Board Meeting for February

The monthly Board meeting occurs tonight at the hospital. These meetings are open to the public, although I have never seen anyone attend. Topics will include:
• The bed shortage problem
• Increased frequency of diversions since opening the new addition
• Patient satisfaction numbers that continue to be low
• ER related issues concerning the patients on hold
• The resolution passed by the Medical Staff asking for two physicians to be placed on the Board
• Plus the routine updates on construction, finances, and other neighborhood issues

Nothing overly exciting, but it will be interesting how they handle the diversion problem that has actually worsened since the new addition opened.

Weekend Blues

Another week and weekend has come and gone. Frustrations grow amongst nurses, physicians and patients.

Diversion is once again the issue.

The hospital was repeatedly on either critical care diversion or total bed diversion for the majority of the weekend. Patients needing admitted had to remain in the Emergency Room for several hours and overnight because we either had no beds or not enough nurses to staff the beds.

Physicians are being asked daily to get patients off of monitors or discharged from the hospital. It occurs so frequently that you’d think they felt we admitted and kept patients in because we had nothing better to do.

In addition, there is now talk about not changing all of the rooms to private rooms as was touted during the advertising of the new addition. This also is causing more animosity amongst the nurses and staff. It may be out of both the need for beds as well as staffing issues.

All of this certainly makes you wonder if another hospital wouldn’t be a bad idea. Do you think Floyd County leaders will grasp the concept before it’s too late?

Editorial Comments

Well it seems my editorial comments in the Tribune this week has ruffled a few feathers. I have had two phone calls, a few emails and lots of comments from patients. Comments have ranged from extremely supportive to somewhat angry about my remarks.

Since editorials are supposed to be thought-provoking and stimulating, I guess it was successful. Editorials typically are controversial and not everyone will agree. Again, I guess in that sense, it also was successful.

I was invited by the staff at the Tribune to participate on the E-board and felt it was another good avenue to bring a different viewpoint to local readers.

For those who didn’t see the article, the question was asked:

What are your opinions of Floyd County government's past — and possibly future — efforts to stop new hospitals from building locally?

My response was:

Floyd County government continually amazes everyone at their inability to overcome the “good-ol-boy” mentality and their lack of vision. Progress to them means “protect the cronies” and maintain the “status quo”. Vision, growth, competition, and change terrify our local leaders.

Being democrat in Floyd County is “tribal”. Once born into it, few ever leave. But the majority has lost the true purpose and goals of the party.

Continually wasting time, effort and our money trying to prevent competition with the new hospital is just one example.

Dan Eichenberger M.D.

I do not believe that all “democrats” are tribal just as I do not believe all republicans are most qualified. But when you continue to see the same attitudes and behaviors from our local leaders, most of whom are the same democrats year after year, you have to acknowledge the obvious.

We have lost out on numerous opportunities for our city and county because of our local leaders and decisions. They continue to delay downtown developments and the Greenway project. They continue to try and stifle competition in many areas. They lost out on the casino several years ago, they lost out on having our own rehab hospital several years ago, and now they will lose more jobs and tax revenue with the new hospital. It will come and it will likely be right next door in Clark County.

In addition, our local leaders cannot seem to hold each other accountable. Therefore, when it comes time to hold “slumlords” accountable for the dilapidated buildings and rental properties that continually drive down property values and progress, our leaders do not find it important to do what is right.

I’d be willing to bet that most of our current leaders have never crossed party lines when it came to voting. I have voted for individuals in both parties. I vote for those I think are most qualified and most likely to help this city and county succeed.

I am Republican because I believe in more individual responsibility, less government, less entitlement programs, lower taxes and more conservative and traditional values. I believe in progress and the “free market” and increased accountability for everyone.

Neither party is perfect. But since we really only have a two party system; working through one of these two parties is the only rational way to have any success in making changes.

Medical Staff Meeting and resolution passed

Tuesday evening was the regular meeting of the Medical Staff of the hospital. These meetings are required for all active medical staff members. They occur every other month and we are required to attend at least half of them throughout the year. This is the only opportunity we have as a medical staff to meet as a group and discuss important topics.

Our Medical Executive Committee members who are our elected leaders meet more frequently and handle the day to day problems and needs of the entire medical staff.

After their February meeting and all the discussions about the commissioners removing the only physician from the Board, the committee decided to propose a resolution. This resolution would be forwarded to the Board of Trustees asking them to solicit the Commissioners to expand the current Board from 7 to 9 members. These additional two members would be physicians. This actually would be in agreement with the consultant’s recommendations as well as a recent article in the Trustee magazine.

The resolution overwhelmingly passed with the 70 or so physicians present. The physicians felt very strongly that with the expansion of the hospital and the changing healthcare environment, we needed more representation at the Board level rather than less.

It will now be up to the Board to take action and forward the resolution and proposal to the Commissioners. If the Commissioners fail to take appropriate action based on the overwhelming support of the Medical Staff, I believe it will clearly state if they really have the best interest of Floyd Memorial in mind.

This is a very important decision that potentially affects all the residents in Floyd County. Stay tuned for the outcome!

Update on physicians committee

For those avid readers who have been loyally following the postings, I appreciate your support. As an update to a posting last month regarding what I felt was a manipulation of certain Physicians serving on our Medical Executive Committee by the administration; there has been some new developments.

As you recall, January was my first month not serving on the Board of Trustees or the Medical Executive Committee. At this meeting, it was brought up that they wanted to change our Bylaws to prevent physicians from serving in both of these capacities even though the only conflict arose because the CEO was always being held accountable and challenged on decisions.

I was appalled and outraged at the blatant misrepresentation of the facts that was given to physicians at this very first meeting that I was not in attendance. I subsequently sent out two separate letters along with supporting documentation to the physicians. They were all enlightened and most were angry at the attempts by certain individuals to manipulate things concerning physicians and the best interest of the hospital.

The issue was brought back up in the February meeting for a vote and the motion failed because of lack of a second. And besides this motion failing, the committee decided to submit a resolution to the Board asking to have physicians placed back on the Board. But more on that tomorrow.

This should send a very loud message to those involved that physicians are not so out of touch and we will do what is right when all the information is given. This is another major setback in the relationship and trust that physicians have with individuals in the current administration.

We hope the Board acknowledges this and decides to not change their bylaws preventing this to occur. We hope the Board continues to watch closely as more and more physicians become increasingly unhappy.

Nursing Shortages: what is the real problem?

In recent years, the nursing shortage has attracted both local and national attention. It also has and generated scores of studies. Unfortunately, in my opinion, many of these studies focus on solutions that, while popular, have no real hope of solving the problem at hand.

Many of these studies were sponsored by managements and were geared to improving recruitment and retention without spending a lot of money. The proposals always touted were to expand the students in nursing schools, improving the image of nursing and instituting superficial workplace reforms aimed at generating team spirit. None of the most common proposals ever really look at changing the underlying reality of stress in the workplace.

In 2001, more than 25 state laws were enacted to address the nursing shortage. Two-thirds of these were designed to encourage more students to go into nursing programs. In September 2001, Secretary of Health and Human Services Tommy Thompson announced a program to give $27.4 million worth of grants and contracts to institutions of higher education to increase the number of future RNs. He commented; “it's absolutely critical that we encourage more of our nation's students to choose careers in nursing.” He went on to say “he wants students to realize that nursing is an exciting and satisfying career that makes a difference in people's lives." These are very altruistic statements, but throwing money at the problem in this manner won’t fix the real underlying problem.

These were probably well-intentioned ideas. But they were misguided. The nursing shortage can most quickly be solved not by expanding the number of students in nursing programs but by improving working conditions so that existing but currently non-working RNs will choose to return to the profession. There are thousands of good, quality nurses who have left the profession. Producing more graduates of nursing schools will do little good if these nurses become disillusioned and drop out after a few years of hospital work like the ones have done thus far. This, in fact, is exactly what the evidence suggests. Recently graduated RNs are no more satisfied with their jobs than are older nurses. The Nursing Executive Center reports that 31 percent of nurses under age 24 changed hospitals within the past two years, as did 20 percent of nurses older. All were looking for something they can’t find.

If the conditions on the job are not improved, the turnover rate will continue to be a huge problem. It will be like pouring water into a bucket with holes and wondering why it never fills up. Hoping that student nurses won't discover the downside of their profession until it's too late is not a wise approach. Inevitably, even beginning nurses will start thinking about leaving once they realize the realities of their chosen occupation.

To solve the workforce crisis, individual hospitals need to recruit new employees into the organization and then make appropriate changes to retain them. Retention is more important then recruitment.

Management in most hospitals address the nursing shortage by offering recommendations aimed at superficial improvements in the workplace atmosphere without significant change in the basic parameters of the job. Organization like the American Hospital Association has advocated hospitals to "increase the time caregivers can spend in the actual care of patients." But their recommendation for achieving this goal has nothing to do with staffing levels. Instead, they encourage hospitals to "introduce new technologies that reduce paper records and the repetitive entry of information." This so-called technology sounds good when you’re not the ones trying to implement it. If there were no learning curve and everything worked precisely as envisioned, it might be easier. But in reality, nurses spend more time doing paper and computer work and even less time with patients. If computerization and technological advances are not implemented together with staffing improvements, they will prove futile.

The problems that are driving nurses out of the industry are global rather than individual or idiosyncratic. Changes to improve retention such as weekly staff brainstorming sessions, a nurse-manager open door policy, suggestion boxes, physician-nurse communication programs, unit equipment audits, a personal nurse-manager skills improvement plans, thank you grams or CARE awards all constitute worthwhile initiatives; but won’t fix the problem.

Patients are sicker and require faster, more tests and procedures in a shorter period of time. Nurses are relational and want hands-on patient care. None of the above strategies will work long-term without increased staffing at the bedside.

Cost is always brought up as the reason staffing levels are maintained at these levels. But in the long run, we cannot afford to continue along this path. To keep nurses in their fields, we need to allow them to do what they do best; take care of patients. This requires more staffing.

Staffing Issues

The hospital finally came off “diversion” last week. But readers should know that different from last year, we were on diversion this past week partly because of shortages in staff. Last year, it was always because of no available beds.

We now have more monitored beds but they are spread out in several locations. This has created increased staffing problems for the management of these beds.

From a physician standpoint, what is troubling is the amount of unfilled nursing jobs. As of Saturday February 18, 2006, there were 50 nursing jobs available and posted on the Hospital’s website: http://www.floydmemorial.org/

This comes as no surprise to physicians who have continually voiced our concerns about this problem.

When the new addition was being contemplated several years ago, the CEO met with physicians for their comments. The first and most important concern we voiced was the shortage of staff. This was a known problem that existed at the time and we knew a continued shortage would occur with the addition.

Our CEO informed us that “staffing was the easy part” of the project. Physicians just shook their heads and knew he didn’t have a clue.

The question remains, if the administration is doing everything so well, and the CEO stated that staffing was the easy part, then why are there 50 open nursing positions. The new addition added fewer than 10 beds to the total number.

Physicians and other staff members know the answers. The surveys have shown the answers. How far down will we have to sink before things change? Will it be salvageable when they finally “get it”?

Opinions on Euthanasia

The topic of euthanasia always elicits strong reactions among physicians, patients and individuals. Many have very strong views both for and against.

The term "euthanasia" comes from the Greek words "eu," meaning good, and "thanasia," meaning death. Hence "euthanasia" means a good death. Euthanasia has been practiced sporadically for thousands of years in multiple cultures. The definition of euthanasia is "the intentional cause of a person's death motivated by the desire to promote this person's best interest, using the gentlest means available." From these 2 perspectives, euthanasia is clearly different from murder, which only serves the murderer and is often cruel and harsh. "Gentle means" usually entail lack of pain along with respect, dignity, peace, and comfort. The process usually requires the active participation of a physician who will facilitate the death.

Did you know that humans are the only species that consistently takes care of their sick, the very young or very old, or those simply incapable of caring for themselves.

The question remains as to why this is. Why have humans “evolved” to a more complex form of human interaction, with the ideals of caring, altruism, and compassion being seen in Humans but not in other species consistently?. Or were we created differently from the beginning. (Sorry, that is another topic)

Many people suggest that the rising cost of healthcare is caused by caring for the gravely ill or those with incurable diseases. It is true that a large percentage of the healthcare dollars are spent in the last few days of a person’s life. But this should not be justification for euthanasia.

End of life expenses and dying patients in the ICU have only recently begun to receive considerable attention when talking about euthanasia. The definition of a good death is subject to interpretation and many physicians will disagree. But most would agree that a good death is more than a lack of pain and agony—it includes dignity and a peaceful environment in the presence of family and friends and possibly a conscious state, which would allow communication. In addition, a good death should not stress or emotionally scar those around the patient.

The issue of terminal sedation differs from euthanasia or assisted suicide in that terminal sedation uses high-dose sedatives and analgesics to alleviate pain and discomfort but not necessarily to hasten death although physicians acknowledge the potential. Death may occur, but it is not the primary intention. The difference between the 2 approaches is probably reflected in the attitudes of the physicians. In one German study, 90% of physicians were opposed to euthanasia but 94% considered terminal sedation to be acceptable.

Another European study called the ETHICUS study, examined end-of-life practices in European ICUs. It showed that although limiting life-sustaining therapy was common in Europe, active facilitation of death was rare. However, of particular concern was that a gray zone separated therapies aiming at pain relief and those that hastened death. In order to alleviate pain in some patients, it requires doses that also suppress respirations and sometimes heart and kidney functions, in effect, hastening death.

Balancing rising costs, and the increased ability to keep people alive with technology and drugs will continue to cause many debates amongst individuals. How a country manages and legislates these actions will speak to the countries priorities and their morality.

As a physician, I believe in being proactive with discussions on end-of-life events along with patient and family wishes. I believe that patients should be the primary decision-maker for what happens to them.

The difficulty caring for patients is when sudden unexpected events occur (as they always do) and patients and families rush themselves to emergency rooms or other facilities where many sometimes unnecessary procedures are done. At this point, we have to carefully consider all options and make the best informed decision.

Withholding care and procedures is not euthanasia if it is done in an informed manner. Allowing “nature to run its course” is an “ok” option in my opinion. If we fail to offer available care to patients because of our personal beliefs, family wishes, or purely financial reasons, without considering the patient’s choice, then that in my opinion is wrong.

I believe that patients should consider cost, burdens placed on families, personal beliefs, quality and quantity of life with the various medical options and at that point make decisions on their care.

I do not believe that intentionally taking life with euthanasia is morally accectable. There are many other options available and the easiest would be to just not seek medical care and treatments. The biggest challenge is to get people to understand that just because we can offer treatments doesn’t mean they have to accept it.

The best physician only extends life. Sooner or later, we all die!!

Physician study on Death with Dignity Act

The New England Journal of Medicine was the first to report on physician experiences with requests for assisted suicide under the Oregon Death with Dignity Act. Since the legislation was enacted in November 1997, physicians have honored 1 in 6 requests, and of these, 1 in 10 actually resulted in suicide.

"We found that Oregon physicians are responding in a careful and prudent manner when patients request assisted suicide," said first author Linda Ganzini, MD, director of geriatric psychiatry at the Portland Veterans Affairs Medical Center and associate professor of psychiatry at Oregon Health Sciences University. "Our data support that the first response of a physician who receives a request is to look for treatable physical and psychological symptoms. Only a small proportion of patients who request lethal prescriptions actually receive and die by them."

Nearly half of physicians receiving requests ended up providing alternative "palliative" care, such as pain control and/or referral to Hospice. Forty-six percent of patients who received these palliative interventions changed their mind about assisted suicide.

The survey also showed that patients who completed suicide were already receiving substantial palliative care, and 81% were in hospice care. This supports the assumption that the majority patients who actually died by suicide were already utilizing all available means to maximize their quality of life.

The researchers of the study received information on 165 people requesting lethal prescriptions. The most common diagnosis was cancer. The most common reasons for pursuing assisted suicide were concern about loss of independence (57%), poor quality of life (55%), readiness to die (54%), and desire to control the circumstances of death (53%). Physical suffering was common ranking pain (43%), shortness of breath (27%), and fatigue (31%) of the totals.

The authors of the study showed that contrary to some concerns, the demographics of patients requesting lethal prescriptions matched those of people in the general population who died during the same period. Vulnerable groups, such as women, ethnic minorities, and people without health insurance, were not overrepresented.

The study did show that eleven percent of patients requesting lethal prescriptions were concerned that they were a financial drain on others, 6% lacked social support, and 2% had no medical insurance. Although 38% perceived themselves as a burden to others, physicians were unlikely to honor requests from these patients.

Physicians reported that 20% of requesting patients had symptoms of depression, but none of these received a lethal prescription. Many physicians reported they had made efforts to improve their knowledge of depression and psychiatric symptoms also had made substantial efforts to improve their knowledge and use of pain control, and other appropriate palliative care.

This study was somewhat revealing because it did not support some of the fears that critics maintained. A follow-up study should be done because as with most things, once they become common-place, we lose our objectivity and our moral reasoning with them. This would have the potential to lead to future abuses.

Oregon's assisted suicide

I was asked by one of our fellow bloggers to comment on “assisted suicide”. Since this topic is extremely complex and challenging in many ways, I decided to blog on the topic over a few days.

To begin, we’ll give a little history on the legislation affecting us in the United States. Other countries have varying degrees of acceptance and their own legislation.

Oregon’s Death with Dignity Act was originally enacted in 1994 and was the U.S.'s first law authorizing physician assisted suicide. It allows physicians to prescribe lethal doses of controlled substances to terminally ill residents for the sole purpose of terminating life. This law established certain procedures to help protect vulnerable patients and ensure that their decisions were voluntary and informed. Oregon voters reaffirmed their support for the Death with Dignity Act on November 4, 1997, by defeating a ballot measure that sought to repeal the law.

Shortly after Oregon passed this law, several Congressmen, including then Senator John Ashcroft, urged then Attorney General Janet Reno to declare that physician assisted suicide violated the federal Controlled Substances Act (CSA). She declined to do so. On November 9, 2001 when John Ashcroft was appointed Attorney General, he reversed the position of his predecessor and issued the “Ashcroft Directive,” declaring that physician assisted suicide serves no "legitimate medical purpose" under DEA regulations. This directive made it unlawful for a physician to prescribe medications for assisted suicide and for a pharmacist to knowingly dispense medications for that purpose.

The Ashcroft Directive brought about a lawsuit from a doctor, a pharmacist, several terminally ill patients, and the state of Oregon. They contended that the “Federal” directive criminalized conduct that was specifically authorized under Oregon State law. The case was originally filed in federal district court, where the judge issued a ruling in favor of the state of Oregon and later the case was transferred to the Ninth Circuit Court of Appeals.

The sole issue considered by the court was whether Congress had authorized the Attorney General to determine that physician assisted suicide violates the Controlled Substances Act (CSA) The appellate court took no position on the merits or morality of physician assisted suicide. The CSA expressly limits federal authority under the act to the "field of drug abuse." The court said: "To the limited extent that the CSA does authorize federal regulation of medical practice, Congress carefully circumscribed the Attorney General's role. The Attorney General may not define the scope of legitimate medical practice."
The court held that the Ashcroft Directive violated the "clear statement" rule, contradicted the plain language of the CSA, and contravened the express intent of Congress and it was basically struck down.

According to congressional testimony, all decisions of a medical nature, if made by a federal agency at all, are to be made by the Secretary of Health and Human Services (HHS). Law enforcement decisions made by the Attorney General are limited to those related to "the security of stocks of narcotic drugs and the maintenance of records on such drugs."

In summary, the court said: “The Attorney General's unilateral attempt to regulate general medical practices historically entrusted to state lawmakers interferes with the democratic debate about physician assisted suicide and far exceeds the scope of his authority under federal law."

Oregon is left to continue its’ State authorized assisted suicide!!

More to follow in the next few days.

February update of the Hospital

The new addition at Floyd has been open nearly a month. Many readers may recall statements made publicly in the Courier Journal and elsewhere by the CEO about how the new addition was going to take care of the bed shortage situation and our frequency on diversion.

Even though all his reassurances were touted in the media, the fact remains that the majority of the weekend from Friday the 10th through Monday morning, the hospital remained on critical care diversion because of lack of beds. Our patients that required monitoring were either diverted to other hospitals or remained on hold in the Emergency Room awaiting a bed to open.

The problem remains with bed shortages, and we have yet to perform the first open heart surgery.

In addition to the above ongoing problem, the rumor around administration is that Mr. Hanson is inquiring about where certain physicians live. There is evidently talk between the commissioners and him about trying to get a physician back on the Board. I guess they are considering the implications from their previous decisions as well as the criticism from many different sources.

Now the key for Mr. Hanson will be to find a physician willing to serve who lives in Floyd County and is sympathetic to his viewpoints. Again, there are many competent physicians in Floyd County, but only a handful are willing to serve as well as be supportive of his viewpoints. There are several who would serve and be fairly complacent, and there are several more who would serve and really be proactive about making the changes necessary. Who to choose???

In addition, I believe that Mr. Hanson manipulated the Medical Executive Committee composition this year and many of the physicians serving are ones more sympathetic to his views. This leaves very few available to serve on the Board because he has stated emphatically that he believes physicians shouldn’t serve on the Board and on the Medical Executive Committee at the same time; at least he believed that when the physician serving was me. So we will see how all of this shakes out in the coming weeks.

Where the Commissioners stand on this issue is another question. How will they decide on who to appoint and when remains a question? Adding just one physician to the Board would make the composition only eight members. We really need an odd number to break any tie-votes. If the number goes to nine members, the consultant we paid a lot of money for stated there should be 2 physicians on the Board if there were nine members. This would make the composition much better for the hospital, but it would make Mr. Hanson’s job more uncomfortable and the Commissioners are likely to hear more ongoing complaints from him. So it is doubtful they will choose this option.

If they wait until next year when Mr. Mill’s term expires, they have a possibility of losing one of the two of the democratic seats on the County Council. This would shift the focus of the County Council and they may not be able to appoint who they would choose if they did it this year.

Again, if they would just do what is in the best interest of the hospital, all of these other issues would be mute. But my bet is they end up doing nothing this year because that would be acknowledging a mistake was made.

Purity Ball Speech

Fot those interested in reading the challenge given to the dads, below is a copy of the speech given to the them at the Purity Ball. The event was a great success and everyone had a terrific time. If the event helps just one dad or daughter commit or re-commit to their purity, it will be worth the effort.

• Welcome dads and sponsors. This is a great turnout for our 3rd annual Purity Ball
• What an incredible event.
• I applaud your courage in being here tonight especially if this is your first time–––and possibly overcoming some fears of connecting emotionally with your daughters.
• The theme for tonight’s event is Treasures!!
• There's a scene in Raiders of the Lost Ark where the evil villain, holds up a pocket watch.
• He explains to Indiana Jones that the watch has little worth.
• But then he adds, "Bury this in the sand for a thousand years, and it becomes priceless."
• His point is––– that over time–––, even the most insignificant thing––– can take on great value.
• And that is certainly true when it comes to what many of us may take for granted.
• Our relationships with our wives and our daughters.
• There's something special about the relationship between a father and his daughter.
• Dads are her first relationship with a man.
• You Dads––– are one of her first teachers, ––– first friends –––and first role models.
• None of these roles should be taken lightly, ––– because they give you the opportunity to shape your daughter into a wonderful woman.
• Consider these statistics of what our daughters are exposed to:
o 6.6 percent of American children begin their sex lives before age 13; more than 60 percent begin by the time they reach 12th grade
o 86 percent of teenage girls are, ––– or think they should be, dieting
o Anxiety disorders affect an estimated 13 percent of children and adolescents during any given six-month period. The disorders are often not recognized, and most who have them do not receive treatment.
• We Dad’s need to start building a nurturing relationship with our daughters as soon as possible.
• When your daughter was 6 months old, ––– she may not have understood the meaning of life, ––– but she surely knew who her daddy was.
• I ask you today, –––does she still really know who her daddy is?
• She'll never be too young or too old for you to start being the dad God wants you to be.
• Being the father and husband God has commanded you to be is a tough role in this secular world that pulls all of us in the wrong directions
• When a man begins to father a daughter, –––the obstacles may seem insurmountable.
• We fathers––– have no experience in what it's like to grow up as a girl –––and no matter how much we love them and how much we want to connect, –––our growing daughters will sometimes be a complete mystery to us–––just because they're female
• There is typically no one to talk to about being a father or raising a girl
• We're afraid that if we ask our daughters' mothers a basic question, ––– we may get a roll of the eye that injures our egos.
• It's embarrassing to ask our own mothers for advice, ––– and our dads seem to know as little as we do.
• Fathers are stereotyped.
• One minute, fathers are seen as second-class parents ––– invisible or incompetent.
• The next moment, ––– we may be cast as all-knowing superheroes and therefore responsible for all mistakes.
• Which role do we identify with and take on?
• Most folks––– (including us dads) ––– think that Mom is best suited to be the primary and most influential parent.
• That mindset manifests itself everywhere from the teacher to family court.
• Watch any of the sitcoms and you will see us dads as not knowing which end of the baby to put the bottle in –––or as someone who gags when changing a diaper.
• That is the stereotype of “Daddy the dummy” that our culture has created.
• Growing up, we learn that the primary job as fathers is to provide for their family.
• That's a true and good thing for us to learn.
• But too many of us define the word "provide" with our wallet.
• We expect ourselves to spend more time at a paying job than Mom, so that we fulfill our role as provider for our kids
• However, this way of thinking requires a significant tradeoff that we seldom address appropriately.
• To meet that relentless economic provider expectation–––, we spend more time, energy and attention away from home (and our kids) than we should.
• We probably got little help from our own fathers, –––as withdrawal, abandonment and laying down the law––– left little room for father-son conversations or questions about being a dad.
• And compared to what moms usually learn from their mothers and their relatives, we as dads are flying deaf, mute and blind on many occasions.
• But the father's role in a daughter's life is invaluable in molding her future male-female relationships
• Whether your daughters are aware of it or not, ––– they tend to pattern relationships after the model set by you ––– (their fathers.)
• Dad’s are the primary example in a girl's life of how she should be treated by men
• With this important position of being the 'first man'–––comes the ability to set the norm of manliness for her ––– a norm that ultimately can be stronger than what our current society, ––– TV –––and media will tell her.
• The preciousness of the treasure that God bestowed on each of us is an awesome responsibility that we should not take lightly
• God has an end and purpose to which He entrusted our daughters, ––– and a goal to which they ought to be directed.
• Our daughters need good role models –––and if we fail to provide this–––they will be lost.
• Our daughter’s view of God is modeled on how their relationship is with us––– as fathers.
• They will see God as relational if they see us as relational with them and in our marriages
• They will see God as honest if we are honest
• They will see God as kind and caring if we are kind and caring
• And they will see God as approachable and loving if we are approachable and loving
• Dads, did you know that over 160 times in the Bible, God asked—often commanded—to remember?
• In Deuteronomy 32:7, we're encouraged to "Remember the days of old; consider the generations long past. Ask your father and he will tell you, your elders, and they will explain to you."
• Our daughters will remember how they are treated by us –––as fathers.
• They will remember if we are that approachable, loving and caring father and our daughters will base their relationship with God on that.
• God is faithful in our lives and in the lives of our children. –––Holding on and nurturing the relationships with our daughters is a beautiful way to celebrate God's goodness and remember his faithfulness.
PAUSE
• Everyone knows babies love cuddles––– but so does your daughters. ––– Physical touch is part of every relationship ––– whether it’s your wife, children, friends, relatives or coworkers.
• Best friends hug–––, grandmas kiss their grandsons on the forehead –––and coworkers pat each other on the back.
• And so it should be with fathers and daughters.
• As fathers, ––– we may not realize the importance of our relationship with her––– or we may shy away from being too physical because of our inexperience or the preexisting conditioning that this secular world has taught.
• As girls move into adolescence we may find it easier––– to distance ourselves from our daughter's awkward and/or dynamic physical and emotional changes.
• This may result in difficult communication –––and can often make parenting issues more complicated.
• However, ––– this is also the time when our daughters most need us to be an even greater presence in their lives.
• We should generously deliver those hugs and kisses to our daughters.
• They are affirming, ––– warm, ––– full of love –––and provide assurance.
• Appropriate physical intimacy with their Dad’s––– helps girls build trust, and a positive self-image.
• These things are your reminder to them––– that you love them just the way they are.
• Our Teenage daughters straddle the world between being children and adults.
• They are in the middle, desperately trying to figure out their place.
PAUSE
• Before the invention of refrigerators, icehouses were common: small barns with thick walls, no windows, and tightly sealed doors. In wintertime, blocks of ice would be cut out of frozen lakes and stored in them, covered with sawdust to help keep them from melting. The ice would often stay frozen well into the summer months, thus allowing people to preserve perishable food.
• A man who worked in one of these icehouses lost a very valuable pocket watch while working there one day. He quickly began searching for it, combing carefully through the sawdust. Not finding it, he recruited his fellow workers, and all gave the place a thorough investigation. In spite of their efforts, the watch remained hidden. At noon they gave up and went outside to have lunch.
• While they were eating, a small boy slipped into the icehouse. He emerged minutes later, proudly carrying the lost watch. The astonished workers asked how he'd been able to find it.
• "I closed the door, lay down in the sawdust, and kept very still," he replied. "Soon I heard the watch ticking."
• The lesson to learn from this story is: How can I make time for just listening?

• Daughters also need dads that will listen, ––– dads that will allow them to spill their guts completely and know that they can trust you.
• They need dads that they can turn to if they mess up or make a mistake–––and they need Dad’s that say they are sorry if they make a mistake.
• This point is especially relevant in the teenage years.
• Girls are already emotional creatures by nature, but when adolescence hits ––– look out!
• Teenage girls may fret about everything from the color of their nail polish, ––– their clothes and hair, ––– to the uncertainty of their future career.
• We need to Just listen.
• They aren't necessarily hoping you will solve all their problems ––– even if you want to or can-––– they just want you to listen and validate their feelings.
• Are you that Dad?
• Daughters also need Dads that will respect their mother
• Our daughters learn so much more from what we do rather than what we say ––– this is called modeling.
• Our daughters imitate the behaviors of their parents long before they understand the full meaning behind such actions.
• This idea translates to how you treat your daughter's mother
• Treating her with love, dignity, respect and value will speak volumes to your daughter.
• Your daughter will remember––– and she will watch your interactions with other females ––– grandmothers, aunts, sisters ––– and she'll notice if your behavior and verbal exchanges with females are different than those with males.
• It's OK if your rapport is different with women than it is with men, ––– as long as it's positive, appropriate, and Godly.
• She will grow to expect in her relationships what she sees between you and her mother.
• As the primary male role model in a girl's life, –––we fathers can and will influence our daughters in many profound ways
• We will help them develop aspects of self-image –––and what they come to expect from men, society –––and the world.
• Are our relationships everything God intended?
• Are you the husband God wants you to be?
PAUSE
• Our economic situations shouldn't determine our priorities in life.
• Real treasures aren't found in the wallet.
• They're rooted in the most essential relationships we enjoy as human beings: our bond to God, –––our marriages, –––our families, –––and the friends and colleagues around us, ––– no matter what season of life we're in
• Since my purpose is to challenge you dads––– it is necessary for me to point out some things:
• Our Daughters are one of God’s Most Precious Gifts, –––
• They are an invaluable Treasure that requires –––and should Claim Our Most Vigilant Attention
• Our kids are a priceless treasure that God has testified to by saying:
• Psalm 127:3 says “Sons are a heritage from the LORD, children a reward from him.”
• And when God speaks of His love towards us, he calls us children as if there were no more excellent name by which to allure us…
• (Matt. 6:19-21) says:
• “Do not store up for yourselves treasures on earth, where moth and rust destroy, and where thieves break in and steal. But store up for yourselves treasures in heaven, where moth and rust do not destroy, and where thieves do not break in and steal. For where your treasure is, there your heart will be also"
• We are confronted with a tremendous statement in these passages.
• But the real key part of the passage is in verse 21:
• For where your treasure is, there will your heart be also
• Ask yourself this question in regard to your life:
• If you’d have to choose if something is for you or for God, whom is it usually for?
• That is the real issue.
• It has been said. Show me your calendar and your checkbook and I will show you where your heart and priorities lie.
• Wherever you put your investment that is where you will put your heart.
• If all that you possess is locked up in success, bank accounts, material items, and earthly recognitions, that is where your heart will be
• We're immensely grateful if we are blessed with financial success—but that, in itself, shouldn’t be our goal.
• We know that money alone will never satisfy. We should see money as a tool, not an end.
• What counts is how it is used for eternal purposes.
• If it is in the process of investing in God's causes—, in your marriage —and your children —and especially your daughter, — then that is where your heart will lead and guide you.
• Where is your heart now? — Is God, — your wife and daughter and family truly your treasure?
PAUSE
• During the time outside of this special event, it is easy to lose sight of what is most important to us.
• Having to do even more work than we usually do with our jobs, — family responsibilities can even try a Saint's patience.
• Yet we should not allow life and societies busy schedules —to detract from God’s desires of love, faith, hope and family.
• When you can't agree with people what is right,
• LOVE is always right
• When you lack the patience to deal with everyday pressures, — having FAITH that with perseverance and God’s direction, it will work out
• When you feel like there is just too much to do
• Know that with HOPE and God’s assistance, — you can make the ordinary into something extraordinary.
• And remember that our Families were chosen for us by God. — He chose them for a reason —and placed their successes on us— as husbands and fathers
• In Matthew 16:26, it says “How do you benefit if you gain the whole world but lose your own soul in the process?”
• Is anything worth more than your soul?
• I challenge each of you
• Be the Dad and Husbands God wants You to Be —and do it NOW!!!

Surviving childhood

This was passed on to me by a good friend.

It is amazing how far we have advanced;

or have we!!

TO ALL THE KIDSWHO SURVIVED the
1930's 40's, 50's, 60's and 70's !!

First, we survived being born to mothers who smoked and/or drank while they were pregnant.
They took aspirin, ate blue cheese dressing, tuna from a can, and didn't get tested for diabetes.
Then after that trauma, we were put to sleep on our tummies in baby cribs covered with bright colored lead-based paints.
We had no childproof lids on medicine bottles, doors or cabinets and when we rode our bikes, we had no helmets, not to mention, the risks we took hitchhiking.
As infants & children, we would ride in cars with no car seats, booster seats, seat belts or air bags. Riding in the back of a pick up on a warm day was always a special treat. We drank water from the garden hose and NOT from a bottle. We shared one soft drink with four friends, from one bottle and NO ONE actually died from this.
We ate cupcakes, white bread and real butter and drank koolade made with sugar, but we weren't overweight because . ..
WE WERE ALWAYS OUTSIDE PLAYING!
We would leave home in the morning and play all day, as long as we were back when the streetlights came on.
No one was able to reach us all day.
And we were O.K. We would spend hours building our go-carts out of scraps and then ride down the hill, only to find out we forgot the brakes. After running into the bushes a few times, we learned to solve the problem.
We did not have Playstations, Nintendo's, X-boxes, no video games at all, no 150 channels on cable, no video movies or DVD's, no surround-sound or CD's, no cell phones, no personal computers, no Internet or chat rooms..........
WE HAD FRIENDS and we went outside and found them!
We fell out of trees, got cut, broke bones and teeth and there were no lawsuits from these accidents.
We ate worms and mud pies made from dirt, and the worms did not live in us forever.
We were given BB guns for our 10th birthdays, made up games with sticks and tennis balls and, although we were told it would happen, we did not put out very many eyes.We rode bikes or walked to a friend's house and knocked on the door or rang the bell, or just walked in and talked to them!
Little League had tryouts and not everyone made the team. Those who didn't had to learn to deal with disappointment. Imagine that!!
The idea of a parent bailing us out if we broke the law was unheard of.
They actually sided with the law!
These generations have produced some of the best risk-takers, problem solvers and inventors ever!
The past 50 years have been an explosion of innovation and new ideas.
We had freedom, failure, success and responsibility, and we learned
HOW TO DEAL WITH IT ALL!
If YOU are one of them . . . CONGRATULATIONS!
You might want to share this with others who have had the luck to grow up as kids, before the lawyers and the government regulated so much of our lives
for our own good.
And while you are at it, forward it to your kids so they will know how brave (and lucky) their parents were.
Kind of makes you want to run through the house with scissors, doesn't it?!

The purity covenant

Some have asked and others were wondering what the fathers and daughters acutally pledge and sign. So here is a copy of the covenant. Remember that this is a church sponsored event and we try to support our statements with Biblical reasoning. This posting is definately more Christian in nature and is not meant to offend any of the non-christian readers but provide insight into the covenant.

The Father

I, __________________as your Father, do solemnly swear and covenant with you this night, to love you with a pure heart. I covenant to help you, protect you, lead, guide and direct you to remain pure and innocent in body, soul and mind. These things we shall accomplish together until such a time that I give leadership and authority of you over to your husband. I further covenant that:
I will study God’s Word and be accountable to It’s directions, using It as the measure of Truth. (Acts 17:11)
I will acknowledge that God desires the marriage relationship to be the priority after my relationship with Him and that I will make efforts to grow this relationship based on God’s principles. I also acknowledge my children are a welcome addition to the family God has established for me. (Ephesians 5:25)
I will establish boundaries and accept the role as my family’s protector under the authority of the Scripture and to instruct you based on God’s principles. (Col. 3:21, Proverbs 22:6)
I will respect and love you as my daughter and spiritually as my sister-in-Christ. (1 Peter 1:22)
I will, as an earthly model of your heavenly Father, love you in good times and in times of trouble, fear and heartbreak. (Deut. 6:1-9, Romans 8:15.)
I will expect, encourage and help you remain pure until your wedding day. (Proverbs 1:7-9)
I will pray for you in your spiritual growth and for the purity of your mind, body and spirit. (Ephesians 1:16-18)

The Daughter

I,___________________, as your daughter, do solemnly swear and covenant with you this night, to love you with a pure heart, to turn to you in times of trouble, confusion and fear. I covenant with you to follow your lead as my spiritual guide and spiritual authority. Tonight I covenant with you to keep myself spiritually, physically and emotionally pure until my wedding day. I place my trust in you to help me choose a man designated by God to be my husband. I further covenant that:
I will study God’s Word and be accountable to It’s directions, using It as the measure of truth. (Acts 17:11)
I will remain sexually pure until I am married. (Corinthians. 7:34)
I will acknowledge this covenant in my courting relationships, and the fact that my heart is entrusted to you until the day I marry. (Matthew 15:4)
I will accept and celebrate you as God’s choice for my earthly father, submitting to the authority and boundaries you establish until I marry. (Ephesians 6:1)
I will conduct myself in a manner that minimizes any challenge or risk of sexual impurity; honoring God’s plan for relational wholeness and health for a lifetime and bringing honor to my God and you, my dad.
I will bless you with prayer as you lead our family. (Ephesians 1:16)

These things we covenant together as father (sponsor) and daughter until the day of her engagement or marriage.

Signed in the presence of God and His Angels,



_________________________
Father (sponsor)

_________________________
Daughter

Girls sexual health

Only having 1 daughter and 3 sons, I feel very strongly that the Purity Ball is a wonderful event. It gives fathers and daughters the opportunity to spend quality time with their daughters and opens up dialogue for what is typically a taboo subject.

For many of these girls, this event is like their first prom. And who better to take you than your dad.

We have had dads with limited relationships bring their daughters over the past two years and both stated how special it was to reconnect.

A study in Child Development showed that teenage girls in the United States and New Zealand have a particularly strong tendency to engage in sexual activity and to get pregnant if they grew up in families without a father present.

Other studies also have shown that early sexual activity and teenage pregnancy is higher among girls who grow up from infancy without a father. But in many of these studies, the researchers have generally assumed that precocious sexuality results from a mix of adverse influences, including a father's absence, divorce, poverty, and the lack of parental guidance.

In this particular study, among the U.S. girls, a father's absence was associated with his daughter's sexual activity before age 16 and teenage pregnancy regardless of other adversities.

In this study, both USA and New Zealand showed the rates of teenage pregnancy were highest among girls who had lived in single-parent homes the longest. The teen pregnancy rate was nearly 8 times as high among girls who were no more than 5 years old when their fathers departed as among girls in two-parent families. The pregnancy rate among girls who were between 6 and 13 years old when their fathers left was about 3 times that of two-parent teens.

What is sad, is to hear those in academia make statements such as psychologist Sara R Jaffee of the Institute of Psychiatry in London when she said; "It's surprising to find such a specific relationship between absent fathers and girls' later sexual behavior," “A father's presence doesn't always serve children well”

She is correct that a father who is abusive, impulsive, irritable, and often violent may not be best for the children, but no one argues that point. The point to be made is that girls need fathers who are loving, patient, kind and supportive. That is what we should encourage, support and expect.

Bruce J. Ellis of the University of Canterbury in New Zealand and his coworkers stated that "These findings may support social policies that encourage fathers to form and remain in families with their children, unless the marriage is highly [conflicted] or violent,"

I am hopeful that this event locally will also impact our community and be a positive influence on these girls, their dads, and their families.

Purity Ball

As we begin to change topics, I want to inform everyone of a very special event scheduled for February 10, 2006. This event is much more important to me personally.

Two years ago, I began the process of implementing the first annual Purity Ball at Northside Christian Church.

This is our 3rd year to host this very special life-changing event for both fathers and daughters. This event is a formal dinner and dance with entertainment and speakers emphasizing purity and the roles of the fathers and daughters. We emphasize the importance of remaining pure until marriage or recommitting to purity if girls have made choices they may regret.




The Father Daughter Purity Ball is a memorable ceremony for daughters to pledge commitments to purity and their fathers to pledge commitments to protect them and to challenge them on being better husbands and dads. This year’s event theme is “Treasures” and we want every father to think of their daughter’s as precious treasures.
Luke 12:34 “For where your treasure is, there your heart will be also.”




I am honored to have been able to chair this event during these three years. We are anticipating 400-450 individuals. Dads will sometimes bring one or several daughters. It is a very special evening for the participants and the many wonderful volunteers that help make it a success.

Cheerleading injuries

Cheerleading injuries are on the rise based on the recent study in the Journal of Pediatrics. Injuries have more than doubled between 1990 and 2002 while participation has only increased 18 percent.

These numbers are actually understated as they cannot possibly know how many injuries are seen in doctor’s offices, ER’s and other clinics and not reported to the Consumer Product Safety Commission where these statistics originated from.

In addition, cheerleading and Pom Pon or dance squads at many High Schools are not sanctioned as sports. Therefore they do not always have qualified coaches and do not necessarily get needed equipment such as mats etc. for practices. This can be an additional source of some of the injuries.

At Floyd Central, for example, the dance team is not considered a sport and the girls do not get credit or a letter for participation. They probably spend more time practicing than most other sports but cannot get a school letter for their participation.

This particular study gives recommendations that are supported by the Memphis, Tenn.-based American Association of Cheerleading Coaches and Advisors. They all recommend that coaches get professional safety training and that high school and cheerleading associations adopt uniform safety procedures and also develop a national database for injuries. All of this is very reasonable and should be implemented by the schools.

It is sad when we see major head and neck injuries that completely destroy the lives of the cheerleaders and their families. We should do whatever it takes to protect these athletes.

Future of FMHHS

To summarize this series on the hospital, I am going to give you my opinion on the direction that FMHHS needs to take to financially survive in the 21st century.

The market place over the next 5 years will continue to expand. Patients want more choices, faster service, up-to-date diagnostics and equipment and the latest innovations and procedures.

Doctors are facing dwindling reimbursements, increased overhead, more regulations from the government and insurers, higher malpractice premiums all leading to declining salaries. Doctors will continue to look at doing more of the testing and procedures in their offices and/or in physician owned facilities as a way to maintain their incomes. Doctors will not continue to accept income losses year after year. They will also begin limiting or refusing to accept some insurances, Medicaid, and Medicare if the hassles and poor reimbursements continue at the current pace.

Hospitals cannot survive without physicians directing patients to their facility. Ninety percent of patients will go to the facility their physician recommends. It is therefore imperative that hospitals meet the needs of the physicians that utilize them and also build meaningful relationships with the physicians.

I believe that collaborative partnerships between hospitals and physicians are absolutely the best means for success. Partnering will mean that hospitals will split the profits of activities they for years have taken 100 percent. Without collaborative arrangements, physicians will partner with each other and continually drain the hospital of the lucrative procedures and tests and leave the hospital managing mainly money-losing inpatient care.

CEO’s and Boards who cannot or are unwilling to adjust to this paradigm shift of partnering with physicians will lead their hospitals into financial ruin. It may take time for some that are currently financially solvent to decline, but as more competition arrives, the steepness of the downward slope will increase.

This is the philosophical difference I have from our current leadership. I believe that the current CEO will not change his philosophy and cannot be trusted when dealing with physicians in these types of collaborative arrangements. His track record with physician relations and employee relations speaks for itself. I fear that if a smooth transition of leadership is not proactively instituted over the next two years, the delay will drain the financial security of FMHHS and limit our abilities for future growth.

Wrapping up

As I wrap up this little mini-series on the hospital, and I am sure there are some in administration jumping for joy with that thought, I am deciding on how to proceed.

Everything discussed in the past few weeks has been primarily related to the hospital, administration and the County Commissioners.

I could spend the next entire month on specific issues between physicians and the hospital and describe the difficulties that have transpired in this arena, but for now will let things settle down and have people digest what they have learned.

I am open to questions and will blog on them as the need arises. My email is healthblogger@yahoo.com
I may or may not use the content of emails (always protecting their identities) in the blogs depending on their remarks.

Tomorrow I will sum up my perspective and philosophy of the changes needed and why.

Although not everyone agrees with how or what information has been revealed, as a private physician, I have legitimate concerns and will continue to work to make the necessary changes. For four years I tried within the current system and made some progress, but with the decision of two Commissioners, all that work was wiped out. So now, as just a private physician, I plan to continue using available methods to make the changes.

Albert Einstein once said that insanity is doing the same thing over and over again and expecting different results. Continuing on the same path with the same people involved as we did for the past 4 years seems a little insane.

Trust

Many people have asked me specifically why so many physicians do not like this administration and CEO. The answer is simply trust, or lack thereof. From my many postings to my responses, it is evident that I, personally, neither like him nor respect him. But there are many other physicians who simply just don’t trust him.

Reasons for these feelings are many, and I don't expect everyone to understand or agree. In my and others 13 plus years and many dealings with him in situations from contracts, to patient care, hospital policies, employee relations, physician relations etc., many have felt burned, lied to, misled, backstabbed, and have witnessed countless numbers of manipulations. These were all done while he smiles and acts as if he likes you. I certainly am not politically correct or as diplomatic as I would like at times, but I am at least open about where I stand.

Trust is earned and once it is broken, the path toward reconciliation is long. When repeatedly broken, it is irreconcilable.

I use the example of married couples. Trust is inherent in the relationship at the beginning, but if infidelity or other things break that trust, it takes a long time to heal. It takes time even when couples live together, raise families together, eat and sleep together and share common goals. Even with these commonalities, it is very difficult to overcome mistrust in a relationship.

Now take physicians and a CEO. We don’t live together, have families together, and may not even share common goals. We rarely spend time with each other except in meetings and therefore the odds of reconciling repeated breaks in trust are next to impossible.

In addition, when a CEO repeatedly thwarts efforts made and fails to acknowledge problems, it compounds the issues. This is especially true when you find out later all of the underhanded, behind the scenes tactics used to manipulate things over the years.

Only those with first-hand experience would understand the depth of these issues. We don’t expect the readers to agree, but want them to hear the other side of the story.

There are many physicians, employees, city leaders, and employers who have similar feelings, but because of personalities, positions and fear, they do not vocalize them as readily as I.

The CEO has some very good qualities as well. When it comes to government relations, involvement in organizations like the VHA and political action groups he seems to do well. He has carried FMHHS into the 21st century, but in my opinion, his management style and interpersonal relations will not carry the hospital much longer. We need someone who has vision, their own ideas, and someone who can truly lead. The status quo is not acceptable for future success.

Again, these are my opinions from my personal dealings over the last 13 plus years. I know others see things differently and I respect those viewpoints. I just won’t agree with them.