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...

Board (or Bored) Woes....9/6

Who Knew? Another from the underground. Again I apologize, apparently these posts came during a maintenance period (when your side is active, but mine isn't) , and they just got lumped into the bottom of the "we'll get to it real soon, now"... pile

Word leaked from the meeting of the "make believe Board" is that Hud spent a long time praising Andrew; whereupon THE COACH asked him to cut the bullshit and come clean with the reason Hud was firing andy. Apparently there were three:

(1)he had two years to solve the Anesthesia problem

(2)Andy failed to solve the Radiology problem

(3)Rehab revenue is in the tank and Hud had to endure a medicare audit that cost him $250K.

It was also noted that Knizley was simply "burned out". Excuse me, has the board been on another planet during the last two years? It was Huds micro management that fired the four long term anesthesiologists that were here when E$$ent took over. I seem to also recall that rather than negotiating with the Clifford group, Hud took the same my way or the highway approach that has resulted in millions of revenue loss from out patients. (I have omitted the stupid fight with Dickey that has also cost millions.)

As to the Rehab situation; medicare rule changes have more to do with this than Knizleys failure. Hubilla needed a scapegoat to passify THE INVESTORS. Igor seems to be the man he brings in to dump the hospital. I just hope East Texas or Baylor would take it before there is nothing left.

Now you notice the snooze missed that, but so did I....until now!



And to all those following the court case: The hearing formerly scheduled for Friday has been moved back a week....frank

I Can't Get No....9/5

Survey Says: We aren't happy! Ha! Didn't have to do a survey to have that conveyed....

Let's dig back a bit. We apparently have people that have to use their own vehicles to go back and forth between campuses to perform their jobs---yet have to clock out. One would think that they would only have to change their department in the time clock to be covered--and paid, but nooooo, you're on your own. I missed a comment and thought I'd bring it to light.

I've been there and done this one. Yes they do pay you milage--no it's not enough milage, I can't remember what they said it was, but it took me 4 miles , and they paid me for i'm thinking 2.2 of them.

No I couldn't use the company car, because I may go home from that location,and yes you do have to clock out between places.

No one had an accident that I knew of, but technically you were off the clock between the two, and we all know what technically means if their ass is on the line.

If you didn't clock out, you could be fired to clock back in at your next location, you could be terminated.

Is it fair? No. Is it reality? Yes.

Wonder if a supervisor, having to get supplies or whatever downtown or at the other campus, would punch out and punch in when they got back??? Where are those cameras over the time clocks when you need them? I don't seem to remember that my job requirements included having a car and driver's license....

Let me put in my suggestion: Pay the people while they are in transit.....frank



badges?? We don't need no stinkin' badges....
P.S. The guy on the left is an engineer at Kronos.....

From HCA?....8/30

...or Atlanticare, or Baylor, or ETMC, or the Lahey Clinic? All of these were perusing the blog in the general time period as this comment. I thought I'd covered this ground in earlier comments, but possibly it was too far back.

Frank:
If there is going to be a significant downturn in revenue next year because of reduced reimbursements what would you do if you were running the company? Maybe you should send your resume to Essent's board. Layout out for them a business strategy that would work.

Let's see, so far we have (i) Criticized the company for making money, (ii) criticized the company for losing money, (iii) saying the reimbursement envirnoment is only going to get worse--which I totally agree with you, (iv) don't reduce expenses, (v) criticized for spending money for renovating patient floors, (vi) applauded Baylor-Plano for have flat screen TVs and all sorts of customer niceities and so on.

Also, I am not involved with Essent,contrary to what you think. I am a senior person at another healthcare company and know that we (and all companies) are one kook away from having someone inflict tremendous damage to one of our facilities like you have managed to do at Paris.

Finally, your other poster's reference to "OUR" blog is pretty pedestrian.

Last things first: You'd be surprised at how many people feel that way about the blog--and the hospital. The town still seems to refer to the facilities by their pre-Christus names, much less Essent.

As to the criticism inflicted on Essent, the bulk of it would never have come up, had the administration invested the employees in the process.

They made the mistake of doing it to, rather than doing it with the people that work here.

There have been several changes in style since MBO (Management By Objective) was developed. All of them seem to have one thing in common: The realization that the employees have to be on board with the changes, and that the process can actually accelerate if they are...when they feel part of it, rather than feel the brunt of it. The original "The Customer" program was far truer to that spirit. What we've seen in the one-man-show is ego.



Maybe Essent will never come out from under the shadow of what they initially did (we still call them the old Sears and Brookshires buildings, and they've been relocated for how long?), and maybe it will take another with a bit more people skills to turn Paris healthcare around. Time will tell.....frank