This must be true for Canada as well.

The Walmart family is the wealthiest family in this country, worth about $100 billion. owning more wealth than the bottom 40 percent of the American people, and yet here's the incredible fact.
Because their wages and benefits are so low, they are the major welfare recipients in America, because many, many of their workers depend on Medicaid, depend on food stamps, depend on government subsidies for housing. So, if the minimum wage went up for Walmart, would be a real cut in their profits, but it would be a real savings by the way for taxpayers, who would not having to subsidize Walmart employees because of their low wages.
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Brain Dead!!!!!

An organ cannot be harvested unless the donor is still alive.  Think about it.  It is after the harvesting that the patient truly dies. A transplant must come from a living person as after death all organs are dead and useless.

LifeNews.com

Patient Wakes Up as Doctors About to Remove Organs for Transplant

by Steven Ertelt | Syracuse, NY | LifeNews.com | 7/9/13 11:34 AM

As some nations move towards presumed consent on organ donations, there are more frequent occupancies of patients who are waking up from presumed death just as doctors are ready to harvest their organs for transplant.
Our of New York state comes this story of a patient who woke up just in time. From ABC News:

It was exactly midnight when Caroline Burns eerily opened her eyes and looked at the operating lights above her, shocking doctors who believed she was dead and were about to remove her organs and donate them to patients on the transplant waiting list.
The Syracuse Post-Standard unearthed a report from the U.S. Department of Health and Human Services that chronicled the series of errors that led to the near-organ removal on a living patient at St. Joseph’s Hospital Health Center in Syracuse, N.Y., in 2009.
“The patient did not suffer a cardiopulmonary arrest (as documented) and did not have irreversible brain damage,” the HHS report concluded. “The patient did not meet criteria for withdrawal of care.”
According to the report, doctors had inaccurately diagnosed Burns with irreversible brain damage and ignored nurses who’d noticed signs that Burns was improving: She curled her toes when touched, flared her nostrils and moved her mouth and tongue. She was also breathing on her own even though she was on a respirator.
Burns, who was 41 at the time, was initially found unresponsive and surrounded by empty bottles of Xanax, Benadryl, a muscle relaxant and an anti-inflammatory drug on Oct.16, 2009, according to the report. She was hypothermic and had a weak pulse, but she was alive.
In the St. Josephs emergency room, doctors performed toxicology tests and determined Burns was suffering from a multidrug overdose, according to the report. She was unresponsive and put on a ventilator.
The family made the decision to take Burns off life support and donate her organs the next day.
Although Burns opened her eyes at the last minute, saving herself from the organ harvest procedure, she committed suicide in 2011. The family never sued, and family members told the Syracuse Post-Standard that Burns was too depressed to be upset about what happened to her at St. Joseph’s.

But this isn’t the first time this has happened.
In what is becoming a more common theme, doctors rushed too fast to attempt to take the organs of a British man who was thought to be “brain dead” but recovered — thanks in part to the dedication of his family.
The case reminds of one that received attention in December in which a 20-year-old man awoke from a coma just hours before doctors were ready to shut off life support and take his organs for donation purposes.
Sam Schmid, an Arizona college student who was thought to be brain dead, recovered from injuries sustained in an automobile accident in October just hours before he was slated to be killed and his organs given to other patients.
The accident took the life of his best friend and college roommate and Schmid’s injuries were thought to be so grievous that a local hospital could not treat him and he was sent to Barrow Neurological Institute at St. Joseph’s Medical Center in Phoenix to receive surgery for a life-threatening aneurysm.
As hospital officials began palliative care and talked with his parents about organ donation, Schmid began to hold up two fingers on command and started walking with the aid of a walker. Now, his speech has improved and doctors say he will have a complete recovery.
The case provides yet another example of what pro-life bioethicists like Wesley J. Smith have warned about misjudging patients as too far gone too soon and relegating them to organ donor status:

For years, organ transplant ethicists and some in the bioethics community have agitated to change the definition of death from a purely biological determination, to one based in utilitarianism and desired sociological narratives. Why mess with death? Too few organs are donated for transplant, leading to long waiting lines and the deaths of some people who might be saved were organs more readily available.
CLICK LIKE IF YOU’RE PRO-LIFE!

But why redefine death? The point of this reckless advocacy — although they don’t put it this bluntly — is that there are thousands of perfectly good organs being used by people who really don’t need them anymore, by which they mean patients with profound cognitive impairments who will remain unconscious or minimally aware for the rest of their lives. Why not harvest such patients, this thinking goes, for the benefit of people who could return to normal lives?
The problem is that would break the “dead donor rule,” the legal and moral pact organ transplant medicine made with society promising that vital organs would only be harvested from patients who are truly dead. Hence, if the definition of death were loosened to include, say, a diagnosis of persistent vegetative state, more organs could be obtained — and the dead donor rule could still appear to be honored, deemed essential for transplant medicine to retain the trust of society.
Of course, that would be fiction, and the redefinition actually a betrayal. What these “ethicists” really propose is killing for organs, a view now being promoted in some of the world’s most prestigious medical, science, and bioethical journals. For example, Nature recently editorialized in favor of liberalizing the rules governing brain death.
Currently, brain death requires the irreversible cessation of all functions of the entire brain and each of its constituent parts. Nature’s editorial claimed — without proof — that doctors obey “the spirit but not the letter, of this law. And many are feeling uncomfortable about it.”

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June 25 2013 VCH Board Meeting

I attended the Vancouver Coastal Health Board Meeting on Tuesday.  I really do not know what VCH is trying to do.  When I attended the first board meeting in 2010 all the board members were there and now only the chair, the chief executive officer Ostrow and the new Operations Manager.  It was as if there was a decision made to hide the Board members so that they could not ask questions from presenters or the public.    It seemed that the audience was packed only by employees of VCH.  Prior to the Board meeting they had a private networking meeting (public not invited) which included a few politicians one of which was the minister for seniors but I didn't see him in the audience. This minister told me before the 2013 election at the Oakridge Seniors Centre that there would be no more money for health care.

I spoke of two items. There was only one other person who had a question.  I had five but Kip ended the meeting twenty minutes early.

I related a discussion I had with the volunteer co-ordinator for VCH.  I asked her what was the number of  professional health care workers  who volunteered with VCH and she said volunteerism by health care professionals were  unheard of.  Those no longer working for VCH  especially those who are retired and have full pensions should be encouraged to engage to volunteer.  They are a human resource which is dearly needed. The least they could do is hang out at health care facilities to act as independent comfort advocates for patients and their families.

Ron Panzer

Quoted by Ron Panzer

The pushing of DNRs on patients will only increase as the culture of death flourishes, making them mandatory in many settings, contrary to patients' wishes.  It was all a stepping stone to legalized euthanasia where the unwanted may be killed against their wishes (all in the name of patients' rights/autonomy!)

Is POLST already here in Canada

What happens if a patient changes his or her mind: like I was told when Randy alledgedly agreed to a DNR him not knowing what a DNR was, I was told that Randy can't change his mind whenever he talks to me. Simple solution get rid of all DNRs and Advanced Directives and make physicians technicians not instruments of quality of life budget constraints.We will all die in good time and we do not need the state to help us. Life is worth it no matter what.


NDY quoted in Pew Trusts’ Stateline: New End-of-Life Measure Quietly Sweeps the Nation

Posted: 21 Jun 2013 03:50 PM PDT

This week, the Pew Charitable Trusts’ Stateline carried an article entitled “New End-of-Life Measure Quietly Sweeps the Nation.”  The measure described is Physician Orders for Life-Sustaining Treatment (POLST), sometimes also called Medical Orders for Life-Sustaining Treatment (MOLST).  According to the National POLST Paradigm website, POLST originated in 1991, and 14 states had adopted it by 2004, when the National POLST Paradigm Initiative Task Force formed to expand the practice.
This blog has only covered POLST twice, once regarding the Illinois program and once regarding the New Jersey POLST bill.  A POLST is a medical order, signed by a physician, instructing a health care provider about what types of life-sustaining treatment to provide or withhold.  The instruction is supposed to be based on the wishes of the individual or their authorized surrogate health care decision maker.  The National Task Force “strongly recommends” that the patient or surrogate signature also be required, but not all states have adopted that requirement.
A primary concern about POLST is whether an individual’s POLST form actually reflects their wishes, and whether the individual’s wishes are based on informed consent.  Other forms of advanced directives in which people designate their health care wishes are not signed by physicians, so they need to be translated into medical orders to direct health care provider behavior, but POLST is a medical order that is effective immediately.  If you or someone else calls 911 in an emergency, the emergency medical technicians (EMTs) know to look for a POLST form and to do what it says.  If the POLST form says “do not resuscitate”, then the EMT’s are supposed to comply.
The Stateline article briefly but accurately reflects the disability community’s concerns as follows:
Some disability rights groups have focused on the issue of patient signatures. Without one, according to Diane Coleman, president of the disability rights group Not Dead Yet, “How do we know the POLST medical order actually reflects the desires of the individual?”  Coleman worries that depending on how POLSTs are presented, they can make life-sustaining treatments—such as the use of feeding tubes—seem unbearable, even though many disabled people are able to live full lives because of them.
The reporter, Michael Ollove, also interviewed Cathy Ludlum from Second Thoughts Connecticut, and noted that:
Disabled rights groups lobbied successfully against POLST in Connecticut this year.
I don’t know about you, but successful lobbying against a mainstream bill by a disability rights group is not something I read about every day.  Second Thoughts CT developed an effective flyer, researched with citations, to talk about the concerns they had with the bill.  Among other things, the flyer said:
While MOLST is intended for people with about a year to live, there is a real danger that people with chronic and severe disabilities will get swept in as well.  In California, nursing facilities pressured all patients to have a POLST, whether or not they were terminally ill.  Delaware recently suspended its MOLST for similar reasons.  People with years ahead of them are often considered “terminal” by medical professionals not familiar with the disability world.  … Many of these concerns could have been addressed if people with disabilities had been at the table designing Connecticut’s MOLST pilot.
Connecticut’s research was very helpful to me and led me to some additional resources.
The Stateline article was picked up by the Huffington Post, which received 78 comments, including several by Stephen Drake, who went toe-to-toe with other commenters, and myself.  As Stephen noted, “If the patient or surrogate signature isn’t required, this document is less about safeguarding the rights and preferences of the patient than it is relieving some perceived burden of uncertainty on medical providers.”
My comment passed on the information that I got from CT, and connected the dots between POLST concerns and futility policies:
Some problems with POLST implementation have come to light.  Delaware suspended use of its POLST form when it was found that it was being used for people who did not meet the state’s criteria for POLST eligibility in that they were not terminal.  In California, the state protection and advocacy agency issued a report documenting a case alleging that an individual’s physician revised his POLST form to say the opposite of the patient’s expressed wishes to receive life-sustaining treatment.    It is perhaps a little known fact that many states allow doctors to overrule a person’s choice to receive life-sustaining treatment under “futile care” policies.  (See http://medicalfutility.blogspot.com.)  A balanced approach to POLST policy development must take these realities into account.
That last sentence sums it up for now. – Diane Coleman

The following demonstrates that a woman was not in cardiac arrest.  Now it seems the cut off for dying from six months is now one year. The woman was 62 years old.

New End-of-Life Measure Quietly Sweeps the Nation

By Michael Ollove, Staff Writer

Joe Takach talks to his friend Lillian Landry as she spends her last days in the hospice wing of an Oakland Park, Fla. hospital. Many states have adopted a new end-of-life document designed to ensure that a patient’s wishes are respected as death approaches. (AP)

The emergency call came in at 10:47 on a Saturday night: “Woman in Overland Park with difficulty breathing. Code one closest.”
Angela Fera, a paramedic in Johnson County, Kan., and her partner raced to the house, sirens blaring. When they arrived, six minutes after the first dispatch, a man told them that his 62-year old wife had terminal cancer and was unconscious. The paramedics found her sitting upright in bed, ghostly pale with a weak pulse and shallow breathing. Death seemed imminent.
The woman was under hospice care, and had signed a “Do Not Resuscitate (DNR)” order. She had made her wishes clear: She did not want to be taken to the hospital if a life-threatening medical emergency arose.
But the woman was not in cardiac arrest, the situation specified in the DNR order. Protocol required that Fera try to save her life, probably by inserting a plastic tube into her trachea to restore breathing and transporting her to a hospital, where she’d be put on a ventilator. Fera guessed that was precisely what the woman did not want. But the husband felt that his wife’s children—his stepchildren—should be the ones to decide whether to withhold treatment.
“We were completely fighting all our instincts to jump in and save her, but on the other hand we really wanted to do what was right,” Fera recalled.

New End-Of-Life Document

A new end-of-life document, more explicit and binding than a DNR and advanced directives, is designed to clarify patients’ wishes—and spare caregivers such as Fera from facing such wrenching choices.
A “physician order for life-sustaining treatment” (POLST) is a medical order, signed by a doctor or other authorized medical provider. The product of a conversation between patient and provider, a POLST specifies a patient’s goals and desires as death closes in. Unlike a traditional DNR, it covers such medical interventions as resuscitation, hospitalization, use of antibiotics, hydration, intubation and mechanical breathing ventilation.

See POLST Form

Without much opposition or attention, many states have adopted POLSTs. This year, Indiana and Nevada approved legislation to allow their use, leaving only seven states and the District of Columbia without POLSTs in at least some stage of development.
They tend to come in garish colors—neon pink, orange, and green, for example—so they stand out among other documents in a home. People are encouraged to put them on their refrigerators, and paramedics are trained to look for them there. In Oregon, where POLSTs originated in the early 1990s, they are recorded in an electronic registry so first responders can access them online. Other states are moving in the same direction.
Research suggests POLSTs are effective in matching treatments to patients’ wishes. According to one study, patient preferences noted on POLST forms matched the actual treatment—or non-treatment—in more than nine out of 10 cases.

Vague or Irrelevant

Dr. Susan Tolle, one of the creators of POLST and director of the Center for Ethics in Health Care at the Oregon Health and Science University, said DNRs and other end-of-life documents tend to be vague or irrelevant to many medical situations. In many cases, they are signed by somebody whose authority may be in question during a medical crisis.
“We needed a portable system of actionable medical orders that would follow the patient and be consistently respected across settings of care, whether that was in a long-term nursing care facility, home, hospice, the ambulance or an acute care hospital,” Tolle said.
POLSTs are often confused with advanced directives, but they differ in significant ways. An advanced directive is often completed by a healthy person, and is purely hypothetical. It lacks the  medical authority of a physician’s signature.
By contrast, a POLST is completed by a medical provider in consultation with the patient. POLSTs are geared toward severely ill patients who are expected to die within a year. According to Tolle, the most common triggers for completing a POLST are when someone begins hospice care, is admitted to a skilled nursing facility or is discharged from the hospital where they had a DNR order.

Some Are Wary

All states require a medical provider to sign a POLST. In most, the signer must be a physician, though some states allow other medical personnel, such as nurse practitioners, to sign it. Most states also require the signature of the patient or a designated surrogate but some, such as Oregon and New York, do not.
Some disability rights groups have focused on the issue of patient signatures. Without one, according to Diane Coleman, president of the disability rights group Not Dead Yet, “How do we know the POLST medical order actually reflects the desires of the individual?”  Coleman worries that depending on how POLSTs are presented, they can make life-sustaining treatments—such as the use of feeding tubes—seem unbearable, even though many disabled people are able to live full lives because of them.
Disabled rights groups lobbied successfully against POLST in Connecticut this year.
In Texas, Wisconsin and Florida,  opposition to POLSTs has come from Catholic groups. Edward Furton of the National Catholic Bioethics Center worries that in cases where POLSTs do not cover the exact circumstances of the moment, denying care may be akin to euthanasia. “When you look at the POLST documents, they don’t take into account the circumstances that the person is in at that particular time and place,” Furton said.
Nonetheless, there is no monolithic Catholic position on POLST. POLSTs have received strong Catholic support in some states, including California and Louisiana.
“This is not about ideology or religious views,” said John Carney, president of the Center of Practical Bioethics in Kansas City, which has worked to bring POLST to Missouri and Kansas. “This is about dignity and making decisions about what I want about my own life.”

Fera’s Choice

At the scene of the emergency in Overland Park a year ago, Fera the paramedic had to act fast: She asked the husband of the unconscious woman to summon his stepchildren and a nurse from the hospice service. Then she directed the fire crew to use a bag valve mask to help the woman breathe for a short time.
When the woman’s children and the nurse arrived, they quickly confirmed that the stricken woman had repeatedly said she didn’t want to be revived in such a situation. With that assurance, plus approval via radio from an emergency room doctor, Fera and her partner left the woman at home in the care of the hospice nurse. They drove off, certain that the woman’s end was near, and fairly sure that they had acted according to her wishes.
Fera is grateful that she is less likely to face similar situations in the future. In the year since responding to the call in Overland Park, Johnson County has adopted POLSTs. “To say we like it,” she said, “is an understatement.”

Issues:

Health

13 June 2013

I went to the food bank this morning.  The story of my future life.  Food banks and the insecurity of rental housing.

1 400 grams of Ccheerios box
1 411 grams of Oroweat Cinnamon Raisin muffins\
2 bottles of water
1 Eastmore brocooli sprouts 60 grams
400 grams of Danone Silhouette yogurt refreshing apple flavour
1 can 540 ml dark red kidney beams
 106 g of Gold Seal small shrimp can
4 medium-small apples
2 medium onions
5 medium-small potatoes
candy canes from Christmas

I spoke to Randy today and he wasn't all that alert.  I showed him a $20.00 bill and he did not know what it was and he allowed it to fly away in the wind.  If Randy concentrates hard enough he can catch things with his right hand.  This I learned when I threw a small plush toy at him when he was in VGH so many years ago. the  months he spent in VGH in isolation with hospital acquired infections.

7:30 pm  Randy was anxious about something and so I gave him a letterboard.  He spelt JAC and then I remembered from yesterday I had washed his jacket and he wanted it.  I washed it but it was still in the washing machine as I forgot to take it out of the washer to put it in the dryer.  His memory astounds me at times.  At other times there is nothing there.  Like I asked him if he went to physio today and he couldn't remember.  

124,624

Off to City hall

On Wednesday Randy and I ventured to City Hall on Cambie to pay the doggie liceences.  This City is so expensive.  It cost $88.00.  Randy had a good day yesterday and he was very alert.  I wish he was like that every day.  He wanted me to take him to see his lawyer but I couldn't as it was late in the day.  As we passed a medical supply store he kept pointing to a pair of crutches in the window.  I wish I knew for certain that Randy will never walk again but I don't.  During the three years Randy has been at GPC I only talked to Dr. Dunn three times.  Two being sixty second sound bites and another time he glossed over Randy's file neglecting to mention he had code blues and also a recent heart attack.  I suspect he isn't even familiar with Randy's medical condition.



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