No room for violence in politics

[Stevie B]

Bill, for a PHD, I have to say you are a pretty good bloke... That is what I was looking for... Maybe just someone to be themselves for once and take humor in their own lives...

[IJ]

Found this via a google news break midway through a weird shift...

http://www.npr.org/templates/story/stor ... =133459867

"The Senate report was released Thursday by Lieberman, chairman of the Senate Homeland Security and Governmental Affairs Committee, and its ranking Republican, Sen. Susan Collins of Maine. It is being delivered to the president and the heads of the FBI, Defense Department and Department of Homeland Security.

It charges that evidence of Hasan's radicalization was "on full display" to his superiors, and that an instructor and colleague "each referred to Hasan as a 'ticking time bomb,'" but no action was taken to discharge him and his evaluations were sanitized.

"This is not a case where a lone wolf was unknown to the FBI, unknown to the military officials, until he struck," said Collins."

Two thoughts:

1) The most sophisticated risk identification system in the world won't help if we don't have individuals who can get past their Genovese Syndrome.

http://en.wikipedia.org/wiki/Murder_of_Kitty_Genovese

This happens all over the place, and in my line of work, under performing doctors are permitted time and time again to squeak by in medical school, training and practice. One example was a multiple murderer eventually caught and when people looked back, the only thing wrong with the record was I think gynecology had said they were concerned about his professionalism once. I met a doctor who was saying and doing crazy stuff while hospitalized and on speaking to his psychiatrist and internist, they both felt he had been a risk to patients for the last NINE years and said nothing (I cared for him only 4 hours but it fell to ME to report him to the medical board for some reason).

2) The current military is having some problems balancing rational decisions and limit setting against providing appropriate psych care. Some problems I hear about often from my bunches of Navy / Marine psychiatry friends are:

a) dozens of enlisted soldiers threatening to x, y, or "kill my commander" or "hurt someone" or "do something wrong" if they're deployed or even if their ship leaves town--and the response isn't to throw them in the brig, but to put them in a very cozy psych ward until whenever they promise they're entirely well again (often the moment their ship has sailed and they can lay around getting paid for nothing, it turns out).

b) seriously disturbed people who aren't getting forced therapy they have been found to need by everyone they've seen (plus visiting consultants!) because no one wants to man or woman up and make the decision, which keeps getting passed along the chain of command

c) applying for disability for people who have obviously fabricated psych symptoms or symptoms that only occur when they have to work, ie, can't be from a major psychiatric disorder which would continue off hours. not liking your job isn't a reason to slurp up tax funded disability and medical your whole life!

I understand some of what's driving this--partly it's entrnched medical culture there, partly it's legitimate concerns about the high mental costs of our current wars and a desire to avoid any risk of suicide / outbursts, but wow... we bend over backwards for grumpy 20 year old sailors with no real psych problems (or service traumas!) who are acting out, yet we let Hassan stay in the military, TREATING patients, for years, despite professions of radical Islamic belief, attempts to convert his patients to Islam (!!), and extremely poor work record including an inability to maintain even a reduced workload? He shoulda been expelled for any of those things?

There's a long way to go...

[Bill Glasheen]

Welcome to the forums, Stevie. Pardon my taking so long to say so. And a shout out to Ohio - my current northeast neighbor (except when I go back to Virginia).

- Bill

[Bill Glasheen]

Ian

That was very well stated. So what next, dog?

You know... I once worked for a health plan that rarely kicked an MD out of their network for poor performance. Fraud? Jail time. Inefficiency and practice far from the the beaten path of their specialty? It just wasn't done, because (name your excuse du jour).

I now work for another company that feels very differently about the matter. Times change.

One thing that has changed is our ability to do proper risk adjustment before measuring resource consumption, and having the physician specialty input into measuring process quality. Got the right tools? Got the buy-in on the metrics? Then it's time to step up or go home.

Or we can just let stuff happen and leave it to ambulance chasers to exercise their random style of "quality improvement." But that's not the world I want to live in. Can you say scumbag?

One thing that people in my world can do is generate the information. But as you stated, Ian, somebody has to follow through.

- Bill

[Stevie B]

Concise, probably correct, and pretty much to the point.... Ian ?!?

[Stevie B]

Loved the "Scumbag" part... Ok, your turn Ian...

[Jason Rees]

Deleted by author. Will post later.

[IJ]

Stevie I only argue if I think there's a point to be made, and Bill and I don't disagree about anything. I can only say that appropriate quality / process measuring is cool, but wouldn't likely have helped here because there are few more red flags and incompetencies that could possibly ave been raised by this psycho. This is a management failure.

Funny thing is they *may* have partly worried about some legal action taken by the moron for wrongful termination, I'm not sure exactly how that works in the military but I do recall the joke about the difference between the VAMC nurse and the bullet:

The bullet can be FIRED, it can draw blood, and it only kills once.

Apologies to all the great VAMC nurses, doubly so because I've worked with your colleagues

[Stevie B]

The only truth about the whole horrific thing was thisThere are psychos every where in the World..Had to pull the body of a good man out of Cambodia a few years back...Not because he was on a misiion, just because he ran across some really bad men...People kill for all sorts of reasons... Some, just because of what they hear or think they are hearing... Really the only good thing that will come out of this whole senseless thing is to demonstrate the healing power of love that the Congress ladies husband has for her..

[Jason Rees]

Hasan is not a psycho. He is an #####.

[Bill Glasheen]

Hasan is not a psycho. He is an #####.

As the moderator of this forum, I have the power to know.

Translation - Hasan brings about visions of Klingons orbiting Uranus.

- Bill

[Jason Rees]

I just think people blow off things like this as the work of the insane, as a mental copout, avoiding thinking about the fact that even a perfectly sane individual can do what Hasan did, can learn from what Hasan did, and do it 'better.' That it doesnt take madness to pull a trigger, or stab a knife, end the life of another human being, and feel justified in doing it... And even sleep well afterwards.

The AZ shooter? That's different, and we have seen evidence there. But enough of this insanity montage for every jerk that kills a bunch of unarmed sheep, already.

[Bill Glasheen]

The AZ shooter? That's different, and we have seen evidence there. But enough of this insanity montage for every jerk that kills a bunch of unarmed sheep, already.

I'm with you on Hasan. His intent to do harm was way out of the barn even before he picked up a pistol. Unlike the Arizona what's-his-name, there was rational thought and political motivation involved. It's a shame that the military was so desperate for medical personnel - and possibly so paranoid about being politically correct - that they kept this dirtbag along for an extended ride.

- Bill

[IJ]

I didn't mean "psycho" as in "not guilty by reason of insanity" or "unable to tell right from wrong." I meant it in the way I refer to all fanatics. I have not heard anything so far that leads me to believe he was not culpable for his actions, and barring such evidence, I hope he fries. I dunno whether paralyzing him (I assume he's still damaged thusly) was at least a partial punishment or bad luck as it would increase his costs of care.

However, I do not think the military kept him out of need. It sounds like he was more trouble than use. I read that he barely saw any patients, so overwhelmed he was with the minimal load they gave him. Instead, it sounds like the usual, "oh, just pass him along, no one has the cajones or ovaries to step up and fire him or declare him incompetent or take his license or whatever" sort of way. We do that all over in this country out of fear of legal repercussions and just wimpiness, but it's especially tragic when the consequences are patient injuries. We might not have predicted a shoot out but trouble was clearly brewing with this wackadoo.

[Jason Rees]

However, I do not think the military kept him out of need. It sounds like he was more trouble than use. I read that he barely saw any patients, so overwhelmed he was with the minimal load they gave him. Instead, it sounds like the usual, "oh, just pass him along, no one has the cajones or ovaries to step up and fire him or declare him incompetent or take his license or whatever" sort of way. We do that all over in this country out of fear of legal repercussions and just wimpiness, but it's especially tragic when the consequences are patient injuries. We might not have predicted a shoot out but trouble was clearly brewing with this wackadoo.

Officers have a tremendous number of resources, compared to enlisted. Dollars, for one. They can afford a good lawyer, one more than happy to sue on any grounds he or she can dream up. I'm sure fear of lawsuits factored heavily into such considerations.

They also develop friends in high places. Who knows who this one might have relied upon to 'align the stars' for him, so to speak. I'm sure they're not speaking up now.