What Rewards for the Whistle Blower?....1/03

Saw an article about an Atlanta Hospital which settled with the government for $26 Million in order to avoid charges of Medicare fraud.

The whistle-blower, a former employee, collected almost $5 Million.

One of the charges in the lawsuit is that I accused PRMC of Medicare fraud. A comment said that it cost the hospital over $250,000 to clear itself during an audit. If that money was paid to the government, isn't that like deferred prosecution? You're guilty, but they just want you to clean up your act? They don't say that a hospital is guilty, but you can draw your own conclusions....

I didn't actually accuse the hospital, but one might characterize a guilty conscious as being overly sensitive...and you wonder if someone pocketed about $45,000!!!

A heart attack at PRMC's Emergency Room....8/9

I received this as an email which had the patient's name and a lot of additional information as to his identity. I suggested that he consider it carefully and he agreed to my removing overt identification. However, I'm sure that his friends and the hospital personnel know who he is and who they are.

On the morning of Aug 1, 2005, I awoke about 4am at home with severe chest pain. It was an intense pain I had never had before.

Heartburn is something I almost never have, but I got up and chewed a couple of Alka-mints. The pain did not go away and seemed to gain intensity, so I woke my partner, significant other or whatever you want to call him. We have been living together for over 33 years and we have lived in ____ 22 years. He is also an ex-EMT basic. He had me lie down and administered oxygen. This helped a little bit, but I still had chest pain and trouble breathing. We decided I needed to go to the ER in Paris.

He drove me there and we arrived at 5:46am. Once in the ER, I sat at a desk while a nurse took my name, address, etc. and finally I was laid down and hooked up to a monitor with my blood pressure all over the chart and pulse as low as 37. When my pulse dropped below 40, an alarm went off and no one came in. I had to tell the nurse that it had gone off. She just looked at me with a blank look on her face.

Over several hours, I was given an Xray, an ECG and had blood drawn. I was left unattended all of the time while they worked on a couple of more patients that they said were critical. I was there forty-nine minutes before I was given nitro several times with no let up of chest pain.

I was never given any aspirin or any other drug of any kind. I was never asked if I had a history of heartburn or upset stomach. Dr Hobbs came in only once for a very short visit. He never listened to my heart or lungs or asked any questions about my history. My partner was in the room with me when asked by nurse Debra Crews who he was. He replied that he was my significant other.

After that statement, the atmosphere seemed to change and I was left lying there with only occasional checks on the monitor. Thirty minutes after shift change at eight a.m., Dr. Rowe came and stood in the door. He said I had GERD and gave me a prescription for a prev-pak ($300). He said my sugar level was high at 146. I asked what should it be and he said "140". Then he sent me home.

All the time Dr. Rowe was in the room he didn't come near me. He never examined me or listened to my heart and lungs. He never asked me any questions or medical history. I went home and the chest pain mostly went away late that afternoon. This visit cost the VA over $2,500. I believed the doctor and thought I had GERD.

The rest of the week was spent in agony. My arms hurt, my legs hurt, I couldn't eat, my blood pressure stayed very low and averaged about 70/50 which is really not enough for kidneys to work properly. By Friday morning, August 5th when I went to Bonham to the VA clinic, my blood was toxic and my heart in really bad shape.

They did an EKG and sent me by ambulance to the Bonham hospital to stabilize me before I was sent to Wilson N. Jones Medical Center in Sherman to the emergency room to be sent to a heart cath lab. There I had one stent put in and angioplasty. They left some blockages because I was on the verge of kidney failure, and more dye would have probably shut down my kidneys. I was told by the renal specialist that I came very, very close to death. Fortunately, I have good kidneys and passed the toxins quickly.

I was released on August 7th. Two days stay at the hospital in Sherman cost the VA $140,000. Later the next week, I was charged over $43 for a copy of my medical records from Paris Regional Medical Center to give to my VA doctor. There were no strips from the monitor in the ER in these records or doctor notes.

When I picked up the records, I asked if I was getting a copy of everything in my medical records and was assured that I was. The ECG in these records clearly showed abnormal heart functions.

On August 20th, I had chest pain and it felt as if I had a heavy weight on my chest. I called the Dallas VA hospital and was told to call 911 or go to the nearest ER. I told them I would rather take my chances on the road to Dallas than to go to the ER in Paris again. I went to the ER at the Dallas VA hospital and was admitted and had another heart cath on Monday, August 22nd. They put in another stent and more angioplasty. I was released on the 23rd with medications for my heart and will do follow-up in the cardiology clinic there.

I believe I was denied medical care for the heart attack I was having when I came into the ER at Paris Regional Medical Center for several reasons. First, I did not have the blank check of Medicare or Medicaid. Second, the personnel at the ER seemed to have no training in treatment of chest pain (heart attack) patients which is simply an aspirin and nitro glycerin under the tongue immediately. Third, Dr. Hobbs and Dr. Lowe acted like they really didn't care about me at all and neither listened to my heart, lungs or asked any questions and seemed to have no training in ER procedures.

I truly believe that if my heart attack had been diagnosed properly at the ER at Paris Regional Medical Center, I would not have gone through so much pain and agony and damage to my heart would have been minimal. By not treating me at all, Paris Regional Medical Center has taken years from my life and is liable for all medical expenses, ambulance trips, medicine and all other expenses incurred by the Veterans Administration clinic and hospitals.

So this is the organization that wants to put in a specialty Heart Hospital? Is this the same place that put up the signs for 'The Chest Pain Center'...and then didn't bother to inform the ER, nor staff appropriately?

And the gay issue...do all Essent hospitals have a problem with that? Personnel need to park their personal beliefs at the door. A patient is a patient is a patient...and they need your care. If you can't provide that, you need to get out of the medical field.

Yes, patients can have their own beliefs--and we have to respect them. That's part of the job. That's part of your training. 'First: Do no harm.' That includes 'by omission', as well.

Christmas 2007....1/18

As in the words of Tiny Tim (A Christmas Carol):

"God bless us, every one!"

Merry Christmas.....frank

Interest Revived?....1/11

You wonder if Essent is back up on the block. Searches from several corporations that would seem directed towards that end. Even the Aussies appear back in play.

And, it would be a good thought: Buy low.

I have been thinking about the Essent finances. The first significant loss was with Crossroads. Their version of buy high and sell low. Now that happened prior to the blog, although I did mention in the postings around Nov.

Even before the blog got rolling, MVH had serious problems, and their gay rights lawsuit didn't help that a whole lot. I think the Lahey Clinic has positioned themselves well in any case.

Sharon Hospital just keeps on producing.

NVMC is keeping its head above water.

Southwest (odd how a corporation with a Texas presence names a hospital in PA "Southwest") has their own problems. The blog didn't seem to really catch on out there, but there are several loyal followers. They just needed a cash infusion for an update. Essent was part of the baggage.

Paris. Paris had its own problems. How Christus was bamboozled into buying Big Mac is beyond me. Maybe the bean counters really believed that two hospitals that were losing money combined would lose it half as fast rather than twice as fast????

The 'due diligence' conducted by Essent missed an awful lot, and Monty was burying as much as he could at that juncture. On paper, the facility looked good (doubling the corporate beds!)...and yes, there were savings areas that were obvious. But, the duplication of services, the number of properties, and the mind-set were essent-ially ignored. When they looked at it rationally, the building of a new facility at the North Campus might well be a fantasy--unless a non-competitive buyer (like the VA) could be found for the South, or a re-designated use (rehab, LTAC) that could stabilize costs could be found.

The cuts were to be expected. The problem is, few realized that. The community was used to a not-for-profit environment, that could deficit spend. The attitude was it doesn't matter what we lose, we'll still have jobs. Essent didn't dissuade that notion during the courtship, but then there is hammer time.

Possibly the way to have gone, was to have involved the community more. But they are in a fix. The heart hospital sounds good "on paper" (again), but the proximity of Dallas, with cheaper pricing and newer facilities, puts a hole in that. Advanced Heart has been directing patients that way for years.

What will play out? Who knows. The lawsuit that Essent is pursuing (you thought it was over????) has to show two things: One, my posts were false. Second, by circulating said falsehoods, enough credence was given that financial losses were incurred. They are hindered by a several things, history, common knowledge, and their own policies.

Another Does Case....12/29

There is another aspect to the lawsuit. Essent does want to know who contacted me with 'tips'. Another 'Doe' case was in the media and finalized last year. That was the Apple vs Does, based on another blog and its sources.

May 26th, 2006

Huge Win for Online
Journalists' Source Protection
EFF Arguments Secure Reporters' Privilege for Internet News Gatherers

San Jose - A California state appeals court ruled in favor of the Electronic Frontier Foundation's (EFF's) petition on behalf of three online journalists Friday, holding that the online journalists have the same right to protect the confidentiality of their sources as offline reporters do.

"Today's decision is a victory for the rights of journalists, whether online or offline, and for the public at large," said EFF Staff Attorney Kurt Opsahl, who argued the case before the appeals court last month. "The court has upheld the strong protections for the free flow of information to the press, and from the press to the public."

In their decision, the judges wrote: "We can think of no workable test or principle that would distinguish 'legitimate' from 'illegitimate' news. Any attempt by courts to draw such a distinction would imperil a fundamental purpose of the First Amendment, which is to identify the best, most important, and most valuable ideas not by any sociological or economic formula, rule of law, or process of government, but through the rough and tumble competition of the memetic marketplace."

The case began when Apple Computer sued several unnamed individuals, called "Does," who allegedly leaked information about an upcoming product to online news sites PowerPage and AppleInsider. As part of its investigation, Apple subpoenaed Nfox -- PowerPage's email service provider -- for communications and unpublished materials obtained by PowerPage publisher Jason O'Grady. A trial court upheld the subpoena.

But Friday, the court said that O'Grady is protected by California's reporter's shield law, as well as the constitutional privilege against disclosure of confidential sources. The court also agreed with EFF that Apple's subpoena to email service provider Nfox was unenforceable because it violated the federal Stored Communications Act, which requires direct subpoenas of account holders.

"In addition to being a free speech victory for every citizen reporter who uses the Internet to distribute news, today's decision is a profound electronic privacy victory for everyone who uses email," said EFF Staff Attorney Kevin Bankston. "The court correctly found that under federal law, civil litigants can't subpoena your stored email from your service provider."

EFF worked with co-counsel Thomas Moore III and Richard Wiebe in this case.

For the full decision in the case.

For more on Apple v. Does: http://www.eff.org/Censorship/Apple_v_Does/

While this is a California case, if you will note, the our appeals court utilized the Cahill decision in their call.

My Rights??....12/21

Had a comment tossed my way that set me a bit on edge:

That's all you have to say about the appeals court decision? How bout a shout-out and a way-to-go for the 6th court of appeals making a stand for your first amendment rights?

It isn't just my rights, it's everyone's. The court's decision was in line with what I had been saying, and the opinion was well within my comfort zone: That I had an expectation of privacy, that if sufficient proof was rendered, the privacy would be set aside, however, prior to that I would have a chance to refute the presented matters.

Maybe it is because I take it for granted that the opposite had me so riled. However, the ruling set things right and all's well with my personal corner of the judicial system.

Should Essent pursue the case? It's their right. But, with the legal commentary that I've received, and my lawyer's counsel, I really don't feel that the facts support an adverse judgment.

But that isn't Essent's goal. Their goal, through the whole matter, is disclosure of my identity and what recourse they might have outside the legal proceedings. Kind of who-are-you-and-how-can-we-make-your-life-miserable.

I'm criticized for bringing up Holly as an example, but she is a PRIME example of what Essent has done and is capable of. And, for merely being suspected of being me, several employees have been fired, or was that just used as a public excuse? IT functions have decreased with the centralized data management, so somewhat less experienced and knowledgeable staffing is required.

Contemplate this: What kind of a split can the Paris medical community sustain now? In their current state, what kind of fence-mending can Essent provide, or would they even try? Is this whole thing merely to cow possible dissidents?



So much for a corporate showplace.

Warming Up??....12/18

Well, Essent's boardroom is probably seeing a bit more reds in their color schemes, considering the ruling handed down on the appeal. For one of the more confusing documents (not that I disagree, of course), follow the link. The ruling isn't confusing (pretty much what I indicated, a Cahill based decision), the formatting is. Don't know what the problem with my browser is.

While there's not singing yet, she's warming up in the wings.

Burning Rubber....12/12

For those who are wondering why the appeals court is taking their time, let's run through some statistics:

62% of cases are disposed of with in 6 months.
25% in 6-12
13% in 12-24
0% longer than 24.

Realize these are last year's statistics, but will probably hold. What complicates this case are the issues involved. A 'constitutional' issue, a somewhat obtuse decision, and statutes that support neither.

So while we're spinning our wheels, they are turning and just need a little traction. What might render the case moot is if it outlasts Essent, and it would seem that that might be the case. Some in corporate are wondering if it will last a year.

Ever Wonder??....12/13

Do we wonder about the Essent Board of Directors? Who they are, what other companies they're involved with? It does become interesting. I was perusing the Business Week description of the Essent corporate structure (which is way out of date) and found the board members.

David Mayer -Jazz Pharmaceuticals
Ron Wolford -ForHealth Technologies
James Elrod Jr. -Vestar Capital
Bryan Cressey -Thoma Cressey
Steven Silver -GoldToeMoretz
Jeff Goldsmith -Cerner
Bryan Marsal -GoldToeMoretz

One tidbit noticed about Cerner--The CEO and the Board vice-Chairman have sold a net of 55,000 shares within the last three months. How much confidence do they have?

As for Essent--Connery has decided not to pursue the lawsuit against Essent for an early release of the money for his shares.

Who's Resumes are in Play?....12/9

You have to wonder...since Essent was Hud's baby, how many executives with the company had personal commitments from Hud, promises if you will, that were keeping them in place? Is Essent due for an outflow of 'talent'?

While Essent is shopping for a new CEO, they might peruse the other aisles as well.

Buying companies is like buying stocks: Some people buy on momentum, some buy when they figure a stock is at its lowest point. There was consideration a while back--when Essent was in its game. Now, however: How low can you go???

Pakistan Repercussions?....12/17

With all the turmoil in Pakistan, the question becomes: How will this affect local healthcare if the political climate changes for the worse? We have several Pakistani physicians in our community, prime example is Doctor Hashmi.

The New England Journal of Medicine indicates: "Pakistan has contributed approximately 10,000 international medical graduates (IMGs) to the United States...." Only 300 have returned to the medically underserved country. Should there be changes in the relationship between the US and Pakistan, how will that affect those physicians currently in the country on resident alien or dual citizenship status? With those with a large portion of their wealth, or the majority of their family in Pakistan.

The new heart hospital, comes to mind. Speculation is all anyone can do without the facts, but that's probably what Essent is having to do as well. Assurances can only be based on the current situation, rather than a future one.

I would imagine that there will be no great changes, but one can never tell....

Awfully Quiet in Nashville....12/4

I figure that they're actually beginning to realize what Hud saddled them with. One scenario:

He bought hospitals that no one else wanted, but looked good on paper, tried to run "the big con" ala the Sting, and with him gone, things will probably fall apart.

He could sell the idea that the hospitals weren't profitable while they were being renovated. That renovation would take years. And years to start. Meanwhile, he could acquire some actually good properties (Muskogee comes to mind, as well as Weatherford) and borrow against the idea that his corporation owned five hospitals that they were willing to put money into. Sort of how they got Paris.

Or:

He actually believed that he could package a working system that would make the 15-20% return that he forecasted from bankrupt hospitals.

Your choice.

Essent should keep community informed....12/7

This is the first time I've seen the Paris News take a chunk out of the hospital:

Staff reports
The Paris News

Published November 26, 2007

Officials at Essent Healthcare, the parent company of Paris Regional Medical Center, need to keep this community informed of events such as a change in leadership at the top as happened earlier this month in Nashville, Tenn.

The Paris News became aware through a third party, and almost a week later, the companys founder, Hud Connery, had been forced to step down as chief executive officer by the companys board of directors and that Mike Browder had been named acting chief executive officer.

Essent public relations specialist David Jarrard did respond to a request for information for a Nov. 19 story, but an e-mail communications problem prevented us from receiving a response in time for that days edition.

Jarrards response was brief, stating the board of directors has a commenced a search for a permanent chief executive officer. He also said in the written statement that Browder joined Essent in 2001 as chief financial officer and that he served in a similar post for TMC HealthCare. From 1993 to 1999, Browder served as vice president of finance operations for Health Management Associates, Inc., where he was responsible for financial operations at 32 hospitals.

We should have received that information as soon as an event of this magnitude took place, not a week later and only at our request.

Members of our community should be kept abreast of what is going on with Essent. Paris Regional Medical Center is one of this communitys largest employers and serves the medical needs of the majority of our residents. In the past this newspaper has been supportive of our local hospital, but being left out in the cold about major events does little to help a relationship. After all, it is the responsibility of this newspaper to keep residents informed. A change in Essent leadership certainly warranted an immediate notification.

Actually, Hud's change in status happened in October. I posted the news on the 9th of November.

What If....12/8

Dux has been more than willing to say that he wants to get rid of those elements that Bitch, Piss and Moan at the hospital, but let's look at that....

His definition of bitching, pissing and moaning might be a bit different than ours. For one thing, those that are recognizing problems, and suggesting solutions are the ones that aren't saying, "That's not my job." Maybe administration would prefer that they were, but patients don't.

Housekeeping used a wax that was softened by the cleaning solution they used to mop it. It produced a sensation of sticking to fly-paper as you walked. Solution: Change the wax, or change the cleaner. The extra money spent would be paid back in public perception almost immediately.

An effective suggestion program can make the difference between red and black ink, but the opinion is anyone that doesn't believe that the moon is made of green cheese (admin's view), is a troublemaker.

Toyota is often cited as having one of the best suggestion programs of any corporation. They also had not laid off any employees since 1950 (not sure if that still holds true, but probably so.)

When you feel that your ideas do not fall on deaf ears, you are far more likely to feel appreciated for your efforts. As admin has found, complaints that you hear are backed 10 to 1 with those you don't. This blog could be a demonstration of that.

Complaints are opportunities (ironically, the link is about Vandy.) And the first part of a problem-solving process is to identify the problem. Those that don't appreciate that fact are doomed to failure.

Say the hospital did get rid of all those who have read or commented to the blog. Can you say, Ghost Town?

Rumors and Propaganda....11/26

Not quite the latest rumor, but it is said that former CEO W. Hudson Connery Jr. was walked from Essent by security and that he is under investigation for embezzlement (a possible criminal charge, forthcoming?) I'd say that it qualifies as not "not unfriendly". What do you think? I can't say that this is first, or second, or third-hand (can you say anonymous?), but you never can tell.

Remember, this is dealing with a capitalization of over $200 million dollars. How tight is the cookie-jar lid? (Note: The real financials from Crossroads were never made available to the CT officials when they were considering Essent's purchase of Sharon Hospital. That was mentioned in the decision summary.)

An aside: In searching for records on Connery and CT, I ran across a house owned by Hud and an Ann Moore. It would appear that Ann Moore used to be in the clique of former Governor John G. Rowland, who pleaded guilty to a corruption charge (his administration approved the Sharon conversion from not-for-profit to for-profit, first in CT). I can follow Ms Moore's career through the CT governmental positions she held, as a lobbyist, and to a law firm (UPDIKE, KELLY & SPELLACY, P.C), after which she disappears (career-wise), apparently not practicing. They even hired an attorney to prepare a variance for submission on the house.

Looking at Hud's replacement, Mike Browder's duty description caused another series of questions, see if you can find and answer them:

"Michael Browder joined Essent in 2001, and is responsible for all traditional corporate financial functions including routine reporting and capital structure development. In addition, he is responsible for information systems development, corporate risk management/insurance and detailed acquisition support functions, including due diligence."

Did you see? Corporate risk management, insurance, and due diligence. Responsibility for due diligence puts him in the hot seat for failing to recognize PRMC's shortcomings, insurance for the gay couple's lawsuit, and risk management for the go ahead on the actual Essent-Doe lawsuit. You wonder why he wasn't out the door before Hud....

Can You Say: Sub-Prime?....11/24

$55 million term loan and $20 million revolving line of credit from GMAC-RFC
$80 million from Vestar Capital Partners of New York City
$50 million Thoma Cressey, plus another $10 million

So, with over $200 million invested, what do they get?
Two hospitals that are paddling in red ink.
One that has gone up and is headed down.
Two that are reasonably profitable. (However, nothing close to what was forcasted....) They're the ones absorbing the losses of the other two.

This, my friends, is called venture capital. They would have done better investing in liquor stores and pawn shops. With the bottom falling out of sub-prime real estate loans, one wonders if this is in the same catagory. Banks and lending institutions all over the country are feeling the pain--just look at the stock market.

But, don't worry, GE only lost $17 million of the $25 million they had in Arcon. (Source: Final Decision, Sharon Hospital.)

I really want to see how Michael Browder's vision for the company is going to pull this one out of the fire....

Essent's Future....11/25

I suggested to a person in the industry that there are only a few possibilities for Essent: Sell or turn into a kinder, gentler Essent--more of what they pitched to Paris in the courtship.


He replied:

Hud was the central focus of this whole thing. With him gone, the venture capital guys have to either expend a lot of effort to put a new team in place and hope that things improve or they can cut their losses, get what they can through a sale and move on to something else. I don't think any of them have a particular passion to manage hospitals. If the company were bigger, I could see them wanting to salvage things with a new management team. But with just 5 hospitals, I'm guessing they'll let someone else have them.

The sale might be compromised by the pending settlement with Hud, depending on the length of time it takes. Ironically, he might be the only winner in this mess, or the spoiler that will destroy the value for everyone. I'm betting on the petulant child.



What could that do for or to Paris? The biggest problem Paris has is the joining of the two hospitals. Too much property, too many duplicated services, and a lack of competition to make it work. If Hud holds out, it could force a fire sale, or, an actual bankruptcy that might split it up (how long have I been saying this?) Or, if he settles early, we're stuck with the status quo.

I can't see any progress on the new Heart Hospital. This was originally delayed until April from the new year. What is the projection now? If Essent is going to bluff it out, it almost has to get going with the plans to show that management hasn't slipped.


I'd say they're dancing on banana peels.

History Repeating....12/10

Looks like Hud has another lawsuit to deal with. When HCA merged with HealthTrust, Hud lost his stock compensation plan (it didn't pay 'til the year end)...and so these are the elements that lawsuits are made of.

It appears that Hud has actually been out of the office for the last couple weeks--and the settlement between he and Essent is not amicable. Several million dollars worth of he said--you said, and wrangling about actual contractual obligations. Wonder if either will be able to use a Nashville law firm?

Anyway, Hud lost the first one, and its appeal. Wonder what happens to this one?? Stay tuned.

And, if anyone was wondering about Matt, I thought I would mention this:

One of the 'discussion groups' that he logs into also logs the IP address that he uses. I have a readout of his as well. And, a lot of his phraseology is the same. Tracking back his comments gave me his posted vocation (but all people lie, according to House). So, either he's Mattndallas, or a co-worker (that has picked up his manner of addressing issues) is. He just picked a poor mentor.

Connery forced out at Essent Healthcare....12/1

According to the Nashville Post, W. Hudson Connery has been forced out of Essent. The former CFO Michael Browder has been named to take his place.

The irony is, he might make out better by that happening than by captaining it into the rocks. If there is a corporate buyout of his stock, it might save his nest egg.

It doesn't mean it's over, folks. Maybe just starting....frank

NashvillePost.com has learned that Essent Healthcare founder and 30-year industry veteran Hud Connery has been forced to step down as CEO by the company’s board of directors.

According to NashvillePost.com sources, the hospital operator’s CFO Mike Browder has been tapped to serve as the acting CEO and, they claim, is a candidate for to take the helm of the company permanently.

The board, led by investors from Thoma Cressey, has not announced the change, even to the Essent’s staff, as the shift, apparently, is not an amicable one. Allegedly, Connery and the board are currently at odds over a severance package and that his options in the company could total several million dollars.

Sources went on to claim that the board and a number of Essent’s investors would like to sell company.

Connery launched Essent in 1999. The company’s first hospital was purchased in April of 2000. Prior to that he was the leader of the now defunct Arcon Healthcare. That company, which was based on a “hospitals without beds'' concept filed for chapter 11 in 1998.

I'm going to add as needed to the original post (one has to be flexible....) just for continuity of the thought. The latest:

[Update, 2:26 p.m. Monday:]
Following the posting of this article on Friday, David Jarrard, a spokesman for Essent, sent an email to NashvillePost.com confirming the departure.

Jarrard disputed NashvillePost.com’s characterization of the shift saying, “the transition is not unfriendly.”

In the e-mail, Jarrard also said that “Connery has no options with Essent,” and “Essent staff were informed of the transition earlier [last] week.” While repeated attempts to contact Jarrard seeking clarification have so far gone unanswered, NashvillePost.com was informed that Connery does in fact have a sizable equity interest in the company, though the use of the word "options" was technically incorrect. Further, NashvillePost.com has been told that despite some staff’s having been informed, as of Friday afternoon the vast majority of Essent’s employees were unaware of the move.

According to Jarrard, discussions of a possible sale have been tabled for the time being noting that “every Essent hospital is profitable and growing in their markets."

Last thing first: Merrimack Hospital is sitting at $-1,498,033 for last period listed, according to American Hospital Directory (AHD.com).
Southwest Regional Medical Center -- $-212,615, and with a net of $860,296, Nashoba Valley Medical Center (57 beds) is over twice as profitable as this (PRMC) hospital (228 beds listed, what happened to the other 100 or so?).

Not "unfriendly"??? What, we haven't dug out the squirrel guns yet? The board has back-doored at least two offers that fell through and finally pitched Hud out. They aren't selling because there are no buyers. What kind of value does that ascribe to Essent??? You do the math:

Zero!

No wonder Hud wants to take his money and run.....

In Need....11/9

There have been a few requests for publicity sent to me, generally for a good cause, and that brought forth an idea. Normally a blog on blogspot is filled with ads for a variety of less than desirable products.



I'd suggest that I can do some local good with announcements for fundraisers/benefits/non-profit affairs. The blog does get a fair amount of attention, and if the cause is a good one, send it in.... I'm going to play with some html tags and see if I can put some of the unused space to a better purpose.



This in no way suggests that the organizations are supporting the blog. This just means that some of the people that read the blog support the organizations.



With some of the limitations on soliciting for even good causes, maybe you can make a difference. 'tis the season....

Alternatives....11/6

You might ask yourself: What could one state representative....one of 140.....not to mention the 31 state senators do that would affect this case one way or the other?

They can't. They are going to have to legislate for the next incident that might show up on the horizon. I suppose Essent could refile, maybe better thought out, but that's another case, not this one.

The appeals court has a bit of a problem. And second guessing might not be my strong suit here: If they rule strictly on the basis of law, the case is finished, and Essent stews in its own juices. But there is a gap that needs to be plugged. Will the legislative body move with haste to plug it?

If they feel that it wouldn't, do they rule against the rule of law? There is a lot of interest in this case on a national level.

This is where one (or more) of the representatives steps up and proposes legislation to fill the gap. And it truly is an issue that should be bipartisan.

I should imagine that there is cross-channel communication between the branches, and this might be an issue that is approached in that fashion.

Changes....11/3

The internet has changed the face of news, advocacy, and social consciousness forever. I don't know what else has been as revolutionary in the distribution of ideas since the advent of moveable type. Television, certainly, but the production and distribution cost takes that out of the reach of most of the population. The internet is a true leveling of the playing field.

For the cost of a computer, an internet connection and an idea, anyone can be published, quoted, and assessed for worth--on an international level. My ideas, comments (rants, if you would), have caught a level of awareness and kindred spirit of which I was previously ignorant. I knew the problems existed, just not how many others did.

But, this hasn't just been my blog, there are thousands of like ilk, advocating almost every conceivable subject. (There are millions of blogs, but most are of the on-line diary type.) I think that the tendency is to try to make an old law fit a new venue. We need legal guidelines that actually fit the circumstances, not that are taken like a square peg, and whittled down to fit.

An example is a blog in Galveston, GISD Watch, which is under legal attack, as well. One would think that the board, since they are elected posts, would be considered public figures, and as such have little to contest, as long as the comments made were true. According to the blog, the board members are willing to spend the district's money to put an end to that idea.

The board wants several items on the blog removed, and is suing the blogger to do so. Kind of sounds like a freedom of speech issue, and vaguely familiar.

Sixth Court of Appeals....11/1

What is taking place now is the consideration of this case as well as the possible ramifications. While I would like to feel that this is exclusively based on the situation at hand, the legal system does not operate in a vacuum. One has to consider the worst case scenario that might transpire under any ruling.

The easy decision would be that of tossing out the case because my lawyer has no standing in the court. (John Does are in somewhat of a quandary, as well as the representation of such in Texas.) A harder decision is whether the judge's disclosure order can stand review.

Should it stand, it makes a mockery of the Cable Communications Act, and any semblance of privacy. Virtually anything that you regard as private can be disclosed on the basis of a civil suit, with out any proof. That's what the Essent lawyer argued.

But, should a far more over-the-top anonymous blog be allowed free rein without fear of repercussion? Legislation should be enacted to plug the hole.

It comes down to the immediate rights of the individual, and the possible distress placed in a worst case senario.

There is national attention being devoted to this case.

Right Click on Case 06-07-00123-CV, and select open in new tab or window depending on your version of Internet Explorer. Users of Macs, Linux, and Firefox are on your own.

Suddenlink Pipes Up....11/6

Received this as a comment, thought it deserved a top billing:

I apologize for the anonymous label. I don't have a Blogger account for work purposes.

In short, I’m with Suddenlink. Please don’t be alarmed by that: I’m friendly (at least I try to be).

I just wanted to drop a comment in here to try and set the record straight. Our company has spent (and continues to spend) time and money to protect this blogger’s interests. For instance, early on – when we were first ordered by the court to disclose the identity of the blogger – we informed the court that, before any disclosure could be made, the law required that the blogger be notified and have an opportunity to object.

Our bottomline position is to protect our customers’ interests while also complying with the law, in this case, the court’s final order. Net: We’re in a tough position, too, and simply trying to do the right thing. I hope that counts for something.

Pete Abel
Vice President, Community Relations
Suddenlink Communications
pete.abel@suddenlink.com

Pete,
My heartburn is that Suddenlink has not filed any objections, especially early on, despite there being no actual Texas legislation requiring the company to turn over records except in criminal matters.

Most of what has been cited has been out of state, because of that simple reason.

And, you don't need a blogger account. Click other and fill in whatever you wish.

I know you have had a legal presence at the proceedings. My contention is that your company should be the ones petitioning the Writ, instead of me. Rather than that, an agreement with Essent was reached for a disclosure. Had I not retained James, some very bad law might have been written from the bench, and had a precedent....frank

Note: Was looking for a "Pipes Up" tie in and ran into this accidentally. Crossroads seemed fitting....frank

Something to Ponder....10/24

One of the areas that we forget to take into account when we transmit records is the fax. Merely stating that "if you weren't supposed to get the fax, you should destroy it" doesn't meet HIPAA standards of PHI protection.

Who is responsible for any breach? The sender.

Received a comment about the circumstances involving the North Campus patient that PRMC accused me of violating HIPAA about. Then I realized: The only way someone could identify the patient was if they had been given information by the family. Or if someone had access to the PHI. I still don't know the patient's name, nor do I want to.

And, yes, it came as an anonymous comment.

Tomorrow, oral arguments will be given in Texarkana as to forcing Suddenlink to disclose my identity. That is all it is for. It has no bearing on the accusations that PRMC has, it only says that the court can or cannot compel the internet provider to disclose without proof of an actual offense, merely by accusation.

Should the court rule in my favor, Essent still has the option of attempting to prove their accusations to a sufficient standard for disclosure. The bar will just have been raised a bit higher. And, rather than making an end run around the system, the means and the goal will be in their proper order.

Is this over? Probably not.

This Week in Brief....10/22

The big issue is the appeal's oral arguments in Texarkana next Wednesday. Hopefully we'll have a definitive view of the subject of privacy in Texas.

I had a commenter that was doing a fair amount of threats, name calling, and bad grammar. So, I made a point of tracking the IPs he used (I can download a report, time sequenced, so I matched the times with the comments. I deleted all the other listings, since that would give the data to Essent, should they win.) The only one they'll have a record of is their stooge. Like I do.

Hal Andrews, former Senior Vice President of Development for Essent (fired by Hud) was made CEO of Data Advantage Corp. Just indicates that being fired from Essent is not one of the worst things that can happen. Actually, it might be the best.....

The second PRMC IT person suspected of being me was fired. Kevin probably didn't want to stay anyway, since Race was sold. Christus ought to pick him up, knowing their system as well as he does. Actually, this is a perfect way of getting rid of an IT person that might be superfluous, since the consolidated data center was created, rather than paying benefits. Even the RIF policy wouldn't have cut those.

We found out that a community can take back its healthcare with Bonham's announcement. And, Hud still thinks that PRMC is a $100M proposition. Too bad no one else does....

Andrews to head Data Advantage as CEO....10/17

Hal Andrews has been named chief executive officer of Data Advantage Corp., the company announced.

Andrews, 40, served previously as senior vice president of corporate development of Irvine, Calif.-based Cogent Healthcare, which manages hospitalist programs in healthcare facilities. He has a law degree from the University of Tennessee College of Law, Knoxville, and a bachelor's degree from Southern Methodist University, Dallas.

Data Advantage, Louisville, provides healthcare information services to more than 500 hospitals and healthcare facilities across the country. -- by Jean DerGurahian/ HITS staff writer

Nice to know that there is life after Essent.....

Twelve local investors to buy Bonham hospital....10/17

From a comment:

By Vicki Graves

BONHAM — Twelve local doctors and investors recently took on the venture to acquire Red River Regional Hospital and it will be locally owned and operated.

Their $3.2 million offer was accepted Thursday by Attentus Healthcare of Nashville, Tennessee, CEO Dave Conejo said Friday. Officials at Attentus Healthcare couldn’t be reached Friday for comment. Hospital officials now move toward “doing the due diligence” and getting the loan completed. Their goal is to have that done by year’s end.

The majority of involvement is from area physicians. Now, they just have to do the work that will consummate the transaction, Conejo said.

The closing process will involve getting the property inspected, having a title search done and making sure there are no problems.

All contributions are held in an escrow account at Bonham State Bank.

When the local investors take ownership, they said they will completely remodel the emergency room and all patient rooms.

“The way the hospital is set up, we decided not to try to squeeze two patients into one room,” Conejo said. “When this hospital was built 38 years ago, two patients were kind of tight in those rooms, so we decided to make them all private.”

Patient rooms also will be equipped with comfortable recliners for family members who want stay at the hospital with their loved ones.

The enterprise began when the idea came up just two months ago.

“We’ve got a lot of people that are really getting behind this,” Conejo said.

The group doesn’t have all the money yet but has pledges lined up for a large portion of it and is confident that by month’s end, the rest will be in. All contributions and investors are welcome, he added.

One has to wonder, why the local docs haven't joined forces with other local moneymen to regain control of PRMC from Essent.....or is the price too high?

Now, my take: Interesting that I was being taunted by one of the Essent hanger-ons, and he had the following to say:

Like I said in my earlier note to you, since you are so good at hospital management, you should go raise some buckaroos and buy the hospital that Community Health ditched in Bonham. Why I betcha as smart as you are, you could jes' suck Paris Regional in no time flat. In fact, I bet you could bring Essent to its knees.

He might actually be right. Clarksville has seen an increase in utilization, as had Bonham. With the troubles we've had here, it would appear that some shrewd investors saw an opportunity to not only take more control of their destiny, but to leverage an advantage out of Essent’s troubles. It isn't the big threats, it's the chipping away of the healthcare dominance that Paris once had. Essent has provided the opportunity, and now it's being taken advantage of. Hopefully they do more “due diligence” than Essent did.

The shame of it is, by the time Essent is forced to sell, there might not be anything that is worth buying.... I heard that the taunt came from a lawyer...maybe he should be advising his clients, as prophetic as he is, rather than me!

Analysis of the Court....10/19

I was flipping through the Googled hits, and happened across the "Citizen Media Law Project":

The Citizen Media Law Project (CMLP) is jointly affiliated with Harvard Law School’s Berkman Center for Internet and Society, a research center founded to explore cyberspace, share in its study, and help pioneer its development, and the Center for Citizen Media, an initiative to enhance and expand grassroots media.

What they had to say about the case was interesting, to say the least, and may help on the 24th, when arguments are presented:

Not surprisingly, Judge McDowell's September 14 letter ruling in the Essent case makes a muddle of all this. First of all, it is bizarrely formatted -- the legal analysis is contained in two paragraphs that are italicized and indented from the rest of the letter, giving the impression that these paragraphs are quoted material, but without any indication of their source. Some independent researched turned up the following observations:

The first paragraph comes almost verbatim from Polito v. AOL Time Warner, Inc., 2004 WL 3768897, at *5 (Jan. 28, 2004), a case involving a subpoena to uncover the identities of anonymous AOL subscribers who allegedly sent the plaintiff harassing e-mail messages. The language that Judge McDowell quotes from Polito, however, relates exclusively to another case, In re Subpoena Duces Tecum to America Online, Inc. (noted above). Specifically, Judge McDowell appears to be invoking the standard applied by that court -- namely, that "the pleadings or evidence" satisfy the court "that the party requesting the subpoena has a legitimate, good faith basis to contend that it may be the victim of conduct actionable in the jurisdiction where suit was filed." In re Subpoena Duces Tecum to America Online, 2000 WL 1210372, at *8. In that case, the court considered evidence outside the plaintiff's complaint, but it did not make clear whether that was required by its standard.

The second paragraph comes verbatim from Alvis Coatings, Inc. v. Does, 2004 WL 2904405, at *3 (W.D.N.C. Dec. 2, 2004), a case which applied an especially weak version of the "prima facie" standard. There, the court was content that the plaintiff had "averred that the statements are both false and damaging to the Plaintiff's trademark and to its business generally." Id. at 4.

McDowell's letter never explains which standard he is choosing to apply -- Polito, In re Subpoena Duces Tecum, Alvis -- they're all different standards, especially if you look at them closely. Worse, McDowell never even tries to apply the (as yet unknown) standard to the facts of the case. The letter ruling says only:

After considering the above [i.e., the two paragraphs taken nearly verbatim from different decisions], the Court hereby concludes that good cause has been shown and the burden by the plaintiff has been met to meet the requirements of the exceptions to the [Cable] Communication[s] Act to grant the request by Plaintiff for the Internet service provider to furnish the name and address of the subscriber.

Apparently, Judge McDowell believes that no evidence to support Essent's claim is required. That is bad enough, but it is a debatable proposition under the case law. He apparently also believes that no analysis of the allegations in the complaint for facial sufficiency is required. Whatever the standard, this is surely wrong.

Blogger to remain unknown for now....10/12

For an update:

By Bill Hankins
The Paris News

Published October 10, 2007
TEXARKANA — The identity of an unknown blogger named in the Essent-Paris Regional Medical Center lawsuit will not be revealed today.

The 6th Court of Appeals in Texarkana Tuesday issued a stay of 62nd District Court Judge Scott McDowell’s order for internet service provider SuddenLink to reveal the identity to the court by 10 a.m. today.

Attorney James Rodgers of the Moore Law Firm in Paris said the Court of Appeals granted a stay of the disclosure until Wednesday, Oct. 24. At that time oral arguments from both sides are to be heard to determine whether the information should be revealed.

Rodgers Monday filed a writ of mandamus asking the court to look at the disclosure issue.

The hospital filed the lawsuit June 19, accusing the unknown blogger of wrongful conduct in publishing “false and misleading” information detrimental to the hospital and asking he be silenced.

In its lawsuit, the hospital alleged some of the information on the blog was obtained illegally.

It said the blogger “published statements with malice, with a reckless disregard for truth or falsity and with negligence in failing to ascertain the truth of the statements.”

McDowell ordered SuddenLink to reveal the name of the blogger, but SuddenLink said the blogger must first be notified and given the right to lodge a protest to the disclosure.

Rodgers countered, telling the court the Cable Communications Act prevents such disclosure.

McDowell, citing a Circuit Court of Virginia case, then said the identity could be revealed if evidence satisfies the court the party requesting it has a legitimate, good faith basis to contend that it may be the victim of conduct actionable in the jurisdiction where the suit was filed.

Rodgers then filed the writ of mandamus asking the appeals court to intercede. It issued the stay order Tuesday.

Intentions....10/10

The intent of the action is solely held by the individual 'acting'. In my case, Essent ascribes my motivations as quite low, while many readers place them on a pedestal. The truth is somewhere in between. The comment about Publius took me back to my 7th grade Civics class, so very long ago.

"The consciousness of good intentions disdains ambiguity. I shall not, however, multiply professions on this head. My motives must remain in the depository of my own breast. My arguments will be open to all, and may be judged of by all. They shall at least be offered in a spirit which will not disgrace the cause of truth." -'Publius' The Federalist No. 1

Hamilton probably wrote the bulk of the Federalist Papers, but the contributions of John Jay and James Madison are far from forgotten. Could you imagine those authors having the power of blogs at their disposal? (A sidebar: Where is an Iraqi Federalist blog? Probably is one, and the topic is better left for a different blog.)


Has the blog been completely altruistic? Probably not, very few things are. I just see too many things that there should be awareness of, hidden from the public consciousness. We base so much of healthcare on trust. When that trust is violated, we all suffer.


Essent would probably say that their trust was violated, but the truth is, in healthcare we have so many barriers to knowledge of what really happens. There really is no 'loyal opposition' in healthcare. Government is the closest thing we have to that, as an advocate.

What happens in a socialized medicine senerio? Would I be facing a Federal suit? And who then is left to monitor?

A long while ago, I received an email from a blogger in the Netherlands, saying that he was fascinated by the blog, because in his country there wasn't such a thing (to this level). He wanted to follow-up with questions and an article, and suddenly nothing. Maybe, in a socialized medicine country, that's one stone you don't kick over.

It is ironic that the reason Essent was able to track back on me is because I wanted to be accurate in what I wrote--by using their own words. Posted at their own websites. I just did it a bit less covertly than I should have.

It's Hard To Remember....10/7

...that the objective was to drain the swamp when you are up to your butt in alligators....

MY problems aren't the problem, merely the symptom. (Lord, that took a bit to say it.) The manifestation of Essent's attitude first impacted staff, then patients, and now the community. Obviously, I was not the first--Holly was. And there are plenty of examples of the staff's treatment.

But what about patients? Rumor has it that Essent is sweating this last incident, and that a case is being talked around.

Have you noticed that several healthcare corporations have been purchased in the last year...and we know that Essent is being shopped out. So why hasn't it been bought?

No matter what you may think, it isn't the blog. Again, merely the symptom, not the cause.

Merrimack Valley Hospital $-1,498,033
Nashoba Valley Medical Center $860,296
Sharon Hospital $1,467,558
Southwest Regional Medical Center$-212,615
Paris Regional Medical Center $288,275*

So, investors have a ROI of less than a million on what kind of investment? Sounds like the Out-Patient Surgical Center here.... You be the judge....

*figures from AHD.com

More From The Blogosphere....10/9

More from the blogosphere:

Picking Up That Gauntlet Again: An Anonymous Medical Blogger Is Sued
I've alluded to this case before (hat tip to Kevin). And it was so disturbing to me, I linked the post as a Housecall on my sidebar.

An anonymous medical blogger is being raked through the coals in court for saying less-than-nice things about a hospital in Paris, Texas. A Texas judge (who seems not to have any real grasp of HIPAA at all) is threatening to sign an order that would "out" him.

I feel his pain. And now I offer you his blog (courtesy of Pure Pedantry). It will be hereafter linked in the sidebar. Like Flea (even though he isn't there anymore).

It was just a matter of time before a corporate lawyer tried to use HIPAA as a weapon to shut people up.

*Note to the hospital CEO's and corporate healthcare lawyers: In this day and Internet age, suing someone for speaking out on the nasty things going on behind the scenes at your hospital ALWAYS works to get your hospital less scrutiny.

Here's a suggestion: Cleaning up you act is usually the better course than shooting the messengers.

Some the messengers you try to pummel don't' just roll over. They fight back.

The hospital (owned by a larger conglomerate) in this case says, "We understand and respect the blogger and general public's right to voice their opinions about PRMC and welcome constructive criticism . . . However, the method used by the defendants is wholly unacceptable. It is a cowardly infringement on the confidentiality rights of PRMC patients and an unwarranted attack on the reputation of the hospital."


Now THAT is just a load of hooey! Thus, my comment at Kevin's:

I would submit that HIPAA, like the "blanket immunity" offered in medical peer review, is tailor-made for cowards who want to cover their ugly messes up.

The LAST thing this lawsuit is about is "protecting" patients.

"We welcome constructive criticism."

I'd like some of what you're smoking if you really believe that.

I've yet to completely digest the blog, but thumbing through the comments tonight (much of it very entertaining given my own dance with confidentiality and privacy issues . . . and very expository of just how convoluted HIPAA can be), it's obvious that somebody is smoking some really good something. This particular profundity (offered in a mind-bending comment that I think ultimately supported the anonymous blogger) caught my eye.

"Privacy trumps truth".

Huh? On what planet?

The last time I talked with a lawyer, the truth is absolute protection in a court of law. It doesn't get "trumped".

Except when people lie . . . and get away with it because the state (in my case, North Carolina) does not care.

The anonymous defender of free speech (a right that, unlike the "right to privacy", is actually specifically addressed in the US Constitution) says this: "If the blog is squashed by a lawsuit, does that really reassure the public? All it shows is that a large corporation can step on an individual."

Don't I know it, Bub. You would think the guy lives in Asheboro, North Carolina.

Posted by DR. MARY JOHNSON at 1:59 AM

The picture is my addition...frank.

Point Taken....10/5

A commenter on the Harvard Law blog brought up a point, however I don't think the court would even consider it:

September 23, 2007 at 4:42 am
Crosbie Fitch
I’m not sure anyone can be defamed by an anonymous and unknown person.

For harm to be caused by falsehood requires the falsehood to have some weight, i.e. someone’s reputation behind it.

An anonymous person has no reputation. Their arguments or assertions stand entirely upon their intrinsic merit.

Look at it the other way around: an anonymous person cannot be defamed no matter the reputation of those defaming them (because the anonymous person has no reputation).

Similarly, one could observe that a child’s defamation has far less weight than an adult’s.

Defamation is inherently inegalitarian, and rightly so.

However, pen names have been used for centuries--in some cases to disassociate the ideas from the source, rather than the other way around. In either case, the ideas have to be able to stand on their own.

I was watching 60 Minutes a while ago, and Clarence Thomas made two points that hit home: "It is always worth it to stand on principle." And, "Wrong is wrong, even if it's over a penny." The principle is the worth of the staff and of the patients. The new RIF policy is wrong. Employees are required to give notice, but the hospital doesn't? Truly amazing that no one had a copy of it prior to the sale of the health centers. The policy mysteriously comes out after the sale, but dated prior to it. You be the judge....

Speaking of which, the judge is to sign the new disclosure order Monday. Obviously we're continuing to fight it.

Comments That Rang Clear....10/5

A lot of folks just skim the posts--ignoring or unaware of the comments. The commentary makes this blog what it is...I'm just along for the ride, especially on this one.

...I'm not one of the so-called "John Does" mentioned in this suit (and Essent would have a hard time proving otherwise). That being said, I want to address the allegation made by Hud that this blog caused PRMC's census to drop.

Had Hud looked beyond his office (and the BS Dickie was telling him), he would have seen the decline in census stems from the policies and practices Essent has put into place. Cut staff, demoralize who's left, don't give them the right tools to do the job, blow off keeping the place clean, anger the local physician staff, and folks are going to have less-than-stellar experiences. Bad news travels very quickly, and folks will talk, whether good or bad news. Those that can, will go elsewhere rather than deal with the possibility of a bad experience.

If Dr. Slipknot-oops, I meant Lui- has departed the staff, then that's a positive step. Ditto for Pranulis in the overgrown broom closet that passes for an emergency room.

If PRMC is supposed to be the flagship of this sad company, what does this say about the rest of the hospitals? So far, it seems PRMC is the only place making money, and not that much. With the other hospitals losing money hand over fist, Essent's bottom line is written in red, as in red ink. They've been rebuffed in recent attempts at purchasing new properties, dumped off one that was drowning in red ink when it was purchased (and was hemmorhaging worse when Essent sold it), and have been scrambling for more money to stay afloat.

Allegations? Fantasy? Nope, all are facts, and can be gleaned from other sources. Perhaps some slick ambulance-chaser can demean these facts, or even shoot the messenger, but they still stand regardless.

I believe in free enterprise and capitalism as Adam Smith wrote in his excellent text, and have no problem with any company who wants to make a profit- after all, profit means more money to invest in a business (or at least it's supposed to). However, any company who sacrifices its employees and customer base to boost its so-called bottom line will not last for long, nor should last.

Most likely the big cheeses in Essent will laugh, scoff, etc. when they read this, but that's OK. I have broad shoulders, and I know I'll still be employed when Hud and his buds are trying to either rearrange deck chairs on the Titanic/Essent, or start up yet another for-profit healthcare business when Essent finally sinks. And when that happens, I as well as others who are disgusted with Essent and its thugs will have the last laugh.

As a comment it received another comment from Essent--but it was the same person that I spell-checked previously, and his current mistakes made it unreadable. Probably a Duke business major....

Anyway, this one ices the cake--public sentiment, plainly spoken, that echoes the previous:

I miss Christus and all it believed in. Since Essent took over, it's all just a big mess.

I hope all you high and mighty.. Hud, whoever you are and the rest of these jokers realize what a damn mess you've made here. I wouldn't take my worst enemy for treatment at any of your facilities just because of how I've seen you conduct yourselves.

You can't expect the remaining employees to be inspired to do their jobs. I hear the morale is so bad. And you can't provide good service with all the cuts you've made. But, I guess you really don't care. The little people don't really make you lose any sleep at night. Shame on you.

What more could I add?

What Essent Wants To Do....9/30

A real timely question:

I guess we're all wondering if we're going to be sued too. Seems like you can't voice an opinion without having to defend it in court, especially with the ones you're dealing with.
I think that's the problem here. Are our isp identifications up for grabs, too?

Probably they would if they could. They listed John Does 1-10 to have an opening, but unless Blogger maintains logs, there is no way of telling who left comments. Blogger is owned by Google, so good luck, Wes.... Hotmail is what, Microsoft? I delete emails, so discovery is moot. And, those with a touch of time on their hands, here is how to go through the Tor network and be 'truely' anonymous.

Suddenlink is not offering any resistance to the discovery, merely responding to the order. Almost feels like they helped phrase the judge's original order so as to avoid culpability. I've heard comments about them 'fighting' the order. Unless they actually submit objections to the court in this, they are just being passive, or even cooperative. The only thing I've seen is the posting of their lawyer's vacation schedule.

The only reason my IP address was targeted was obvious, once I actually thought about it: THEY track the visitors to THEIR sites. So, everytime you search out something on Essent, the search parameters are displayed, as well as where you came from. So, if I had thought about it, I would have blocked cookies and possibly gone to the trouble of using a separate workstation/browser for searching. Then it would have been only a guess, with the search parameters used, and what was published.

Gallows Humor....9/26

Man came in said, "All rise." We all stood up, and Obie stood up with the twenty seven eight-by-ten colour glossy pictures, and the judge walked in sat down with a seeing eye dog, and he sat down, we sat down. Obie looked at the seeing eye dog, and then at the twenty seven eight-by-ten colour glossy pictures with circles and arrows and a paragraph on the back of each one, and looked at the seeing eye dog. And then at twenty seven eight-by-ten colour glossy pictures with circles and arrows and a paragraph on the back of each one and began to cry,'cause Obie came to the realization that it was a typical case of American blind justice, and there wasn't nothing he could do about it, and the judge wasn't going to look at the twenty seven eight-by-ten colour glossy pictures with the circles and arrows and a paragraph on the back of each one explaining what each one was to be used as evidence against us. ...from Arlo Guthrie's Alice's Restaurant

A man falls off the Empire State Building, and half-way to the ground he yells to someone watching, "So far, so good...."

The initial ruling (on disclosure) is apparently against me. Which means the appellate process. While this isn't the actual lawsuit, it is most critical. It's hard to believe the standards for disclosure were met under Cahill.

As Cahill's "Summary Judgment" Standard contends:

It requires that a plaintiff, suing for defamation, must satisfy a summary judgment standard in order to unmask the identity of the anonymous speaker. In this case, Cahill was a public figure, and to prevail in a defamation lawsuit, he had to prove that (1) Doe made a defamatory statement (damaging to Cahill’s reputation); (2) the statement was concerning Cahill; (3) the statement was published (disseminated to others); (4) others would understand the statement to be defamatory; (5) the statement was false; and (6) Doe made the statement with actual malice (he either knew it was false or acted in reckless disregard of the truth).

The Court concluded that Cahill must satisfy the summary judgment standard relating to most of these elements. That means that Cahill must show that there’s a genuine issue of material fact about these issues. In other words, he must show enough evidence to justify why he should proceed to a jury on these issues.

...the easier one can expose the identities of John Does, the more likely it will "chill the use of the Internet as a medium for free-ranging debate and experimentation with unpopular or novel ideas".

The biggest issue is #5: Was it false?

...that element of a summary-judgment-like test still ought to be relaxed, because evidence of "actual malice" could likely only be obtained through discovery, whereas a plaintiff could make a threshold showing of falsity and defamation from his own resources.

Example: Items 24&25 in the suit deal with specific accusations of falsehood by John Doe#1.

So, to prove #24, the hospital would be required to provide logs of call personnel, a list of the types of studies done by the call personnel, and statements from the call personnel and the staff that called in the tech. And a copies of their certifications. All of which they should have on hand.

Up-coding verification requires the patient records, and the submitted billings, but it was indicated in the blog that it was 'suspected', not as an absolute. Didn't one of the supposed Essent resonsive comments mention a Medicare audit? With a specific settlement figure? Maybe they were suspected....

As for demonstrating #25, the hospital would have to provide to the court the same information they provide to the state and CMS. Not a terribly demanding task.

Many of the quotes that are attributed to me in the lawsuit are not mine. A careful study of the context they were clipped from will plainly demonstrate that fact. In many cases, I specifically mention that they are quotations from comments, either before or after, in others I used italics to indicate where my comments started.

The gain from 'unmasking' me towards identifying the commenters is negligible. The thought that an anonymous blogger is going to know who an anonymous commenter is tends to strain the fabric of the argument. The only security one has in this is that which is generated by the anonymity of both parties. Additionally, comments are deleted automatically from the queue as they are published.

The only thing this might do is silence an open criticism of Essent's method of doing business.

But there is no joy in Mudville....9/20

So far, no news is...no news..... The good judge is enjoying his weekend off, and both sides of the lawsuit are waiting...for Monday.

I almost think that should I lose, I'll take the keys out and throw them to the next in line...passwords and monitoring accounts, and let them carry on. There are a few that have made the offer, both here and in the other Essent locations. Everyone is replaceable...at least in Essent's eyes. That way I wouldn't have to worry about new articles during the appeal process, and it could be a set of outside eyes watching the proceedings.... Heck, they might be even more of a burr than I was! Some said I was far too restrained...and I have some advice for avoiding being tracked, now....

So, for those interested, get your best piece together for submission over the weekend, and you too could be the guy or gal that Essent just loves to hate!

If you submit articles under the comments, you can call yourself by what you want your password to be! That way there is no track-back to or for me. It would be like trying a key in a lock at the Toyota-thon.

This could be rather fun!...frank

The Rule Of Law....9/30

“There is no such procedure in Texas and federal jurisprudence for what is taking place in this case. I find no legal authority for a subscriber having to take part in this action. I challenge anybody involved in this case to show any precedent for employing such a procedure as this.” ...Letter from James Rodgers to the court.

The lawsuit and the third-party disclosure order were two parts of a back-door attempt at ascertaining my identity and silencing the blog. The HIPAA 'violation' was used to justify the disclosure order, even though this was a civil matter. The cited US Code was plainly meant for criminal cases.

The 'two law firms' mentioned in the post, How Essent Really Feels, probably thought that their level of expertise would bulldoze the court into over looking the very law that they were utilizing in a perverted manner. From the article in the Snooze, it didn't happen, and that was due to James Rodgers. I'm feeling fortunate.

While this battle is stalemated, the war goes on.

I would guess that with the last vascular certified ultrasound tech giving notice, they would have to go back to a locum...or not be able to bill for services.... How many US techs have left this hospital since Essent took over, anyway? Bonus points given for this answer....

Second question: The Snooze used another direct quote from the letter, what consequences could that portend?

The fighter might not be appropriate, but the comments that surround it are (click on it and see what I mean.) I thank the men and women of the armed forces of our country for the freedoms which we enjoy and for the existance of the rule of law that protects us.

Labor Day....9/7

The First Labor Day

The first Labor Day holiday was celebrated on Tuesday, September 5, 1882, in New York City, in accordance with the plans of the Central Labor Union. The Central Labor Union held its second Labor Day holiday just a year later, on September 5, 1883.

In 1884 the first Monday in September was selected as the holiday, as originally proposed, and the Central Labor Union urged similar organizations in other cities to follow the example of New York and celebrate a "workingmen's holiday" on that date. The idea spread with the growth of labor organizations, and in 1885 Labor Day was celebrated in many industrial centers of the country.

Labor Day Legislation

Through the years the nation gave increasing emphasis to Labor Day. The first governmental recognition came through municipal ordinances passed during 1885 and 1886. From them developed the movement to secure state legislation. The first state bill was introduced into the New York legislature, but the first to become law was passed by Oregon on February 21, 1887. During the year four more states — Colorado, Massachusetts, New Jersey, and New York — created the Labor Day holiday by legislative enactment. By the end of the decade Connecticut, Nebraska, and Pennsylvania had followed suit. By 1894, 23 other states had adopted the holiday in honor of workers, and on June 28 of that year, Congress passed an act making the first Monday in September of each year a legal holiday in the District of Columbia and the territories.

A Nationwide Holiday

The form that the observance and celebration of Labor Day should take were outlined in the first proposal of the holiday — a street parade to exhibit to the public "the strength and esprit de corps of the trade and labor organizations" of the community, followed by a festival for the recreation and amusement of the workers and their families. This became the pattern for the celebrations of Labor Day. Speeches by prominent men and women were introduced later, as more emphasis was placed upon the economic and civic significance of the holiday. Still later, by a resolution of the American Federation of Labor convention of 1909, the Sunday preceding Labor Day was adopted as Labor Sunday and dedicated to the spiritual and educational aspects of the labor movement.

The character of the Labor Day celebration has undergone a change in recent years, especially in large industrial centers where mass displays and huge parades have proved a problem. This change, however, is more a shift in emphasis and medium of expression. Labor Day addresses by leading union officials, industrialists, educators, clerics and government officials are given wide coverage in newspapers, radio, and television.

The vital force of labor added materially to the highest standard of living and the greatest production the world has ever known and has brought us closer to the realization of our traditional ideals of economic and political democracy. It is appropriate, therefore, that the nation pay tribute on Labor Day to the creator of so much of the nation's strength, freedom, and leadership — the American worker.

From The Mouth....

Well, if you look at what has to happen if this commenter is anyone but Hud: First, the person has to be monitoring the blog. Then he has to come up with the response. Then he has to clear it with Huddie himself...because if it makes Hud look bad... Suffice it to say, there are several former players from corporate that found out the results....

"If THE COACH and other board members were being paid off as you have suggested multiple times on this site, then why would he ruffle feathers and challenge Essent's decisions? Your suggestion that the board is on the take is but one of many libelous statements that will soon catch up with you.

I don't know anything about the anest. group but, if I am not mistaken, wasn't Essent paid damages by the radiology group? If so, who was right, and who was wrong?

Thirdly, I also don't know the specifics of the rehab issue you raise. However, you stated that Essent had to pay $250,000 for an audit. What you failed to follow up on is what was the result of the audit? Was Essnet fined materially for wrongful behavior or was everything determined to be OK? Even in our personal lives, any of us can be audited by the IRS....just because they audit our taxes doesn't mean we did anything illegal, does it? Same goes for CMS auditing a healthcare provider.

Have a great weekend Frank just know that progress is being made in outing our dear little blogger.....who knows maybe you will be the Sen. Larry Craig of Paris.....do you spend alot of time in public restrooms, Frank? :) I wonder if you are upset because Hud didn't play footsie with you in the restroom and you just haven't been able to shake the rejection. Bye for now (also you still don't posts all of my submissions.....hmmmm do you like the word "submission" Frank....you bad boy, you.)"

Now take a look at this comment sent to hospital impact:

"Frank Pasquale's ideas may be good but his delivery cheapens them. He is too personal. I went to his blog about a hospital in Paris TX- but it is really about his feelings for the CEO. Must have been a romance gone bad which is better left to blogs of a different ilk than hospitals."

Note the similarities? Whatcha think? Hud=Leon? You be the judge.... Both have gay fixations. Too much porn, huddie? This is the guy you want to share a table with at the Gala???

The site that was listed for Leon had three titles posted, no explanation, no comments since March. You can get comments about a post that says that grass is green! Funny, he even copied the template.

But, let's tackle the comments (sorry, coach.)

I said the board had voted for Essent, when the top bidder indicated that they would disband the board. Does the board receive compensation? The more radical comments were comments from the readers.

The anesthesiology group: One is still here, one was fighting cancer and, well, let me put it in their own words:

"To clear up a point, the "four long term anesthesiologists" were not fired per se, two of them resigned and gave ninety days notice, one was fighting a battle with cancer, and the fourth is still hard at work in PRMC, God bless him. The reasons for the resignations included our refusal to continue working with a certain surgeon (who no longer is employed in Paris), and the hospitals insistence on our firing our long-term billing company and allowing them, Essent, to assume billing and collections for us. They also wanted us to to hire the nurse anesthetists.

All this would have meant that we would be working for Essent and not necessarily for our patients. This situation was intolerable for a number of reasons.

Although I miss many dear friends made over twenty years, I wouldn't come back on a dare as long as Essent is in charge.
M.C. Young, M.D."

As for the radiology group, they were kind of held by the short hairs: It wasn't their building. So they had to convert an existing structure because of the time factor...which just happened to be right on the loop. They're more visable than the North Campus! Don't throw me in the briar patch, Brer Fox.

With the fines that are already racked up, should we keep on that track? I think a commenter mentioned the largest fines of any hospital in the state that stayed open...

Regarding the lawsuit, the hearing was backed up a week. Possibly the letter to the judge characterizing the actions as "patently illegal, unconstitutional and an abuse of process" had something to do with it.

One more thing to toss into the mess:

"This could be purely rumor that the Essent board is looking for a buyer for the company. Hud and the CFO were not consulted. At least one company was interested but did not have the funding."

Stay tuned...