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The ramparts of the neurosurgeon’s mind were unassailable

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An excerpt from Azazel’s Inn.

Pete tried to get into Tommy’s brain and force one Oops Moment. But the walls of the neurosurgeon’s brain were impregnable.

Clancy, unaware that he was fighting on two fronts, tried to spare any brain that had a shred of life, but in places the good brain was so mixed up with the bad that it was impossible to tell where one began and the other ended. Eventually he achieved his surgical goal. A shimmering white cavity remained where the frontal and temporal lobes of Anthony’s brain had been. Maybe he’s better off dead Thought Tommy. But that’s not my calling. I’m only here to do my job. Tommy sighed heavily. “Ours cannot explain why. Ours is do or die.”

and die,” the anesthesiologist corrected.

“What?” asked Tommy.

“The Tennyson poem: ‘Ours is not reasoned why. Ours is just to do and die.’ The soldiers knew they were riding towards certain death. They fought anyway.”

“Hemo-Clip,” Tommy said somberly. A bleeder erupted in the depths of Anthony’s brain. It was a tiny branch that had broken out of the main trunk of Anthony’s basilar artery.

Lee handed him a long, elegantly tapered instrument. It used a tiny steel clamp to pinch off the bleeding vessel.

He’s better off dead. Tommy thought as he guided the opening of the hemoclip over the hole in the inconsequential vessel. And it would be better for his family.

The basilar artery, just a few millimeters deeper, looked as big as a garden hose under Tommy’s loupe. It was one of the main blood sources for Anthony’s brain. If I put the clamp over the basilar, it would surely die. Tommy’s nimble fingers moved the clip back and forth. The mouth of the clip alternated between the tiny branch and the main trunk.

I would do him a favor. His family too.

Pete’s spirit snorted, Do it, Tommy boy.

The clip swung back and forth, from lethal to life-saving.

Thomas thought I certainly wouldn’t want to live if I was doomed to be hemiplegic and aphasic.

pete huffed, You want it too. Just do it.

Back and forth, from life-saving to deadly.

Thomas thought Repelling him would be a mercy.

Pete was seething with frustration. He couldn’t crack Tommy’s skull in. He was a helpless spectator.

Tommy pulled the trigger and pinched the tiny tributary. Ours cannot explain why. He withdrew his hand, leaving Anthony’s crucial basilar artery intact.

This damn hospital has been a thorn in my side since it openedPete bleated.

Marc Arginteanu is a neurosurgeon and author of Azazel’s Inn.

Photo credit: Shutterstock.com


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Montana calls for oversight of nonprofit hospitals charity gifts

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Montana health officials are proposing to monitor the charitable contributions that nonprofit hospitals make in their communities each year and set standards to justify their access to millions of dollars in tax exemptions.

The proposal is part of a package of legislation that the state’s Department of Public Health and Human Services will ask lawmakers to approve when it convenes in January. It comes two years after a state audit called for the department to play a stronger oversight role, and nine months after a KHN investigation found some of Montana’s wealthiest hospitals are lagging behind state and national averages in community donations .

Montana State Senator Bob Keenan, a Republican who has questioned whether nonprofit hospitals deserve their status as charities, said the proposal is a start that could be expanded later.

“Transparency is the name of the game here,” Keenan said.

The IRS requires nonprofit hospitals to count their “health promotion” spending to benefit “the community as a whole.” How hospitals credit such contributions to justify their tax exemptions is opaque and varies widely. National researchers studying community performance have called for tightening standards for what counts towards the requirement.

Montana is one of the latest states to consider introducing new rules or increasing oversight over nonprofit hospitals amid questions about whether they pay their fair share. dr Vikas Saini, president of the national health think tank Lown Institute, said people in California at both the state and local levels are considering whether to oversee hospital community performance and enforce new standards. Last year, Oregon introduced a minimum amount that nonprofit hospitals must spend on community services. And Massachusetts has updated its community service guidelines in recent years, urging hospitals to make more detailed assessments of how spending aligns with identified health needs.

Montana hospital industry officials said they wanted to work with the state to shape proposed legislation, which they said the industry would support if it did not conflict with federal regulations. Saini said to be effective, laws would have to go beyond federal requirements.

In recent years, more and more people like Keenan and Saini have questioned whether nonprofit hospitals contribute enough to their communities to deserve the big tax breaks they receive while becoming the city’s largest corporations.

“Hospitals are like the pillars of communities, but people are starting to ask these questions,” Saini said.

Saini’s institute reviews hospital donations each year and has found that the majority of nonprofit schemes nationwide spend less on what the institute calls “meaningful” services than the estimated value of their tax breaks. Actions counted by the Institute include financial assistance to patients and community investments such as food aid, health education or services provided at a loss, including addiction treatment.

The 2020 Montana Audit found hospitals benefit vague and inconsistent in the state report, making it difficult to determine whether their status as a charity is warranted. However, state legislatures did not address the issue during their 2021 biennial term, and a memorandum from the Legislative Audit Division issued in June found that the state health department has since made “no significant progress” in developing an oversight of charitable donations by nonprofits made hospitals.

KHN found that Montana’s nearly 50 nonprofit hospitals spent an average of about 8% of their total annual spending on charitable causes during the fiscal year ending 2019. The national average was 10%.

In some cases, hospital donation rates have since declined. For example, in the fiscal year ending 2019, Logan Health-Whitefish — a small hospital that’s part of Flathead Valley’s larger health care system — reported that less than 2% of its total spending went to charitable causes. In its most recent available documents, the hospital said it spent less than 1% of its spending on welfare for the period through 2021, while making $15 million more than it spent.

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Logan Health spokeswoman Mellody Sharpton said the medical system’s overall community benefit is nearly 9% of its spending and reaches its six hospitals. It also has clinics throughout the valley. “It’s important to consider the benefits our organization brings to the community as a whole as our facilities work together to ensure the appropriate care is provided in the appropriate facility to meet the healthcare needs of our patients,” Sharpton said.

State health officials are asking lawmakers to allow the agency to draft a bill that would give the Department of Health clear authority to require hospitals to submit annual reports that include data on community services and charities. The measure would also allow the Department to develop standards for these charitable spending, as described in the Department’s proposal.

“We see a great need to get the ball moving here,” Charlie Brereton, chief of the state health department, told lawmakers in August.

Montana Hospital Association President Rich Rasmussen said his organization wants to work with the Department of Health to refine the legislation, but said the definition of what counts as benefits should remain broad to allow hospitals to focus on the most pressing needs their region can react.

In addition, the hospitals are already working on their own reporting standards. This year, the association created a manual for members and set a goal for hospitals to report their services to the community consistently by 2023, Rasmussen said. The association declined to provide a copy of the manual, saying it will be available to the public once hospitals are trained to use it later this fall.

The association also plans to launch a website that will serve as a one-stop shop for people who want to know, among other things, how hospitals report on community services and address local health issues.

Republican Rep. Jane Gillette said she supports increased Health Department oversight and the idea behind the association’s website, but doesn’t believe the hospital industry should produce this public resource on its own. Gillette said she plans to introduce legislation that would require hospitals to report data on community services to a group outside the industry — like the state — which would then publish the information online.

In the past, hospitals have resisted attempts to introduce new rules for the issuance of benefits. In an interview with KHN last year, Jason Smith, Bozeman Health’s then chief advancement officer, said the system supported efforts to improve reporting of posts “outside of new laws,” adding that hospitals could do better without “government regulators to use”. arena with us.”

When asked if the health system still stands by the statement, Denise Juneau, Bozeman Health’s chief government and community affairs officer, said hospital officials hope any new laws will be aligned with existing federal guidelines. She said Bozeman Health will continue to work with the Montana Hospital Association to define and provide better information on community benefits, with or without new legislation.

A lawmaker would have to support the state’s proposal by mid-December to keep it alive.

Kaiser Health News is a national health news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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House passes bill addressing mental health concerns among students, families, educators

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The House passed legislation on Thursday aimed at addressing the mental health problems of students, families and educators, exacerbated by the COVID-19 pandemic, which lawmakers said have had a “severe impact” on those three groups.

The invoice, entitled Mental Health Matters Act., passed in a broadly partisan 220-205 vote. One Republican, Rep. Brian Fitzpatrick (Pa.), joined all of the Democrats in attendance in support.

The bill, if passed by the Senate and enacted into law, would provide grants to establish a pipeline for school-based mental health professionals. Additionally, it would increase the number of mental health professionals in elementary and secondary schools located in high-need locations.

The measure would direct the Department of Education to allocate these grants.

The Department of Education would also be directed to provide grants to state education boards to hire and maintain school-based mental health service providers in public elementary and secondary schools that are deemed to be badly needed.

The passage of the bill comes approximately two and a half years after the start of the COVID-19 pandemic, which has led to the further spread of mental illness.

That World Health Organization unveiled in March that in the first year of the pandemic, the prevalence of anxiety and depression increased by about 25 percent worldwide.

The 2022 KIDS COUNT Data Book, released in August, revealed that about 1.5 million children in the US experienced depression or anxiety in the first year of the pandemic.

Rep. Mark DeSaulnier (D-Calif.), the sponsor of the bill, said his legislation was needed to address the impact of students who have mental health concerns on schools and educators.

“Educators have been forced to play an outsized role in supporting and responding to students’ psychological needs, leading to increased depression and trauma among educators, their students, and the families and community. However, our schools do not have the specialized staff needed to respond to the increasing prevalence and complexity of student mental health needs,” he said.

“Put simply, the Mental Health Matters Act provides the resources students, educators and families need to improve their well-being.” Added DeSaulnier.

Rep. Virginia Foxx (NC), the top Republican on the Education and Labor Committee, said the “country would be better off without” the legislation on the ground.

She specifically criticized the provision that allows the Secretary of Labor to levy civil fines on plan sponsors and administrators of group health plans if they fail to meet parity requirements related to mental health.

“Provide [the Department of Labor] having the power to impose civil fines on plans and increase the risk of litigation will only force the plans to end mental health coverage,” Foxx argued.

“This money should be better spent on helping with compliance rather than targeting employers based on ambiguous standards,” she added.

The law also requires that students arriving at college have access to disabled housing if they have documentation showing their disability, and will introduce a grant program to increase student access to evidence-based trauma support and mental health services through projects that connect schools and local education agencies with trauma-informed support and psychiatric systems.

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The HCD 10: Kimberly Cowman, Building Professional

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After 17 years leading engineering teams focused on healthcare, Kimberly Cowman was promoted to her current position as National Director of Engineering at in 2019 Leo A Daly. This role gave her the opportunity to further pursue her career-long passion and professional mission of increasing awareness and acceptance of sustainability and high-performance design in healthcare and beyond.

She believes that healthcare has not only an opportunity but also a responsibility to transform the way its buildings function and lead the way in creating more sustainable and healthier places.

“As designers, we not only have a direct impact on the climate-related outcomes of communities, but also on the health outcomes of the people who inhabit healthcare facilities,” she says.

For example, in 2021, Cowman helped found Leo A. Daly’s enterprise-wide Design Integration Group (DIG), which strives to drive an integrated design agenda focused on high-performance building outcomes. The group’s efforts include cross-sector benchmarking, including two major hospital projects: Veterans Hospital in Tulsa (VHiT) in Tulsa, Okla. and St. Francis Hospital in Muskogee, Okla. Integrated design workshops involving representatives from across the design team and different design disciplines were brought together for each of these projects to identify performance targets such as: B. for the energy consumption intensity (EUI), and to find design strategies that could lead to a more efficient design.

These efforts included considerations of thermal comfort, site community, daylight supply, and indoor air quality, among others. Cowman believes that by working to develop a design culture around interdisciplinary solutions, the industry can make greater strides toward achieving goals related to energy conservation, carbon reduction and healthier indoor environments.

In the meantime, she frequently offers her knowledge to help advance the industry through publications, speaking engagements, and more. Her recent work includes the white paper, Raising indoor climate to reduce the spread of pathogens, which explores new approaches in building design to slow the spread of COVID-19 and other airborne pathogens, and outreach to promote Energy Star adoption indicates certification in healthcare facilities.

Cowman advocates Energy Star certification in healthcare facilities to address a facility’s operational energy impact and to focus on finding efficiency opportunities throughout a building’s operating life.

click here to learn more about all winners of the HCD 10 2022.

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