoms of a heart attack. I drove her to Enloe’s "emergency room," where she was met by a functionary with a computer, who took her name and sufficient indicia proving an ability to pay. My co-worker was then directed to sit on a bench. Which she did. For six hours.
Now, as it developed, when once she was actually seen by someone with medical training, this woman was not suffering a heart attack. But there was no way for anyone at the hospital to know that, during the entire six hours she was required to wait. I assume that if at some point she had collapsed on the floor and gone into convulsions, she might have been seen by someone with a stethoscope. But everything I have read about heart attacks tells me that it is generally a good idea to receive treatment as soon as possible, long before you have actually stopped breathing and are flopping about on the floor.
Call me a pedant, but to me an "emergency" is just what the dictionary says it is: "an unforeseen combination of circumstances or the resulting state that calls for immediate action; an urgent need for assistance or relief." I work in the law, so I know how elastic words can be, but I find it hard to believe that any reasonable person would define six hours, in the context of someone seemingly suffering a heart attack, as "immediate action." But what I learned that day is that Enloe, at least for the people who walk in through the front door, does not offer an "emergency room." What it offers is a "walk-in clinic." Now I go, for most of my medical needs, to a walk-in clinic in Oroville, and I know there what to expect: a long wait. So I would not go there if I thought my heart had grown cranky enough to give up my ghost. I would—okay, call me naive—go to a hospital emergency room, where I would expect to be treated as if I were suffering an emergency.
Seem trivial, that complaint? Try this one: the third woman’s son died at Enloe, in "the recovery room," after elective, risky, but highly profitable surgery that, after his passing, non-Enloe physicians, surveying his medical history and general physical condition, averred should never have been performed.
Four members of my family have been treated at Enloe over the past five years. Two of them there suffered serious harm. My father-in-law, in receiving "treatment" for a rare form of skin cancer, suffered agonizingly painful third-degree burns, from his groin to his knee, from radiation "therapy" provided by a newly purchased machine that had not been properly calibrated, operated by a technician that had not, in the use of this machine, been properly trained. The resulting scarring has made further treatment difficult; at Feather River Hospital, where today he receives medical care, my father-in-law is routinely referred to as "FBE"--"Fried By Enloe."
My daughter, several summers ago, broke her back and bruised her spine. She was promptly airlifted from our remote rural abode to Enloe, where she received thorough and caring treatment in the emergency room. She was then gifted with an ICU nurse who proved, for a variety of reasons that I haven’t the space to share, to be the greatest blessing my daughter would in the next three years receive. The doctor, that first day, was urgent and professional: shards of vertebrae had entered the spinal canal, and were pressing against my daughter’s spinal column. Surgery was necessary to relieve that pressure, and it was necessary that it be performed immediately: the surgery was scheduled for very early the next morning.
But when her mother and I arrived that morning, we found that the surgery had been called off. Somehow, magically, my daughter’s condition had improved, overnight, to where the would-be Enloe surgeon now could certify her as capable of being moved to Kaiser Hospital in Sacramento.
What was this magic, that had occurred in the night?
Money.
My daughter was insured through Kaiser, and soulless bean-counting Kaiser drones had informed Enloe that Kaiser would not reimburse Enloe if the surgery was performed at Enloe. My daughter was insured by Kaiser: Kaiser would pay only for treatment by Kaiser medical personnel. So. If Enloe performed what Enloe itself had declared a medical necessity, Enloe could not now count on receiving moolah. So. Through magic, sheer magic, overnight Enloe downgraded my daughter’s surgery from "medically necessary" to "sure, it’s okay: put her in an ambulance and bounce her down to Sacramento, where she can wait, oh, say, four days for the surgery, until she fits into the schedule of the Kaiser surgeons."
After all, what did it hurt them, those Enloe bean-counters? The hospital wouldn’t suffer a loss of profit--that’s the important thing--and besides, it wouldn’t be any of their children who wouldn’t be able to walk.
Still and all, don’t think that through these personal experiences I have conceived a jihad against Enloe. Not at all. I doubt my stories are unique. I would hazard to guess that just about anyone, who is at least of advancing middle age, could, in casting a net around friends and family, pull in similar Enloe horror stories. (Besides, it wasn’t Enloe, after all, but Kaiser, that tried to turn my daughter into a vegetable, something right out of The Verdict, by insisting she eat a full meal one hour before her scheduled surgery. For weeks either myself, her mother, or her boyfriend, had to stay in her room there at Kaiser, 24/7, just to make sure that those ham-handed buffoons didn’t somehow bumblingly kill her.) The entire American medical system is rotten, rotten to the core, but this is where I live, and Enloe is the place I should be able to depend on to make sure I continue to live. Since I can’t reasonably depend on that, Enloe has to go--as, inevitably, it will . . . once it’s paid its lawsuit dues for employing The Gang That Couldn’t Gas Straight.
The doctors, nurses, and staff at Enloe Hospital are, for the most part, good and decent people, practiced and professional, who want only to help, heal the patients under their care. When they are bent, when they are broken, compromised, led astray, it is by those who, at Enloe, as throughout the entire American medical system, are unconscionably placed above them--"administrators," those quintessential "non-producers," who lay not a hand on a patient, but instead spend their days coveting, counting, currying favor with those who possess, coins.
That is why in our community’s new hospital, Chico Community Hospital, there will be no administrators. "Administrators" will be thrown down to howl in their natural abode--the eighth circle--while here in the light above, the healers will remain, always, firmly in charge. Our modest little hospital will be run the right way: by the doctors and the nurses. The people into whose hands we place the fragility of our corporeal containers. Sure, someone will need to be hired to purchase the toilet paper, but those someones will serve at the whim of the caregivers. They can be dismissed, "at will," at anytime, by those who actually practice the healing art of medicine
Chico Community Hospital will be supported by those 100,000 plus people in the "Chico urban area" (as well as anyone else in the region who wishes to sign up). Instead of funneling money to those rapacious pirates and brigands running under the rubric of "insurance providers," citizens will deliver their ducats to the City of Chico, who, to save the hospital the worry, the hassle, the fatigue, the "administrative costs," will assume responsibility for the collecting and the figuring, and then forward the money on to the caregivers.
I can’t do the numbers--I don’t do numbers--but that’s why evolution made Michael McGinnis. A certain amount of money will need to be received from each citizen to make the hospital go; someone like Michael can, and will, arrive at that number.
Be aware that this number, to an American, will no doubt at first seem crippling, even confiscatory. But only because it is seen from an American view.
The light in this darkened, fuzzy, pointed little head began to dawn a decade or so ago, when I read an op-ed piece in the San Francisco Chronicle by an American expatriate journalist working in France. He wrote that for years he had moaned, groaned, complained, veritably rended his garments, about what he perceived to be the stratospheric, confiscatory, wholly unjustifiable taxes levied on him by the French government. How could he be expected to live, riding high, as befits any American, on the hog, when all this money was sucked away each week for health care? Then, one day, in his fifties, after a long life of unconscious living, he learned that his arteries were not much interested any more in pumping blood to his heart. He needed serious "cardiac intervention." Which he received. In less than a week. Performed by one of the country’s premier surgeons, who operated on him as patient number two, first performing the identical procedure on a humble Parisian baker, last fixing up a member of the president’s cabinet. For which our now-humbled expat was charged, four weeks later when he left the hospital, the grand total of this: $0. Not even the usual American hospital cost of $8 a piece for aspirin.
America is a young and raw-boned country without a lot of sense. Each American is trained to labor under the delusion that any day s/he will become rich. So there is really no need to consider any of that humble brotherhood bullcrap about equality and solidarity with one’s fellows. Because, here in America, any day now, each and every shall awake, magically uplifted, to those Bill Gates heights, where "the hell to you" may be said, to all and every, knowing your own is comfortably, eternally guaranteed.
Problem is, here in reality, generational movement between classes is now far more retarded in America than it is in Europe. For it is, in fact, the reality that for centuries Europe suffered under unceasing oppression and crippling privation from church and state, that caused Europeans (once they stopped after WWII their 2000-year killing spree against one another) to wholly jettison the church, and to mold the state to an instrument that, at last, would serve all the people, all the time. Thus, today, according to the World Health Organization, France offers the best health care in the world--to every French citizen. And Cuba, even though crippled by 40 years of international sanctions, offers better health care to its citizens than does the United States. (Though--oh yes--if you are Richard Nixon, in the US you can be kept alive by Walter Reed Hospital, twenty years beyond the natural date of your death. Though also--oh yes--if you are former Chief Justice Earl Warren, despised by Richard Nixon, you can be prevented by Nixon from receiving treatment at Walter Reed, and thus die twenty years before the date of your natural death.)
Chico Community Hospital will of course also accept Medicaid and Medicare patients. It is here that the state and federal government will no doubt try to block Chico’s modest little experiment in socialized medicine. But that is why evolution made Dick Molin. He was made to keep those wolves at bay.
Chico can have its own Community Hospital. All that is required is the application of sufficient Will and Energy. (I think Einstein said something like that.) One life is all you get. All of us will die. Before we die, almost all of us will get sick. Hospitals are good for that: for the sick, and the dying. There is little other, real, help, really, for the sick, and the dying, than medical care. That is what, with our hospital, we will all, together, pay for. For ourselves, and for ourselves as incarnated in others. That.
One life is all we are promised. It is sacred. Profit, it is never sacred.
And make no mistake: profit is not the remuneration a doctor receives for setting a bone. A nurse for administering dilaudid. A pilot for smoothly ferrying a newly crippled young woman to an emergency room. Profit is the papering of our village with press releases, the ceaseless cozying up to councilmembers, the dispatching of a human-gone-automaton to yawn that all and every corpse is "normal," just "something in the newspapers," but a "sentinel event."
One more thing. While awaiting the necessarily slow and gradual transfer of Enloe personnel to Chico Community Hospital, we will need a place to receive Chico citizens seeking quality medical care. For this I suggest that the Chico City Council requisition whatever city-owned land lies nearest to Enloe, upon which will be placed a number of trailers, staffed by trained medical personnel from Cuba. On the public sidewalks fronting Enloe, people may daily pace (I will volunteer) with signs directing would-be Enloe patients to the Cuban trailers.
It may be argued that there could be visa problems, bringing these Cuban doctors into the US. Not to worry. I, and my twelve best friends, will volunteer to enter into "green card" marriages with any Cuban health-care workers willing to come to town, to save us from Enloe. These Cubans too can help round out the staff of Chico Community Hospital, once its doors are finally flung open.
This all seems silly, now. Sure. I freely admit. But this, I also, freely predict: one hundred years on, it will seem silly, that we thought something like this, so simple and sensible, silly.