McCleary MRSA Prevention

Andrew Day

This is a story about two men in my family and a squirrel family.  I have been married to Mike Day, for 45 years this year.  He is a quiet gentle man who  has the patience of a saint.  He has stuck it out with me and that speaks for itself!  My son Andrew Day is my youngest and he is also a special and big hearted man.  None of us expected notoriety for their patience and kindness but then last Sunday a weird thing happened.

Andrew was visiting us at our Pearl Street home in Bangor and he was about to leave when he looked out our front window.  He said, “Uhoh, there is some cat/squirrel action out there”.   At the end of the driveway across the street, there was a big old orange cat, stalking what we thought was a single squirrel on our side of the street.  We thought we were seeing an injured adult squirrel.  He went outside to find FOUR baby squirrels, all joined together at the tail by a weird ball of debris.  Oh no, what to do!!!  They couldn’t walk or run because they would all pull in different directions.  They couldn’t climb a tree because one or two of them would weigh the others down.  Mother squirrel was on the side of a tree across the street and she was frantically screaming and crying for her babies.  The babies all huddled in a crevice at the base of one our maple trees.

Andrew called for the Bangor, ME animal control.  The dispatch told him they weren’t available on a Sunday, so they put in a call for us to the Game Warden service.  We knew these babies were in jeopardy.  The Game warden called back and he couldn’t come right away, because he was at a remote pond.  When we described our predicament, he said he would just use his pocket knife to cut away the debris, and he would need our help to do it.  So, based on that, my men decided they could do this themselves.

They gathered up some rudimentary tools.  We got a large plastic rake, a soil cultivator tool,  3 foot deep box, scissors, long leather gloves (no bites or scratches for them!), some branch trimmers, and a grabber which is used by handicapped people to pick things up or reach things.  Mike got the rake under the squirrels and Andrew used the claw like cultivator to gently help them into the box.  The little buggers had picked up a number of long branches during their excursion, and Mike cut away all of those.  Andrew then spent almost an hour and a half cutting, trimming and picking away at the ball of stuff that cemented the babies together.   At the end of this operation, they used some Dawn detergent to lubricate and condition the remaining small tangles and then they were separated.  Whew!

The tails were tattered and skinny for lack of hair, but they were intact.  The little guys were stressed and tired, and they curled up around each other and rested under an old blanket while I called the warden.  We couldn’t see the mother squirrel anywhere and were uncertain about the next step.  He told me that their only chance for life was with their mother, and to let them out of the box.  We did.  They ran off immediately, and separately, for the first time I think!   Two went up the tree where their nest was, and the two others went in different directions.

About an hour later, we saw Mamma squirrel nudging one of the babies up the tree.  We were all happy and relieved that the little family was back together.  Andrew’s friend Peg dropped by to support Andrew and a couple of neighbors stopped to satisfy their curiosity.  We were all pretty triumphant that these little guys would make it.

THEN! Andrew posted his video of the babies, before they were separated, on YouTube.  A friend of a friend who writes for the Bangor Daily News asked to do a story for the newspaper. http://actoutwithaislinn.bangordailynews.com/2017/05/22/recreation/four-baby-squirrels-with-tails-tangled-together-rescued-by-bangor-men/

WLBZ Channel 2 news asked for an interview.  http://www.wlbz2.com/life/a-tale-of-4-squirrels/442317489

Mike’s and Andrew’s big hearted heroism had spread far beyond our family, a friend and a couple of neighbors. In fact, the story went viral and so did the video.  After only 3 days, there are almost 150,000 hits on his video and numerous media reports.

I love this story and telling it, because it just plain warms my heart.  But, both Mike and Andrew are a little embarrassed by all of the attention.  Neither of them think they did something heroic.  I beg to differ!

I was seen a month or so ago for floaters and flashers in my left eye, in  Bangor, Maine.    I walked out of EMMC ER without being seen,  because of a very poor  and unprofessional reception, watching a suffering young woman being ignored, and a very long wait time.  I went across town to St Joes.  I was nicely welcomed, quickly and efficiently triaged, waited an hour in an exam room, and was seen by a competent and nice nurse practitioner for about 5 minutes, maybe less.  I had no medicines, no sterile instruments, no diagnostics, no treatments,   and nothing extra.  I walked out with instructions and an appointment with an ophthalmologist the next day.  I had a good experience of care.

Grand total   $1313.85.  HOLY CRAP!

I looked up St Joe’s list of usual ER charges online.  My charges, on my itemized bill were way out of whack.  So, even though my copay will not change ($125), I called St Joe’s billing inquiry line.  The lady was very nice until I asked to participate in the weekly inquiry meeting where they will discuss my bill.  I want to know what they have to say about my bill and be part of the discussion.   It was obvious that this was really really weird for them to deal with someone who actually wants transparency and details about how they came to this wild price for my visit.  She finally relented and said she would tell the supervisor who participates in their billing inquiry meetings that I want to be there.

I asked the billing lady if she has ever heard of the concept of “nothing about me without me”.  I know that this generally pertains to collaboration and communications about our actual care and plans for it, but why not billing and costs.

After reading Rosmary Gibson’s new book. Medicare Meltdown, I fully realize how important it is for healthcare consumers to fully engage in all aspects of quality and cost in healthcare.  We need to protect our ability to access and afford healthcare, because Hospitals, providers, medical device and pharmaceutical companies, for profit companies and others are usurping all of the cream..off the top of the fresh milk bucket of healthcare. They do this with predatory pricing and charging of all patients, and getting what they can from all payers, public and private.      If we do not engage, our existing systems will not survive.

$1313.85 for a 5 minute visit is outrageous and unexplainable….and I want to know details about how they came to that astronomical price.  We all need to become inquiring minds when it comes to healthcare costs and quality.

 July 12, 2012 

 The debate over the sale of EMMC dialysis patients to Davita is not a Union vs EMMC issue, as some choose to say.   It is a Patient Safety issue.  Patient safety is an issue for every single Maine resident who uses our healthcare systems. This Davita issue is also about relinquishing local control and governance over the quality and safety of care provided to local Maine patients.  Unforeseen illness, injury or medication complications could put any one of us in a dialysis chair some day.  This should frighten every single one of us.

  I asked for a tour of the EMMC (BOYD) dialysis services the other day. The clinic supervisor seated me in the waiting room for about 10 minutes while he made the necessary calls to EMMC bosses to address my request. That gave me the opportunity to talk with the spouses of 3 local dialysis patients.  They were uncertain and fearful of Davita coming to Bangor.  One dedicated husband said he wished he had known about the hearing because he would have attended.  It’s a shame they didn’t know. Patients and families would have benefited more than anyone from the DHHS Certificate of Need  hearing. It seems that EMMC staff should have posted the hearing information in a dominant spot for all to see…especially patients and their families.  Sadly, the patient’s voice is left out of decisions that are most important to them.

 I was denied a tour of the facility.  Apparently, my concern for the safety of EMMC dialysis patients was not a good enough reason to be allowed to see it. Before I left, I had a brief conversation with the clinic supervisor.  He said he had done research on Davita.   I asked if he had read about how Davita has sued doctors because they resigned and left to work elsewhere because they believed Davita policies were not safe for patients. They bucked Davita policies.   Yes, the young supervisor had read about that.  “How did that make you feel?” I asked.  He said with a very non expressive face “indifferent”.  Wow.  I didn’t have anything else to discuss with this man.  His indifference over something this damning of Davita was alarming. He was responsible for every patient who was hidden behind those securely locked EMMC clinic doors.  Even though his response floored me, I realize that EMMC and Davita have wedged him into the middle of a situation that he has absolutely no control over.  If Davita comes, he and every other person, including doctors on staff at our dialysis clinics had better get use to not having control over anything in the “business” of Davita.

I am extremely concerned for EMMC dialysis patients if this financial deal goes through.  At the July 10 Certificate of Need hearing, I displayed  3 posters. Two of them had the real life stories of 5 patients from Davita clinics from across the US. The patient heroes (whose photos and stories were displayed) wrote their own testimonials about personal harm from their Davita clinics.  Most of them had been dismissed from their clinics, simply because they were vocal about their concerns and harm.  These 5 people were just a tiny sample of thousands of patients who have experienced the exact same thing.  I didn’t observe one single Davita rep, EMMC manager or dialysis staff person reading those stories, even after repeated welcomes to all to do so.  Could it be that they don’t care about patient harm?  Dr Razcek, EMMC vice CMO described the patients’ experiences  as anecdotal.  It’s odd that he would describe the stories of real life dialysis patients anecdotal, but swallow the stories or “so called” evidence of Davita whole. Dr R’s comment was insulting to the integrity of those 5 people who have suffered through harm, retaliation, segregation, bullying, physical and mental abuse, and now someone is questioning their honesty?   I have spoken with each and every one of those patients and they are real, their suffering is real and their stories are real.  I offered to put EMMC leaders in touch with those patients and that offer was refused.  These patients’ stories are the absolute and dangerous  truth about Davita.  

 “The right care, at the right time, in the right place” was in bold print in the half page EMHS ad in today’s BDN. .  Apparently, that promise is made to everyone except dialysis patients.  EMMC/EMHS  will have no control over Davita policies or the quality of care that our Maine citizens receive in Davita managed dialysis clinics.  There will be no local governance. Davita skewered the EMMC dialysis care  outcome reports during the public hearing.  If I had been an EMMC manager, that would have made me very angry. In fact, although I am no longer employed by EMMC, I do remain loyal, and it made ME angry. My family and I receive some of our healthcare services from EMHS and EMMC.  Who validated Davita’s data?  Davita did.  Conspicuously missing were Davita’s records of dismissals and patient harm.  Records of their care outcomes, patient safety measures,  and regulatory violations in California are available online.   The 5 patient stories I displayed were just a sample of many who have been harmed and dismissed by Davita.  As a Mainer, a retired nurse and as a former employee of EMMC, I was insulted by Davita leaders and their condescending presentation. 

 If EMMC continues to pursue this $10,000,000 sale, and dialysis patients are harmed by Davita, EMMC becomes complicit in any resulting harm and sickness that our local dialysis patients my encounter.

 Keep the control and funds for dialysis services in Bangor, ME.  Use any revenue to address perceived defects  in our local clinics. Keep the dialysis business-related revenue in the local pharmacies, laboratories,  and supportive services.  Keep the  safety of Maine patients in Mainer’s hands.  Davita cannot do one single thing better than EMMC except make money and pay stockholders.

My third display poster for the hearing , showed photos of the CEO of Davita in a Three Musketeer Costume and quotes from him  saying “It is not about the patients, it is about the teammates”.  These photos, quotes and articles are available to anyone online.   This poster should have made it perfectly clear that money intended for high quality dialysis care is siphoed off by Davita and goes to glitzy rich booze soaked  parties, huge new $100,000,000 Denver, CO headquarters, a $22,000,000 annually compensated CEO,  and most importantly to them,  into stockholders hands.  Davita is even banking on boomers!  I posted that article on this board as well.

Mainers, demand that the control of our local dialysis clinics stay in local hands.  Cheapened care, cookie cutter treatments, and Walmartesque  services from Davita will not benefit Maine dialysis patients.

 The State of Vermont rejected Fresenius (Davita’s biggest competitor) because citizens declared that For profit dialysis services were not for the public good of Vermonters.

 Davita services are not for the public good of Mainers.

Kathy Day RN Patient Safety Activist

I pray to God that I never go into End Stage Renal Disease.

When I read in the Bangor Daily News that Eastern Maine Medical Center was going to sell their Dialysis services (patients at average $70,000 annually each in 2008) to DaVita Dialysis Corporation, I was shocked. http://bangordailynews.com/2012/04/24/health/eastern-maine-medical-center-to-sell-dialysis-clinics-to-national-chain/  It is my understanding that EMMC offers a fine service already, just as they have promised their charitable donors they would.  Charitable donors have given money toward a beautiful 4 year old facility on the West Side of Bangor, ME, and I have never heard anyone complain about their treatment.  Information about bad care often trickles down to me because I am a patient safety activist and advocate.

The BDN news article went on to describe 3 concurrent investigations into Davita  by regulatory agencies.  One is for fraud in overcharging for a common medication given to dialysis patients, Epogen.  These investigations were fluffed over by EMMC  and we, the BDN readership were assured that these investigations are no big deal…..really?  Apparently the investigations are not as big a deal as a check for over $10.000,000 for the purchase of EMMC dialysis.   A fellow activist from California contacted me about  Davita.  She warned that Northern Maine does not want or need them here.  She in turn connected me with Arlene Mullin Tinker.  Arlene and her team of legal advisors  have advocated for thousands of harmed dialysis patients.  Many of them have been Davita patients.  Her experience is that Davita is #1 for dismissals. During my 42 years as an RN,  I had never heard of dismissing dialysis patients.  Wouldn’t that be a death sentence??  A death sentence usually involves a judge and a  jury of our peers.  Not so for dialysis patients.

As it turns out, Davita clinics nationwide have repeatedly dismissed dialysis patients without cause or notice.  These patients have generally been patients who were vocal. They complained about unsafe care, complications of their care, poorly trained staff or poor infection prevention techniques.  All of these complaints sound reasonable to me.  I would certainly complain if I was on the receiving end of poor care.  Dialysis patients are captive to  their illness and to the treatment for it, dialysis.  Without regular high quality  treatments, they will die.  So, even if their care is substandard, they generally have no choice about where to get their treatments.  Their only option is to continue care, often times  from the same people who may have harmed them.  My research revealed that the only reason to “dismiss” or fire a dialysis patient is violence.

At EMMC Dialysis services, the hierarchy beyond the director of the clinic, is EMMC management, and then Eastern Maine Health Services management, and finally we have 2 local Boards of Directors.  Managers and Board members are Bangor  and EMMC service area residents.  They live, shop, go to church and social  functions  in the same places that the patients do.  Our local Hospital hierarchy coexists in the same community as the patients and they are accountable to them.

Davita, now that is a different story. They are a Fortune 500, for profit company headquartered in Colorado.  They are buying up Dialysis clinics all over the World.   Davita people  ”from away” came to Bangor on May 25 to do a slick sales pitch at a State of Maine DHHS Certificate of Need hearing.   They presented  an almost religious mission and presentation.  They explained their trilogy of care. 1. We care for the World 2. We care for each other.  Last and finally,  3. We care for patients.   I immediately figured it out.  Patients are last on the list.  But, the money that patients bring in, mostly from taxpayers  in the form of Medicare/Medicaid dollars, is really #1.  The “world” is their stockholders.  ”Each other” are the so called citizens of the Governors community(will explain in a moment).  And finally at the bottom of the pit are the patients…..who get the dribs and drabs of whatever  remains of the healthcare dollars after the coffers are filled.   I looked into Davita leadership. Their CEO, Kent Thiry is quite a guy.  He likes to be called “Governor”, which seems  kind of egomaniacal.   Employees are called “citizens” of his community.  He runs RAH RAH rallies for his cult like “followers’ and dresses up like a Muskateer.  He leads loud Nazi like rants/chants.  He does somersaults on the stage.  He hired a bull for a ritzy Las Vegas meeting to prove that he can ride one.  What does any of this have to do with Patient Safety and high quality of care.  Dialysis funding (through Medicare patients)  pays for all of these Davita variety shows! http://www.youtube.com/watch?v=JowmBdx4nFw

Davita is a perfect example of everything that is wrong with Healthcare today.  Taxpayers pay into Medicare and Medicaid services.  Coverage for dialysis treatment in guaranteed to every US citizen regardless of income. Around $70,000 to $100,000 is paid annually  for every medicare dialysis patient.  EMMC was offered over $10,000,000 by Davita for their dialysis services.  Kent Thiry ‘s 6 year average yearly compensation was over $22,000,000, http://www.forbes.com/lists/2012/12/ceo-compensation-12_Kent-J-Thiry_IPFN.html,  more than all of the  dialysis services of EMMC is worth.  All of these  figures prove that there is HUGE money in corporate dialysis services.   My concern is …How much is spent on safe, high quality dialysis care?  If the profits in this for profit  ”business”  are any indication, not much actually goes to patient care.

The slick sales people at this CON meeting also bragged about Walmart-like “one stop shopping” for patients.  They are proud that they offer their own  mail order pharmaceuticals for their patients.  Most dialysis patients are on at least 8 prescription drugs.  Staff are trained to be sales people and to encourage their patients to purchase their medications through Davita mail order services.  Then they will deliver them directly to the patient, at the bedside.  WOW, it’s a miracle. Bill Miller of Miller Drug on State St in Bangor has been doing that for free for years…same day, home delivery for free.  And Bill’s profits stay in Bangor, and help the local economy. Bills neighbors and friends can also borrow certain medical equipment for free. I borrowed a wheelchair from Bill a few years back to help my father get around at the American Folk Festival….no charge!  What does Davita do for free?   What else will Davita sell their patients?  They are starting to buy up employee health clinics, nursing homes and other practices.   This is a company with outside policies and controls, and with inside sales.  This is a company that will profit off our local dialysis patients, and bring nothing to our local or State economy.  The money will go to the corporation/stockholders.  Living, breathing, suffering and captive Patients become cash cows for Wall Street Commodities.

Where do patients fit into the Davita scheme?  Good question.  If they are harmed or have issues with their care or safety, the complaint process is complex, and my understanding is that complaints often go into a black hole.    The End Stage Renal Disease Network fields these complaints.  Davita has representation on that network, so complaints essentially go to the people who are being complained about.  If a complaint somehow reaches a state health department, they might do an investigation, but generally the investigators are nursing home inspectors, and they do not know the specialty of dialysis.  If CMS (Centers for Medicare Services)  is brought in and they make recommendations, Davita may or may not comply.  Since there are no sanctions, there is no accountability and no incentive for Davita to fix problems. Then if a Davita clinic does not like the patient, because they have asserted themselves about substandard care or complications, Davita may just dismiss them. Some  patients that have been both harmed and dismissed by Davita clinics were also blackballed from other dialysis services.  Since Davita will purchase 3 dialysis clinics business, in Bangor, Ellsworth and Lincoln, ME, all inpatient EMMC services and home dialysis services, this leaves local dismissed pateints out on a limb….facing either death or horrible long commutes to distant clinics.    None of this bodes well for patients.

Davita answers to their stock holders, not to their patients and as importantly, not to our community or service area.  It is very clear what this company’s priorities are.  Patients bring money to the company, and by cheapening dialysis care, they make their stockholders happy.   Ask Warren Buffett.

Maine does not need Davita. They are exactly what is wrong with Healthcare today. Davita is a prime example of why healthcare is bankrupting this country and our States.    The fact that EMMC service area patients may recieve cheaper and lower quality care is reason enough to escort them out of State. We need to tell them “Thanks anyway, but we value our citizens too much to invite you in.”   Maine welcomes business..there is a sign near the New Hampshire border saying “Maine is open for Business”.  If that business has potential to harm our citizens or suck money out of our economy, we do not welcome them.  I look forward to seeing the back side of Davita going over the NH border….headed back to Colorado.

Addendum  http://bangordailynews.com/2012/05/27/business/who-makes-the-most-50-highest-paid-ceos/

check out who is #46 on the list of the highest paid CEOs in the US…all made on some of the sickest patients in our country, and on Taxpayer dollars to care for them.

A local guest editor, Dr Eric Steele, Bangor, ME, writes about transparency regarding Medical Errors in today’s Bangor Daily news.  This link tells the story of an unfortunate man who lost his life in a small Maine Hospital because of a huge overdose of Epinephrine.  Dr Steele, while recognizing the tragedy of the mans death, also applauds the hospital because they accepted the responsibility of this error ,made changes to correct the problem and apologized to the family.

If only this same thing could be done for the thousands of people who die each hear from Hospital Acquired Infections.  Many things are being done, but the most important one for MRSA is not being done as practice in the State of Maine.  Active Detection and Isolation is a proven method of prevention for MRSA.  Mandatory public reporting as also been successful in making hospitals accountable and transparent about these infections, and yet the Maine Hospital Association and Epidemiologists and other representatives from all Maine hopsitals have rejected and fought both of these measures.

I hope that Dr Steele is as serious about HAIs as he is about other Medical Errors. 

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