When patient care be under attack? What do you do? Stand up, fight back!

God knows, there are plenty of problems with health care in this country - access, outcomes, etc. When my much beloved primary care physician bailed to practice concierge medicine, it was difficult to find a primary in the MGH-Brigham system who wasn't located a train, two buses, and a walk uphill (both ways) away from where I live. To stay in walking distance of my medical care (admittedly a luxury) I had to settle for having a resident as my PCP. Which is fine in some respects. She's quite good, very responsive, and I like her a lot. But in another year or so, she'll be moving on. I'm trying to convince her to specialize in geriatric primary care, but she seems hell bent on urology. When Dr. O goes, I'll probably get another resident. There are, at present, no PCP's in Boston in the MGH-Brigham system who are accepting patients.

And this is within the non-profit world of medicine.

Everything, it seems to me, is far worse in the for-profit health care systems, which (most? all?) studies seem to suggest have worse outcomes. 

The pressure to spend less on actually delivering care to individual patients, while seeing more and more of those patients in rushed-through, truncated visits is bad enough in the non-profits, let alone in the systems owned by private equity and/or by doctors focused more on profit maximization than on becoming latter-day Dr. Welbys. 

Case in point is Steward Health Care, which was founded in Massachusetts but, post-bankruptcy, is no longer operating here. Among other choice details of their operation: the system didn't pay the bill on a piece of critical equipment, so it got repossessed. Too bad a woman who'd just given birth needed it to save her life. By the time the Steward hospital transferred her to a hospital (non-profit, of course) that had the key device, it was too late. She bled to death, leaving her devastated husband and perfectly healthy baby girl behind. That and a picture of the glowing new mom holding her beautiful infant a short while before she died. 

This woman is not the only one to alleged to have died due to staffing and/or equipment shortages at Steward hospitals. 

Another nifty feature of Steward was its CEO, Dr. Ralph de la Torre, who used the system to fund an extravagent private jet, swanky yacht(s) lifestyle. 

So, while I'm more than happy to see healthcare professionals make a good living, I'm a believer that healthcare institutions shouldn't be run on a for-profit basis.

Apparently, the doctors at Eugene (Oregon) Emergency Physicians (EEP) agree. This is a smallish (40 doctors and PA's), local, doctor-owned practice that runs the emergency department for some local medical centers. They were about to be replaced by Apollo MD, a national corporate for-profit entity. 

EEP pushed back, arguing that bringing in Apollo would violate a 2025 Oregon law that "bans corporations from taking control of a medical practice's operations and finances."

The case garnered national interest because Oregon's new law targets the loopholes large staffing firms have been employing to circumvent state corporate medicine laws.

Most states have laws requiring that doctors own medical practices, not corporations. These rules aim to put patient interests ahead of profit motives. Over the last several years, companies have used a model where a doctor technically owns the local practice, but as Erin Fuse Brown, a professor at Brown University, explains, those physician owners are often not involved in care and cede hiring, firing and other operational functions to the corporation.

Fuse Brown said these arrangements are attractive to hospitals because these companies often promise more revenue and take over the responsibilities that come with running an ER.

"There's worry that these investors or these corporate management companies should not be totally controlling the operations and the clinical decisions of those who are trained to deliver patient care," Fuse Brown said. (Source: NPR)

These rules aim to put patient interests ahead of profit motives which seems to be the heart of the matter for the doctors at EEP, which feared that patient care would be compromised. They also feared that if Apollo started meddling in the delivery of care and they pushed back, they would lose their hours. Which seems like a reasonable double whammy fear: potentially worse care for the patients, potentially worse income for the doctors. 

The EEP pushback was successful. 

The medical center that had been considering going with Apollo decided to stick with EEP. 

Questions are still whirling around about the long-term viability of physician-owned practices. 

Do they need the investment in business expertise and systems that a corporation can provide?

And, as noted in the NPR article, some practices may be nominally physican owned, but those doctor's are owners, not actually delivering any care. So it's not as if Dr. Doug Ross (George Clooney on ER, which I never watched for some reason when he was on it) and Dr. Robby (Noah Wyle on The Pitt, which is pretty much my favorite TV thang) may be owners, but they're hip deep in gore. 

Anyway, happy to see that the little guys at Eugene Emergency Physicians, when they saw that their livelihoods and maybe their patients' lives were under attack, decided to stand up and fight back. 

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Image Source: Vecteezy

Was the Peppa Pig themed birthday party worth it, Ms. Mayor?

I'm like a broken record here, but stories about people with their hand in the workplace till NEVER fail to amaze me. Do these folks think they'll pay back what they've embezzled before it gets found out? Do they think that they're going to get away with it, outsmarting the system? (Maybe a lot of them do and that the ones who get caught are in the minority.)

I suppose that many/most embezzlers start small, and once they get away with the initial theft, they just keep upping the ante. 

It just completely shocks me that there are so many people that are willing to grab at easy money only to end up doing time.

Politician thieves are another category altogether, as a lot of times they get caught using government and/or campaign funds to settle illegitimate expenses. After all, politicians being politicians, I'm sure that they can convince themselves that the fancy night out, the spa day, the pricey car, are necessary for them to stay in office. They let themselves stretch the bonds of what faithfully executing their oath of office entails. 

The latest saga to amaze me is that of New Britain, Connecticut's former mayor (in office from 2013 to 2025) Erin Stewart.

Stewart was on the course to get the Republican nomination for governor when details about fraudulent spending came out and she ended her campaign. If she'd gotten her party's nod, it's unlikely that she would have won the gubernatorial race come November. Connecticut is pretty reliably Democratic, and Ned Lamont, the incumbent, is quite popular. (Lamont does have a Democratic challenger, but is likely to be nominated this summer.)

Still, Stewart is young - she's only 39 - and running for statewide office is a credential-builder even if you don't manage to win. Things change over time. Who knows? She might have had a political future. Even reliably blue states have a habit of electing Republicans to state office as long as they temper their fiscal conservatism with social moderation. (C.f., Massachusetts governors Weld and Romney, among others.)

I doubt Stewart has much of a political future now. 

Not after it appears that she spent a lot of dimes on New Britain's account during her mayoral tenure. 

A law firm hired by the city found that Ms. Stewart had racked up $123,018 in expenses from June 2016 to November 2025 that had no supporting documentation to justify them.

The items included clothing, gifts for her husband, diapers, groceries and a membership in a members-only social club in Hartford. The goods were delivered to her home, ordered from Amazon, Instacart, Costco and other retailers, according to investigators, who combed through Ms. Stewart’s social media photos for images of items that she had purchased.

“The findings of this investigation point not to isolated lapses in judgment, but to a pattern of behavior that violated public trust and the standards expected of an elected official entrusted with taxpayer funds for nearly a decade,” said the report, prepared by the Crumbie Law Group in Hartford. (Source: NY Times)

Among the myriad personal expenses Stewart made were party supplies for her daughter's second birthday party, which was "tropical Peppa Pig-themed." State investigators matched these are other dubious expenses to party posts to Stewart's Facebook accounts. Some of her wanton spending had no supporting justification/receipts; some was noted as "office supplies."

An awful lot can fall under the category "office supplies" that would never be found out. But Peppa Pig decorations? Come on, ex-Mayor Stewart. Peppa Pig's cute and all, but please get a little real. 

Stewart also used her government card to buy clothing and jewelry for herself and her family, and baby supplies for her second child. 

All told, the law firm investigation Stewart's spending found over $100K worth of spending with no supporting documentation (and which was pretty much unsupportable, with or without documentation). 

That may not sound like much when, say, compared to the enormity of the multi-billion grift underway by the Trump family, but it's still pretty significant, especially in a blue-collar town like New Britain. And Stewart, although she has said she "will take I will take accountability for any mistakes," and that she "intend(s) to make full and complete restitution to the City of New Britain — my home — for anything that" she ends up owing, she could be in for some non-trivial hurt.

The Connecticut State Police confirmed on Thursday that they had opened an investigation into the matter after the state’s Division of Criminal Justice received a complaint.

I can't imagine that she'll do any time, but she's no doubt out of politics for good. She'll have to come up with the $100K plus payback. And she has to live with the colossal embarrassment.

Sheesh, do people just not think that misdeeds like this may one day catch up with them? Was that Peppa Pig themed birthday party worth it, Ms. Mayor?

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Additional information source: CT Insider

Image Source: Craiyon

Has your duck gotten its flu shot yet?

A few weeks ago, I got my jab. Double jab, actually: next round of covid, annual flu.

What I did not get was vaccination against avian flu. That's because humans rarely get avian flu, and the humans who do come down with it have generally been up close and personal with birds. So avian flu vaccination? Strictly for the birds.

And among the birds it's for are the 64 million ducks of France. So France has embarked on a major campaign to get its extensive population of canards squared away. The initiative:

...aims to prevent the spread of a deadly variant of avian influenza that has forced French farmers to cull more than 30 million birds in the past three years, contributing to a downturn in the production of foie gras. (Source: NY Times)

64 million is an awful lot of ducks. It's almost the equivalent of France's human population. In contrast, the US has a bit over 30 million ducks, for a ratio of humans to ducks of over 10:1.

“A real glimmer of hope,” Éric Dumas, a duck farmer and the president of France’s foie gras federation, said in a statement after the agriculture minister, Marc Fesneau, visited his farm near Bordeaux to inaugurate the campaign.

The French government will be picking up most of the$80M euro ($84 USD) tab for the vaccination. That's beaucoup de sous, but:

That is a fraction of the more than a €1 billion the government paid in 2021 and 2022 to compensate farmers who had been required to cull their birds, according to a recent French parliamentary report.

I'm happy that the ducks will stay healthy, but I have mixed feelings about foie gras. (I'm no gastronome, but I will confess to having eaten it on occasion. I just don't love-love it, and don't tend to seek it out.):

Foie gras is the term for the liver of a duck or goose that has been fattened by forced feeding. For many the dish is a hallmark of French gastronomy; others say that the way it is produced constitutes torture and animal cruelty.

So, it's a pretty nasty business. (Side note: I associate foie gras with geese, not ducks, but there's greater than an order of magnitude more foie gras ducks than there are foie gras geese in France.)

One downside of the vaccination program - other than the fact that someone's (make that a lot of someones) is going to have to go to all these farms and inoculate 64 million ducks - is that, because the French ducks will be vaccinated, they won't be exportable to the U.S. Our Agriculture Department fears that symptoms of avian flu will be hidden as "vaccinated poultry may not show signs of bird flu, thus masking whether the virus is circulating."

But on the upside, there are concerns that, if it's not wiped out, "bird flu could mutate into a version that can be transmitted to humans." So by all means, vaccinate those ducks.

And it sounds like the US - even though we have nowhere near as many ducks as France does - might want to get on the vaccination stick here, too. 

But this would probably just bring even more anti-vaxxers out of the woodwork. 

Bonne chance to France!