I heard today from a physician whose hospital is on the verge of collapse, and an ICU nurse at a different hospital who is likely struggling with COVID, but being instructed not to get tested so as not to miss work. Two fairly typical stories from the edge of the healthcare abyss, but entirely predictable and a long time in the making. “Hospitals are understaffed” is now common knowledge, not a news story. The question is why. There’s no way to answer that question in the absence of information about staffing and budget decisions, themselves connected to facts about medical billing and collecting. This article is a case in point.
Category Archives: EVS Journal
Desert and Merit (4)
In a previous post, I criticized George Sher’s view that merit-based desert is based on (the recognition of) existing conventions of merit. In these cases, the existing rules are already fashioned to reward merit in a justified way, so that justice (in the sense of rewarding desert) consists simply in acknowledging that a given person satisfies the criteria of merit, and acknowledging that in accepting the convention, we accept the further implication that the person deserves what the rules say they deserve. Continue reading
Too Much Time on Their Hands: The Underemployment of Our Managerial Class
I keep hearing hand-waving stories from right-leaning members of our managerial class about how unemployment benefits are dampening the desire to work among rank-and-file workers. Let me give you a small glimpse into the work ethic of this same managerial class in my own case. I’ll leave you to decide, at least in this case, whose work ethic could use some improvement.
I’ve been writing here since October about the eight month gig I recently did working full time for Operating Room Environmental Services (OR EVS) at Hunterdon Medical Center in Flemington, New Jersey. About seven weeks ago, I gave notice at the hospital, telling both Surgical Services and HR that I would continue to work at HMC’s OR once a month as a per diem worker at the same rate as I’d earned before. They were delighted to hear it; OR EVS has been decimated by turnover, and was practically dying for weekend coverage. I could easily have insisted on a raise, but didn’t. This, by the way, for an institution that failed to give me bereavement leave after the unexpected death of my wife in March.
Continue readingHospitals Are Not Safe: Infection, PR, and EVS
For at least six months now, hospital spokespersons have been coming before the public to assure would-be patients that hospitals have been thoroughly scrubbed clean of potential infectious agents, most of all SARS-CoV-2. So, they insist, “hospitals are safe,” and no one should hesitate to go. This video below is typical of standard-issue hospital propaganda.
No, hospitals are not safe. The video above, like so many in its genre, above confuses de jure policies with de facto realities. Yes, policies are in place “to ensure safety.” But as should be obvious, a policy’s being in place doesn’t ensure safety. People have to be following it, all the time, and to the last letter or decimal place. Even if they are, adherence to policy is not sufficient to ensure that a hospital is 100% infection free, or 100% safe. Nothing can do that.
Continue readingCode Blue to Code Green: EVS, RCM, and Health Care
As many readers will know, I just spent the last eight months working full time for OR EVS at Hunterdon Medical Center in Flemington, New Jersey. About a week ago, I started a new job as a junior analyst in hospital revenue cycle management (RCM) with Aergo Solutions in Iselin, New Jersey. People have asked how I like my new job. Get back to me on that when I know what the hell I’m doing, since for now, I obviously don’t.
For now, I can only comment on the transition between the one job and the other. And the only comment I can muster is that I’m having trouble putting things in words. The difference between working for OR EVS and working for hospital RCM is so stark and abrupt that I’m inclined to think that you really have to experience it first-hand to know what it’s like. One day you’re working with fracture tables; the next day, you’re working with pivot tables. The two things have about as much in common as the two jobs themselves.
Continue readingEVS Journal (3): Mr Clean and the Politics of Disinfection
From an article in yesterday’s New York Times, “U.S. Regulators Find More Flaws at Plant Where Doses Were Ruined”:
WASHINGTON — Federal regulators have found serious flaws at the Baltimore plant that had to throw out up to 15 million possibly contaminated doses of Johnson & Johnson’s coronavirus vaccine, casting doubt on further production in the United States of a vaccine that the government once viewed as essential in fighting the pandemic.
The regulators for the Food and Drug Administration said that the company manufacturing the vaccine, Emergent BioSolutions, may have contaminated additional doses at the plant. They said the company failed to fully investigate the contamination, while also finding fault with the plant’s disinfection practices, size and design, handling of raw materials and training of workers.
The F.D.A. has not yet certified the plant, in Baltimore’s Bayview neighborhood, and no doses made there have gone to the public. All the Johnson & Johnson shots that have been administered in the United States have come from overseas.
The report amounted to a harsh rebuke of Emergent, which had long played down setbacks at the factory, and added to problems for Johnson & Johnson, whose vaccine had been seen as a game changer because it requires only one shot, can be produced in mass volume and is easily stored.
Right, “harsh rebuke.” As someone who works in the field–health-care environmental services (EVS), tasked with cleaning and disinfecting health care-related spaces–let me let you in on a little trade secret. If every health-care related facility were put under fine-grained regulatory scrutiny of the kind described in this article, the shortcomings ascribed to this one plant would suddenly become forthcoming just about everywhere you looked.
Continue readingWaheed Hussain, RIP
A few months ago, I wrote an entry here about my new job, drawing heavily on Waheed Hussain’s Stanford Encyclopedia of Philosophy entry on “the common good.” I’d made a mental note at the time to forward my post on to Hussain in case he found it of interest, but procrastinated, partly for the usual reasons, and partly from a sense of timidity and inhibition: what if he found my post, or my use of his entry, superficial and callow?
I finally resolved to send it to him today, only to end up encountering his obituary. Tragically, he died less than two weeks ago, at the age of 48, of causes related to cancer.
By some strange coincidence, I just realized that we had missed one another twice before: he matriculated at Princeton the year I graduated (1991), and graduated the year before I moved back to town and started attending philosophy events at the university (1995).
My condolences to his family, friends, and colleagues.
EVS Journal (2): Migraines, Operating Rooms, and the Common Good
The second entry in a series on working in an OR.
I occasionally get migraines, but before today had never gotten one at work. And I got the works, so to speak: the icepick-behind-the-eye headache, the photophobia, the nausea. Migraines always arise, at least in my case, unpredictably, seemingly without rhyme or reason. They just haven’t ever done so when I’ve still got seven hours left on the clock, 20+ surgical cases ahead of me, and a team of three of us, EVS workers, having to prepare four operating rooms ASAP for incoming cases. So today was a milestone that felt a bit like a gravestone: the first time, at work, that I felt as though I’d go blind, throw up, and collapse in a heap, but couldn’t. Continue reading
Policy of Truth 