Volume 20, Number 11
NYC Subway Workers
Outside The Bomb
Malai Joya Interview
Peltier: Silence Screams
Responsibility & Guilt
Gabriel matthew Schivone
Shock, Awe, and Antioch
George j. Bryjak
Guatemala '07 Election
Black Caucus Demise
Crackpots & the Left
Men and Abortion
Eleanor J. Bader
Guthrie's Live Wire Reviewed
In the Valley of Elah Review
Genocide in Iraq?
Health Care Hokum
There are no articles.
NOTE: Z Magazine subscribers and sustainers have access to all Z Magazine articles here and in the archive. The latest Z Magazine articles available to everyone are listed in the Free Articles box at the top of the table of contents, and are starred in the list below. Questions? e-mail Z Magazine Online.
Book Review - Coronary by Stephen Klaidman
A True Story of Medicine Gone Awry
Throughout the 1990s, doctors on the staff of a hospital in Redding, California routinely performed unnecessary angiograms and coronary artery bypass grafts (CABGs) on unsuspecting patients. Dr. Chae Hyun Moon, a chain-smoking, foul-mouth- ed cardiologist, performed the unnecessary angiograms and told patients with healthy coronary arteries they needed immediate surgery. Dr. Felix Realyvasquez performed the bulk of the unnecessary CABGs without looking at the angiograms that allegedly justified them. The hospital where this happened was Redding Medical Center (RMC), which was owned by Tenet Healthcare Corporation, a for-profit 115-hospital chain with an unsavory past.
In his new book, Coronary: A True Story of Medicine Gone Awry, former New York Times and Washington Post reporter Stephen Klaid- man describes in excruciating detail the human suffering caused by Drs. Moon and Realyvasquez and how the physicians were busted.
Zona Martin, for example, was a 78-year-old grandmother who, prior to her unnecessary triple bypass, “enjoyed an active social life” and “had often driven her friends to bingo at the church.” But during the unnecessary surgery by Realyvasquez, the plaque in one of her coronary arteries was jarred loose, traveled to her brain, and she subsequently suffered two strokes. She lay in a coma for a month after her surgery. When she recovered consciousness, she was nearly blind in one eye, she slurred her words, she needed assistance to do the simplest tasks, and her mental acuity was so diminished she couldn’t remember simple things like telling her daughter when she needed to go to the bathroom.
Thirty-six-year-old Paul Alexan- dre was another victim who suffered severe side effects from his unnecessary CABG. The wire that was supposed to hold his sternum together after it was sawed apart broke (apparently because Alexandre made a living doing strenuous labor which put pressure on his sternum) and the sternum never healed despite three subsequent operations.
The abuse of patients came to the public’s attention in October 2002 when 40 FBI agents raided RMC. Sad to say, neither the doctors nor anyone at Tenet has been prosecuted for criminal acts against RMC patients. But the bad guys did pay out large sums of money to avoid prosecution. The doctors forked over millions to government agencies and plaintiffs, suspended their practices (at least in California), were prohibited from billing Medicare again, and suffered great public embarrassment. Tenet paid out a billion dollars and sold RMC.
Klaidman’s riveting account of the scam perpetrated by the doctors and Tenet, and how it was uncovered by a few persistent whistle-blowers and the FBI, is a useful antidote to the ridiculous argument that competition works in the health-care industry and can be relied on to solve the health care crisis. According to the insurance industry and its allies, health- care is not the sort of service (like electricity or national defense) that requires government ownership or regulation, but resembles, rather, simpler commodities for which “market forces” work reasonably well at setting prices and maintaining quality. Dog food, believe it or not, is one of the commodities to which market buffs have compared health care. Coronary documents what all of us with common sense know: “market forces” are incapable of policing medical quality.
For a market to be competitive, several conditions must be met. One is that buyers must be able to understand the price and quality of what they’re buying. Although Klaidman does not say this, his description of how easy it was for RMC’s doctors to victimize patients and how hard it was for patients to convince authorities they were being victimized, illustrates how difficult it is for patients —the “buyers” in the heart surgery “market”—to know when they’re being harmed, much less discern differences in the price and quality of cardiovascular services.
The FBI might never have investigated the strange happenings at RMC’s vaunted California Heart Institute (the name RMC gave its cardiology and heart surgery departments) if a Catholic priest named John Corapi, whom Moon misled into thinking he needed surgery, had not been persuaded by a friend to have the surgery done in Las Vegas rather than at RMC. Corapi’s friend did not at first doubt that Corapi needed surgery. He questioned, rather, whether a relatively small hospital in rural California could outperform the larger hospitals in Las Vegas.
When Corapi showed his angio- gram to two heart specialists in Las Vegas, they told him he had no sign of heart disease. Corapi was still so doubtful that the famous Dr. Moon would have lied to him that he sought opinions from two more Las Vegas doctors. They told him the same thing—he did not need surgery.
Corapi’s initial inability to shake loose from the influence of Moon’s terrifying verdict on his heart (Moon had told him while he was still lying on the table where the angiogram had been performed, “I’m sorry; there is nothing I can do for you. You need a triple bypass tomorrow morning”), and his need for reassurance from four other physicians, illustrate how difficult it can be for buyers of medical care to know the value of what they’re getting. Corapi was no dummy and he was not easily intimidated. He made a good living delivering lectures all over the country decrying what he perceived to be the gradual adulteration of Catholicism by modern culture. If Moon could have fooled someone like Corapi, it is reasonable to conclude he could have fooled even the smartest, most aggressive “shoppers” for angio- graphy and CABG surgery.
Conservatives and insurance industry officials claim to have an answer to the problem of medical care’s great complexity. That problem, they say, can be remedied by “report cards” on all the players in the health care sector—insurance companies, hospitals, clinics, individual doctors, and other providers of health care. Report cards will make insurers and health care providers “transparent” to the public, they say, and enable purchasers of insurance and medical care to “shop” more intelligently and thereby hold insurers and providers “accountable.” Because the logic of this fantasy is the same as that behind George W. Bush’s No Child Left Behind report cards on schools, I refer to the medical report card fantasy as No Patient Left Behind.
There are numerous problems with this fantasy. The most intractable of these problems, at least for services more complex than flu shots, is the extraordinary difficulty of grading the quality of medical care accurately. The hospital report cards on heart surgery that were available in the 1990s and early 2000s perfectly illustrate the problem: they failed to warn the public about the shoddy care RMC was providing its heart patients.
In fact, some of them led the public to think RMC’s services were superior. The most commonly used measures of quality in those report cards were (and still are) the number of heart surgeries done by a hospital or doctor, and mortality rate within 30 days of surgery. In RMC’s case, both measures misled the public.
The number of surgeries performed at a hospital is a common measure of CABG surgery quality because several studies have found a rough negative correlation between the number of CABG procedures a hospital or surgeon does and the mortality rate. That is, the more surgeries a hospital performs, the lower the mortality rate usually is. But, of course, in RMC’s case, the high volume of CABGs masked the terrible problem that the high volume was being caused by Moon’s practice of declaring healthy people to be in need of surgery. This practice not only created high CABG volume for RMC, it also artificially lowered RMC’s mortality rate.
At least three of the more prominent report cards available in the late 1990s and early 2000s gave RMC’s heart surgery department satisfactory or superlative grades at a time when RMC was performing hundreds of unnecessary angiograms and CABGs annually. “HealthGrades, a nationwide online rating service, consistently ranked RMC’s heart program among the best in the United States,” reported Klaidman. Solucient, another U.S. corporation making money off the report card craze, listed RMC as one of the 100 top cardiovascular hospitals in 1999.
The most publicized heart surgery report card in California, the California Report on Coronary Artery Bypass Graft Surgery, started in the mid-1990s by a group of Fortune 500 companies that calls itself the Pacific Business Group on Health (PBGH), did not explicitly label RMC’s heart program as superior, but it was nevertheless very misleading. Its report card for 2000-2002, for example, reported that RMC did an astounding 2,098 CABGs during that period. That placed RMC, a relatively small hospital, number 4 among the 77 California hospitals that reported their CABG data to PBGH. The PBGH report card also stated that RMC’s mortality rate was 1.6 percent for 2000-2002 compared with the national rate of 2.9 percent and a rate of 2.7 percent for the 77 participating California hospitals.
Tenet and RMC eagerly exploited these misleading report cards. For example, in a press release dated October 9, 2002 (21 days before the FBI raid would give the lie to RMC’s boasts), RMC stated: “Redding Medical Center was ranked by Health- Grades, a national healthcare quality solutions company, as the top-ranked hospital for cardiac care in far Northern California, and earned a five-star rating, putting RMC in the top five percent of hospitals nationwide for cardiac care.”
What RMC’s patients needed was not more report cards (a topic Klaidman does not discuss), but more aggressive enforcement of the laws and regulations already on the books (a topic Klaidman does touch on). It was clear to anyone who looked at the data that RMC was doing angio- graphy and CABG surgery at very high rates years before Father Corapi filed his complaint with the FBI. Because Medicare was paying such a large portion of RMC’s bills (Medicare is the largest source of revenue for most U.S. hospitals), it was the government agency with the clearest window into RMC’s operations. It was almost certainly the agency with the greatest clout over RMC.
Although Medicare initiated an investigation of RMC years before the FBI got involved, the investigation was too slow and timid to be of any use to RMC’s patients. This was uncharacteristic of Medicare. Since the early years of the first Clinton administration, Medicare has had a reputation among doctors for being too aggressive at sniffing out fraud. I would like to have seen Klaidman examine why Medicare failed to expose Moon and Realyvasquez before Father Corapi did.
Kip Sullivan writes frequently about health policy.
Z Magazine Archive
AnnouncementsLABOR - May 1 is May Day. Workers of the world will celebrate the 124th anniversary of International Worker’s Day. Born out of a call for an 8-hour workday in the United States, this day is an opportunity for all workers to show their solidarity with one another, as well as to renew the call for labor rights.
FARM CONFERENCE - The Farm Conference on Community and Sustainability will be held May 24-26 in Summertown, TN, in partnership with the Fellowship of Intentional Communities. Tour green homes, see sustainable food production, learn about solar installations, alternative education, midwifery, and more.
Contact: Douglas@thefarmcommunity.com; http://www.thefarmcommunity.com/.
PALESTINE - The Conference of the Palestinian Shatat in North American will be held June 3-5 in Vancouver. The conference will examine the future of the Palestinian liberation movement.
Contact: email@example.com; http://www.palestinianconference.org/.
LABOR - The Pacific Northwest Labor History Association’s 45th annual conference will be held May 3-5, in Portland, OR. This year’s theme is Labor Under Attack: Learning from the Past and Preparing for the Future. A call for presentations, workshops and papers is currently underway.
Contact: PNLHA, 27920 68th Ave. East, Graham, WA 98338; 206-406-2604; PNLHA1@aol.com; http://www3.telus.net.
MARIJUANA - On the first Saturday of May marijuana legalization activists will hold informational and educational events, rallies and marches in over 300 cities around the world.
ECONOMICS - The Union For Radical Political Economics will hold its 39th annual conference May 9-11 in New York City.
RECLAIM THE DREAM - The 2013 Poor People’s Campaign & March from Baltimore to Washington D.C. will be May 11. Communities, schools and unions interested in participating are encouraged to contact the Baltimore People’s Assembly.
Contact: 410-500-2168; 410-218-4835; BaltimorePeoplesAssembly@gmail.com; Southern Christian Leadership Conference of Baltimore and the Baltimore Peoples Power Assembly, 2011 N. Charles St., Baltimore, MD 21218.
MOTHER’S DAY - The 17th Annual Mother’s Day Walk For Peace will be May 12th, in Dorchester, MA. The walk began in 1996 for families who had lost children to violence. The day has become a way for thousands of people to financially support the work of the Louis Brown Peace Institute.
Contact: http://www.ldbpeaceinstitute.org/; http://mothersdaywalk4peace.org/.
NATO 5 - An International Week of Solidarity with the NATO 5 has been called for May 16-21. Supports call on supporters to raise awareness of the NATO 5 and support funds for the defendants on the one-year anniversary of their preemptive arrests.
Contact: firstname.lastname@example.org; https://nato5support.wordpress.com.
MOUNTAINTOP - The 2013 Mountain Justice Summer Activist Training Camp will be held May 19-27 in Damascus, VA. It will be a week of workshops, field trips to view Mountain Top Removal coal mines, direct actions, and service project.
FEMINIST SCI-FI - The feminist science fiction convention WisCon 37 is scheduled for May 24-27 in Madison, WI.
Contact: WisCon, ? SF3, PO Box 1624, Madison, WI 53701; email@example.com; http://www.wiscon.info/.
ANARCHY FEST - A month-long Festival of Anarchy is scheduled for May in Montreal. The festival includes The Montreal Anarchist Bookfair (May 19-20).
Contact: http://www.anarchistbookfair.ca/; http://www.radicalmontreal.com/.
LABOR - The International Labor Rights Forum will present: Down the Supply Chain, Driving Corporate Accountability, on May 22 in Washington, DC. The Labor Rights Awards Ceremony and Reception will honor pioneers in supply chain worker organizing, working solidarity and international labor rights policy.
MULTICULTURE - The 26th annual National Conference on Race & Ethnicity in American Higher Education (NCORE) will take place May 28-June 1, in New Orleans.
Contact: SWCHRS, 3200 Marshall Avenue, Suite 290, Norman, OK 73072; 405-325-3694; firstname.lastname@example.org; www.ncore.ou.edu.
MEDIA - The 2013 Alliance for Community Media Annual Conference will be held May 29-31, in San Francisco, CA. Participants will include educators, community leaders, media professionals, journalists, nonprofit leaders, policymakers and students.
RADIO - The 38th Annual Community Radio Conference is schedule for May 29-June 1, in San Francisco, CA, with discussions and workshops.
Contact: 1101 Pennsylvania Ave. NW, Suite 600, Washington, DC 20004; 202-756-2268; email@example.com; http://www.nfcb.org/.
BRADLEY MANNING - On June 1, a rally will be held at Fort Meade in support of Bradley Manning.
BIKES - Bikes Not Bombs is holding its 24th annual Bike-A-Thon and Green Roots Festival in Boston, MA on June 3, with several bike rides scheduled, music, exhibitors and more.
Contact: Bikes Not Bombs, 284 Amory St., Jamaica Plain, MA 02130; 617-522-0222; firstname.lastname@example.org; www.bikesnotbombs.org.
LEFT FORUM - The 2013 Left Forum will be held June 7-9, at Pace University in New York City.
Contact: 365 Fifth Avenue, CUNY Graduated Center, ? Sociology Dept., New York, NY 10016; http://www.leftforum.org/.
VEGAN FEST - Mad City Vegan Fest will be held in Madison, WI, June 8. The annual event features food, speakers, and exhibitors.
Contact: 122 State Street, Suite 405 B, Madison, WI 53701; email@example.com; http://veganfest.org/.
ADC CONFERENCE - The American-Arab Anti-Discrimination Committee (ADC) holds its annual conference June 13-16, in Washington, DC, with panel discussions and workshops on civil rights, media and other topics.
Contact: 1990 M Street, Suite 610, Washington, DC, 20036; 202-244-2990; firstname.lastname@example.org http://convention.adc.org/.
CUBA/SOCIALISM - A Cuban-North American Dialog on Socialist Renewal and Global Capitalist Crisis will be held in Havana, Cuba, June 16-30. There will be a 5 day Seminar at University of Havana, plus visits to a cooperative, urban garden, community development project, social research centers, and educational & medical institutions.
Contact: email@example.com; http://www.globaljusticecenter.org/.
NETROOTS - The 8th Annual Netroots Nation conference will take place June 20-23 in San Jose, CA. The event features panels, trainings, networking, screenings, and keynotes.
Contact: 164 Robles Way, #276, Vallejo, CA 94591; firstname.lastname@example.org; http://www.netrootsnation.org/.
MEDIA - The 15th annual Allied Media Conference will be held June 20-23, in Detroit.
Contact: 4126 Third Street, Detroit, MI 48201; http://alliedmedia.org/.
GRASSROOTS - The United We Stand Festival will be hosted by Free & Equal, June 22 in Little Rock, Arkansas. The festival aims to reform the electoral process throughout the U.S.
SOCIALISM - The Socialism 2013 Conference is scheduled for June 27-30 in Chicago, featuring talks and panel discussions.
Contact: email@example.com; http://www.socialismconference.org.
LITERACY - The National Association for Media Literacy Education (NAMLE) will hold its conference July 12-13 in Los Angeles under the heading, Intersections: Teaching and Learning Across Media.
Contact: 10 Laurel Hill Drive, Cherry Hill, NJ 08003; http://namle.net/conference/.
IWW - The North American Work People’s College will take place July 12-16 at Mesaba Co-op Park in northern Minnesota. The event will bring together Wobblies from branches across the continent to learn new skills and build One Big Union.
PEACESTOCK - On July 13th, the 11th Annual Peacestock: A Gathering for Peace, will take place at Windbeam Farm in Hager City, WI. The event is a mixture of music, speakers and community for peace. Sponsored by Veterans for Peace.
Contact: Bill Habedank, 1913 Grandview Ave., Red Wing, MN 55066; 651-388-7733; firstname.lastname@example.org; http://www.peacestockvfp.org.
CHILDREN’S DEFENSE - July 15-19, join clergy, seminarians, Christian educators, young adult leaders and other faith-based advocates for children at CDF Haley Farm in Clinton, Tennessee, for five days of spiritual renewal, networking, movement building workshops, and continuing education about the urgent needs of children at the 19th annual Proctor Institute for Child Advocacy Ministry.
Contact: email@example.com; http://www.childrensdefense.org.
ACTIVIST CAMP - Youth Empowered Action (YEA) Camp will have sessions in July and August in Ben Lomond, CA; Portland, OR; Charlton, MA. YEA Camp is designed for activists 12-17 years old who want to make a difference in the world.
Contact: firstname.lastname@example.org; http://yeacamp.org/.
LA RAZA - The annual National Council of La Raza (NCLR) Conference is scheduled for July 18-19 in New Orleans, with workshops, presentations and panel discussions.
Contact: NCLR Headquarters Office, Raul Yzaguirre Building, 1126 16th Street, NW, Washington, DC 20036; 202-785-1670; www.nclr.org.
LABOR - The Eastern Conference For Workplace Democracy: Growing Our Cooperatives, Growing Our Communities, will be held at Drexel University in Philadelphia, PA, July 26-28.
Contact: email@example.com; http://east.usworker.coop/.
WOMEN/LYNNE STEWART- Radical Women is asking for support letters and cards to be sent to Lynne Stewart. Stewart is a civil rights attorney and political prisoner who is currently in jail. She has breast cancer and authorities have denied her request for transfer from her Texas prison to the New York City hospital where she received medical attention during a prior bout of breast cancer. Send messages and cards to: Lynne Stewart 53504-054, Federal Medical Center Carswell, P.O. Box 27137, Fort Worth, TX 76127.
Contact: 747 Polk Street, San Francisco, CA 94109; 415-864-1278; RadicalWomenUS@gmail.com; http://lynnestewart.org/; http://www.radicalwomen.org/.
HAITI/WOMEN - Haiti’s government is considering a legal reform measure that would prohibit and punish all sexual assault, including marital rape. MADRE and the International Campaign to Stop Rape & Gender Violence in Conflict are launching a petition to raise international support for this push to address violence against women in Haiti.
Contact: 121 West 27th Street, #301, New York, NY 10001; 212-627-0444; firstname.lastname@example.org; http://www.madre.org.
SYRIA/MIDDLE EAST - The Middle East Children’s Alliance (MECA) is currently seeking funds to assist more than 200,000 refugees fleeing violence in Syria.
FOLK FESTIVAL - The Falcon Ridge Folk Festival will be held August 2-4, in the Berkshires, NY.
Contact: http://www.falconridgefolk.com/; email@example.com.
WAR RESISTERS - The War Resisters League will hold its 90th anniversary conference, Revolutionary Nonviolence: Building Bridges Across Generations and Communities, August 1-4, at Georgetown University. The event will focus on the U.S.’ long history of antimilitarism.
Contact: 339 Lafayette Street, New York, NY 10012; 212-228-0450; firstname.lastname@example.org; http://www.warresisters.org.
POPULAR ECONOMICS - The Center for Popular Economics is holding its 2013 Summer Institute August 4-9 at Hampshire College in Amherst, MA. No background in economics is needed for this intensive training. This year’s theme is, The Care Economy: Building a Just Economy with a Heart.
Contact: Center for Popular Economics, PO Box 785 Amherst, MA 01004; 413-545-0743; email@example.com; www.populareconomics.org.
VETERANS - Veterans for Peace is holding the 28th annual convention August 6-11 in Madison, WI. This year’s theme is, Power To The Peaceful.
DEMOCRACY - The Democracy Convention will take place August 7-11 in Madison, WI. The convention brings together nine conferences including topics such as media, education, defense, race, environment and others.
MEN - The 38th National Conference on Men & Masculinity: Forging Justice: Creating Safe, Equal and Accountable Communities, presented in partnership with HAVEN, will be held in Detroit, MI, August 8-10.
Contact: firstname.lastname@example.org; http://www.nomas.org/.
OCCUPY - An Occupy National Gathering will be held in Kalamazoo, MI, August 21-25.
Contact: email@example.com; http://occupynationalgathering.net/.
COMMUNITIES - The Communities Conference is a networking and learning opportunity for co-operative or communal lifestyles, with workshops, events and entertainment; scheduled for August 30-September 2 at the Twin Oaks Community in Louisa, Virginia.
LABOR DAY - The 29th annual Bread and Roses Festival, a celebration of the ethnic diversity and labor history of Lawrence, MA, will be held September 2, in honor of the 1912 Bread and Roses Strike. There will be music, dance, poetry, drama, ethnic food, historical demonstrations, walking & trolley tours.
Contact: PO Box 1137, Lawrence, MA 01842; 978-794-1655; http://www.breadandrosesheritage.org/.
OCCUPY WALL STREET - September 17 is the two-year anniversary of the Occupy Wall Street movement. Events are planned in New York City and worldwide.
TEACHERS - The 13th Annual Conference, “Teaching for Social Justice: The Politics of Pedagogy,” will be held October 12 in San Francisco, CA. The free event features workshops, resources, and free childcare.
Contact: 415-676-7844; firstname.lastname@example.org; http://www.t4sj.org/.
HAITI - International Action, which brings clean water and chlorinators to Haiti, seeks office space capable of housing up to six people and their office equipment.
Contact: Zach Bremer, Zbrehmer@haitiwater.org; 202-488-0735; http://www.haitiwater.org/.
MEDIA - The Union for Democratic Communications and Project Censored are sponsoring a joint conference on media democracy, media activism and social justice to be held November 1-3 at the University of San Francisco. Proposals for presentations, workshops and panels from activists and critical scholars are invited.