An aerial view of the devastation caused by high winds and heavy flooding in the greater New Orleans area following Hurricane Katrina in Baton Rouge, Louisiana August 30, 2005. Floodwaters engulfed much of New Orleans on Tuesday as officials feared a steep death toll and planned to evacuate thousands remaining in shelters after the historic city’s defenses were breached by Hurricane Katrina. |
Month: September 2005
-
-
Fred R. Conrad/The New York Times
Maureen Dowd.
September 21, 2005
Message: I Can’t
By MAUREEN DOWD
WASHINGTON
The president won’t be happy until he dons a yellow slicker and actually takes the place of Anderson Cooper, violently blown about by Rita as he talks into a camera lens lashed with water, hanging onto a mailbox as he’s hit by a flying pig in a squall, sucked up by a waterspout in the eye of the storm over the Dry Tortugas.
Then maybe he’ll go back to the White House and do his job instead of running down to the Gulf Coast for silly disaster-ops every other day.
There’s nothing more pathetic than watching someone who’s out of touch feign being in touch. On his fifth sodden pilgrimage of penitence to the devastation he took so long to comprehend, W. desperately tried to show concern. He said he had spent some “quality time” at a Chevron plant in Pascagoula and nattered about trash removal, infrastructure assessment teams and the “can-do spirit.”
“We look forward to hearing your vision so we can more better do our job,” he said at a briefing in Gulfport, Miss., urging local officials to “think bold,” while they still need to think mold.
Mr. Bush should stop posing in shirtsleeves and get back to the Oval Office. He has more hacks and cronies he’s trying to put into important jobs, and he needs to ride herd on that.
The announcement that a veterinarian, Norris Alderson, who has no experience on women’s health issues, would head the F.D.A.’s Office of Women’s Health ran into so much flak from appalled women that the F.D.A. may have already reneged on it. No morning-after pill, thanks to the antediluvian administration, but there may be hope for a morning-after horse pill.
Mr. Bush made a frownie over Brownie, but didn’t learn much. He’s once more trying to appoint a nothingburger to a position of real consequence in homeland security. The choice of Julie Myers, a 36-year-old lawyer with virtually no immigration, customs or law enforcement experience, to head the roiling Immigration and Customs Enforcement Agency with its $4 billion budget and 22,000 staffers, has caused some alarm, according to The Washington Post.
Ms. Myers’s main credentials seem to be that she worked briefly for the semidisgraced homeland security director, Michael Chertoff, when he was at the Justice Department. She just married Mr. Chertoff’s chief of staff, John Wood, and she’s the niece of Gen. Richard Myers, the chairman of the Joint Chiefs of Staff.
As a former associate for Ken Starr, the young woman does have impeachment experience, in case the forensic war on terrorism requires the analysis of stains on dresses.
Julie makes Brownie look like Giuliani. I’ll sleep better tonight, knowing that when she gets back from her honeymoon, Julie will be patrolling the frontier.
As if the Veterinarian and the Niece were not bad enough, there was also the Accused. David Safavian, the White House procurement official involved in Katrina relief efforts, was arrested on Monday, accused by the F.B.I. of lying and obstructing a criminal investigation into the seamy case of “Casino Jack” Abramoff, the Republican operative who has broken new ground in giving lobbying a bad name. Democrats say the fact that Mr. Safavian’s wife is a top lawyer for the Republican congressman who’s leading the whitewash of the White House blundering on Katrina does not give them confidence.
Just as he has stonewalled other inquiries, Mr. Bush is trying to paper over his Katrina mistakes by appointing his homeland security adviser, Frances Townsend, to investigate how the feds fumbled the response.
Mr. Bush’s “Who’s Your Daddy?” bravura – blowing off the world on global warming and the allies on the Iraq invasion – has been slapped back by Mother Nature, which refuses to be fooled by spin.
When Donald Rumsfeld came out yesterday to castigate the gloom-and-doomers and talk about the inroads American forces had made against terrorists in Afghanistan and Iraq, he could not so easily recast reality.
In Afghanistan, the U.S.’s handpicked puppet president is still battling warlords and a revivified Taliban, and the export of poppies for the heroin trade is once more thriving.
Iraq is worse, with more than 1,900 American troops killed. Five more died yesterday, as well as four security men connected to the U.S. embassy office in Mosul, all to fashion a theocratic-leaning regime aligned with Iran. In Basra, two journalists who have done work for The Times have been killed in the last two months.
The more the president echoes his dad’s “Message: I care,” the more the world hears “Message: I can’t.”
Copyright 2005 The New York Times Company Home Privacy Policy Search Corrections XML Help Contact Us Work for Us Site Map Back to Top -
Almost Before We Spoke, We Swore
Tim Bower
William Shakespeare, in keeping with traditions of Elizabethan drama, peppered his plays with profanity and celebrated the vulgar as well as the sublime
Tim Bower
Geoffrey Chaucer’s “Canterbury Tales” were unabashedly bawdy and profane. That may be why students can still be persuaded to read them.
September 20, 2005
Almost Before We Spoke, We Swore
By NATALIE ANGIER
Incensed by what it sees as a virtual pandemic of verbal vulgarity issuing from the diverse likes of Howard Stern, Bono of U2 and Robert Novak, the United States Senate is poised to consider a bill that would sharply increase the penalty for obscenity on the air.
By raising the fines that would be levied against offending broadcasters some fifteenfold, to a fee of about $500,000 per crudity broadcast, and by threatening to revoke the licenses of repeat polluters, the Senate seeks to return to the public square the gentler tenor of yesteryear, when seldom were heard any scurrilous words, and famous guys were not foul mouthed all day.
Yet researchers who study the evolution of language and the psychology of swearing say that they have no idea what mystic model of linguistic gentility the critics might have in mind. Cursing, they say, is a human universal. Every language, dialect or patois ever studied, living or dead, spoken by millions or by a small tribe, turns out to have its share of forbidden speech, some variant on comedian George Carlin’s famous list of the seven dirty words that are not supposed to be uttered on radio or television.
Young children will memorize the illicit inventory long before they can grasp its sense, said John McWhorter, a scholar of linguistics at the Manhattan Institute and the author of “The Power of Babel,” and literary giants have always constructed their art on its spine.
“The Jacobean dramatist Ben Jonson peppered his plays with fackings and “peremptorie Asses,” and Shakespeare could hardly quill a stanza without inserting profanities of the day like “zounds” or “sblood” – offensive contractions of “God’s wounds” and “God’s blood” – or some wondrous sexual pun.
The title “Much Ado About Nothing,” Dr. McWhorter said, is a word play on “Much Ado About an O Thing,” the O thing being a reference to female genitalia.
Even the quintessential Good Book abounds in naughty passages like the men in II Kings 18:27 who, as the comparatively tame King James translation puts it, “eat their own dung, and drink their own piss.”
In fact, said Guy Deutscher, a linguist at the University of Leiden in the Netherlands and the author of “The Unfolding of Language: An Evolutionary Tour of Mankind’s Greatest Invention,” the earliest writings, which date from 5,000 years ago, include their share of off-color descriptions of the human form and its ever-colorful functions. And the written record is merely a reflection of an oral tradition that Dr. Deutscher and many other psychologists and evolutionary linguists suspect dates from the rise of the human larynx, if not before.
Some researchers are so impressed by the depth and power of strong language that they are using it as a peephole into the architecture of the brain, as a means of probing the tangled, cryptic bonds between the newer, “higher” regions of the brain in charge of intellect, reason and planning, and the older, more “bestial” neural neighborhoods that give birth to our emotions.
Researchers point out that cursing is often an amalgam of raw, spontaneous feeling and targeted, gimlet-eyed cunning. When one person curses at another, they say, the curser rarely spews obscenities and insults at random, but rather will assess the object of his wrath, and adjust the content of the “uncontrollable” outburst accordingly.
Because cursing calls on the thinking and feeling pathways of the brain in roughly equal measure and with handily assessable fervor, scientists say that by studying the neural circuitry behind it they are gaining new insights into how the different domains of the brain communicate – and all for the sake of a well-venomed retort.
Other investigators have examined the physiology of cursing, how our senses and reflexes react to the sound or sight of an obscene word. They have determined that hearing a curse elicits a literal rise out of people. When electrodermal wires are placed on people’s arms and fingertips to study their skin conductance patterns and the subjects then hear a few obscenities spoken clearly and firmly, participants show signs of instant arousal.
Their skin conductance patterns spike, the hairs on their arms rise, their pulse quickens, and their breathing becomes shallow.
Interestingly, said Kate Burridge, a professor of linguistics at Monash University in Melbourne, Australia, a similar reaction occurs among university students and others who pride themselves on being educated when they listen to bad grammar or slang expressions that they regard as irritating, illiterate or déclassé.
“People can feel very passionate about language,” she said, “as though it were a cherished artifact that must be protected at all cost against the depravities of barbarians and lexical aliens.”
Dr. Burridge and a colleague at Monash, Keith Allan, are the authors of “Forbidden Words: Taboo and the Censoring of Language,” which will be published early next year by the Cambridge University Press.
Researchers have also found that obscenities can get under one’s goosebumped skin and then refuse to budge. In one study, scientists started with the familiar Stroop test, in which subjects are flashed a series of words written in different colors and are asked to react by calling out the colors of the words rather than the words themselves.
If the subjects see the word “chair” written in yellow letters, they are supposed to say “yellow.”
The researchers then inserted a number of obscenities and vulgarities in the standard lineup. Charting participants’ immediate and delayed responses, the researchers found that, first of all, people needed significantly more time to trill out the colors of the curse words than they did for neutral terms like chair.
The experience of seeing titillating text obviously distracted the participants from the color-coding task at hand. Yet those risqué interpolations left their mark. In subsequent memory quizzes, not only were participants much better at recalling the naughty words than they were the neutrals, but that superior recall also applied to the tints of the tainted words, as well as to their sense.
Yes, it is tough to toil in the shadow of trash. When researchers in another study asked participants to quickly scan lists of words that included obscenities and then to recall as many of the words as possible, the subjects were, once again, best at rehashing the curses – and worst at summoning up whatever unobjectionable entries happened to precede or follow the bad bits.
Yet as much as bad language can deliver a jolt, it can help wash away stress and anger. In some settings, the free flow of foul language may signal not hostility or social pathology, but harmony and tranquillity.
“Studies show that if you’re with a group of close friends, the more relaxed you are, the more you swear,” Dr. Burridge said. “It’s a way of saying: ‘I’m so comfortable here I can let off steam. I can say whatever I like.’ ”
Evidence also suggests that cursing can be an effective means of venting aggression and thereby forestalling physical violence.
With the help of a small army of students and volunteers, Timothy B. Jay, a professor of psychology at Massachusetts College of Liberal Arts in North Adams and the author of “Cursing in America” and “Why We Curse,” has explored the dynamics of cursing in great detail.
The investigators have found, among other things, that men generally curse more than women, unless said women are in a sorority, and that university provosts swear more than librarians or the staff members of the university day care center.
Regardless of who is cursing or what the provocation may be, Dr. Jay said, the rationale for the eruption is often the same.
“Time and again, people have told me that cursing is a coping mechanism for them, a way of reducing stress,” he said in a telephone interview. “It’s a form of anger management that is often underappreciated.”
Indeed, chimpanzees engage in what appears to be a kind of cursing match as a means of venting aggression and avoiding a potentially dangerous physical clash.
Frans de Waal, a professor of primate behavior at Emory University in Atlanta, said that when chimpanzees were angry “they will grunt or spit or make an abrupt, upsweeping gesture that, if a human were to do it, you’d recognize it as aggressive.”
Such behaviors are threat gestures, Professor de Waal said, and they are all a good sign.
“A chimpanzee who is really gearing up for a fight doesn’t waste time with gestures, but just goes ahead and attacks,” he added.
By the same token, he said, nothing is more deadly than a person who is too enraged for expletives – who cleanly and quietly picks up a gun and starts shooting.
Researchers have also examined how words attain the status of forbidden speech and how the evolution of coarse language affects the smoother sheets of civil discourse stacked above it. They have found that what counts as taboo language in a given culture is often a mirror into that culture’s fears and fixations.
“In some cultures, swear words are drawn mainly from sex and bodily functions, whereas in others, they’re drawn mainly from the domain of religion,” Dr. Deutscher said.
In societies where the purity and honor of women is of paramount importance, he said, “it’s not surprising that many swear words are variations on the ‘son of a whore’ theme or refer graphically to the genitalia of the person’s mother or sisters.”
The very concept of a swear word or an oath originates from the profound importance that ancient cultures placed on swearing by the name of a god or gods. In ancient Babylon, swearing by the name of a god was meant to give absolute certainty against lying, Dr. Deutscher said, “and people believed that swearing falsely by a god would bring the terrible wrath of that god upon them.” A warning against any abuse of the sacred oath is reflected in the biblical commandment that one must not “take the Lord’s name in vain,” and even today courtroom witnesses swear on the Bible that they are telling the whole truth and nothing but.
Among Christians, the stricture against taking the Lord’s name in vain extended to casual allusions to God’s son or the son’s corporeal sufferings – no mention of the blood or the wounds or the body, and that goes for clever contractions, too. Nowadays, the phrase, “Oh, golly!” may be considered almost comically wholesome, but it was not always so. “Golly” is a compaction of “God’s body” and, thus, was once a profanity.
Yet neither biblical commandment nor the most zealous Victorian censor can elide from the human mind its hand-wringing over the unruly human body, its chronic, embarrassing demands and its sad decay. Discomfort over body functions never sleeps, Dr. Burridge said, and the need for an ever-fresh selection of euphemisms about dirty subjects has long served as an impressive engine of linguistic invention.
Once a word becomes too closely associated with a specific body function, she said, once it becomes too evocative of what should not be evoked, it starts to enter the realm of the taboo and must be replaced by a new, gauzier euphemism.
For example, the word “toilet” stems from the French word for “little towel” and was originally a pleasantly indirect way of referring to the place where the chamber pot or its equivalent resides. But toilet has since come to mean the porcelain fixture itself, and so sounds too blunt to use in polite company. Instead, you ask your tuxedoed waiter for directions to the ladies’ room or the restroom or, if you must, the bathroom.
Similarly, the word “coffin” originally meant an ordinary box, but once it became associated with death, that was it for a “shoe coffin” or “thinking outside the coffin.” The taboo sense of a word, Dr. Burridge said, “always drives out any other senses it might have had.”
Scientists have lately sought to map the neural topography of forbidden speech by studying Tourette’s patients who suffer from coprolalia, the pathological and uncontrollable urge to curse. Tourette’s syndrome is a neurological disorder of unknown origin characterized predominantly by chronic motor and vocal tics, a constant grimacing or pushing of one’s glasses up the bridge of one’s nose or emitting a stream of small yips or grunts.
Just a small percentage of Tourette’s patients have coprolalia – estimates range from 8 to 30 percent – and patient advocates are dismayed by popular portrayals of Tourette’s as a humorous and invariably scatological condition. But for those who do have coprolalia, said Dr. Carlos Singer, director of the division of movement disorders at the University of Miami School of Medicine, the symptom is often the most devastating and humiliating aspect of their condition.
Not only can it be shocking to people to hear a loud volley of expletives erupt for no apparent reason, sometimes from the mouth of a child or young teenager, but the curses can also be provocative and personal, florid slurs against the race, sexual identity or body size of a passer-by, for example, or deliberate and repeated lewd references to an old lover’s name while in the arms of a current partner or spouse.
Reporting in The Archives of General Psychiatry, Dr. David A. Silbersweig, a director of neuropsychiatry and neuroimaging at the Weill Medical College of Cornell University, and his colleagues described their use of PET scans to measure cerebral blood flow and identify which regions of the brain are galvanized in Tourette’s patients during episodes of tics and coprolalia.
They found strong activation of the basal ganglia, a quartet of neuron clusters deep in the forebrain at roughly the level of the mid-forehead, that are known to help coordinate body movement along with activation of crucial regions of the left rear forebrain that participate in comprehending and generating speech, most notably Broca’s area.
The researchers also saw arousal of neural circuits that interact with the limbic system, the wishbone-shape throne of human emotions, and, significantly, of the “executive” realms of the brain, where decisions to act or desist from acting may be carried out: the neural source, scientists said, of whatever conscience, civility or free will humans can claim.
That the brain’s executive overseer is ablaze in an outburst of coprolalia, Dr. Silbersweig said, demonstrates how complex an act the urge to speak the unspeakable may be, and not only in the case of Tourette’s. The person is gripped by a desire to curse, to voice something wildly inappropriate. Higher-order linguistic circuits are tapped, to contrive the content of the curse. The brain’s impulse control center struggles to short-circuit the collusion between limbic system urge and neocortical craft, and it may succeed for a time.
Yet the urge mounts, until at last the speech pathways fire, the verboten is spoken, and archaic and refined brains alike must shoulder the blame.
Copyright 2005 The New York Times Company Home Privacy Policy Search Corrections XML Help Contact Us Work for Us Site Map Back to Top -
Greed, It Turns Out, Isn’t So Good
Seth Wenig/Reuters
Dennis Kozlowski leaving State Supreme Court in New York City in June.
September 20, 2005
Greed, It Turns Out, Isn’t So Good
By CLYDE HABERMAN
MANY years ago, when we both toiled for The New York Post, a colleague passed the time one night telling me about corruption trials that he had covered in New Jersey, a state graced with an ample supply of government officials caught with their hands in the till.
One case involved a mook who was charged with pocketing $100,000 in public funds. The prosecution had this fellow nailed. They could have measured him for a striped suit right there in the courtroom. In the end, his lawyer played the only card he had left.
He paced theatrically in front of the jurors. Then he raised his hands beseechingly and said in his best “they arrested my guy for this?” tone: “Ladies and gentlemen of the jury – I mean, we’re talking about $100,000.”
Nice try. Too bad for his client that it didn’t work.
A faintly reminiscent scene was played yesterday in a Manhattan courtroom. There, the Tyco tycoons L. Dennis Kozlowski and Mark H. Swartz were handcuffed and led away to begin long prison terms for having robbed their company, if not blind, then certainly nearsighted.
To earn their sentences of 8 1/3 to 25 years, Messrs. Kozlowski and Swartz stole, by the prosecution’s count, a cool $180 million and ultimately cost Tyco shareholders billions in the resulting scandal. “Kleptocratic management” was how an assistant district attorney, Owen E. Heimer, described their style.
That the two men would go to prison was never in doubt. The only question was for how long. In pleading yesterday for leniency, the defense team offered an echo of the “what’s so terrible?” argument that did that New Jersey official no good long ago.
“Tyco is not Enron,” said Mr. Swartz’s lawyer, Charles A. Stillman.
In other words, unlike Enron and other paragons of corporate greed, Tyco International did not go bankrupt because of Mr. Kozlowski’s much-joked-about excesses and sins against good taste. Remember his $6,000 shower curtain and $15,000 umbrella stand? How about the $2 million birthday party that he threw for his wife on Sardinia, complete with an ice sculpture of Michelangelo’s “David” urinating vodka.
Despite all that, the company’s stock did not implode. Thousands upon thousands did not lose their jobs. No old man or woman, so far as anyone knows, was forced to go on a Purina diet.
I mean, we’re talking about $100,000 – updated with a lot of extra zeroes for the new century.
The judge, Michael J. Obus, was not buying Mr. Stillman’s reasoning.
Oh, he suggested, perhaps Mr. Heimer went overboard in describing the defendants as barely below monstrous. But let’s not be airheaded. Harm was done and trust was violated, he said. So he sent the two men to prison for a good long while, ordering them also to pay $134 million in restitution and $105 million in fines. Goodbye shower curtain and umbrella stand.
If nothing else, Mr. Kozlowski and Mr. Swartz were guilty of monumentally bad timing.
They learned too late that greed is out of fashion, ever more so now that Hurricane Katrina has violently exposed the fault lines of class in America. Sorry, Gordon Gekko, but for the moment at least, corporate plunderers are no more tolerated than common criminals. Indeed, their reputations may be worse.
“What gunman in the street,” Mr. Heimer asked the judge, “has ever managed to steal $180 million?”
Speaking of street gunmen, the punctuation-challenged rapper named Lil’ Kim began a yearlong jail sentence yesterday. She had committed perjury in testifying about a 2001 shootout between rival hip-hop groups outside a Manhattan radio station. In the land of rap, settling differences with lead qualifies as intelligent discourse.
Still, that world has more in common with the corporate realm than one might think. A unifying thread is greed: getting as much as you can while you can. One group can’t talk enough about bling. The other has stock options.
But who knows? Prison did Martha Stewart no harm; she is bigger than ever. Maybe Lil’ Kim will prosper, too. And while not quite in their league when it comes to celebrity, Mr. Kozlowski might also figure out how to bounce back.
That, however, lies well in his future. He has more immediate concerns. For one thing, Attica or wherever else he winds up may not be the best place for jokes about shower curtains.
Copyright 2005 The New York Times Company Home Privacy Policy Search Corrections XML Help Contact Us Work for Us Site Map Back to Top -
The Jersey City Medical Center, in Hudson County.
The Health Factory
The Jersey City Medical Center, in Hudson County.
In addition to the surgery building and the maternity hospital, the campus included the nurses’ residence (Murdoch Hall), hospital for chest diseases (Pollock), a psychiatric hospital, and an outpatient clinic. The Medical Center’s services were free
By STEVEN J. SPEAR
Published: August 29, 2005
TODAY, going to an American hospital seems about as safe as parachuting off a bridge. An estimated 98,000 Americans die each year as a result of medical error, and a nearly equal number succumb to infections they acquire in hospitals. Those rates are unacceptable in the world’s most medically advanced country.
This month, President Bush signed a bill intended to reduce the rate of medical errors. The legislation authorizes the creation of ”patient safety organizations” to which health care providers can report errors and near misses. On the basis of these reports, the organizations will recommend ways to avoid such mistakes. And to reduce disincentives to reporting, the bill prevents information disclosed to these organizations from being used in malpractice lawsuits.
The new legislation is a step in the right direction. It will allow hospitals to study their errors without fear that acknowledging mistakes will lead to reprisals. But within the hospitals themselves lies a far bigger opportunity to reduce the rate of catastrophic medical error, if the hospitals would just follow the example of the world’s most successful industrial organizations.
Companies like Toyota, Alcoa and Vanguard differ from one another in the products they produce and the technologies they employ, but they share a management approach that has resulted in a combination of safety, quality, efficiency and responsiveness unmatched by their competitors.
It may seem a stretch to compare a carmaker’s, aluminum refiner’s, or mutual fund company’s operations with a hospital’s. But all these companies manage complex processes that require a great deal of problem solving — and they have something important to teach health care.
Typically, health care workers, like employees in many other industries, tend to work around problems when they encounter them, meeting patients’ immediate needs but not resolving the problems’ root causes. Therefore, people confront ”the same problem, every day, for years,” as one nurse phrased it to me. These persistent difficulties manifest themselves as regular inefficiencies within the system, and they occasionally lead to catastrophic mistakes.
What sets the non-health care leaders apart is that as they do their work, they are constantly learning how to do it better. Work is designed to reveal even little problems as they occur– well before they cause errors or near misses worthy of being reported. Managers respond to these problems immediately, with rapid experiments aimed at generating sustainable fixes, rather than with workarounds that are constantly repeated. The knowledge that results from this process is then shared through collaborative experimentation in which all employees take part.
A number of American hospitals have tried this approach, with promising results. For example, hospitals in the Pittsburgh Regional Healthcare Initiative addressed a recurring predicament in intensive care. Catheters placed directly into veins or arteries, called central lines, are used to deliver medication swiftly to critically ill patients. But a quarter-million patients nationwide who receive this treatment each year suffer bloodstream infections as a result, and of those, 15 percent die. At one Pittsburgh area hospital, mortality was a staggering 40 percent of those infected, and the cost for each infected patient was $25,000 to $80,000. To eliminate these infections, the hospitals taught themselves to find problems and institute small process enhancements at a rate far faster than a national reporting program will most likely allow. Together, these small fixes added up to a significant improvement.
For periods of days or weeks, the Pittsburgh hospitals observed the placement and maintenance of every central line, looking for minor breaks in routine that could create opportunities for infection. Along the way, they found dozens of factors that were potentially suspect. One hospital realized that in its line-maintenance kits, gloves were stored on the bottom, causing nurses to fish through sterile material with bare hands. Other kits had drapes — sheets that isolate the area on which a nurse or doctor is working — that were either too small to be effective or so large that patients knocked them out of the way.
Other hospitals discovered that only on certain shifts were there doctors expert in placing the more difficult but least infection-prone type of line. And the shifts that lacked such expertise also lacked simple, reliable ways to signal the experts on other shifts to move lines from high-risk to low-risk locations or to remove them entirely when they returned to work.
By quickly identifying and resolving these small procedural problems, the Pittsburgh hospitals as a group cut their central line infection rates in half, and some hospitals were able to cut their individual infection rates nearly to zero. These hospitals and others used a similar approach to solve other problems, like patient falls and faulty medication administration.
To go from working around problems to identifying and solving them required hospital workers to change the way they worked, from the front lines to the senior levels. But the effects were profound. If the rest of the country’s hospitals follow that example, the national savings would be measured in tens of thousands of lives and billions of dollars every year.
Copyright 2005 The New York Times Company | Privacy Policy | Home | Search | Corrections | Help | Back to Top -
Doctors Join to Promote Electronic Record Keeping
Stewart Cairns for The New York TimesDr.
Eugene Heslin receives computer training from Lori Jesman.
September 19, 2005
Doctors Join to Promote Electronic Record Keeping
By MILT FREUDENHEIM
He is a self-described techie, but that did not help Dr. Eugene P. Heslin harness the wonders of electronic medical records. The technology seemed too complicated and expensive for a small medical group like his six-doctor family practice in rural upstate New York.
“The large groups can afford the software,” said Dr. Heslin, a family physician in Saugerties. “For the onesies and twosies, small groups like ours, there is no profit margin.”
Now, though, in a collaboration with 500 like-minded doctors, as well as hospitals, insurers and employers in two Hudson Valley counties, Dr. Heslin and his partners are clearing barriers that have made modern information technology inaccessible to the hundreds of thousands of small doctors’ offices around the nation.
The Hudson Valley effort is being watched as a potential model by federal and state government and industry officials, who say that up to 60 percent of Americans receive their primary care at small-scale physicians’ offices. Unless those small medical practices can adopt the most modern and efficient information technology, millions of Americans may never know the benefits of the most advanced and safest care.
Electronic records, particularly ones that can be shared online by different doctors and hospitals, can improve the quality and safety of patient care by reducing errors that kill tens of thousands of patients each year. That is why, with considerable cheerleading but only modest financial help from Congress and the Bush administration, big organizations like Kaiser Permanente, the Mayo Clinic and many medical centers across the country are spending billions to convert to electronic records.
And last week, in the aftermath of Hurricane Katrina, government and private health care officials were rushing to build an electronic database of prescription drug records for hundreds of thousands of people who lost their records in the storm. Health and Human Services Secretary Mike Leavitt said the chaos wreaked by Katrina “powerfully demonstrated the need for electronic health records.”
Also helping propel the electronic revolution are private insurers, Medicare and some employers, which are paying incentives to medical providers that can achieve better efficiency and patient care through improved information management.
But smaller medical practices have typically been ineligible for such bonuses because the doctors lack the computerized records that help them qualify. The hurdles typically include up-front costs as high as $30,000 for each doctor, and the need for support and training.
As a result, fewer than 5 percent of physicians nationally are using a computerized system as part of patient care, said Dr. Thomas J. Handler, a research director at the Gartner market research group. For most doctors who work in groups of five or fewer, the portion is probably 3 percent or less, he said.
To overcome such obstacles, Dr. Heslin and his regional colleagues, who call their cooperative effort the Taconic Health Information Network and Community, are pooling their resources and knowledge.
A Web-based, central database approach means that doctors need little more than a few standard PC’s, a high-speed Internet connection and the willingness to pay a monthly subscription fee of $500 to $600, eliminating the initial outlay of tens of thousands of dollars.
The Taconic group, operating in Dutchess and Ulster Counties, received a seed grant of $100,000 from the eHealth Initiative, a national nonprofit organization that is intent on bringing the medical profession into the modern digital era. The organization’s affiliated foundation cited the Taconic group in its annual progress report late last month. The Taconic network has also received $1.5 million from the federal Agency for Healthcare Research and Quality, to pay for an evaluation of the system by an independent researcher.
Dr. David J. Brailer, the Bush administration’s health information technology coordinator, said that programs like the Taconic network “are obviously out in front of the rest.
“My mantra is to ask, How can we make electronic medical records cheaper and more valuable to the doctor?” Dr. Brailer said. “These are grass-roots efforts that are filling a hole that the federal and state governments cannot respond to.”
Under the Taconic system, which is being introduced in phases, doctors can log onto a secure Web site to get prompt laboratory and X-ray and other imaging results for their patients from four local hospitals and two big lab companies. Later this year, the doctors will be able to send prescriptions electronically to participating local drugstores or online pharmacies. The biggest part of the push is to start next year: the introduction of electronic health records accessible online to the patient’s doctor and, with the patient’s permission, to any other medical provider on the network.
Mark Foster, a pediatrician in Wappingers Falls, in Dutchess County, has already seen the benefit of his electronic lab-results link. When a boy came in recently with a painful swollen knee, Dr. Foster suspected Lyme disease, which is endemic in the county.
“We tested him, and the next morning I looked online and called his mother and got him on antibiotics,” Dr. Foster said. “Within 48 hours, his fever was gone. He’s absolutely normal now.”
Under the former system of communicating by fax with the laboratory and sorting through the piles of paper that arrive daily, he said, “the kid could have been suffering for two more days.”
The Taconic network, along with two other medical alliances – one in Indianapolis, the other in Whatcom County, in Washington State – are “well ahead of the pack,” said Janet Marchibroda, the chief executive of the eHealth Initiative.
The Taconic group is negotiating discounts with software and hardware vendors, according to Dr. A. John Blair III, a laparoscopic surgeon who is the organization’s chief executive. Dr. Blair is paid by a separate regional doctors’ organization that currently donates his time to the Taconic network. The day-to-day work of building and running the system, dealing with vendors and providing technical support to the doctors is performed by a rapidly growing paid staff, now numbering 15 and based in Wappingers Falls.
The key to the system is its secure shared database. “Instead of having dozens of systems in doctors’ offices, it is hosted on one facility,” Dr. Blair said.
All a participating doctor needs is at least one computer terminal with high-speed access to the Internet, he said, and a router computer for security protection and antivirus software. Some doctors have flat screens in each examining room. Some have wireless tablets or laptops they take from room to room. Most have separate terminals for themselves and their nurses and administrative staffs.
The Taconic network supplies the training for doctors and their staffs and maintains local support centers to troubleshoot the inevitable challenges posed by new software.
“That’s what they need, that’s why I like this model,” said Dr. Handler at the Gartner research group. Without such technical support for small medical practices, “it’s hard for them to get over the hurdles,” he said.
Much of the Taconic doctors’ costs for the system can be offset by payments from insurers and employers like I.B.M. and Verizon that offer bonuses to doctors in their networks who meet quality standards.
I.B.M., which has 60,000 employees in the mid-Hudson Valley region, is enthusiastic about the Taconic group’s approach. “You can cut down dramatically on medical errors; you are less likely to be accidentally given a drug you are allergic to,” said Dr. Paul Grundy, a medical director at I.B.M. The company will pay doctors who use the electronic prescription system an additional $6 a year for each employee they treat.
MVP Health Care is an insurer in upstate New York that has 100,000 members who receive care from the Taconic physicians. It will pay an additional $18 a year per member to doctors who meet patient satisfaction and service standards, prescribe generic drugs and log onto the Taconic system regularly, said Dr. Jerry Salkowe, an MVP vice president.
Verizon and other big local employers, like the Price Chopper and Hannaford Brothers supermarkets, are talking to MVP and the Taconic network about additional bonuses through the Bridges to Excellence program, a national employer-sponsored experiment in paying doctors for meeting quality goals.
Francois de Brantes, a General Electric health care official who is president of the e-Health Initiative Foundation, says early studies show that computerization can yield some savings for physicians, mainly in productivity, by freeing them to see more patients. “But the majority of savings go to someone else than the physician,” he said. The issue is “how to redistribute a portion of those savings back to the physicians.”
Bridges to Excellence pays doctors bonuses of $50 a year per insured patient – money that can add up to tens of thousands of dollars for some large groups. The Taconic group intends to make smaller doctors eligible for such bonuses.
“Many health plans are prepared to pay for performance,” said Dr. Blair. “The rub is that you have to have the technology in place to garner those incentives. You need to automate the reporting capability.”
Copyright 2005 The New York Times Company Home Privacy Policy Search Corrections XML Help Contact Us Work for Us Site Map Back to Top -
Fugitive Wanted in Vegas Heist Surrenders
Heather Catherine Tallchief speaks to members of the press before surrendering to federal authorities in downtown Las Vegas on Thursday Sept. 15, 2005. Tallchief told reporters that she drove the armored truck in a $3.1 million Las Vegas Strip casino armored truck heist in October 1993. (AP Photo/Isaac Brekken)
Fugitive Wanted in Vegas Heist Surrenders By KEN RITTER, Associated Press Writer
Thu Sep 15, 8:22 PM ET
A woman accused in a multimillion-dollar armored car heist on the Las Vegas Strip surrendered to federal authorities Thursday, saying she was tired of more than a decade on the run and wanted her son to have a normal life.
“I truly feel this is the right thing to do,” Heather Catherine Tallchief, 33, said minutes before turning herself in at a federal courthouse.
Tallchief was 21 and working for an armored car company when authorities say she drove away from the Circus Circus hotel-casino with at least $2.5 million in cash.
Her lawyer, Robert Axelrod, said Thursday there was no doubt Tallchief committed the October 1993 theft, but said she was influenced by her then-boyfriend, Roberto Solis, a manipulative ex-con.
“The evidence of the physical acts are quite overwhelming. But there are mitigating factors,” Axelrod said. “He brainwashed her.”
Tallchief appeared briefly Thursday before a U.S. magistrate judge, who ordered her held without bond on nine felony charges. A preliminary hearing was scheduled for Sept. 29. If convicted, Tallchief faces at least 30 years in prison.
Tallchief told reporters she and her 10-year-old son have been hiding in Amsterdam, Netherlands, where she and Solis fled after the heist.
A few months after their son was born, Tallchief said she left Solis, now 60, with the cash and has no idea where he is today. Solis remains a fugitive in the case.
Tallchief said she told her son about her intent to surrender, leaving him at school Monday in Amsterdam with some parting words.
“I told him to practice his guitar, have fun at his sporting club, do his homework, and I’ll see you soon,” Tallchief said, adding that her son will be cared for by friends in Amsterdam.
Court records say Tallchief took a position as a driver and armed guard with Loomis Armored Inc. less than six weeks before the heist.
Joe Parris, an FBI supervisory special agent in Washington, D.C., said Tallchief was a “highly sought” fugitive, but never made the FBI’s Top 10 Most Wanted list.
Mark Clark, spokesman for Loomis Armored successor Loomis Fargo & Co. of Houston, said he welcomed Tallchief’s surrender, but said the company wants the missing money.
“I don’t suppose she turned the money in when she turned herself in,” Clark said.
Copyright © 2005 The Associated Press. All rights reserved. The information contained in the AP News report may not be published, broadcast, rewritten or redistributed without the prior written authority of The Associated Press.
Copyright © 2005 Yahoo! Inc. All rights reserved.
Questions or Comments
Privacy Policy -Terms of Service – Copyright/IP Policy – Ad Feedback -
Many Women at Elite Colleges Set Career Path to Motherhood
Doug Mills/The New York Times
Emily Lechner, at home in North Potomac, Md., with her mother, Carol, is a student at Yale who plans to become a lawyer, but who says her career will take a back seat once she starts having children.
September 20, 2005
Many Women at Elite Colleges Set Career Path to Motherhood
By LOUISE STORY
Cynthia Liu is precisely the kind of high achiever Yale wants: smart (1510 SAT), disciplined (4.0 grade point average), competitive (finalist in Texas oratory competition), musical (pianist), athletic (runner) and altruistic (hospital volunteer). And at the start of her sophomore year at Yale, Ms. Liu is full of ambition, planning to go to law school.
So will she join the long tradition of famous Ivy League graduates? Not likely. By the time she is 30, this accomplished 19-year-old expects to be a stay-at-home mom.
“My mother’s always told me you can’t be the best career woman and the best mother at the same time,” Ms. Liu said matter-of-factly. “You always have to choose one over the other.”
At Yale and other top colleges, women are being groomed to take their place in an ever more diverse professional elite. It is almost taken for granted that, just as they make up half the students at these institutions, they will move into leadership roles on an equal basis with their male classmates.
There is just one problem with this scenario: many of these women say that is not what they want.
Many women at the nation’s most elite colleges say they have already decided that they will put aside their careers in favor of raising children. Though some of these students are not planning to have children and some hope to have a family and work full time, many others, like Ms. Liu, say they will happily play a traditional female role, with motherhood their main commitment.
Much attention has been focused on career women who leave the work force to rear children. What seems to be changing is that while many women in college two or three decades ago expected to have full-time careers, their daughters, while still in college, say they have already decided to suspend or end their careers when they have children.
“At the height of the women’s movement and shortly thereafter, women were much more firm in their expectation that they could somehow combine full-time work with child rearing,” said Cynthia E. Russett, a professor of American history who has taught at Yale since 1967. “The women today are, in effect, turning realistic.”
Dr. Russett is among more than a dozen faculty members and administrators at the most exclusive institutions who have been on campus for decades and who said in interviews that they had noticed the changing attitude.
Many students say staying home is not a shocking idea among their friends. Shannon Flynn, an 18-year-old from Guilford, Conn., who is a freshman at Harvard, says many of her girlfriends do not want to work full time.
“Most probably do feel like me, maybe even tending toward wanting to not work at all,” said Ms. Flynn, who plans to work part time after having children, though she is torn because she has worked so hard in school.
“Men really aren’t put in that position,” she said.
Uzezi Abugo, a freshman at the University of Pennsylvania who hopes to become a lawyer, says she, too, wants to be home with her children at least until they are in school.
“I’ve seen the difference between kids who did have their mother stay at home and kids who didn’t, and it’s kind of like an obvious difference when you look at it,” said Ms. Abugo, whose mother, a nurse, stayed home until Ms. Abugo was in first grade.
While the changing attitudes are difficult to quantify, the shift emerges repeatedly in interviews with Ivy League students, including 138 freshman and senior females at Yale who replied to e-mail questions sent to members of two residential colleges over the last school year.
The interviews found that 85 of the students, or roughly 60 percent, said that when they had children, they planned to cut back on work or stop working entirely. About half of those women said they planned to work part time, and about half wanted to stop work for at least a few years.
Two of the women interviewed said they expected their husbands to stay home with the children while they pursued their careers. Two others said either they or their husbands would stay home, depending on whose career was furthest along.
The women said that pursuing a rigorous college education was worth the time and money because it would help position them to work in meaningful part-time jobs when their children are young or to attain good jobs when their children leave home.
In recent years, elite colleges have emphasized the important roles they expect their alumni – both men and women – to play in society.
For example, earlier this month, Shirley M. Tilghman, the president of Princeton University, welcomed new freshmen, saying: “The goal of a Princeton education is to prepare young men and women to take up positions of leadership in the 21st century. Of course, the word ‘leadership’ conjures up images of presidents and C.E.O.’s, but I want to stress that my idea of a leader is much broader than that.”
She listed education, medicine and engineering as other areas where students could become leaders.
In an e-mail response to a question, Dr. Tilghman added: “There is nothing inconsistent with being a leader and a stay-at-home parent. Some women (and a handful of men) whom I have known who have done this have had a powerful impact on their communities.”
Yet the likelihood that so many young women plan to opt out of high-powered careers presents a conundrum.
“It really does raise this question for all of us and for the country: when we work so hard to open academics and other opportunities for women, what kind of return do we expect to get for that?” said Marlyn McGrath Lewis, director of undergraduate admissions at Harvard, who served as dean for coeducation in the late 1970′s and early 1980′s.
It is a complicated issue and one that most schools have not addressed. The women they are counting on to lead society are likely to marry men who will make enough money to give them a real choice about whether to be full-time mothers, unlike those women who must work out of economic necessity.
It is less than clear what universities should, or could, do about it. For one, a person’s expectations at age 18 are less than perfect predictors of their life choices 10 years later. And in any case, admissions officers are not likely to ask applicants whether they plan to become stay-at-home moms.
University officials said that success meant different things to different people and that universities were trying to broaden students’ minds, not simply prepare them for jobs.
“What does concern me,” said Peter Salovey, the dean of Yale College, “is that so few students seem to be able to think outside the box; so few students seem to be able to imagine a life for themselves that isn’t constructed along traditional gender roles.”
There is, of course, nothing new about women being more likely than men to stay home to rear children.
According to a 2000 survey of Yale alumni from the classes of 1979, 1984, 1989 and 1994, conducted by the Yale Office of Institutional Research, more men from each of those classes than women said that work was their primary activity – a gap that was small among alumni in their 20′s but widened as women moved into their prime child-rearing years. Among the alumni surveyed who had reached their 40′s, only 56 percent of the women still worked, compared with 90 percent of the men.
A 2005 study of comparable Yale alumni classes found that the pattern had not changed. Among the alumni who had reached their early 40′s, just over half said work was their primary activity, compared with 90 percent of the men. Among the women who had reached their late 40′s, some said they had returned to work, but the percentage of women working was still far behind the percentage of men.
A 2001 survey of Harvard Business School graduates found that 31 percent of the women from the classes of 1981, 1985 and 1991 who answered the survey worked only part time or on contract, and another 31 percent did not work at all, levels strikingly similar to the percentages of the Yale students interviewed who predicted they would stay at home or work part time in their 30′s and 40′s.
What seems new is that while many of their mothers expected to have hard-charging careers, then scaled back their professional plans only after having children, the women of this generation expect their careers to take second place to child rearing.
“It never occurred to me,” Rebecca W. Bushnell, dean of the School of Arts and Sciences at the University of Pennsylvania, said about working versus raising children. “Thirty years ago when I was heading out, I guess I was just taking it one step at a time.”
Dr. Bushnell said young women today, in contrast, are thinking and talking about part-time or flexible work options for when they have children. “People have a heightened awareness of trying to get the right balance between work and family.”
Sarah Currie, a senior at Harvard, said many of the men in her American Family class last fall approved of women’s plans to stay home with their children.
“A lot of the guys were like, ‘I think that’s really great,’ ” Ms. Currie said. “One of the guys was like, ‘I think that’s sexy.’ Staying at home with your children isn’t as polarizing of an issue as I envision it is for women who are in their 30′s now.”
For most of the young women who responded to e-mail questions, a major factor shaping their attitudes seemed to be their experience with their own mothers, about three out of five of whom did not work at all, took several years off or worked only part time.
“My stepmom’s very proud of my choice because it makes her feel more valuable,” said Kellie Zesch, a Texan who graduated from the University of North Carolina two years ago and who said that once she had children, she intended to stay home for at least five years and then consider working part time. “It justified it to her, that I don’t look down on her for not having a career.”
Similarly, students who are committed to full-time careers, without breaks, also cited their mothers as influences. Laura Sullivan, a sophomore at Yale who wants to be a lawyer, called her mother’s choice to work full time the “greatest gift.”
“She showed me what it meant to be an amazing mother and maintain a career,” Ms. Sullivan said.
Some of these women’s mothers, who said they did not think about these issues so early in their lives, said they were surprised to hear that their college-age daughters had already formed their plans.
Emily Lechner, one of Ms. Liu’s roommates, hopes to stay home a few years, then work part time as a lawyer once her children are in school.
Her mother, Carol, who once thought she would have a full-time career but gave it up when her children were born, was pleasantly surprised to hear that. “I do have this bias that the parents can do it best,” she said. “I see a lot of women in their 30′s who have full-time nannies, and I just question if their kids are getting the best.”
For many feminists, it may come as a shock to hear how unbothered many young women at the nation’s top schools are by the strictures of traditional roles.
“They are still thinking of this as a private issue; they’re accepting it,” said Laura Wexler, a professor of American studies and women’s and gender studies at Yale. “Women have been given full-time working career opportunities and encouragement with no social changes to support it.
“I really believed 25 years ago,” Dr. Wexler added, “that this would be solved by now.”
Angie Ku, another of Ms. Liu’s roommates who had a stay-at-home mom, talks nonchalantly about attending law or business school, having perhaps a 10-year career and then staying home with her children.
“Parents have such an influence on their children,” Ms. Ku said. “I want to have that influence. Me!”
She said she did not mind if that limited her career potential.
“I’ll have a career until I have two kids,” she said. “It doesn’t necessarily matter how far you get. It’s kind of like the experience: I have tried what I wanted to do.”
Ms. Ku added that she did not think it was a problem that women usually do most of the work raising kids.
“I accept things how they are,” she said. “I don’t mind the status quo. I don’t see why I have to go against it.”
After all, she added, those roles got her where she is.
“It worked so well for me,” she said, “and I don’t see in my life why it wouldn’t work.”
Copyright 2005 The New York Times Company Home Privacy Policy Search Corrections XML Help Contact Us Work for Us Site Map Back to Top
Recent Comments