Me

The Effect of Cost Cutting

Five days ago, I posted about the hospital where I work trying to save money by cutting out the shift bonuses that were being used to entice the staff to work 50 and 60 hour workweeks. Today was the first day where I worked and there were no overtime people. Where a 50 bed ED normally needs 14 nurses to operate? We had 10 for most of the day. Meaning that we should have 5 patients to each nurse.

Nope, we were too busy for that. We tried to tell EMS agencies that we couldn’t take any more patients (it’s called being “on divert”). It didn’t work. At one point, we had 90 patients. For ten nurses.

I work a swing shift, which is supposed to be 11am to 11pm. Most of the ED works 7-7. By 9pm, my patients were:

  • A 37 year old female who kept having seizures. She had 6 of them the first 2 hours she was my patient.
  • A 26 year old male fentanyl overdose.
  • A 76 year old with a bowel obstruction that is vomiting coffee grounds.
  • A 35 year old who came to our facility two weeks ago complaining of chest pain and went into cardiac arrest. He is complaining of chest pain and has elevated troponin levels.
  • A 78 year old woman with perforated diverticulitis.
  • A 56 year old intoxicated woman who is with us for altered mental status and is covered head to toe in her own feces.

For those of you who don’t know, most of those patients need to be in a unit that offers a higher level of acre than what we can provide in the ED. The problem is that all of those units are already full.

In the meantime, there are 22 people in the waiting room, waiting for us to have room to treat them. At one point, there were 7 ambulances lined up at the door, waiting to drop off patients. So I wound up ordering Wendy’s through DoorDash at around 8pm, and eating it at the nurses station while I wrote notes on patient’s charts.

Needless to say, everyone was getting testy, patients AND staff.

As 11 o’clock approached, the charge nurse asked me to hold over because we still had more than 60 patients, and three of us were scheduled to go home at 11, which would leave her with no techs and only 8 nurses. Because I like her and she always does me favors, I agreed to hold over for a couple of hours.

Right at 1, when I was planning to go home, all hell broke loose. An intoxicated woman was brought in by EMS, who claimed they were unable to get an IV. Ten minutes after they dropped her off, she vomited about a 1.5 liters of blood.

So a third of the remaining nurses spent the next 45 minutes trying to keep her alive. All of their patients were getting ignored in the meantime.

One nurse remarked, “As long as we keep doing this, they will keep making us do it, until it becomes the ‘way we have always done things.'”

I finally left the place at around 2 am, having worked a total of 15.5 hours. But think of all the money they are saving by not having to pay those bonuses.

By Divemedic, ago

Shortages

Last month, I mentioned that the hospital where I work is bringing Philippino nurses in to fill vacant positions for less money than hiring Americans. There is more news on that front.

We have been short staffed for nearly three years. They have made up the shortfall by paying huge bonuses to get nurses to work extra shifts. They tried foreign workers. Still, they don’t have enough. Determined to save money now that the COVID funding has dried up, hospital administration announced on Saturday that there will be no more bonuses offered. Once the shifts that are already promised bonuses are paid out, they will be no more. Nurses who were making $2500 a day for working a 12 hour over time shift are now being asked to work the same overtime hours, but for $600-$900 each 12 hour shift.

I know that I was working 60 hours or more a week. I was making good money to do that, but now that the money has dried up, I am not working those kinds of hours for a fraction of the pay. No one that I know is willing to do that.

So now the entire staff of the ED is not taking any extra shifts. They are working their contracted hours, and that is it. Me? My contract says that I have to work 4 shifts a month. That is all I am doing. Everyone else is doing the same. So now the hospital is even more short handed.

Here is what was texted out to us this morning by the ED department head:

Hello team
We know this week has definitely had its ups and downs already and we appreciate all the hard work done by everyone. While we all fight this same battle we still have patients who are expecting the best care we can provide.
Starting tonight through the weekend we could use anyone on any shift to assist your fellow team and patients.
Please any help is appreciated.

As if guilt tripping us will get us to work all of those extra hours for a third of what we were making before. I want to help my patients and coworkers, but at the end of the day, this is a financial arrangement. It’s business.

So now the hospital is getting desperate. A third of the ED beds were shut down today for lack of staff.

The hospital where I work can only fill itself to somewhere near 60% capacity because they don’t have enough nurses, and that was when people were working extra shifts for bonus money. That means that patients often stay in the ED until there is an open bed on the inpatient floors. Our ED is frequently more than half filled with patients on “admission holds” awaiting beds. Couple that with the fact that the ED is also short nurses, and you have a problem.

Picture a 50 bed emergency room. To staff a 50 bed ED takes 14 nurses, 4 paramedics, 4 general technicians, 3 doctors, a nurse practitioner or PA, a respiratory therapist, secretary, three registration clerks, two lab technicians, three radiology techs, and two janitors. Every shift.

Now picture that you only have enough nurses for 10 per shift. Now you can only handle 40 patients at a time instead of 50. Now also picture that you have 30 admit holds, taking up beds and waiting for an inpatient bed- some for more than 48 hours. Now you can only handle 10 patients because your staff is busy caring for holds. So the waiting room backs up.

This means you have people sitting in the waiting room for 4, 5, or even 6 hours as they wait for treatment. And all of that was happening before you cut off the bonus money.

Now instead of 60% staffed, you are more like 45% staffed. Instead of 10 nurses, you only have 7. Now picture that across the entire hospital. A 600 bed hospital with a 50 bed ED requires 100 nurses or more each shift. You only have 50 or 60. Now what do you do? There aren’t enough foreign workers to fill that many spots.

My hospital can’t be alone in this. Here is the warning: there is a potential collapse of health care coming. It takes 3 to 4 years to train a nurse to the point where they are licensed, and another 2 years or so for that nurse to be proficient enough in their job to staff an ED, even longer for places like the ICU.

By Divemedic, ago

A Love of Reading

When I was a kid, I liked to read. My mother used to get me books, and the first books I remember reading were the Hardy Boys. I got to the point that I could read a Hardy Boys book in about 45 minutes by the time I was in the second grade.

I loved reading so much that the school librarian began paying me with Oreos to place returned library books to the shelf for her. I became a voracious reader, often reading an author’s entire contribution to the library in a few days.

Soon after that, Boys’ Life magazine published the Heinlein story Between Planets. I remember enjoying the story so much that it turned me on to SciFi. Star Wars came out, followed by fan fiction novels like Foster’s Splinter of the Mind’s Eye, which in my mind is a better story than any of the Star Wars sequels by Disney.

I soon had read every Heinlein, Clarke, and Asimov book in the library. I moved on to novels like Silent Ship, Silent Sea, the Guadalcanal Diary and more. So many I can’t even remember them all.

The came the Mack Bolan books, the Penetrator, and many other pulp fiction novels of the late 70s and early 80s.

This shaped my childhood, my view of the world, and an intense love of my country. It also made me who I am. By the time I was 12 years old, I was maxing out reading tests. I was reading at the level of a college senior, 300 words per minute with 85% comprehension. Reading fiction became a way to energize the brain and make complex thought not only possible, but enjoyable.

Now contrast that with what kids are being fed today. Pushed away from reading books into reading trash on social media. A constant stream of tranny, communist propaganda.

It’s no wonder that we have lost a nation. Our nation, brain dead and on life support, is soon to see its plug pulled. The artificial life support of endless fiat cash is becoming toxic to the very systems it is supposed to keep running. The land that I grew up in is gone.

Can we change it? Is there enough there that it can be saved? I don’t think that there is. We are entering a dark age where people no longer read, no longer think, and knowledge is of little value. We value the athlete more than the scientist. Most people, including scientists, don’t even know what science or the scientific method is.

It saddens me to see our nation dying, one idiot at a time.

By Divemedic, ago

I Hate Dealing with IT

This is where I vent about the computer nerds at my hospital.

I have been having a problem with a piece of medical equipment at work. In order to perform a procedure, a Doctor’s order must be in the system. The problem is that whenever the device tries to download orders, I get an error message “The Server Returned an unrecognized response.”

If the medical device can’t find the order, it won’t proceed with the test. There is no way to get around it. There used to be, but they eliminated that ability about three months ago.

So I did what I am supposed to do- I put in a work order. I did so at 8 pm.

The next morning, I find an email reply with a very snarky response. It says “If you would read your emails, you will see that we were doing server maintenance at XXX hospital from 10 pm onwards, and the server was unavailable.” Your work order has been closed.

There are a couple issues with that:

  • I don’t work at XXX hospital. I work at YYY hospital.
  • The problem was happening well before 10 pm
  • I work in the Emergency Room, and this equipment is pretty important. Why would you shut it down with no way to operate it?

Then the very next email in my box is a request that I take a survey about the “service” I received from the IT department. I blasted them, but in a controlled, polite way.

I was called into my boss’ office because “If you have a problem with the work done by another employee, you come to us. There is no need to disparage other employees on interdepartment surveys.”

If you don’t want my opinion, don’t ask for it.

Also, why does the IT department in every place I have ever worked have to be staffed with condescending assholes who treat you like a moron because THEIR equipment doesn’t do what it is supposed to be doing? I get that you don’t want to be bothered with actually interacting with people, but that is kind of your own fault for making sure that no one can do anything without calling the helpdesk because even changing the font on your screen requires an admin password that only you possess.

OK. Rant over.

By Divemedic, ago

Inflation

July is the time of year when I do the budget for the coming year for my businesses. That’s the main reason why I didn’t post yesterday. Busy with business. From an inflation standpoint, things are actually looking more dire than they were last year. My property taxes are up 10%, my landscaping costs are up 15%, insurance costs up 21%, and interest (in dollars) on the mortgage is up 18% year over year.

In December, I posted about the increasing popularity of rent control. It turns out that Florida’s constitution and state laws make rent control a difficult prospect at best. So the communists in the blue counties are looking at other ways to make financial war on landlords. Miami-Dade is looking at requiring that tenants be provided government funded attorneys in landlord/tenant disputes. That also increases both the expense and risk for landlords. If that catches on, then there will be even more increases.

I predicted that landlords would find other ways to increase income without increasing rent. Things like fees for lawn maintenance, rental fees for appliances like washers and dryers, forcing maintenance costs like pressure washing on to the tenants.

It seems like I called it, because that is exactly what is happening. Landlords are passing these “extras” on to tenants, adding all sorts of fees on to the lease. These are costs that are associated with a rental property that tenants just don’t think about. Here is a complaint:

“Usually these increased costs do not come with increased services or amenities,” Rabin said. “They are often used as a way to deprive people.”

Take washers and dryers. Once common in rentals across Florida, now, many tenants rent not just their apartments and homes, but the appliances within it.

I don’t see how making you rent a washer and dryer is a way to deprive a tenant. A washer and dryer is an unnecessary convenience item that costs the landlord to both purchase and maintain. Many tenants destroy these appliances because, well, they just have no respect for the property of others.

The cost of buying and maintaining property is increasing. That includes opportunity cost. Let’s say that I bought a house for $200K. I can rent it out, or I can sell it. The only way that I would (and do) choose to rent is if I can get a better return on that investment by renting than by selling it. As housing prices rise, so do rent costs.

The same goes for appliances. Washers, dryers, kitchen appliances, they all cost money. In the past two years, I have had to replace a range, repair a refrigerator and a central air conditioner, and replace a dryer. That costs money that must be recouped. As appliance prices increase, so do my costs. As the cost of lawn maintenance and appliance repairs increase, so do my costs. That means higher fees and rent.

So far, I limit the fees on my rental property. I charge an application fee for each adult who will live at the property. That covers my cost to do the background and credit check. I provide a washer, dryer, and lawn maintenance. I pay HOA fees. The tenant provides for electric, water, and trash service. They also have to pay for cable TV and Internet service, if they so desire.

So how rents are priced is actually pretty straightforward: the amount that it costs me to maintain and rent the property is my base. That includes maintenance expenses, insurance, taxes, landscaping, administrative overhead, and legal expenses. To that, I add my expected return on investment. Since there is more risk than previous years, my expected return is around 8 percent. If I get much less, it is more profitable to sell. The resulting number is my rent.

What all of this means is that my rents this year will be increasing to reflect those added costs and risks. Last year, I increased rent on my rental property by 8%. This year, the increase will likely have to be around 9 or 10 percent.

By Divemedic, ago

July 11, 2007

This blog is fifteen years old today. It wasn’t always here at AreaOcho. This blog began over at blogger those fifteen years ago as a way for me to vent about things from my job as a fire medic. The first post was about one of my patients getting his penis stuck on a keyring. In the past fifteen years, there have been more than 4,500 posts, over 10,000 comments on those posts, and I don’t know how many people have read what I have written over the years because I didn’t count them for the first decade or so. There have been nearly a million views in the past year, so there is that.

So many things have changed for me in the past fifteen years. When I started this blog, the death of my father was still fresh on my mind. Since that time I have been married, divorced, and then married again. Employed, retired, then employed again. I declared bankruptcy and then became a millionaire. The last decade and a half have been busy:
In 2008 I got married.
In 2009 the bottom dropped out of the housing market, my pay was cut by 30% and, faced with a depreciating asset, I declared bankruptcy with the intent of giving my house back to the bank.
In 2010 My bankruptcy was discharged.

Before the bank could get the paperwork done to repossess the house, they were caught lying to the court. It turns out that they lied in court and hadn’t been the mortgage holder of my house for years. They were forced to pay me nearly $10,000 in damages.

A year later, they tried to repossess the house again and their lawyer was caught forging mortgage paperwork in my case and several dozen others. Their lawyer was disbarred and the bank had to pay me more than $25,000 in damages. He disappeared with a pile of his clients’ money and I have no idea where he went.

The FTC stepped in and filed a class action against the same bank, and I got paid another $4,000 as my part of the settlement.

In 2011 My wife announced to me (during the week of my birthday, no less) that she wanted a divorce. That divorce became final in June. In November, I retired from my career as a firemedic and began school to be a physician assistant.
In 2012 I decided to leave school, moved back to Florida, and began teaching adult education while remaining mostly retired.
In 2014, I met my current wife. I also applied for my teacher’s license and became a high school science teacher.

In the spring of 2015, my daughter made me a grandfather.

In the spring of 2016, my daughter made me a grandfather for the second time. By the end of that year, I was married again.

In 2017, my new bride and I took a 51 day road trip across the nation, spending two weeks in Alaska in the process.
In 2018, I finally had a net worth of over a million dollars. Not bad for being insolvent less than a decade earlier. We celebrated by spending the summer in Europe.

Of course we all know what happened in 2020, and this led to me leaving the teaching profession and returning to medical work in 2021.

My son, the man I thought would be a committed bachelor until the day he died, got married in 2021.

Fifteen years is a long time, especially for a blog. I wonder what the next few years will bring.

By Divemedic, ago

Airplane Medical Kit

Because of the comments to the post about the doctor on the airplane, I wanted to do a follow up. So let’s first talk about what is in the medical kit on a commercial aircraft. The FAA requires an AED, and a medical kit that contains the following items:

The most common inflight medical events are:

  • Gastrointestinal/Nausea (31%)
  • Neurological, such as fainting or seizures (26%)
  • Respiratory (7%)
  • Cardiovascular (5%)
  • Dermatological (5%)

My wife was on an aircraft flying from JFK to Heathrow where there was a death in flight. The flight attendants cleared out the back row of the plane and put the body on the seats, covering him with a blanket. That is where he stayed for the remainder of the flight.

I myself have been on two flights were there were medical issues. In both cases, the flight crew called for medical personnel. I wasn’t going to volunteer, but no one else did, so I raised my hand. The FA brought me a radio headset that was connected to the airline’s on call doctor, who consulted with me and we agreed upon a course of action.

The first was a moderate allergic reaction (urticaria, wheezes, pruritus) on a flight from Orlando to Boston. The passenger got himself 50mg of IV diphenhydramine and some inhaled albuterol. He was fine and slept the rest of the flight.

The second was on a flight from Las Vegas to Orlando. It was a guy who was having himself an anxiety attack. He was hyperventilating and complaining of shortness of breath, chest pain, along with numbness and tingling to his fingers and lips.

The reason for it was hilarious. He had gotten married to his fiancé (a white woman) while in Vegas. He was Puerto Rican, and was dreading his mother’s reaction when he told her that he had married a woman (who wasn’t Puerto Rican) that his mother hadn’t even met yet. If you know anything about Puerto Rican mothers, you would know that they are much like Italian mothers. He had every right to be afraid.

Anyway, I told the doctor that his vitals looked good and I felt like it was an anxiety attack. The doctor agreed. I traded seats with his wife for about half an hour and talked him down. Once he felt better, I went back to my seat. An hour later, his wife came and got me a second time. During that second visit, his wife told mine that I was a very patient and nice man.

That’s it for my aircraft stories.

By Divemedic, ago

Insurance

I lost the genetic lottery. Let me explain.

  • My father was a type 2 diabetic. He died 18 years ago at 63 years old.
  • My grandmother was a type 2 diabetic. She died 50 years ago at 63 years old.
  • My grandfather died at 56 years old in 1948. It could have been diabetes, but there was no real testing for that back then.
  • You can trace it back. My great-grandfather died at 47 years old, his mother died at 57 years old.
  • My sister has diabetes. My brother does not.

So genetics are working against me here. I was diagnosed with diabetes about 12 years ago, while I was in my mid 40s. I went on a diet and lost 90 pounds. That was good enough to manage my diabetes for the next 6 years.

As you may or may not know, diabetes is a progressive disease. Those with it know that it will progress eventually, and I am medically knowledgeable enough to know that it will likely be what kills me at some point. I am just committed to making that date as far in the future as I can. So I watched what I ate, stayed active, and kept up doctor visits.

At any rate, it was about six years ago that my blood sugar began climbing. My A1C was right around 8. So the doctor put me on Metformin. The doses slowly increased, another drug was added. Still, my A1C stayed pretty good, wavering between 6.5 and 7.5.

My levels slowly have been increasing. Last September, my A1C was up to 7.8. Then in April, my A1C was as high as it ever has been: 10.0. The doctor tested my blood to see if I was still making my own insulin, and I am. So we talked about a few options.

One option is to stay the course. That is the worst of the choices and, considering my family history, will lead to a death within a few years. Not a good choice.

The second option is insulin, meaning that I would have to inject myself at least once per day. There are a lot of drawbacks to that plan, and isn’t much better than option one. I’ve seen for myself that type 2 diabetics don’t do well or last very long once they go on insulin.

The third option was to try one of the new drugs: Trulicity, Ozempic, Rybelsus. The one we decided on is Trulicity. The catch? The drug costs $800 to $1,000 a month. None of the others are any cheaper. My insurance company says that they won’t cover it unless I can prove that I am a diabetic who has tried other, cheaper options, and those options don’t work. The Dr wrote the prescription.

Of course the insurance company kicked it back and demanded more documentation. We provided it. According to their own website, I fit the criteria.

The doctor just called me. The insurance company denied it anyway.

I have some calls to make to try and take care of this. I don’t think that I have any legal recourse, so I have to review my options. It is stuff like this that makes me believe that insurance companies should be liable for malpractice.

By Divemedic, ago

Yesterday

About yesterday’s post. It’s been a trying week. At work in the ED, I had a guy with a serious heart attack (STEMI alert), some COVID patients, and more. The one that took the cake was the woman who was a mother of 3 kids. She was in the middle of a miscarriage and was bleeding to death. Her pulse was 120, her blood pressure was 72/42 and a MAP of 52. Her ER bad looked like a movie murder scene. Watching her fight to save her own life as well as the life of her unborn child, while at the same time watching other people literally fight to kill others. It made for a tough day at work. Emotionally draining.

On top of that, I am trying to complete my CEN certification while at the same time completing my BSN, all while working PRN in the emergency department. This will mean completing my 6th college degree. Lots going on that was physically tiring. Oh, did I mention that I am on the HOA board, my wife is dealing with some (minor) health issues, and I also had to do some minor repairs on the rental?

There are times when the cup is empty, when you are simply out of the energy that you need to do all of the things, and yesterday was one of them.

Today will be better, once I am done with today’s scheduled 3 hour class. I expect to be back to my usual opinionated self this afternoon. Thanks for listening to my venting.

By Divemedic, ago

Again

I haven’t posted in a couple of days. After managing to make it two years without COVID, I have managed to catch it twice in as many months. The odd part is that the two episodes have differed in symptoms.

The first time consisted of large amounts of congestion and coughing that lasted eleven days. I had no fever and COVID tests came up negative, but I lost my sense of taste and smell.

This latest bout had me with a mild stuffy nose and cough, no fever, and only lasted four days. I was so tired, I couldn’t stay awake. I wasn’t sure that I had COVID until my wife got sick, took a test, and it was positive. So I took one too, and what do you know, it was positive. Then yesterday morning, I woke up without a sense of smell or taste. This second bout with COVID has been MUCH milder than the first. The only other symptom is copious amounts of sweating.

I have no idea how we caught it. With my wife being a teacher and me working in a busy emergency room with daily contact with COVID patients, who knows?

By Divemedic, ago