Internet Freedom of Speech--10 Years Old.....7/3

Ten years since Supreme Court upheld Internet freedom of speech
By Nate Anderson Published: June 26, 2007 - 12:11PM CT

Today is the ten-year anniversary of the Supreme Court decision striking down the Communications Decency Act—a landmark ruling for Internet freedom of speech. Thanks to the decision, the Internet (in the US) now enjoys the same freedom of speech protections as print and remains more open than either television or radio. On the tenth anniversary of the decision, let's take a quick look back.

The Communications Decency Act was passed in 1996. The goal was to protect children from harmful content on the Internet, which sounds great in theory but turns out to be terribly difficult to implement in practice. Many groups believed that the CDA was overly vague and could restrict all sorts of legitimate speech between adults, and the ACLU took the lead in the legal challenge to the law.

The case worked its way up to the Supreme Court, where it became the first Internet-related case addressed by the Court. Reno v. ACLU was decided on June 26, 1997, and it struck down major sections of the CDA.

The Court found that the law was imprecise; regulating speech generally requires highly-specific controls, and the text of the law did not meet that standard. The CDA did not define "indecent" and "patently offensive," nor did it include the caveat that "patently offensive" material with some socially redeeming value would be allowed. The justices found that filtering on the user end (that is, by parents) was a less-troubling method of filtering out unwanted Internet content.

But if radio and television can be regulated, why can't the same regulations apply to the Internet? The justices found that the two mediums are quite different; spectrum for over-the-air radio and television signals is limited, for instance, and expensive to use (setting up a large-scale transmitter in studio costs serious money), making "speech" over the airwaves available to only a privileged few. By contrast, the Internet is so simple and inexpensive to use as a publishing medium that it deserves the same First Amendment protection as print.

The ruling was a strong statement of support for freedom of expression on the Internet at a time when the Web was just entering mainstream consciousness. The EFF's David Sobel, a co-counsel in the case, said yesterday that "the Reno decision defined the First Amendment for the 21st century. The Court wrote on a clean slate and established the fundamental principles that govern free speech issues in the electronic age."

Congress attempted to craft a better bill soon after, passing the Child Online Protection Act the following year, but it too was never enforced. Tied up by the same legal challenges that derailed the CDA, COPA met the same fate as its predecessor earlier this year when a federal judge ruled that the bill was unconstitutional.

Ten John Does.....7/2

Thinking about this lawsuit, the described 'John Does' would be contributors to the blog that have used searches ending up on Essent web pages. The searches would be the telling factor, not the 'logging in' to the blog. To prove anything other than they were curious would be a stretch. But would get people fired.

Now, the suit as filed, is stating that the 'John Does' are the blogger. Seems like the hospital is more interested in hanging their own employees with a wide net, given to them so graciously by Judge McDowell. The blogger being only secondary.

After what happened with Holly...we do remember what happened with Holly? She emailed Salerno with an offer to help...he rebuffed...she forwarded the emails to me...he got Holly's husband banned from the hospital (medical equipment rep) and fired from his job. The poor guy had no idea as to what happened...and that could be what happens here.

Someone asked a while ago in a comment if they were responsible if someone else was using their computer. I have no idea. Does the library have liability, should they be one of the 'John Does'? If they were both employees, I would suppose they could/would fire them. It certainly would fit the conduct to date. Just can't fire the library. This is what was related to me:

Forbes online lists two open wifi sites for laptop access in Paris: The Holiday Inn and Hastings. There are a lot more. Most motels. Dozens of businesses. And on almost any block, you'll find them. So, who then is responsible? The laptop owner, or the owner of the IP address that was unlucky enough to be utilized?

Just remember, all this took was a search on Google, MSN, Yahoo, Ask, or whatever. The search parameters were the tell, and the ISP and IP were there to the clicked result. If you searched for Essent +lawsuit +blogger, the terms of the search would be available, who provides the internet connection, and the IP of the user. If you click on one of the results with essenthealthcare.com, you might be named in the suit!

Most people don't pay for a fixed IP, so that can get somewhat tricky, with floating IPs (first come, first served, and numbers reassigned randomly.) One would hope that the information provided by Suddenlink was accurate, or they might be the recipient of a lawsuit by the various 'John Does'.

Didn't think I'd re-run a graphic, but it fits too well not to...frank

A Piece of the Pie.....6/30

Had an interesting reply to a query I made to a HIPAA blog:

...I thought I'd give you a better response and answer the HIPAA question.

Basically, a covered entity is a covered entity, and he/she/it can't use or disclose PHI (broadly defined to include any information about the past or present health or payment for health of an individual, if it's such that you can reasonably discern the identity of the individual) except for treatment, payment or healthcare operations, as required by law (think gunshot victims or other things that must be reported), with the individual's permission (persuant to a written authorization that meets specific requirements), or in particular other circumstances (pursuant to a valid subpoena that's survived a motion to quash or has a protective order with it, to law enforcement officials in particular instances, in appropriate research studies that have appropriate human subject protections, to the secret service or military in certain situations, etc). The basic prohibition, which plenty of folks think is way too lax, is pretty draconian, actually, and there's not a "common sense" exception.

Now, if you're not a covered entity, you can't violate HIPAA. A presume you could aid and abet a HIPAA violator, but I can't see the DOJ going after somebody for such a thing unless they're engaging in good old fashioned identity theft. And the HIPAA penalty multiplier is for when the disclosure or use is done under false pretenses and with intent to sell, transfer or use for commercial advantage, personal gain, or malicious harm; I don't see commercial advantage, the only personal gain is self-satisfaction and I don't think that would be enough, and the malicious harm is surely intended to refer to harm to the individual whose PHI is disclosed, not to the hospital.

If the disclosing person is a HIPAA covered entity, and the relative didn't give a HIPAA-compliant written authorization, the disclosure is technically a HIPAA violation. Of course, the only person who would care is the relative, who probably doesn't, so it's not a violation that's ever going to go anywhere. Unless someone else wants to make a big deal out of it for completely different purposes, as may be the case here. There may be some other PHI disclosures that they're alleging from elsewhere in the blog; like I said, it's a pretty draconian prohibition.

As for the Medicare billing issues, did you consider pursuing that as a "qui tam" action? (Allow me to emphasize here that I am not your lawyer.) If there's real wrong-doing there, it seems like the US Attorney's office would likely be willing to go after it, and the qui tam relator gets a piece of the pie if there's any recovery.

I understand your desire to not censor commentators; I totally moderate those on my blog, even though I don't get very many because it's not controversial stuff.

Note the second to the last paragraph. A "qui tam" filing can get a piece of the pie--which could possibly be significant. In some cases of Medicare billing, fines can be hefty: $10,000 per instance. I haven't a clue as to the actual percentage...haven't put in for it. But, there are a lot of poorly paid individuals out there that could use the cash. And some are wondering if this witch hunt will affect them...

Out Witches, Out.....7/23

This would appear to be a fishing expedition for all the dissidents/contributors in the area. Suddenly, we go from get the blogger, to silence the masses. And the court goes along, providing the horsepower.

Suddenlink is being compelled to disclose up to 10 identities of its customers, with most if not all totally innocent of the blog, merely contributors/readers.

Since contributing to the blog is a firing offense for Essent employees, what does that foretell for their customers? I would say a rapid decrease, if the company willingly complies. Even unwillingly. Have heard several business owners say they will be pulling their business should this go through. Both advertising and internet.

Since no federal agencies have entered into the fray, it would seem that no federal laws have been broken: No HIPAA violations. What Judge McDowell has done is act on a case without merit. Giving a stick to Essent to ferret out those making honest commentary.

In the 62ND DISTRICT COURT
Lamar County, Texas
Cause No. 76357
ESSENT PRMC, L. P. VS. JOHN DOES 1-10
Filed on 06/19/2007
Case Type: Other Civil Cases - DC

Current Status: Filed
Defendants Defendant Attorneys
John Doe #
John Doe #
John Doe #
John Doe #
John Doe #
John Doe #
John Doe #
John Doe #
John Doe #
John Doe #1

Plaintiffs
Essent Prmc L P Dba Paris Regional Medical Center
CT CORPORATION SYSTEM
350 N. ST. PAUL STREET
DALLAS, TX 75201

Plaintiff Attorneys
Tidwell, Ronald Wesley
101 W. HOUSTONPARIS, TX 75460

Events and Orders of the Court
06/19/2007 ORDER GRANTING PLAINTIFF'S MOTION TO NON-PARTY TO DISCLOSE INFORMATION
06/19/2007 PLAINTIFF'S ORIGINAL PETITION

Welcome to the Gulag.....7/4

Welcome to the gulag
(To the similar song by Guns 'N Roses. Only had to change one word!)

Welcome to the gulag
We got fun 'n' games
We got everything you want
Honey we know the names
We are the people that can find
Whatever you may need
If you got the money honey
We got your disease

Chorus:

In the gulag
Welcome to the gulag
Watch it bring you to your shun n,n,n,n,,n,n,,n,n,n,,n,n,,n knees, knees
I wanna watch you bleed

Welcome to the gulag
It gets worse here everyday
Ya learn ta live like an animal
In the gulag where we play
If you got a hunger for what you see
You'll take it eventually
You can have anything you want
But you better not take it from me



Corporate Compliance--I never thought that they would actually put out their 'disinformation'. The Big Lie is alive and well in Paris.



No, I wasn't avoiding releasing HIPAA information, I was keeping the faith with the contributors. Some of their information was too identifiable. In one particular case, the information that was given by the victim would be too easily recognised, and that is the reason for HIPAA: To protect the patient. Not this gaggle of prison guards. Besides, it was the individual herself that sent it in. While she may have the right to talk about it, I will not publish it--not when she might have considerable regret later--and not without some serious discussion. They might have, if she signed the right release.


And, the Amnisty: Trust me, and we'll forgive all the nasty things you said.....



One thing that is good has transpired: The Paris News is finally publishing commentary about the hospital. A few more, and I'll change the 'Snooze' link to 'News' on the site.



I told you this had the feel of Stalinist Russia.....

AMICUS CURIAE.....7/2

An email possibly made some sense:

It would probably be nice if some aspiring Clarence Darrow filed an Amicus Curiae brief reguarding the voracity of the suit. No federal agency had claimed infraction.

Enjoining Suddenlink from releasing information, based on a presumption of privacy might be helpful as well.

Comments?

All is Forgiven.........6/27

Obviously, not with Essent, but one of the items that the Snooze researched by calling was Frank Pasquale. Frank is an assistant professor at Seton Hall Law School, and a prolific blogger...which I didn't know at the onset of this blog. Now I do. And I appologised for unintentionally causing some confusion...at least to the Snooze.... How anyone could think that a law professor would be running the-paris-site kind of goes beyond the pale.

So, today I posted on a few blogs that had picked up the story--and there are a lot! And, I received this email:

Re: [Concurring Opinions] New Comment Posted to 'Purloined Persona or Just Another FP?'From: Frank Pasquale (http://by126w.bay126.mail.live.com/mail/ApplicationMain_11.10.0000.0112.aspx?culture=en-US&hash=99283837#)

Sent:
Sat 6/23/07
9:13 AM
To: fac_p@hotmail.com (fac_p@hotmail.com)
No offense taken---I thought it pretty likely that this was the case, since I'm not famous!

best wishes,
--Frank

And a friend of his had this to say:

INFO/LAW: Blogger Identity Theft by William McGeveran

Finally, two asides about this particular case:

First, we are going to see more and more of these motions to disclose the identity of John Doe defendants in cases involving pseudonymous or anonymous online speech. It seems clear to me that there needs to be a mechanism for plaintiffs who are truly harmed by such speakers to hold them accountable in court (including in legitimate IP infringement cases). On the other hand, it should not be a routine procedural formality to unmask anonymous speakers just because you filed a complaint with some allegations. Our system is extremely lenient toward complaints at the initial or “pleading” stage. There is tension here with underlying fundamentals of civil procedure, because we would need a judge to make some assessments of the lawsuit’s merit at the very outset. This happens to some degree when plaintiffs seek preliminary injunctions, but in those situations at least the defendant is already at the table. There is more work to be done in developing appropriate standards for these ISP subpoenas.

Second, I have not seen the complaint, but based on the newspaper story alone I wonder whether the hospital’s case is very strong to begin with. It seems to allege defamation and violation of patients’ privacy.

On defamation, many of the newspaper’s quotations from the Paris Site seem to be statements of opinion that are not actionable, for example: “This isn’t Nashville or Boston or Dallas or Austin. It is a community that you wounded and are sucking out the life’s blood. We don’t like your style of vampires.” Clearly this is not an accusation that Nosferatu actually works at the hospital in Paris, Texas. The most likely candidate for defamation — again, just going on the news report — is this insinuation: “Apparently Medicare fraud is in the air, and PRMC is looking for a scapegoat. Billing practices from the rehabilitation unit are suspect, as well as vascular ultrasound studies billed by the hospital, but done by unregistered technologists.” I’m not sure, and I’d need to see it in context, but this may also skirt the boundary of defamation if it can be found to raise questions based on reliable information rather than to state flatly that the hospital is engaged in wrongdoing.

As to the patient privacy angle, what gives the hospital standing to sue on behalf of its patients? Not the privacy torts. Not HIPAA, which provides no right to sue (and anyway, a loophole in HIPAA means that individuals who are not “covered entities” cannot be held liable for breaches under the statute, as explained in this DOJ memorandum — the topic of an excellent seminar paper by one of my students last year). Again, I have not seen the complaint, but this does not sound like a slam-dunk case. If it is harassment against a gripe site — if that’s what’s really happening — then I hope these bloggers can find themselves a good pro bono lawyer.

The Email from the Top.....7/16

This is the email that made it to employees. I note things that I agree with and others that I don't. Let's handle it together:

It is our duty as employees of a healthcare entity and our obligation to the community to protect our patients’ right to privacy. In addition to this moral and ethical responsibility, we have a legal obligation to safeguard our patients’ privacy under the federal Health Insurance Portability and Accountability Act (HIPAA). [frank: I agree entirely.]

You all know of the-paris-site blog. The blogger has stated he has received patient information from employees of PRMC. Some of that information has appeared on the blog, a clear breach of HIPAA. This is of extraordinary concern and something we cannot legally disregard. We are not taking this lightly. We cannot take it lightly. It is our duty to act, and I felt you should be among the first to know what those actions will be. [frank: If you note, several lawyers have commented, and others quite familiar with the HIPAA provisions have looked at the blog. No violation. But their attempt gives them a handle to base the lawsuit on.]

Today, we are filing suit against the-paris-site blogger for willful violation of federal HIPAA laws. This litigation process is the first step to resolving this issue quickly and efficiently and protecting the community we serve from having sensitive medical and personal information compromised. [frank: They are not an agency of the govenment, nor has there been compromised information in this site.]

Second, I would ask you to be fiercely vigilant in safeguarding our patients’ privacy. If you suspect a HIPAA violation, please report it immediately. You can do that by contacting our compliance officer, Ken Miller, or anyone in Administration. If you prefer to remain anonymous, call the compliance reporting hotline at 1-800-472-8868. [frank: I'll go along with that.]

Third, I want to be certain that each and every PRMC employee fully understands our legal and moral obligation to protect the privacy of our patients. Our Corporate Compliance Officer, Charles Fletcher, will be in Paris the week of June 25 to conduct refresher training on our responsibilities under HIPAA. Classes will be offered at numerous times and dates throughout the week, and all employees will be required to attend.

We understand and respect the blogger and the general public’s right to voice their opinions about PRMC, and welcome constructive criticism that may help us to better serve this community. However, the method used by the blogger is wholly unacceptable and it is an infringement on the confidentiality rights of PRMC patients and a breach of law. I hope you will join me in protecting our patients and putting a stop to the blogger’s unlawful access to information to which he has no right. [frank: If I was dealing with identifiable information, I would have been sending letters to them soliciting their help in an investigation of the hospital...if I was breaching HIPAA confidentiallity. I'm not, my sources aren't, and this is a dog that doesn't hunt.]


Stacy Eatherly
Executive Assistant
Paris Regional Medical Center
820 Clarksville Street
Phone: (903) 737-3232
Fax: (903) 737-3848

A Piece of the Action.....6/23

There are two news agencies that are interested in a story. On national, one regional. If you are a patient that has had 'difficulties' with the hospital, or employees/former employees with issues, we now have a work-around the Snooze. Email them to me.




And, not just local. We've fielded comments from almost all the Essent hospitals. For TV media they can do a block out and voice distortion.





If I'm going down in flames, might as well be a big splash!

Your Comment????.....7/15

Interesting email quote:

it appears essent PRMC has filed suit against a blogger, perhaps you, please answer with any statement you might have in response.

This was from the Paris News, Bill Hankins? Hawkins? Whatever....

When someone gets sued by the hospital (rarified company: RRVR, Dr. T, etc.), they want to publish. Yet, when citizens have legitimate complaints about care, working conditions, and the like---no response.

This site has been an outlet for pent-up frustrations for many of us, and only a few have actually put in their real names. 'twould be a shame if they should bear the brunt of Essent's wrath.

But, how did they come up with a name? If it's me (and I don't know that it's not), we might be eating chicked broth and crackers for a long while. (and we'll look at privacy, electronic eves-dropping, wiretapping, and the like issues. But, I wasn't served at work...if it's the last commenter that generated a post, the Snooze had to collude with the hospital, since they haven't published the comment, nor an article. So much for an unbiased media.

So, one could say this is my comment. Hope you publish, Bill.... Make sure you get the URL right....

A History of Dux.....6/29

So, have DDux's and Hud's paths crossed before? Was his stint in TN about run its course?

In perusing Daffy Dux's work experience, and his home page, I noticed two conspicuously absent references (present on home page, not on work experience): Wentzville, MO, and Davenport, IA. Wentzville isn't that large, and only has the former Crossroads Medical Center. The two together have nothing listed in his show-and-tell of organizations he's belonged to (most will give you membership for showing up, or buying a function ticket, or allowing your hospital to be a nursing clinical site.)

New American Healthcare Corp.(June98-Nov99) filed for bankruptcy in 2000, guess they couldn't live without him. In early 2000, guess which hospital was bought by Essent? Yep, Crossroads, formerly Doctors Hospital under New American Healthcare. Preceding that was the sale of Davenport Medical Center, in July of '99. Guess they weren't two of the three he turned around? And the quote of the day:

Commenting on the announcement, Thomas W. Singleton, president and chief executive officer (of NAH), said, "I regret that one of my first official acts is to signal poor financial results. Unfortunately, the Company is experiencing certain operational challenges which have made this announcement necessary. I don't expect to convince anyone that this is not a serious event; however, I assure you that I would not undertake this challenge unless I was confident that we can fix the problems and restore credibility."

Another goodie is one DDux had in his work history:

"Averted pending loss of Medicare certification by CMS and successfully passed multiple Arizona State Department of Health Services inspections and investigations"

That is an unusual statement, but it indicates that they (Phoenix Baptist) had lost their Medicare certification under DDux and had to scramble to reclaim it, the likes of which here would sink the hospital.

That has almost the same ring as the indictments against Columbia/HCA/Healthtrust in 1996-2002, wouldn't you say?

If You Snooze.....6/21

Well, campers, this is what greeted us in the Snooze on Sunday. More pap from the top, or actual changes? YOU decide:

CEO has big plans for PRMC

By Mary Madewell
The Paris News

Published June 17, 2007

Christopher Dux, Paris Regional Medical Center's new chief executive officer, told Rotary Club of Paris members Friday he plans to ignite a fire under hospital staff members who may have lost their passion for “care and compassion.”

Speaking about the hospital’s 1,000 employees, Dux told Rotarians the majority chose health care because “they have a burning compassion to help others.”

“In some of our employees that passion for care and compassion is burning brighter than others, but I believe all of them have an ember inside them,” Dux said. “We can rekindle that fire, and we will do that.”

In Paris a little more than a month, Dux said he has had many discussions about a number of issues.

“A lot of things need to be fixed,” Dux said. “I don’t believe anything I have seen here is unique to this facility because all the problems we have exist in other facilities as well.”

The administrator said he plans to put into place measures to encourage employees ”to start taking risks in terms of challenging the status quo.”

“Health care is constantly changing, and we have to adapt,” Dux said. “I don’t have the answers. The answers reside in the front line employees."

“You have to empower them to help us make the changes we need to make to stay current,” Dux said.

The administrator spoke about process improvement and said industry is ahead of health care in process monitoring and improvement.

“We have to teach people to see things through the eyes of their customer,” Dux said.

Change is possible, Dux said.

“It takes a culture change with people wanting to be the best and making a commitment to that,” the administrator said.

Dux said he is encouraged about the number of people who want the Paris facility to be among the best hospitals in the country.

“If we can get employees, physicians and the community to want that also, we can make it happen,” he emphasized.

Asked to give an example of a hospital he may have turned around during his career, Dux spoke of one in Virginia that was barely breaking even when he took the helm.

“Four out of five employees said on an opinion survey they would not recommend the hospital to a relative,” Dux said.

Five years later the hospital received Hospital Joint Commission Certification with a perfect score and patient satisfaction scores were in the 95th percentile, he said.

“The hospital went from a break-even situation to an operating income of $9.6 million and from a 27 percent to a 72 percent market share,” Dux added.

He has worked in hospital administration since 1977 with his career taking him to several states from North Carolina to Iowa to Arizona.

“I’ve been everywhere, man, I’ve been everywhere,” Dux joked, using the words of a once popular song. “Hopefully my traveling is over, and I will be here for quite some time.”


To which I replied-

In re: Christopher Dux's recent comment in the News on improving PRMC:

He is correct in that the desire to serve the patient must be rekindled, but the question is, how and why did that desire get lost in the first place? Granted it took a hit when the two hospitals became one, but it really came under fire when Essent bought the facility in 2004.

Ask yourself, if you have the guts, why a facility who claims itself to be a for-profit organization is losing money in four out of its five facilities; is turned down for ownership in its last three acquisition attempts (two of them being Muskogee, OK and Weatherford, TX); and has had three CEOs in town in the last 3 years. Couple this with the conditions Essent has let the facilities and equipment go to, and the low patient census, and then ask yourself (if you dare) if this is the right ownership for the area.

Attitudes must change, true, but in this case so must the management, from Machavellian policies to pro-employee, pro-physician, pro-patient policies. If the ownership cannot make these changes, perhaps it's time to change ownership.

Now between you, me and the fencepost, this letter has as much chance seeing the light of day in the Snooze as a snowball in Hell. But, again to keep the pressure on these clowns to do some journalism, letters like this one must be written, not by me, but by everyone (And I mean EVERYONE) who wants to see the truth out in the light of day.

No time for idle cynics, folks- start sending those letters into the Snooze via their website, snailmail, hand delivery, or however.

This comment was too on the money not to put in now...frank

Here We Go Again.....6/17

An email excerpt:

This ought to really be good: Around $2,000,000 for a new Cath lab, $4,000,000 to re-do the x-ray department, a new 3T MRI at about $2,500,000, for a 64-slice CT --$1,000,000 on up, and then all the other movings and updatings and the associated costs....looks like they could put a good $30M into the North Campus...probably with the same results as Crossroads....

I wonder about their real understanding of the community, for without that, they might as well be pounding sand. The community has lost faith in the two hospitals. I say two hospitals, because like it or not, that's how people feel. Essent might own them, but if you ask the people, most will say St Joe and McCuistion. They probably go to Dallas for their major problems, and their local physicians, but ask them (after they've been treated in the ER) where they were seen...at St Joe.

And the physicians are still divided along those lines. It's starting to blur, but think about this: they deal with the reality every day. Their patients only see it during hospitalization. The physicans are supposed to be more flexible...where does that put public perception? St Joe and McCuistion....

So, if they want to plug that kind of money into a lost cause, fine. Hud has to do something, since he's lost the last three attempts, and acquisition money has dried up.

But, all things being equal, which would you rather pay: 20% of $23,299 ($4,660) for a Baylor stay, or 20% of $62,281($12,456) at PRMC? (I did find out that these figures are for a regular pacemaker, and matched that of a previous comment.)

In the Loop.....6/21

Frank,

Just to keep you in the loop: My mom was scheduled for a pacer placement a week ago at PRMC. I suppose it was the case of the devil you know, vs that which you don't. Got a call Monday morning and found out that the cath lab was down and we'd have to go to Baylor--the Heart Hospital--in Plano for the pacer.

The immediate area hotels had special rates far below the usual. We arrived the night before, with some trepidation. But, the experience was eye-opening: The morning admission was breathtakingly simple, five minutes in admitting, a ride up to the room, and an inital crew of three nurses in the room to do prep, answer any questions, and make things as smooth as possible. No confusion, they knew we were coming.

I included pictures of the room, and the room she recovered in--exactly the same, one floor difference, and setup to convert to an ICU bed if needed. There was even a hide-a-bed for a family member. A 32-37" lcd tv (I didn't measure) was wall mounted and quite clear.

The procedure was smooth, with only a bit of problems with the recovery--previous meds depressing blood pressure. After that, clear sailing. Dinner was even a filet--quite tender and to order.

The staff was motivated, hand-selected, and very professional. If a light came on, it was answered--fast! But then again, the hospital is owned 49% by the physicians, so they make sure that the customer is king. I'm certainly convinced.

I appreciated the care my mom received when she was in PRMC for her cath, but I'll have to opt for a facility that is new, with equipment to match.

Certainly looks good, and I've heard that a lot of Paris residents are taking advantage of it. If Essent and Hashmi want to compete, this is the standard to shoot for....frank

The Bux Stops Here.....6/13

"Ok I was told that by November, ICU, ER, Cath Lab, Chest Pain center would all be on North. Snif, Dubuis/LTACH, and rehab will go to South. Pedi, which Christus spent a fortune renovating North's old ICU will now be bumped back up to 5th floor(where LTACH is now--more remodling!) and Day surgery (which Essent spent a small fortune on remodling North's old ER) will be put on 4th floor (rehab at the moment)And how much did they spend remodling South's ER? and now it's going to be moved north? Does anyone think ahead here?"

Essent just ran across the same thing that Christus did in the ER remodel: Load bearing walls between ER and Fastrack. So, now it moves to North. It might be the first intelligent move they've made...albeit somewhat late. However, all the physicians that have taken up shop by South are probably wondering why did they bother....

It does have room for expansion on the grounds (which everyone said years ago) and some aspects are better. And since they've driven off most of the patients, the space issue isn't as critical (something like when Presby jacked the rents on physician offices, thereby negating the need for expansion of the office space.)

And if they are going to have to update the Cath Lab, Xray, Lab, ICU, and the ER again, might as well do it at a facility that isn't landlocked.

Guess it took a physician to push a bit...seems a shame that others couldn't put aside their bickering and push things in the right direction....

For Whom the Bell Tolls.....6/15

The biggest thing that can bring down Essent is having (and being) a losing proposition. They hate the counter, and the more people that are aware of what their philosophy is, the harder time they have raising capital for expansion. Expand or die is the mantra. It's been two years since they acquired Greene (Southwest), and for them to be losing and sitting back is not good.

They say they're consolidating, what it really means is they're stagnating, if not in an actual decline.They had to sell the medical office building in Mass, and here, Hashmi is making some demands. He says he was promised a heart center at the north campus--with all the bells and whistles. Ain't going to happen. It's the same situation as the ER--two are not economical, and when they have a crashing patient at the south, where are they going to take them? Not to the north....

It was suggested that he buy the north campus, since he has more money than God. Don't know that he likes Paris that much. Don't know that Paris likes him that much...or that Hud would sell. But, he's been seen in quiet conversation with Knizley and a couple others which may pop a new one on Hud as well...