PUBLIC HEALTH CRISIS CREATED BY TRUMP ADMINISTRATION FAMILY SEPARATION POLICY

“Even the judge in her black robes breathed a soft “aww” as her latest case perched on the brown leather.
Her feet stuck out from the seat in small gray sneakers, her legs too short to dangle. Her fists were stuffed under her knees. As soon as the caseworker who had sat her there turned to go, she let out a whimper that rose to a thin howl, her crumpled face a bursting dam.
The girl, Fernanda Jacqueline Davila, was 2 years old: brief life, long journey. The caseworker, a big-boned man from the shelter that had been contracted to raise her since she was taken from her grandmother at the border in late July, was the only person in the room she had met before that day.
“How old are you?” the judge asked, after she had motioned for the caseworker to return to Fernanda’s side and the tears had stopped. “Do you speak Spanish?”
… there are more children showing up more often to federal immigration courtrooms like Judge Zagzoug’s, at hearings that could determine whether they will be deported, reunited with their parents, or granted the asylum that their parents desperately want for them. They often sit at counsel tables alone, unaccompanied by any family and sometimes without even a lawyer.” (A)

“ACLU attorney Lee Gelernt said Immigration and Customs Enforcement isn’t always providing advance notice before sending children back to their parents in Central America. That means the children end up stranded in airports, with their parents sometimes days away in distant villages.
Gelernt said ICE flew a five-year-old boy to Guatemala City without notifying the ACLU or the parents, so he would have to “spend the night in a strange shelter.” (B)

“A top Health and Human Services official told Congress on Tuesday that he and others repeatedly warned the Trump administration that its policy of separating immigrant families apprehended at the U.S.-Mexico border would not be in “the best interest of the child.”
“During the deliberative process over the previous year, we raised a number of concerns in the (Office of Refugee Resettlement) program about any policy which would result in family separation due to concerns we had about the best interest of the child as well as about whether that would be operationally supportable with the bed capacity that we have,” Jonathan White, with the Public Health Service Commissioned Corps, told lawmakers at a Senate Judiciary Committee hearing…
The latest number of immigrant children who remain in detention and apart from their parents stands at 711, according to the Department of Homeland Security. The parents of 431 of those kids have already been deported, while the parents of 120 children waived their right to reunify with them. Sixty-seven other children had parents or guardians that raised a ‘red flag’ about their fitness for the child following background checks.” (C)

“The Department of Homeland Security was not ready to carry out the Trump administration’s family separation policy, and some of the government’s practices made the problem worse, according to a report issued Tuesday by the department’s inspector general…
“DHS was not fully prepared to implement the administration’s zero-tolerance policy or to deal with some of its after-effects,” said John Kelly, the acting inspector general.
Tuesday’s report said Customs and Border Protection held children for long periods in facilities intended to be used for only short terms, lacked the ability to reliably track children separated from their parents, and in some cases failed to adequately inform parents about the separation policy…
Computer systems used by CBP and Immigration and Customs Enforcement lacked the ability to share data about parents whose children were separated from them. And those systems were not integrated with the resettlement agency…
In a separate DHS inspector general report dated September 27, the Adelanto ICE Processing Center, a detention center housing up to 1,940 ICE detainees in California, was cited for serious violations including nooses found hanging in detainee cells, “improper and overly restrictive segregation,” and “untimely and inadequate medical care.” “ (D)

“ICE agents detaining children needing emergency care, targeting immigrants visiting sick family members and deporting patients as they exit hospitals are putting healthcare workers in precarious positions. Some are finding their professional purpose compromised by federal immigration policies and fear patient health will suffer.
A recent survey from the advocacy group Children’s Partnership found about 40% of immigrant patients in California are skipping appointments and scheduling fewer visits with their providers for fear of confrontation with ICE. One recent study of 545 Mexican women in the United States concluded that fear of deportation could be a cardiovascular risk factor for the country’s ethnic minorities…
The American Hospital Association does not have a specific policy on the removal, detainment or apprehension of immigrant patients from medical facilities, so hospitals have largely been navigating their own way through murky immigration laws…
As a law enforcement body, ICE must go through a subpoena process to get a patient’s information. But what happens when ICE agents camp on hospital property while a person of interest is being treated, as was the case with a critically ill woman from El Salvador who last year was bound in her wheelchair by federal agents who moved her from the Texas hospital where she was awaiting emergency brain tumor surgery and into a detention center?” (E)

“The U.S. government has deported hundreds of migrant parents without their children in the aftermath of President Trump’s now-defunct family separation policy. But now administration officials are arguing that it’s the responsibility of the American Civil Liberties Union, not the federal government, to find those deported mothers and fathers.
Justice Department lawyers wrote in a court filing Thursday that the ACLU should use its “considerable resources,” its network of advocacy groups, and information from the government to locate parents removed to foreign countries. The Trump administration added, however, that the State Department has made contact with foreign governments to assist in facilitating family reunions…
ACLU lawyers pushed back against the Trump administration’s demands to find the deported parents, saying that they will do “whatever they can” but that the government must bear the ultimate burden.
The government told a federal court judge that non-profit groups, rather than government officials, should take the lead in reunifying immigrant families…
The ACLU wrote that “there is no blueprint for finding deported parents,” who are scattered in various cities across Central America and who, in many cases, left behind minimal address information.” (F)

“In shelters from Kansas to New York, hundreds of migrant children have been roused in the middle of the night in recent weeks and loaded onto buses with backpacks and snacks for a cross-country journey to their new home: a barren tent city on a sprawling patch of desert in West Texas.
Until now, most undocumented children being held by federal immigration authorities had been housed in private foster homes or shelters, sleeping two or three to a room. They received formal schooling and regular visits with legal representatives assigned to their immigration cases…
But in the rows of sand-colored tents in Tornillo, Tex., children in groups of 20, separated by gender, sleep lined up in bunks. There is no school: The children are given workbooks that they have no obligation to complete. Access to legal services is limited…
The camp in Tornillo operates like a small, pop-up city, about 35 miles southeast of El Paso on the Mexico border, complete with portable toilets. Air-conditioned tents that vary in size are used for housing, recreation and medical care. Originally opened in June for 30 days with a capacity of 400, it expanded in September to be able to house 3,800, and is now expected to remain open at least through the end of the year.” …
The roughly 100 shelters that have, until now, been the main location for housing detained migrant children are licensed and monitored by state child welfare authorities, who impose requirements on safety and education as well as staff hiring and training.
The tent city in Tornillo, on the other hand, is unregulated, except for guidelines created by the Department of Health and Human Services. For example, schooling is not required there, as it is in regular migrant children shelters…
The longer that children remain in custody, the more likely they are to become anxious or depressed, which can lead to violent outbursts or escape attempts, according to shelter workers and reports that have emerged from the system in recent months.” (G)

“It doesn’t take a psychologist to understand that ripping children from their beds in the middle of the night, tearing them from anyone they’ve forged a connection with, and thrusting them into uncertainty could damage them…How to best handle the cases of unaccompanied minors has perplexed authorities since the Obama administration. But the current crowding is not a result of some sharp increase in children stealing across the border — the influx is no greater now than it has been for the past two years.
Instead, the Trump administration’s own draconian policies are to blame. Around the same time that it began separating immigrant children from their parents as they crossed into the United States, the Department of Homeland Security also established strict requirements for the relatives and friends who might care for these children while their cases are sorted out. Prospective sponsors are now required to submit fingerprints, and to share their information with federal immigration officers. Because most of them are undocumented immigrants themselves, they have been scared off by these requirements. And with good cause: Dozens of applicants who took the chance of applying to be sponsors have been arrested on immigration charges. As would-be sponsors shrink away, more children are stranded in federal custody”… (H)

“Thousands of foster children may be getting powerful psychiatric drugs prescribed to them without basic safeguards, says a federal watchdog agency that found a failure to care for youngsters whose lives have already been disrupted.
A report released Monday by the Health and Human Services inspector general’s office found that about 1 in 3 foster kids from a sample of states were prescribed psychiatric drugs without treatment plans or follow-up, standard steps in sound medical care.
Kids getting mood-altering drugs they don’t need is only part of the problem. Investigators also said children who need medication to help them function at school or get along in social settings may be going untreated.
The drugs include medications for attention deficit disorder, anxiety, PTSD, depression, bipolar disorder and schizophrenia. Foster kids are much more likely to get psychiatric drugs than children overall.
“We are worried about the gap in compliance because it has an immediate, real-world impact on children’s lives,” said Ann Maxwell, an assistant inspector general.” (I)

“Traditionally, most sponsors have been undocumented themselves, and therefore are wary of risking deportation by stepping forward to claim sponsorship of a child. Even those who are willing to become sponsors have had to wait months to be fingerprinted and otherwise reviewed.
Federal officials say their vetting procedures are designed to safeguard the children in their care.
“Children who enter the country illegally are at high risk for exploitation by traffickers and smugglers,” Ms. Stauffer said in her statement.
But the longer children are detained, the more anxious and depressed they are likely to become, according to Mr. Greenberg, who oversaw the program under Mr. Obama. When that happens, children may try to harm themselves or escape, and can become violent with the staff and with one another, he said.
Stories of such behavior have emerged through reporting in recent months as the shelter system has faced intense criticism by members of Congress and the public…
The separated children injected a new degree of chaos into the facilities, according to several shelter operators, who spoke anonymously because they are barred by the government from speaking to the news media. The children were younger and more traumatized than those the shelters were used to dealing with, and they arrived without a plan for when they could be released or to whom.” (J)

“These are kids who fled some of the most violent countries in the world. Many have experienced trauma … rape, robbery, all kinds of exploitation,” said Bob Carey, who ran the HHS office overseeing child detention at the end of the Obama administration.
“The question I would ask is, are measures legitimately enhancing the security situation?” added Carey, who’s now a leadership and government fellow with the Open Society Foundations. “The ultimate security is not releasing any child to a sponsor, because then nothing would happen to them. But how much harm are you causing by keeping kids in custody indefinitely in settings that were never designed for that?”
In September 2017, then-ICE acting Director Tom Homan said at a public event that his agency would arrest undocumented people who came forward to care for the children.
“You cannot hide in the shadows,” Homan said at a Washington border security event, adding that parents should be “shoulder-to-shoulder” with their children in court. “We’re going to put the parents in proceedings, immigration proceedings, at a minimum. … Is that cruel? I don’t think so.” (K)

“Deep within the fine print of a newly proposed federal rule change is an admission of its disastrous health consequences. The Department of Homeland Security’s plan would deny legal immigrants permanent residency status if they accept government assistance to which they are entitled, allegedly an effort to “promote immigrant self-sufficiency” and ensure “they are not likely to become burdens on American taxpayers” or “public charges.”
But the certain collateral damage of this misguided policy, which greatly expands an existing principle to make its application downright punitive, reveals it’s not about promoting self-sufficiency at all.
In describing the impact of this effort, the Department of Homeland Security states, “Disenrollment or foregoing enrollment…by aliens otherwise eligible for these programs could lead to:
“Worse health outcomes, including prevalence of obesity and malnutrition, especially for pregnant or breastfeeding women, infants or children…
“Increased use of emergency rooms and emergency care as a method of primary health care due to delayed treatment
“Increased prevalence of communicable diseases, including among members of the U.S. citizen population who are not vaccinated.”..
The rule change, if implemented, will cause legal immigrants, their spouses and children, including U.S. citizens, to withdraw from government assistance programs out of fear that it would endanger the chances for a family member to obtain a green card and become a legal permanent resident. Washington will, in effect, force individuals to choose between their welfare and a family member’s legal residency status…
Some children will not receive necessary vaccines, making them susceptible to preventable diseases, such as measles, mumps, Hepatitis A and B, and polio. Illnesses will not be addressed when they are easily treatable. Without proper prenatal and perinatal care, there will be an increase in birth complications.” (L)

“I didn’t like the sight or the feeling of families being separated,” President Trump said on June 20, when he signed an executive order halting his administration’s depraved practice of separating migrant children from parents seeking asylum at the nation’s southern border. “This will solve that problem.”..
With its zero-tolerance barbarism, the Trump administration managed to do an impressive amount of damage in a very short time. In the six weeks the policy was in effect, more than 2,600 children were taken from their parents, with zero thought or planning for how the families might eventually be reunited…
Predictably, the Trump administration has shown less enthusiasm for cleaning up this mess than it did for making it. Earlier this summer, it tried to weasel out of a big chunk of its reunification responsibilities by asserting that it was the A.C.L.U.’s job to locate all of the parents who had been deported by the administration without their children. Once again, Judge Sabraw had to step in and call foul, ordering that the government coordinate with the A.C.L.U.
Complicating matters, the administration has decreed that reunifications must take place in the family’s country of origin. Which means that, once contacted, parents face an excruciating choice: give up their children’s asylum claims and have them returned home, or leave the children in the United States to try to navigate the asylum process on their own.” (M)

“The Trump administration wants to change how the government defines who is or is likely to become a “public charge.” The Department of Homeland Security released a draft regulation on Sept. 22, in which it proposed that any immigrant who is likely to use or who has already used Medicaid, public housing or a rent voucher, cash assistance or food stamps could be barred from the country or kept from getting permanent resident status.
The proposed rule change is part and parcel of the Trump administration’s hostility to immigrants. But it’s also about more than that. The administration would remake the idea of self-sufficiency, admitting only those who never need to turn to the public safety net, but instead rely solely on “their own capabilities” or the resources of their families and private charity. It even asserts that people who use public programs “in a relatively small amount or for a relatively short duration” are still considered dependent on the welfare state.
This redefinition of self-sufficiency ignores the way that most people use these programs. Even people with jobs often cycle on and off assistance as work comes and goes, or to plug the gaps when it just doesn’t pay enough. These programs allow people to remain healthy and solvent — supporting their independence. This rule therefore hurts everyone, not just immigrants, by stigmatizing the safety net funded by all of us to help people survive when they fall on hard times.” (N)

Coda:
“Helen—a smart, cheerful five-year-old girl—is an asylum seeker from Honduras…
Helen had been brought to Baytown, a shelter run by Baptist Child & Family Services, which the federal government had contracted to house unaccompanied minors…
..in early August, an unknown official handed Helen a legal document, a “Request for a Flores Bond Hearing,” which described a set of legal proceedings and rights that would have been difficult for Helen to comprehend. (“In a Flores bond hearing, an immigration judge reviews your case to determine whether you pose a danger to the community,” the document began.) On Helen’s form, which was filled out with assistance from officials, there is a checked box next to a line that says, “I withdraw my previous request for a Flores bond hearing.” Beneath that line, the five-year-old signed her name in wobbly letters.
An uncounted number of separated children in shelters and foster care fall outside the lawsuit’s current purview—including many like Helen, who arrived with a grandparent or other guardian, rather than with a parent. Many such children have been misclassified, in government paperwork, as “unaccompanied minors,” due to a sloppy process that the Department of Homeland Security’s Office of the Inspector General recently critiqued. Chavez believes that, through misclassification, many kids have largely disappeared from public view, and from official statistics, with the federal government showing little urgency to hasten reunifications…. “(O)

Next Episode:
The Trump administration is mulling plans to renew family separations at the U.S.-Mexico border, as the number of migrant families entering the country illegally has skyrocketed in recent months.
One policy under consideration would be to give asylum-seeking parents a “binary choice” after spending 20 days in detention with their families: either stay in a detention center for months or years awaiting an immigration trial, or allow children to be taken to government shelters while other relatives try to seek custody for them. The Washington Post first reported that this option was being considered…
The option to give families a choice about staying together was endorsed by the Justice Department and the American Civil Liberties Union in a court filing in July. The motion stated that if a parent chose to stay with their children, the parent would waive the child’s “rights with regard to placement in the least restrictive setting appropriate to the minor’s age and special needs.” If a parent did not make any decision, the motion said that the government would keep the family detained together.” (P)

(A) Migrant Children in Search of Justice: A 2-Year-Old’s Day in Immigration Court, by Vivian Yee and Miriam Jordan, https://www.nytimes.com/2018/10/08/us/migrant-children-family-separation-court.html
(B) (B) More Than 200 Immigrant Children Remain Separated From Their Parents, by Jean Guerrero, https://www.kpbs.org/news/2018/oct/09/more-200-immigrant-children-remain-separated-their/
(C) (C) Top HHS official warned Trump administration against separating immigrant families, by Eliza Collins, Alan Gomez, https://www.usatoday.com/story/news/politics/2018/07/31/trump-administration-official-warned-family-separations/874963002/
(D) (D) DHS not prepared for family separations under Trump zero tolerance policy, watchdog finds, by Pete Williams and Jacob Soboroff, https://www.nbcnews.com/politics/politics-news/dhs-not-prepared-family-separations-under-trump-zero-tolerance-policy-n915916(
(E) When ICE comes knocking, healthcare workers want to be prepared, by Tony Abraham, https://www.healthcaredive.com/news/when-ice-comes-knocking-healthcare-workers-want-to-be-prepared/531058/
(F) (F) Trump administration puts burden on ACLU to find deported parents separated from children, by Samantha Schmidt, https://www.washingtonpost.com/news/morning-mix/wp/2018/08/03/trump-administration-puts-burden-on-aclu-to-find-deported-parents-separated-from-children/?noredirect=on&utm_term=.d4c8f475919f
(G) Migrant Children Moved Under Cover of Darkness to a Texas Tent City, by Caitlin Dickerson, https://www.nytimes.com/2018/09/30/us/migrant-children-tent-city-texas.html
(H) Hundreds of Children Rot in the Desert. End Trump’s Draconian Policies. https://www.nytimes.com/2018/10/01/opinion/migrant-children-tent-city-texas.html
(I) Thousands of foster children may be getting psychiatric drugs without safeguards, watchdog agency says, by Ricardo Alonso-Zaldivar, https://www.statnews.com/2018/09/17/thousands-of-foster-children-may-be-getting-psychiatric-drugs-without-safeguards-watchdog-agency-says/?utm_source=STAT+Newsletters&utm_campaign=fab0f6340f-MR_COPY_12&utm_medium=email&utm_term=0_8cab1d7961-fab0f6340f-149527969
(J) Detention of Migrant Children Has Skyrocketed to Highest Levels Ever, by Mike Blake, https://www.nytimes.com/2018/09/12/us/migrant-children-detention.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosam&stream=top
(K) ICE arrested undocumented immigrants who came forward to take in undocumented children, by Tal Kopan, https://www.cnn.com/2018/09/20/politics/ice-arrested-immigrants-sponsor-children/index.html
(L) One sick immigration rule: The ‘public charge’ regulation will make America less healthy, by KENNETH L. DAVIS, http://www.nydailynews.com/opinion/ny-oped-one-sick-immigration-rule-20181009-story.html
(M) The Continuing Tragedy of the Separated Children, https://www.nytimes.com/2018/08/30/opinion/family-separation-trump-zero-tolerance.html
(N) (N) Trump Wants to Turn the Safety Net Into a Trap, by By Bryce Covert, https://www.nytimes.com/2018/10/01/opinion/trump-wants-to-turn-the-safety-net-into-a-trap.html
(O) The Five-Year-Old Who Was Detained at the Border and Persuaded to Sign Away Her Rights, by Sarah Stillman, https://www.newyorker.com/news/news-desk/the-five-year-old-who-was-detained-at-the-border-and-convinced-to-sign-away-her-rights?mbid=nl_Daily%20101218&CNDID=50144682&utm_source=Silverpop&utm_medium=email&utm_campaign=Daily%20101218&utm_content=&spMailingID=14422852&spUserID=MjAxODUyNTc3Mjk4S0&spJobID=1500966416&spReportId=MTUwMDk2NjQxNgS2
(P) Trump administration considering new family separation policy for undocumented immigrants, by GRACE SEGERS, https://www.cbsnews.com/news/trump-administration-considering-new-family-separation-policy-for-undocumented-immigrants/
(Q)

Prequels
..The HHS needs to review thousands of case files by hand for clues to which children were taken from their parents…

“Most immigrants facing deportation wouldn’t climb onto a table during their court hearings. But then again, most 3-year-olds don’t go to court without parents or lawyers.

“President Trump has moved on from caring about the migrant children in cages

“Only a dead heart is unstirred by the intentional infliction of suffering on children and babies as a weapon of deterrence.”

“In 6 Days, Trump Admin Reunited Only 6 Immigrant Children With Their Families”, https://doctordidyouwashyourhands.com/2018/06/in-6-days-trump-admin-reunited-only-6-immigrant-children-with-their-families/

“…the only way parents can quickly be reunited with their children is to drop their claims for asylum… and agree to be deported.”

White House Press Secretary Sarah Huckabee Sanders said the government was starting to
“run out of space” to house people apprehended crossing the border

Trump’s policy “could be creating thousands of immigrant orphans in the U.S.”, https://doctordidyouwashyourhands.com/2018/06/trumps-policy-could-be-creating-thousands-of-immigrant-orphans-in-the-u-s/

Tender-Age Immigrant Children. “They need bilingual workers. Some kids speak indigenous languages, so that’s an issue as well. https://doctordidyouwashyourhands.com/2018/06/tender-age-immigrant-children-they-need-bilingual-workers-some-kids-speak-indigenous-languages-so-thats-an-issue-as-well/

“The idea of pulling a child out of a parent’s arms, or identifying a parent but still keeping them separate—it isn’t right.”

“The business of housing, transporting and watching over migrant children detained along the southwest border is not a multimillion-dollar business. It’s a billion-dollar one…

“If it could happen to them…why can’t it happen to us?”…separating children from their parents,

“…Trump’s (family separation) policy amounts to “government-sanctioned child abuse.””,

“The Trump administration’s policy of separating parents and children at the U.S.-Mexico border will have a dire impact on their health, both now and into the future.” (C)

“It is fine to celebrate success, but it is more important to heed the lessons of failure.” – Bill Gates

Vignette 1
One summer Friday early afternoon I was in my car heading off for the weekend when the New Jersey Commissioner of Health called and told me he was closing the Jersey City Medical Center Trauma Center for failure to get renewed State approval.
Our new Trauma Service Director had told me that we were at risk for non-approval so we should have an American College of Surgeons consultation visit before the ACS certificationvisit, a prerequisite for State approval. But apparently he did not know that State approval had an absolute re-approval date of three years no matter what preparatory steps we chose to take.
The call was on the re-approval deadline date so the Commissioner shut the TC down but the radio stations said the ER was shut down, making the matter even worse.
To make a long story short, we got approval to reopen the TC on Monday after an early morning compliance visit by the State, and three months to get re-approval. Which we did with no contingencies, conditions or recommendations.
And what would you do about the Trauma Service Director?

“Failure is only the opportunity to begin again, only this time more wisely.” – Henry Ford

Vignette 2
Bariatric Surgery was the rage and our new Chairman of Surgery said we had to be in the game. So he recruited a team of bariatric surgeons to branch out to Jersey City Medical Center, and spent time at their home base training to be an Assistant Bariatric Surgeon (and thus able to bill for this role).
We staffed up, lots of prospective patients came to orientations, but no cases were ever done. Why? The prospective patients were mostly our own employees who “chose”, we were told, to have the surgery at the team’s home base for “privacy concerns.” So we not only paid for the programs fixed costs but also for the insurance impact when our employees had the surgery elsewhere.

“There are no secrets to success. It is the result of preparation, hard work and learning from failure.” – Colin Powell

Vignette 3
Each of our three hospitals had different protocols to avoid “wrong site/ wrong side” surgery (e.g., a wrong kidney removal actually happened). Some surgeons operated at 2 or 3 of our hospitals (as well as at other non-system hospitals) and thus had to navigate the different protocols. We called a meeting to establish one standard protocol for our system, to be approved by each hospital’s medical staff.
Only to find out months later that our two community hospital medical staffs amended the protocol rather than simply adopt it. So as CEO of all three hospitals I mandated the standard protocol, it rose to the level of the Boards of Trustees, but common sense prevailed.

“A person who never made a mistake never tried anything new.” – Albert Einstein

Vignette 4
Three full time Chairmen told me they were in the final stages of building a free-standing surgi-center a half mile away from the hospital, and that the previous President had promised to buy it. Nothing in writing. I demurred. So they partnered with two competing hospitals. One Wednesday morning I went to a Chamber of Commerce showcase event only to find the three Chairman at their surgi-center booth. All three ran residency training programs and Wednesday was Grand Rounds for all three. They told me they were using vacation time. I said that was not appropriate. They said it was none of my business. I told each of them they had a choice, either sell their shares of the surgi-center or be fired. Two sold, one “left” and took his residents with him to one of the competing hospitals.

Vignette 5
The Mystery of the Hospital CLAUSTROPHOBIA CLUSTER
Recently a friend was told by his doctor he needed an MRI and said that he could get it at the hospital on the campus where the doctor’s office was located, or at a private imaging center two blocks away.
This reminded me of the mystery of the Claustrophobia Cluster about twenty-five years ago, in Greenville Hospital, a member hospital of LibertyHealth.
Our Teaching Hospital, Jersey City Medical Center had just acquired a new state-of-the-art MRI, GH was only a little over a mile away, there was an MRI transfer protocol in place, and we ran a robust county-wide EMS transport system.
But almost every insured patient at GH who needed an MRI was referred to a “private” free-standing Imaging Center due to CLAUSTROPHOBIA. Somehow, also mysteriously, Medicaid patients and the uninsured made it to JCMC.
The problem was compounded by the fact that we were under a DRG reimbursement system where we got reimbursed an all-inclusive rate for every diagnosis, and had to pay for “outside” MRIs out of that bundled payment. These very expensive outside MRIs often meant that GH and the system lost money on many of these patients.
Whichever entity provides the service tacks on a Facilities Fee to the professional fee charged, for example, by a radiologist.
This raises the question of whether self-referral is a purely clinical recommendation or might “ownership” and the Facilities Fee be an influence.
We never solved the CLAUSTROPHOBIA CLUSTER mystery, because the outside MRI was buried in a myriad of corporations, although we felt somewhere this was the case of physicians referring patients to a facility they owned.
But it ended as mysteriously as it started when we started tracking referrals.

Vignette 6
The DOH issued a CN “call” for inpatient rehabilitation beds. This was an excellent opportunity for Meadowlands Hospital with all single bedded rooms and flagging admissions.
The Meadowlands medical staff wanted a patient care model where any physician could admit to the rehab unit and the physiatrist was a consultant. The best practice at academic medical centers as well as rehab hospitals in New Jersey was a “closed unit” where the physiatrist managed the patients and other physicians could consult on other medical conditions such as COPD, UTI, and coronary disease.
This was not a battle over best patient care but a battle over money. We adopted the “closed unit” model but the major Meadowlands attending staff members punished Liberty by never referring patients to Jersey City Medical Center, the closest tertiary care hospital, again unless they were uninsured.
Parenthetically two MH urologists covered the Urology Clinic at JCMC. Patients with insurance were transferred to MH for surgery while those without insurance were treated medically at JCMC. When the urologists were fired MH/ JCMC animosity increased.

Vignette 7
Jersey City Medical Center had “free-standing” residency training programs in medicine, obs/gyn, and pediatrics. After JCMC became a teaching affiliate of the Mount Sinai School of Medicine the programs could be either be affiliated, sponsored, or integrated. “Affiliated” was a euphemism for “free-standing”, “sponsored” meant over sight by the Mount Sinai Dean for Graduate Medical Education, and “integrated” was the “gold standard” or one set of residents rotating between Mount Sinai, JCMC and other Mount Sinai affiliated hospitals.
Our chiefs wanted “affiliated” so no one would be looking over their shoulders but I mandated “sponsored” as a step toward “integrated.”

Vignette 8
In the early 1990’s Jersey City Medical Center was the only hospital in Hudson County to have a diagnostic cardiac catheterization lab. Interventional cardiac catheterization was highly regulated with on-site cardiac surgery back-up required, so there were no interventional labs in the County.

When I was a member of the State Health Planning Board, DOH staff were against a hospital in Trenton getting a CN for open heart surgery, and just assumed the Board would agree. Under-the-radar we garnered support for the application and to the amazement of the DOH staff, it was approved – setting the stage for JCMC in the future.

Then the New Jersey Department of Health issued a Certificate of Need “call’ for a demonstration project allowing a handful of community hospitals to have cath labs for primary angioplasty without cardiac back up, but each applicant had to have a transfer agreement for elective angioplasties. Nearby Bayonne Hospital put in an application including an agreement with JCMC for patient transfers, so we provided a letter of support and together we lobbied the DOH. We were trying to position JCMC as a referral center so we could apply for cardiac surgery, anticipating a “call” down the road. Bayonne got its cath lab and then immediately sign a new transfer agreement with a hospital in Newark.

Later the DOH essentially deregulated primary cath labs and in a period of about one year over 20 new cath labs opened across the State, including three in Hudson County, one being at Meadowlands Hospital. I was against the MH lab but the parent Liberty Board supported the MH Board. Most of the new labs closed within a few years, including all three in Hudson County.

In 1999 JCMC had the opportunity to apply for a CN to start a cardiac surgery program. Everyone on the senior staff was against it except for the CMO. The CFO may and end run to the Board, and the Board chairman told me it was my decision but my “job was on the line.”
We were in the process of building a total replacement hospital on a new site. It was impossible to become a Top Tier New Jersey Hospital without cardiac surgery/ interventional cardiology.
The payer mix at the old hospital was 70% Medicaid/ Charity Care/ self-pay.
We opened the cardiac surgery program at the new JCMC just two months before the CN expired.
Several factors helped the program and saved my job. The American College of Cardiology protocol channeled many insured patients to JCMC mostly those candidates for stenting within the one hour “golden” hour (only JCMC did stenting then). The cardiac surgery payer mix eventually becoming 75% insured, 25% Medicaid, uninsured.

Coda
“Cardiac department at Jersey City Medical Center reaches milestone with 503rd open-heart surgery, looks to future expansion.” Saturday, April 09, 2011 By RHEA MAHBUBANI, JOURNAL STAFF WRITER
“Although each surgery costs between $30,000 and $50,000, there has been a constant demand for both elective and emergency operations. On most days, the cardiac surgery team can expect one such four-to-five hour procedure, while some days bring none and others, two or three.
The first 500 operations were representative of the efforts being made to establish a high-quality program, which could serve as a backbone for the Hudson community, they said.
Having reached nearly 550 surgeries by late-March, the team is no longer focused on simply the basic, daily functioning of their department. “Now its time to start expanding,” “

Vignette 9
Three baseball umpires are at a continuing education program on Barbados, the subject “What’s a ball, and what’s a strike?” The rookie umpire says “There are balls, and there are strikes and I call them as they are.” The mid-career umpire says: “There are balls, and there are strikes and I call them as I see them.” The veteran umpire, about to retires, says” “There are balls, and there are strikes and they ain’t nothing ‘til I call them.” (source unknown)

Vignette 10
There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know. (Donald Rumsfeld)

Vignette 11
“Don’t depend on anyone else to bring the coffee! There’s nothing worse than starting the day at a meeting where they don’t provide coffee. It’s better to have two cups than none.”
I started every new course with this “early morning meeting” aphorism. But students took this as something much more “strategic” and started using it in presentations, papers etc. as a metaphor.
What do you think they were thinking?

“I made a lot of mistakes in my time but didn’t waste any time making them.”
(attributed to Gustave Levy, Goldman Sachs)

“TRUST, BUT VERIFY.” (Ronald Reagan)

“If Columbus had an advisory committee he would probably still be at the dock.” (Arthur Goldberg)

“Never, never, never give up.” (Winston Churchill)

ASSIGNMENT: Profile the University of Maryland Medical System COI challenge.

DISCLOSURE. I am a member and Interim Chairman of the IRB* at Stevens Institute of Technology.

“There are many varieties of conflicts of interest, and they appear in different settings and across all disciplines. While conflicts of interest apply to a “wide range of behaviors and circumstances,” they all involve the use of a person’s authority for personal and/or financial gain. Conflicts of interest may involve individuals as well as institutions. Furthermore, individuals, in certain circumstances, may have conflicts occurring on both an individual and an institutional level, as may be seen among members of an Institutional Review Board (IRB).
Conflicts of interest are broadly divided into two categories: intangible, i.e., those involving academic activities and scholarship; and tangible, i.e., those involving financial relationships.” (A)

“In an article in the May 2014 issue of Compliance Today, Bill Sacks, Vice President and co-founder of HCCS, a HealthStream company, describes how new NIH regulations are forcing academic medical centers (AMCs) to examine and update their conflict-of-interest policies. He lists the 15 best practices for management of conflicts of interest that have been proposed by the Pew Charitable Trust and discusses how some of these recommendations are enjoying wide acceptance, as others are being met by serious objections. The Pew “Best Practice” recommendations are summarized below.
1. No gifts or meals should be accepted from industry sales representatives…
2. Faculty must disclose all conflicts of interest. All academic medical centers must have a process in place to manage conflict of interest (COI) disclosures.
3. Industry-funded speaking should not be allowed…
4. Industry-funding of continuing medical education (CME) should be severely limited or prohibited…
5. Faculty, students, and trainees should not attend industry-supported promotional or educational events…
6. Limit or prohibit pharmaceutical sales representative access in academic medical centers…
7. Limit medical device representative presence in academic medical centers to what is necessary…
8. Conflict-of-interest education should be required for all clinical staff and students
9. Conflict-of-interest policies should apply to everyone with a relationship to the academic medical center—paid, volunteering, affiliated, etc…
10. Industry-supported clinical fellowships should be available for scientific training only…
11. Ghostwriting and honorary authorship are strictly prohibited…
12. …Consulting arrangements must require written contracts with clear deliverables, to ensure that inappropriate payments are not involved…
13. Consulting relationships for marketing purposes are prohibited.
14. Pharmaceutical samples can be accepted and used only when they don’t become marketing tools.
15. Members of pharmacy and therapeutics committee cannot vote on formulary or treatment changes involving a company or product in which they have a financial interest… (B)

“Open Payments gives the public more information about the financial relationships between physicians and teaching hospitals and applicable manufacturers and GPOs. Specifically, the program:
Encourages transparency about these financial ties
Provides information on the nature and extent of the relationships
Helps to identify relationships that can both lead to the development of beneficial new technologies and wasteful healthcare spending
Helps to prevent inappropriate influence on research, education and clinical decision making. (C)

“Community Catalyst offers this Policy Guide to Academic Medical Centers and Medical Schools to assist leaders, faculty, staff and medical students in successfully adopting and improving policies to address conflicts of interest and interactions with the pharmaceutical and device industries. Policies such as these and their effective implementation are of critical importance to the integrity of medical education and patient care…
Toolkit on Transparency and Disclosure. Toolkit on Relations with Sales Representatives. Toolkit on Promotional Speaking. Toolkit on Continuing Medical Education. Toolkit on Ghostwriting and Name-Lending. Toolkit on Samples. Toolkit on Pharmaceutical and Therapeutics Committees. Toolkit on COI Policy Implementation. Conflict of Interest Curriculum Toolkit (D)

“Papers in medical journals go through rigorous peer review and meticulous data analysis.
Yet many of these articles are missing a key piece of information: the financial ties of the authors.
Nearly two-thirds of the 100 physicians who rake in the most money from 10 device manufacturers failed to disclose a conflict of interest in their academic writing in 2016, according to a study published Wednesday in JAMA Surgery.
The omission can have real-life impact for patients when their doctors rely on such research to make medical decisions, potentially without knowing the authors’ potential conflicts of interest…
They did this by sampling 10 large surgical and medical device manufacturers. This list includes Medtronic, Stryker Corp., Intuitive Surgical, Covidien, Edwards Lifesciences Corp., Ethicon, Olympus Corp., W.L. Gore & Associates, LifeCell Corp. and Baxter Healthcare.
The researchers also pinpointed the 10 physicians who received the highest compensation from each company. They then searched for articles published by these physicians between Jan. 1 and Dec. 31, 2016, and reviewed the full text of each article for COI disclosure.
According to their findings, those 10 companies paid more than $12 million in 2015 to the 100 doctors included in the study. The median payment to these physicians was $95,993.” (E)

“Memorial Sloan Kettering Cancer Center launched a conflict of interest task force in the wake of the resignation of its chief medical officer, Dr. José Baselga, who failed to disclose connections to medical industry…
The Manhattan-based cancer center said the task force will assess its internal policies and processes for reporting and managing outside activities and industry-supported clinical trials.
The task force was announced by President and Chief Executive Officer Dr. Craig Thompson. It will be chaired by Debra Berns, MSK’s Senior Vice President and Chief Risk Officer.
Among its objectives, the task force will: Review MSK’s policies, procedures, and training on conflicts of interest; Identify best practices in COI, including monetary and commitment limits; Assess new or improved processes to support timely and thorough disclosure; Identify medical societies and journals with whom to partner in improving public disclosure at meetings and in publications. (F)

“One of the world’s top breast cancer doctors failed to disclose millions of dollars in payments from drug and health care companies in recent years, omitting his financial ties from dozens of research articles in prestigious publications like The New England Journal of Medicine and the Lancet.
The researcher, Dr. José Baselga, a towering figure in the cancer world, is the chief medical officer at Memorial Sloan Kettering Cancer Center in New York. He has held board memberships or advisory roles with Roche and Bristol-Myers Squibb, among other corporations; has had a stake in start-ups testing cancer therapies; and played a key role in the development of breakthrough drugs that have revolutionized treatments for breast cancer.
According to an analysis by ProPublica and The New York Times, Baselga did not follow financial disclosure rules set by the American Association for Cancer Research when he was president of the group. He also left out payments he received from companies connected to cancer research in his articles published in the group’s journal, Cancer Discovery. At the same time, he has been one of the journal’s two editors in chief.
At a conference this year and before analysts in 2017, he put a positive spin on the results of two Roche-sponsored clinical trials that many others considered disappointments, without disclosing his relationship to the company. Since 2014, he has received more than $3 million from Roche in consulting fees and for his stake in a company it acquired.” (G)

“Dr. José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, resigned on Thursday amid reports that he had failed to disclose millions of dollars in payments from health care companies in dozens of research articles…
Thompson echoed comments he made to the hospital staff on Sunday, saying that the cancer center had “robust programs” in place to manage employees’ relationships to outside companies, but that “we will remain diligent.” He added, “There will be continued discussion and review of these matters in the coming weeks.” (H)

“An artificial intelligence start-up founded by three insiders at Memorial Sloan Kettering Cancer Center debuted with great fanfare in February, with $25 million in venture capital and the promise that it might one day transform how cancer is diagnosed.
The company, Paige.AI, is one in a burgeoning field of start-ups that are applying artificial intelligence to health care, yet it has an advantage over many competitors: The company has an exclusive deal to use the cancer center’s vast archive of 25 million patient tissue slides, along with decades of work by its world-renowned pathologists.
Memorial Sloan Kettering holds an equity stake in Paige.AI, as does a member of the cancer center’s executive board, the chairman of its pathology department and the head of one of its research laboratories. Three other board members are investors…
Hospital pathologists have strongly objected to the Paige.AI deal, saying it is unfair that the founders received equity stakes in a company that relies on the pathologists’ expertise and work amassed over 60 years. They also questioned the use of patients’ data — even if it is anonymous — without their knowledge in a profit-driven venture.” (I)

“…The AAMC is continuing to work with member institutions, other associations and societies, journals, and the continuing education community to develop tools and resources to help institutions and individuals manage the disclosure of conflicts of interest.
Institutions looking for immediate steps to take could:
Remind faculty of the importance of full disclosure, not only to your institution, but in other writing, speaking and teaching situations, as well as grant applications.
Use relevant current events as an opportunity to recommit to the institution’s obligation to facilitate transparency about the ways in which faculty and industry may be collaborating, and the processes that are in place to review and manage those relationships.
Encourage faculty to review the information posted about them publicly on the Open Payments website, and to ensure its accuracy as well as consistency with complete disclosures in all aspects of their professional responsibilities.” (J)

* “Under FDA regulations, an IRB is an appropriately constituted group that has been formally designated to review and monitor biomedical research involving human subjects. In accordance with FDA regulations, an IRB has the authority to approve, require modifications in (to secure approval), or disapprove research. This group review serves an important role in the protection of the rights and welfare of human research subjects.
The purpose of IRB review is to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of humans participating as subjects in the research. To accomplish this purpose, IRBs use a group process to review research protocols and related materials (e.g., informed consent documents and investigator brochures) to ensure protection of the rights and welfare of human subjects of research.” (K)

(A) https://ori.hhs.gov/education/products/columbia_wbt/rcr_conflicts/foundation/#1_1
(B) 15 Conflict-of-Interest Best Practices for Academic Medical Centers, https://www.healthstream.com/resources/blog/blog/2014/06/04/15-conflict-of-interest-best-practices-for-academic-medical-centers
(C) Open Payments Data in Context, https://www.cms.gov/OpenPayments/About/Open-Payments-Data-in-Context.html
(D) Conflict of Interest Policy Guide for Medical Schools and Academic Medical Centers, https://www.communitycatalyst.org/initiatives-and-issues/issues/prescription-drugs/conflict-of-interest-policy-guide
(E) Financial Ties That Bind: Studies Often Fall Short On Conflict-Of-Interest Disclosures, by Rachel Bluth, https://khn.org/news/financial-ties-that-bind-studies-often-fall-short-on-conflict-of-interest-disclosures/
(F) Memorial Sloan Kettering launches conflict of interest task force after CMO’s resignation, by David Robinson, https://www.lohud.com/story/news/health/2018/09/21/memorial-sloan-kettering-conflict-interest-task-force/1381042002/
(G) Top Cancer Researcher Fails to Disclose Corporate Financial Ties in Major Research Journals, by Charles Ornstein and Katie Thomas, https://www.propublica.org/article/doctor-jose-baselga-cancer-researcher-corporate-financial-ties
(H) Top Official at Memorial Sloan Kettering Resigns After Failing to Disclose Industry Ties, by Charles Ornstein, and Katie Thomas, https://www.propublica.org/article/memorial-sloan-kettering-official-jose-baselga-resigns-after-failing-to-disclose-industry-ties
(I) Sloan Kettering’s Cozy Deal With Start-Up Ignites a New Uproar, by Charles Ornstein, and Katie Thomas, https://www.propublica.org/article/sloan-kettering-cozy-deal-with-start-up-paige-ai-ignites-new-uproar
(J) Conflicts of Interest and Transparency Initiatives, https://www.aamc.org/initiatives/research/coi/
(K) Institutional Review Boards Frequently Asked Questions – Information Sheet, https://www.fda.gov/RegulatoryInformation/Guidances/ucm126420.htm
(L) Facing Crisis, Sloan Kettering Tells Exec to Hand Over Profits From Biotech, by Katie Thomas and Charles Ornstein, https://www.propublica.org/article/facing-crisis-sloan-kettering-tells-exec-to-hand-over-profits-from-biotech(M)

Addendum
“A vice president of Memorial Sloan Kettering Cancer Center has to turn over to the hospital nearly $1.4 million of a windfall stake in a biotech company, in light of a series of for-profit deals and industry conflicts at the cancer center that has forced it to re-examine its corporate relationships…
The move to hand over his stake is one of several steps now underway as the cancer center tries to contain a crisis that has already led to the resignation of its chief medical officer and a review of its conflict-of-interest policies. Several board members and some executives of the nonprofit institution have maintained close ties to the health and drug industries at a time when stunning cancer breakthroughs are generating excitement among investors and spawning a flurry of biotech startups.
At other cancer centers and research institutions, employees are barred from accepting personal compensation when they represent their institution on corporate boards. But Memorial Sloan Kettering had no such prohibition until now.” (L)

Previously posted was an op-ed describing Jersey City Medical Center’s “Rapid Response” role after the attack on the World Trade Center towers.
Military helicopters and jets were overhead, as President Bush was getting ready to leave. The plumes of smoke from the World Trade Center were still billowing skyward.
https://network.aupha.org/communities/community-home/digestviewer/viewthread?MessageKey=d375f16c-d2ff-4d54-b93f-d33c3c6330b3&CommunityKey=7457c476-880a-47b2-ad0b-8677bba9e9e4&tab=digestviewer#bmd375f16c-d2ff-4d54-b93f-d33c3c6330b3

Since Jersey City Medical Center was the New Jersey anchor in the response, I prepared a confidential Lessons Learned memorandum in preparation for a Debriefing Meeting called by the Democratic Party candidate for Governor.
As a courtesy I provided a copy of the memorandum to Bret Schundler, the former Mayor of Jersey City who was out-of-the country on September 11th and could not get back for almost a week. He was the Republican Party candidate for Governor. I forget that “No good deed goes unpunished” and Schundler widely circulated the document as a campaign issue.
“Rookie” mistake! Read the article below. What would you have done differently?

New York Times. September 22, 2001

Schundler Assails New Jersey’s Response to Terrorist Attack
By DAVID M. HALBFINGER
Making the World Trade Center disaster the focus of his campaign for governor, Bret D. Schundler is criticizing New Jersey’s response to the attack and has released his own plan to improve the state’s defenses against terrorism and its preparedness for future emergencies.
Mr. Schundler, the Republican candidate, has said that both the State Police and the National Guard reacted slowly and mismanaged their resources after the Sept. 11 attack, and that flaws in New Jersey’s emergency-management system made it difficult to coordinate the efforts of hospitals, ambulance crews and other volunteers.
Mr. Schundler, the former mayor of Jersey City, is now calling for bolstering New Jersey’s defenses, including restoring to the nation’s air-defense system an Air National Guard fighter wing that is stationed in Atlantic City and which, until two years ago, had two F-16’s ready to scramble 24 hours a day. He said New Jersey should conduct a thorough inventory of sensitive installations, like power plants, reservoirs and chemical factories, and immediately enhance security at Newark Airport and the the Hudson and Delaware River crossings.
He is also proposing an array of measures to improve the state’s response to emergencies, like maintaining rosters of doctors, nurses, engineers and others who might be needed in the case of another terrorist attack.
Mr. Schundler’s aides described his proposals as an attempt to provide leadership where it was needed and denied that he was trying to jump-start his campaign, which has stalled along with most of the political machinery in New Jersey.
But in critiquing the state agencies, hospitals and other institutions that responded to the attack — while the smoke is still rising from ground zero and many voters are still awaiting the remains of their loved ones — Mr. Schundler is running a huge risk: that he could be seen as trying to make hay out of a national tragedy.
”This is not a political exercise,” said Richard McGrath, a spokesman for James E. McGreevey, the Democratic candidate. ”Jim McGreevey’s been working in a quiet way to assimilate as much information as possible to address emergency needs and prevent future catastrophes,” Mr. McGrath said. ”This terrorist incident has had a profound effect on all Americans, and we don’t intend to parcel it out with any political agendas.”
In a telephone interview he initiated on Thursday, Mr. Schundler described a number of ways in which the state’s response to the attack had apparently broken down. For instance, he said he had been told by a police official in Jersey City that the State Police troopers who set up an operations center in Liberty State Park ”didn’t do much of anything — they just sat there.”
Mr. Schundler added that the troopers’ ”inaction” had forced the city’s police department to coordinate the supply effort for emergency workers, and said that troopers did not even arrive in Jersey City until 4:30 p.m. on the day of the attack.
Officials of the State Police and other agencies today briefed Mr. Schundler and Mr. McGreevey about their efforts. But on Thursday, Col. Carson Dunbar, the superintendent of the force, said there had been numerous tussles over turf in the hours after the attack, which were compounded by the loss of a radio-transmission tower at the World Trade Center, and which could have led to crossed signals about troopers’ assignments. But Colonel Dunbar said that state troopers were on the scene in Jersey City almost immediately after the attack. For instance, he said, one marine unit was among the first to ferry the injured to safety in New Jersey.
On Thursday, Mr. Schundler also released a five-page memorandum about breakdowns in the state’s response system that was prepared by Jonathan M. Metsch, president and chief executive of Jersey City Medical Center, which treated 175 people hurt in the attack.
The memo noted that police from outside Jersey City had prevented staff members from getting to the hospital; that National Guard troops who drove ambulances to the hospital ”had no leadership and provided no help”; that the blood donor system ”did not work”; and that it ”took too long” to prepare a list of the injured being treated at New Jersey hospitals, meaning each hospital was inundated with thousands of calls.
Dr. Metsch, reached today, said he had written the memo for state health officials, that it amounted only to his own impressions, and that he had done so merely to ensure that lessons would be learned, not to assess blame. He said he provided a copy to Mr. McGreevey on Wednesday after a private meeting of hospital executives that Mr. McGreevey had called to inquire about the response to the twin towers attack and ways to improve New Jersey’s readiness.
Dr. Metsch said he then provided a copy to Mr. Schundler, whom he called a friend, as a courtesy. But he said he had not expected the memo to be released to the public. ”These were off-the-record observations,” he said, adding that over all, New Jersey performed admirably.
But Bill Pascoe, Mr. Schundler’s campaign manager, said Dr. Metsch had not asked Mr. Schundler to keep the memo confidential. And he said Mr. Schundler’s use of it transcended politics.
”If the U.S. responds anytime in the next few days or weeks, we may be facing an immediate counterattack from the terrorists,” Mr. Pascoe said.
”We don’t have the luxury of time to let the dust settle. We have to use this event and our response to it right now as a learning exercise. What have we learned about what we did right and did wrong? What can we do better? That’s the point, and that’s the job of a leader.”

*written by Jonathan M. Metsch on September 14, 2001; published in the Jersey Journal on September 18, 2001

Suddenly a huge white military hospital ship with four Red Crosses steamed by and docked right across river. I thought how this hospital ship brought the war even closer to home but mostly about how the hospitals in Hudson County had responded and performed so magnificently.
Liberty HealthCare System is comprised of Jersey City Medical Center, Greenville Hospital, and Meadowlands Hospital Medical Center. The Medical Center, the County’s Trauma Center, treated 175 patients. Greenville treated 11 patients and processed over 500 volunteers who wanted to give blood; Greenville had originally been asked by the Red Cross to be a blood center but this was changed early on so donor information was passed (every volunteer was “typed and matched”) to the blood collection centers. Meadowlands treated 7 patients and was preparing to be a command center given its heliport; late Tuesday night Governor DiFrancesco used the heliport to depart from his visit to the triage center at Liberty State Park.

Every hospital in the County provided emergency services to victims. According to the Jersey Journal: Palisades Medical Center treated 12 patients; St. Francis Hospital treated 67 patients; Christ Hospital treated 54 patients; St. Mary Hospital treated 74 patients. Bayonne Hospital treated 58 patients.

At the Medical Center staff watched from windows the attack on the World Trade Center, then immediately went on Disaster Alert. Over 150 physicians covering all medical and surgical specialties were in the building as they are every day, and over 1000 other staff joined predetermined teams – trauma and surgery in the emergency room, and “walking wounded” in the auditorium. The library was organized for aftercare and rooms were set up for family members arriving from all over the metropolitan area. The injured started arriving around 10AM and suddenly, and sadly, everything stopped about 6PM. We hope and waited for more patients, and still wait “on alert”, our hope fading.

Since the New York City Command Center was in the World Trade Center complex and destroyed, good information was not available. We were told to expect somewhere between 2000 and 5000 injured.
Many others contributed to our success in handling the medical response to this act of war:
– Over 200 ambulances simply appeared from all over the state to assist. They were restocked from Medical Center inventory and dispatched by Medical Center EMS.
– New Jersey Commissioner of Health and Senior Services George DiFerdinando was in contact with us immediately and made sure we were re-supplied, and developed a plan with whereby trauma centers outside of Hudson County were on high alert so patients could be transported there to prevent Hudson County hospitals from being overwhelmed.
– Every hospital in the New Jersey was on disaster alert with elective admissions and surgery cancelled, and disaster teams ready until late Tuesday evening.
– Providers of food, IV solutions, medications, surgical supplies, and much more sent in truckloads of supplies without being asked.
– Volunteers poured in to help us in any way possible. For example with their help a “Hot Line” was set up at the Medical Center with up-to-date information on all disaster victims seen at New Jersey hospitals. This “Hot Line” was soon designated as “official” until the New York City Command Post was reestablished.
– Hudson Cradle opened its doors, wanting to help, wanting to serve.
– Mayor Cunningham and Jersey City police and fire officials coordinated all local efforts while supporting the recovery in New York City and securing the waterfront where victims were arriving by ferry in great numbers to several sites including Exchange Place and Liberty State Park. I know public officials in Hoboken, Secaucus, Bayonne and Weehauken did the same.
– And untold numbers were praying for the victims and those providing care – we could feel those prayers.

How can you help? Volunteer to give blood; blood will be needed for weeks and months to come. If you can, make a cash donation to help the families of those killed in this tragedy. Certainly go to community vigils and prayer services. Befriend someone who does not look like you and let them know that all Americans share this pain together and that the beauty of America is that we all came from somewhere else, and now live and work harmoniously side-by-side.

On a practical level we and other local hospitals can use your help. If you are a mental health worker and want to help with World Trade Center disaster Crises Counseling in hospitals, schools, and offices please call us. If you are a nurse who works outside the County or doing something else right now – particularly emergency room, critical care and operating room nurses, though all nurses are welcome – and want to be on our roster of volunteers for future emergencies please us. And if you just want to join the cadre of volunteers at our hospitals please call us. Please call 201 915-2048.

Finally I want to thank all the staff at Liberty, who once again, provided services so well. They acted heroically while worried about missing family and friends, and their children at home who had to cope with this tragedy without them nearby. I am honored to work with you