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Why Georgia matters

Even failed “progressive” actions by US legislators are rarely, if ever, reversed. Often, they enable broader progressive changes.

As I write this, it’s nine days after the 2020 election and we still don’t know who will be inaugurated as President of the United States. In spite of the precipitous “calling” of the election by the AP an other media for Joe Biden, the actual result is not a given due to close votes in several States. Lawsuits and recounts will likely play out at least until the day of the Electoral College vote, December 14, 2020, if not beyond.

Georgia officials have announced that they will conduct a recount and audit of the vote in that State because the difference in the Presidential election votes is about 0.2%. There’s a chance that the State will determine who will be sworn in on January 20, 2021.

But the biggest impact for the State may be as a result of another election. (Or, technically, two elections.)

On January 5, 2021, the State of Georgia will hold a run off election to determine both of their Senators. Currently, it appears that both races can be handily won by the Republicans if they turn out as they did on November 3, 2020.

(Each race had several candidates and Georgia requires a majority to win. Republican John Purdue beat Democrat Jon Ossof 49.7% to 48%.

While Republican Kelly Loeffler only received 25.9% of the vote in the Special Election compared to the 39.2% won by Democrat Raphael Warnock, the other Republicans in the race bled off Loeffler’s votes have endorsed her, including Doug Collins, who had 19.9% of the vote.)

In the event that Joe Biden wins the Presidential election each of us, regardless of Party affiliation, should ask ourselves whether the current crop of Democrats can govern without turning our Nation over to the chaos that is the status quo in many of the cities they already govern.

In addition, it’s imperative to remember the consequences of compromises and the influence of the Left on policies of the future.

Take an example from my profession: 1993’s “HillaryCare” debacle. Hillary Clinton’s plan to centralize health care to impose universal, single-payer government financed health insurance failed due to closed door meetings and a chaotic lack of political planning. It still resulted in SCHIP, HIPAA, the Balanced Budget Act of 1997 that removed all privacy from medical records and forced utilization of mid-level medical personnel as employees of “providers,” the ridiculous idea that cutting numbers of physicians by restrictions on funding for residencies would save money for Medicare, and ultimately, ObamaCare.

The Republicans have already won 50 seats, at least, but that is no majority and ties would be settled by the vote of the “President of the Senate,” the Vice President of the United States. In the event that Biden is the final winner of the Presidency, those ties would go to Kamala Harris – or her VP after Joe resigns or is unseated.

It’s a cliché that we’re likely to hear slot in the next 2 months, but do keep Georgia on your mind.

Dueling Statements by “Experts:” More COVID-19 politics

The blatant political and personal attacks on the integrity and qualifications of the three original signers of the “Great Barrington Declaration” (“GBD” or “Declaration” ), Dr. Martin Kulldorff, Dr.Sunetra Gupta, and Dr. Jay Bhattacharya by the reactionary “John Snow Memorandum” (the “Memo”) are more prominent than any legitimate criticism, much less an honest breakdown of the science behind it.
Look at this Guardian article. Then there’s the Lancet’s editorial.
The Declaration’s original authors are three physicians, extensively published instructors at prestigious teaching institutions. They are acknowledged epidemiologists immunologists, experts in vaccine development, biostatistics, economics & health care policy. The article refers to the author’s as “defiant” “professors” & contrast them with the “scientists” who disagree.
Yet, the words “physician” or “Doctor” do not appear in the Guardian article, at all. There’s absolutely no discussion of the GBD author’s qualifications. Instead, the argument turns immediately to politics, and blaming the supporters of the earlier document for the response of the latter.
The reactionary “John Snow Memorandum” was written a few days after the GBD was announced. The Memo authors oppose the GBD mainly by claiming their own purity of agenda, free of both politics and financial interests. They imply that the Declaration is tainted because of backing from the economics think tank, the American Institute for Economic Research, which is supported by business donors and investment fund that sponsored the original conference presentation.
The Memorandum authors paint with a broad brush to discount natural immunity, insisting that the only way for governments to react to COVID-19 is to mandate total lockdowns and strict isolation of entire populations until acquired immunity from a vaccine can be implemented. The Memo doesn’t give us any guidelines to enforcing the mandates, they throw pejoratives like the Guardians’ “deniers,” or “right-wing” (and “creationists !”), as though the GBD signers disavowed any use of common sense infection control such as hand-washing, distancing, or masks.
Significantly, the CDC, Journal of the American Medical Association, and theUK’s Office for National Statics

The major points of discussion ought to be that by some estimates deaths due to the lockdowns and restrictions

equal or exceed the deaths due to infection, and that protecting the vulnerable by “focused” isolation, hand washing, and masking of the vulnerable where needed is much more achievable and humane than using laws legally mandating these same measures (along with fines, involuntary quarantine, intrusion in private realms and appropriate total isolation), in an attempt to protect everyone for another year or so.

On Blame

Amid sanctimonious reassurance that they don’t wish bad things on the President – or his “cronies” – Facebook, Twitter, and, certainly, the media are claiming that the President is responsible for each and everyone of the US deaths due to COVID-19.

(I won’t link to the sites, giving them more traffic. It’s easy to find samples.)


What would you have done? Scare tactics? Usurp State & local government with Federal force?

How would you shut down the economy and our kids’ education even more severely without imposing martial law, forbidding even “mostly peaceful” protests, using military guns to enforce your edicts?

The people getting sick aren’t just “Trumpsters” running around in MAGA hats at the White House.

In fact, most cases are nursing home patients and household contacts, people who necessarily live together.

And just as many, if not more, have died of suicide, overdoses and homicide – in addition to the increase of deaths due to heart attacks, strokes, and Alzheimer’s because of the lockdowns and lost jobs and businesses.

From Milwaukee, “[D]eath tolls would amount to 514 overdoses, 455 COVID-19 deaths, 193 homicides, and 120 suicides.”

And, no, the President hasn’t “lied” about the serious nature of the virus. In my opinion, he has chosen to give the best case, rather than worst case scenario whenever possible.

Consult this (Dr.) Atlas

Dr. Scott W. Atlas, former Chief of Neuroradiology at Stanford University Medical Center, current Senior Fellow at Stanford’s Hoover Institute, author, and public health policy consultant was added to the White House COVID-19 task force this week. Unfortunately, he and his appointment have already become a political target by some.

Far from being unqualified, or someone who “clearly wouldn’t know science if it kicked him in the atlas” (see above link – I refuse to give clicks to the original source or the ignorant woman who spoke those words), Dr. Atlas speaks common sense, science-based truth, as in this video from 23 June, 2020 interview with Peter Robinson of the Hoover Institute’s. “Uncommon Knowledge.”

In fact, Dr. Atlas states what I’ve been saying since I heard about the virus outbreak in Italy, while attending Carnivale parades just a few miles away in

Carnivale float, Nice France, depicting Chinese labor in Fashion industry.

Nice, France: the reaction by governments and fearful people has been just as bad if not worse than the results of the infection itself.

The initial lockdown was correct, but we have new data – and new models – every day. Yet, we are still acting as though the early models were accurate.

Worse, instead of “flattening the curve,” the call is to conquer or eliminate the virus “at all costs.” The latter has never happened and will never happen with a Coronavirus. There is the possible exception of the elimination of smallpox, a much more deadly disease, at the cost of egregious human rights violations and even deaths.

I’m surprised that anyone would attack Dr. Atlas or his qualifications. Before you dismiss him, please listen to his testimony and critique the facts rather than the source.

43% of COVID- 19 deaths linked to nursing homes

Traditional germ theory explains the deaths & spike in COVID-19 cases in the US better than any political accusations going around. But, some politicians do carry real blame, however denied:
“”You had this political conspiracy theory that the deaths in nursing homes were preventable,” said Mr. Cuomo.””

At a press conference today, New York Governor Andrew Cuomo insisted that his March order requiring NH’s to accept COVID positive patients from the hospital didn’t cause deaths – in spite of the fact that it’s estimated that those orders caused more than 6300 such transfers.

The NYTimes previously reported 43% of COVID19 deaths have been linked to nursing homes.
State NH deaths

Click to view the percentage of death in NH by State

The problem with the spread of disease has been a lack of common infection control where it counts: in the care of the most vulnerable in nursing homes (“NH” ) and hospitals, as well as the failure to protect healthcare workers who come into close contact with the vulnerable and infected — and who travel between facilities & the community.
The first reported US case led to an outbreak in a Washington State nursing home and the local hospital. It began after a traveler returned from China – while that country still denied person-to-person spread – and sought treatment at the hospital. Employees carried it between facilities and into the community.
In spite of this history, New York & New Jersey governors each ordered nursing homes to accept COVID positive patients from the hospital & the Minnesota Department of Health insisted that hospitals discharge positive patients back to NH’s that weren’t prepared. It’s estimated that 1/4 of NY NH workers contracted the disease between March and June.

NY didn’t mandate NH testing until mid-May. NJ required testing by May 26th!

The Atlantic” gives more details about the lack of anticipation about the NH risk in a July 6 article.
The cycle of poor infection control in facilities caring for the vulnerable elderly – with inadequate protection for residents, employees, & their contacts – spread the virus.

Wear a mask if you, too, are at risk or will spend time with someone who is. Wash your hands! But, please don’t politicize this disease.

To kill or not to kill – or even to call it killing?

It seems that an advocate of Euthanasia and Assisted Suicide (EAS), which is legal in Canada since 2016, complained to the “The Protection of Conscience Project” administrators about their use of the word, “killing,” rather than “Medically Assisted Death” (MAD) when writing about the law. The wording of the objection exposes the potential limitations even on thoughts, much less the act of refusal, of physicians who object to participating in EAS.

In response, Sean Murphy, an Administrator of the Project, discusses and defines the acts and prohibitions involved in EAS, threatened conscience protection in law as decided by Canadian legislators and courts, and policy statements of the Canadian Medical Association.
A recent case decided by the Supreme Court of Canada considered “whether or under what circumstances physicians and institutions should be allowed to refuse to provide or collaborate in homicide and suicide.” While the Canadian courts have not made it illegal to refuse, the author points out that the Canadian Medical Association now considers EAS medical treatment. Although refusal isn’t illegal, if it becomes “unethical,” the licenses of conscientious objectors may one day be at risk. (Mr. Murphy let me know that the CMA is trying to respect both views)*
Just as all inalienable rights are dependent on the protection of the right to life, all medical ethics principles (autonomy, beneficence, justice) are based on the foundation of nonmaleficience, “Cure when possible but, first, do no harm.” This is the First Principle of Medicine.
The editorial gives an useful “litmus test” for discerning between ethical and unethical acts carried out under the umbrella of medical therapy: it’s considered a “failure” if the patient doesn’t die as a result of EAS.
In contrast, the intent of withdrawal or withholding medical treatment is not necessarily to cause death, but to stop acts that are unwanted or medically inappropriate because they do not heal, cure, slow the progression of the disease or relieve pain and suffering, but actually exasperate suffering and may cause damage beyond that inflicted by the disease.
To use a current case in the news in the USA (which I recently covered here), Baby Tinslee Lewis’ doctors wish to withdraw life sustaining treatment that they believe is medically inappropriate. The doctors would not consider it a failure if, rather than die of her severe heart and lung damage, she continued to live.
Canada is already far down the slippery slope of mandating participation in induced (elective) abortion and “MAD” by designating each as “therapeutic and medical services.” The Project Conscience authors rightly predict the possible consequences:
“[I]f the state can force unwilling people to kill or help to arrange for the killing of other people, there would seem to be nothing that the state cannot demand of its citizens. This would promote the development of dangerous forms of authoritarian and even totalitarian government: ultimately more effective and deep-rooted, perhaps, within a democratic framework than they ever have been in dictatorial regimes.”

(*EDITED An earlier version stated that licences were at risk. Not yet.

BBN 11 February 2020 12:30 AM)

More thoughts on Texas Advance Directive Act

I was asked about the #BabyTinslee case and what we should do, what can we do, in the disputed cases.

We need to educate more. People don’t understand basic medical ethics in this day of “choice.”

Autonomy doesn’t supersede nonmaleficience. In other words, the First Principle of medicine, “Cure when possible, but first do no harm,” always should guide us, rather than “wants” or “choice.”

In the end, doctors are the ones actually performing the acts and we’re most likely to understand the projected outcome. We benefit from oversight by colleagues and the community, both informally and in the process prescribed by the Texas Advance Directives Act.

Some people demand that every one of these cases go to court, for “due process” and “cross examination.”

But judges and courts can’t be as knowledgeable as doctors are. Their decisions are necessarily informed by dueling (paid) lawyers and (hired) medical experts.

In all the cases that have gone to court, the family has had quite a lot of notice, but the 48 hour notice before the committee meeting is perceived as too abrupt, especially since the relationships all appear to be adversarial by that point.

(And who could get your family to a meeting in 2 days?)

The 10 days isn’t thought to be long enough to arrange a transfer, either. Again, in many of the Court cases, the attempts to find another doctor willing to accept the patient’s care has begun before the committee meeting.

Doctors acknowledge the great trust and privileges we are given by agreeing not to abandon our patients. When we have a disagreement with a patient or surrogates (usually a familymember), we accept that we must continue treatment for a period of time. But not indefinitely.

If we could get the reforms that have been attempted to lengthen the statutory timeframe (multiple times) since before 2005, the TADA would be much better. It’s still the best process we have, currently.

Doing to, not for (Baby Tinslee & TADA)

“We’re doing things to her. Not for her.” (Wini King, spokesperson for Cook’s Children’s Hospital, January 3, 2020) This may be the best description of a very sad case. 

Tinslee Lewis was born prematurely on February 1, 2019, with severe heart and lung defects. She had cardiogenic shock and was admitted to the Cardiac ICU at Cook’s Children’s Hospital immediately. ♡(See Cardiac Pathology ♡below.)

Even after three open heart surgeries, a fourth to close her sternum, a short time on ECMO (essentially, heart-lung bypass) and constant ventilator since July, of 2019, Tinslee’s enlarged heart and small, damaged lungs can’t keep up with the necessary blood circulation and exchange of oxygen and carbon dioxide, even with the assistance of multiple blood pressure medicines, diuretics and the ventilator on high, except when she’s still and quiet with the help of sedating and paralyzing drugs.


In response to a lawsuit against Cook’s Children’s Hospital,  where Tinslee has been in the CICU since birth, Tinslee’s medical records were submitted to the Court.  I’ve been able to review approximately 200 pages that are now public record, describing the constant,  repetitive interventions necessary to keep Tinslee alive on the ventilator.  

Tinslee’s doctors (and, the notes show, the nurses and staff) believe that they are being forced to cause Tinslee pain and suffering, while keeping her paralyzed and sedated. They report increasing difficulty with managing the ventilator so that her damaged heart & lungs can maintain oxygenation. She requires repetitive heart, lung and blood tests to guide adjustment of meds & treatments and has had several infections requiring treatment. In contrast to my earlier presumption, the notes in the records show that the ventilator and all its required meds and manipulations are indeed causing undesired problems, including fluid overload, infections and cardiopulmonary distress, in addition to her underlying lung disease. Even the baby’s growth, something we usually celebrate, increases her risk of cardiopulmonary insufficiency. 

Those records also contain notes from many attempts to explain and council Trinity Lewis,  Tinslee’s mother,  about her baby’s underlying problems and prognosis and the reasoning behind, in contrast to some past media reports.

Ignoring the fact that doctors, not hospitals, practice medicine in Texas, Texas Right to Life Lawyer Joe Nixon is quoted, claiming that the “hospital ” has decided to withdraw treatment. Texas Attorney General, Ken Paxton, is shown to have Tweeted that the problem is a “legal issue,” rather than an ethics and justice matter of forcing doctors (and by their orders, nurses and other staff) to cause pain and suffering for a little girl who is dying as her body fails to heal, in spite of every intervention possible.

Many people, out of compassion, object that “the family ” should decide when to withdraw life support. Yet, the family  members aren’t watching the oxygen levels drop while they rinse Tinslee’s airways with a bicarbonate solution to keep her lungs clear. And it’s certainly not the lawyers that are probing, injecting, measuring and adjusting constant, innumerable hourly interventions done to a baby who must be sedated and paralyzed to prevent cardiac and respiratory distress. 

In spite of the diligent  complicated interventions and care of the doctors and nurses at Cook’s, there have been comments in blogs and social media that the “hospital” wants to “kill” Tinslee. Startlingly,  AG Paxton called the latest Court ordered, indefinite hold on removal of life support  a “Stay,” as though the doctors, not her multiple medical problems, would kill Tinslee. He also misrepresents the process that Cook’s Children’s Hospital and Tinslee’s doctors followed,

“The statute fails to require that physicians provide an explanation of why they refused life-sustaining treatment and provide the patient’s family with adequate notice and opportunity to argue their position prior to the committee reaching a decision, effectively allowing the government to deny an individual’s right to his or her own life and to do so without due process.”

In fact, though, it is the lawyers, particularly at Texas Right to Life, who are turning a little girl’s tragedy into a continuation of their legal battle against the Texas Advance Directive Act. I’ve covered the benefits of and the struggle to improve the Act – repeatedly blocked by TRTL and their lawyers – for years on both WingRight.org and Lifeethics.org

The Act, TADA, was hammered out in 1999 by a group of stakeholders   including  patient and disability advocates, hospitals, doctors, ethicists and lawyers. Texas’ prolife organizations,  including TRTL and the organization for which I served on the Board of Directors for 15 years, Texas Alliance for Life, and for whom I wrote this essay.  

Briefly, TADA allows a balance and legal options when there’s a difference in opinion between a patient’s desire for a given treatment and the medical judgment (a combination of education, experience, and the standard of care) of the doctors who are tasked with the most difficult medical and surgical cases. 

I’ll admit that it’s my opinion – and only my opinion – that the lawyers hate that TADA provides a safe haven from lawsuits if doctors follow the law (!). I slowly came to this conclusion over the years because at virtually every Legislative hearing and stakeholders’ meeting about any changes to the Act, the lawyers bemoan the fact that doctors don’t have to go to court over each of these cases and that they face no legal penalty or “liability.” 

Poor Tinslee Lewis will most likely never leave the hospital alive. Disease and death don’t respect “due process,” but, they are predictable and an inevitable part of life. Hopefully,  we will see her mother and those who love her come to find peace with her death, celebrating the time they’ve had to be with her, especially these last 2 months. However, I fear that the lawsuits will continue for years, adding to their grief.

Edited 1/19/2020 for a typographical error: in the secondparagraph, “cardiogenic” replaced “carcinogenic.” BBN

♡Ebstein Anomaly – Cardiac Pathology 101, about as simple as I can make it (and understand,  too);

Ebstein Anomaly
(Thanks to Mayo Clinic)

Babies born with Ebstein Anomaly have a malformed right and atrium and ventricle and misplaced (tricuspid) valves between the right sided ventricle and atrium. The larger right ventricle can’t pump efficiently. 

In addition,  the blood the right ventricle tries to pump into the lungs leaks/flows/churns (risking blood clots) back into the right atrium, which grows even bigger, with even thicker walls. The ventricle also grows bigger. When the  muscle fibers of the chamber walls get stretched apart enough, they are less inefficient. (Think of two hands gripping at the fingers. The farther out the grip, palm > 1st joint  > fingertips,  the less strength and pull on the opposite hand.) (For the geeks: Frank-Starling law.

The lungs aren’t efficiently filled with blood, they don’t expand, the pressure builds up in them and efficient exchange of gasses doesn’t take place. 

In the meantime, the blood backs up in the body, the liver, kidneys and extremities & eventually the left side of the heart, which can hypertrophy , too. 

The enlarged heart puts pressure on the lungs and nearby soft tissue,  including the blood vessels coming to the heart.

The combination of leaking high pressure blood vessels and the body’s increasing fluid in order to try to pump what oxygen there is, leads to edema or swelling of the body.

Sometimes,  the fetal atrial-septal defect stays open, allowing mixing of the un-oxygenated blood from the right, with the oxygenated blood. This malfunction can help, temporarily. 

With the high pressure, poor flow, and actual physical damage due to the mass of the heart, none of the organs can function well. Increased activity, stress, and growth will increase the demand for oxygen, kidney & lung function.

Washington Post attacks Life via Texas

The Washington Post distorts history and geography to advocate for abortion- and for the Democratic Party.
The Texas Medical Board this year reported that 25 Counties don’t have any physicians at all. Many Texas Counties are health care shortage areas because of there’s not enough population to keep doctors busy. And many high population centers are shortage areas because Texas has a doctor shortage over all.
In 2011, Texas cut virtually every item on our budget due to the requirement of the State Constitution to balance our budget. One measure used to balance the budget was to focus State healthcare dollars on County clinics and hospitals that provide comprehensive, continuing – not single organ system – care.
Then, in 2013 we prioritized public and county clinics and hospitals over those single-issue facilities. Planned Parenthood was never mentioned, nor were the other abortion providers in the State. If the clinic or group took care of the whole patient and didn’t provide abortions, they would be eligible after County and State funded health care was funded.

We could have done more if President Obama hadn’t blocked Texas from receiving Federal Women’s health or Family planning funds. Texas taxpayers paid into that Federal fund, but were denied its return to us. Texas did our best to fill in the gaps this lost funding created, allocating $32M of our State tax funds to Family Planning and Women’s Health programs in 2013-14.

In 2015, when the budget improved, we increased State spending for Women’s health and Family Planning beyond historic amounts. In 2019, nearly $400M was allocated, including raising the cut off for eligibility to 200% of the poverty level. $15M+ was set aside to improve post-partum care.

The main goal of the opinion piece is not only to increase State and Federal funding for Family Planning and Women’s Health. The author, Richard Rival of San Antonio, attacks Texan’s science, religion and assumes that government should consider elective abortion an integral part of “reproductive health” programs.

Nevermind that science affirms that the life of each human begins at fertilization. Or that “reproduction” has obviously occurred before any woman has an abortion, ending the life of that other body, her child. (Yes, one commenter tried to tell us that not only women seek abortions.)

But it’s the last paragraph that tells the truth about the author’s agenda, with a little side dressing of racism. Mr Rivard tells voters to end the ,”one-party state” – to force taxpayers to fund elective abortion for both citizens, non-citizens, and illegal aliens alike.

Beverly B Nuckols, MD

Edit 8/21/19 5:15 EST (France time) to fix typos. BBN

Why does TRTL lie? (UPDATE)

I can’t tell you why, but it’s true: Well below their “Donate Now” banner, Texas Right to Life (TRTL) is shamefully spinning another one of their false stories.
Just as they lied on their website that Chris Dunn was “slain by his doctors,

they now post that a woman, Mrs. Carolyn Jones, had to be “rescued” from hers, “racing” to another facility “in the middle of the night.”

Okay, it’s night in that picture. That and the proper names are the only things they got right.
Mrs. Jones wasn’t “rescued” from the hospital that has been giving her excellent care for over 6 months. Nor were her doctors and nurses “surprised.” that she was able to breathe on her own. After all, they were the ones who weaned her from the ventilator over a month ago.
What was expected was that Mrs. Jones would be transferred out if the hospital where she’s been admitted since November, 2018 to a more appropriate, lower level of nursing care two months ago.
On April 10, Mr. Jones testified to the Texas Senate Health and Human Services Committee that, thanks to the hospital doctors, his wife now needed the ventilator only “occasionally at night.”

The family were given notice that they needed to transfer Mrs. Jones in March. They’ve had another doctor and three facilities capable of providing the treatments she needs waiting to accept Mrs. Jones.

When the family of a hospitalised patient refuses to allow her to be transferred to a more appropriate treatment facility, the attending doctor has no legal means other than the 166.046 process laid out in the Texas Advance Directives Act (TADA). This is the legislation that has been called the “Futile Care Law” in the past, but TRTL likes to call it the” 10 Day Rule,” now, in spite of their rejection of effort after effort, etc., to expand the time frame and increase transparency and assistance. This is the issue that led to the rebuke (.PDF) of TRTL by the Texas Conference of Catholic Bishops and gleefully reported by the liberal press in Texas
The Jones family are real people, scared and hurting. Mr. Jones somehow was misled to believe the lie that “food and water” would be removed. I would have thought that at least one of the many, many lawyers at TRTL would have assured him that that is not legal under Texas law.
Instead, the Jones family’s fears – and your compassion – are being used as a means to TRTL’s political – and fundraising – ends.

And now, TRTL – in direct competition with – and with absolutely no mention of – Mrs. Jones’ family’s GoFundMe campaign – has been raising money in Mrs. Jones’ name. They state that the funds will be used for (TRTL) lawyer’s fees in addition to Mrs. Jones’ healthcare needs and that “excess” funds will go to help (TRTL’S) efforts for other patients.

I hope that TRTL’s money will also be used to pay for the very large hospital and doctor’s bills that the Jones family will receive. While there’s a chance that Texas Medicaid will pay for three months of medical bills, retroactively, Medicare doesn’t pay for hospitalizations over 90 days and has a 20% co-insurance (co-pay).

That’s bound to have added up in over 6 months.

We’ll just have to trust that TRTL won’t lie again.

Beverly B Nuckols, MD

Edit, Updated information:

One of the bloggers has told us more about that “rescue.” (Or today’s story, anyway.)

TRTL put her in a private ambulance and took her to *another ER,* one that couldn’t provide dialysis, so they then transferred her somewhere else.

There were comments about the first Hospital refusing transfer — no, refusing to be complicit with “dumping” a patient. Discharging to without ( or even with) acceptance of the transfer from the docs at the other facility is highly irregular and likely illegal.
Much has been said about funding. Yes. It appears that Medicare funding ran out, so no longer paying. 90 days per admission, with an extra 60 days over, under certain conditions.

About that Medicaid funding: I don’t know the limits of the mandatory asset tests, but the yearly income level is $60,000. One way to adapt is to spend money on medical costs.

Medicare makes it difficult to navigate the private pay process. When we had some question, we got informed consent, promise to pay, then performed the service, filed with Medicare, waited to be denied, then tried to Bill the patient. The risk is always a charge of “fraud and abuse.”

The same thing would have happened if the hospital had privately charged for Dialysis.

(5/20/19, BBN)

False story about Texas Advance Directives Act (TADA)

I’m a subscriber to the new reader-supported online news site, The Texan which is the project of former State Senator, Konni Burton, having recently paid for the annual subscription. (A heads up: if you click through on all my links, you’ll risk using up all your free views this month.)
But I’m disappointed to see a definite spin in today’s news story about the Texas Advance Directives Act (TADA), even though one of my WingRight blog posts is quoted.

TADA isn’t just for disagreements over whether CPR and ventilator support are “medically inappropriate treatment” It covers any dispute between the doctor and the hospitalized patient when “the attending physician refuses to honor a patient’s advance directive or a health care or treatment decision made by or on behalf of a patient.” (emphasis mine) This could be demand for inappropriate surgery or medications or if the patient refuses to leave the hospital or be transferred after 6 months, for instance.
From all the previous news reports and blog posts, her husband’s testimony to the Senate Health and Human Services Committee, and a few of my blogs, Mrs. Carolyn Jones’ case seems to be a disagreement over whether to transfer her from the hospital, where she’s been admitted and improving for about six months.

Mrs. Jones is not dependent on the ventilator.

In fact, it sounds like Mrs. Jones has had excellent treatment at the hospital,

even after the Committee meeting on March 8.

Mr. Jones told the Texas Senate Health and Human Services Committee that the doctors at the hospital successfully weaned Mrs. Jones from the ventilator.

He also said that three other facilities are ready for her admission.

Drew White, Senior Editor of The Texan, and I communicated by email over the weekend, after I wrote to explain some errors in the news coverage.

I’m happy to see that today’s article by reporter Tony Guajardo quotes both opponents and supporters of TADA and corrected the impression that Mrs Jones is dependent on the ventilator: “She requires dialysis, occasionally needs a ventilator for breathing assistance, and uses a feeding tube.

All of these treatments are routinely provided at lower level of care facilities, other than tertiary hospitals.

And yet, today’s The Texan article still misrepresents this case: “UPDATE: Recovering Beaumont Woman’s Life-Sustaining Treatment to End Due to 10-Day Rule.”

There’s also a quote from Mrs. Jones’ daughter, repeated from the earlier article: “My mom is going to die on Monday because of a law that saves hospitals money.”

It turns out that money and Medicaid paperwork is actually what is keeping the family from allowing Mrs. Jones to be transferred to another doctor and facility. The family is concerned that they (rather than the hospital) will be responsible for the costs of Mrs. Jones’ care.

This is in spite of the fact that when a patient first goes on dialysis, she becomes immediately and automatically eligible to apply for Medicare and Social Security Disability.

Depending on assets and income, patients unable to work on dialysis also qualify for Medicaid and other State benefits in Texas. Medicaid will even pay bills retroactively for three months.

Even more than usual, I double checked all of my information to ensure that I’m right that Mrs. Jones isn’t dependent on hospital treatments – since it was reported in the article that the hospital would withdraw “life-sustaining treatments” at 2 PM, today, May 13, 2013.

The good news is that she isn’t dependent on the ventilator, dialysis is not constant but only 2-3 times per week and paid by Medicare, food and water by the feeding tube can’t be withheld under TADA.

Hopefully, the Jones family will finally agree to transfer her, even if costs them more than her Medicare & Social Security Disability will pay.

End of life or end of hospital stay?

What a tragic story!

While I only know what I’ve seen online, in my experience, it appears that the dispute about Mrs. Carolyn Jones is over continued hospitalization at this hospital, versus transfer to care at another facility.

(See this television news report.)

I’m the first to say that hospitals are scary places and to sympathize with families struggling to cope with the bureaucracy and protocols. However the current news, press releases, and pro-life blogs are reporting several errors and omissions about Texas’s law and legislation up for consideration in Austin.

The obvious errors in this report include:
1. First. It’s not correct that Mrs Jones will die on Monday, even if the ventilator is turned off at the hospital. She’s not intubated through the mouth or nose. Instead, there’s a tracheostomy and a feeding tube in place. Supplemental oxygen could be provided many different ways, at home or in a nursing home.
2. Mr. Jones has testified at the Texas Senate Health and Human Services Committee meeting (EDIT: the video is here, at 52 minutes in) on 4/10/19 and elsewhere that Mrs Jones had been weaned off the ventilator, needing it only occasionally, at night.
2. She should be able to speak and swallow with training.
3. Texas Advance Directives Act doesn’t require that the doctor declare the treatment be “futile.” Instead, the doctor must declare that he refuses to follow a certain treatment decision that the patient or family demands .
4. Kidney dialysis is paid for by the Federal government, so the problem isn’t only funding.

In my admittedly limited knowledge about this particular case – it appears that Mr. Jones disagrees that it’s time to move from the hospital to home or nursing home, even after 5 months (not 10 days).

At least since 2005, legislation has been introduced at the State to increase the timeframe to as long as a month. Texas Right to Life refuses to agree to anything other than indefinite treatment, with the doctor forced to act against his will, violating his conscience and ignoring his medical judgement.

TRTL has even clashed with other pro-life organizations and Texas’s Catholic Bishops and “primaried” several conservative Legislators, although they are the only Texas pro-life group that opposes the law.

It would be good to add more time – I don’t know of anyone who disagrees. But there needs to be a limit to how long a doctor is forced to act against his conscience. One Bill that was rumored this year would change the “10 days” to 21 days and add a week to the notification period before the Ethics committee meets. Unfortunately, it never got past the Powers That Be.

For more on the ethics of the Texas Advance Directives Act, see this WingRight post.

The most urgent need is communication with families, correcting misunderstandings like those outlined here.

(Edited May 10, 2019 at 12:22 AST, to correct the Link to the testimony of Mr. Jones. BBN)

Emergency: Liberty Right Infringement

Texas Right to Life General Counsel Emily Cook is attacking Texas Medical Association on Facebook, even though virtually every other pro-life, medical, nursing, hospital, and disability group in Texas oppose SB 2089 by Hughes, that would change the “Texas Advance Directive Act, “TADA” will harm patients and attack the right of doctors to refuse to act against our conscience.

Here’s a partial list of organizations opposing SB 2089: Texas Medical Association, Texas Baptist Christian Life Commission Ethics, Texas Catholic Bishops, Texas Nurses Association, Texas Society for Anethesiology, Texas Osteopathic Association, Catholic Health Association, Texas Hospital Association, Baylor Scott and White, Texas Teaching Hospitals, Texas Alliance for Life, Coalition of Texans With Disabilities.
The central question isn’t “10 days” or the actions of a “Committee.” Doctors start the process, and under the law, the Committee can only affirm that his decision is medically appropriate or not.
The question is whether a patient can demand that a doctor be forced against her conscience to indefinitely write orders and provide treatment she believes is not in the best interest of the patient because the patient or family wants it?
The patient is near death and in the hospital, so the doctor can’t morally just “fire” him if there’s a disagreement. We all agree that 10 days isn’t enough time for families, and have tried since 2005 to add days to the process – we had a Bill that would expand the time to a month in 2007. (CSSB 439)
But Texas Right to Life would/will accept nothing but indefinite “treatment until transfer.” They keep demanding lawyers, courts and trials for medical decisions.
This is the issue that caused the break between TRTL and the Catholic Bishops.
It would force Drs to violate our conscience, without compromising with a set, limited time frame.

We’ve worked to fix other problems: Artificially administered food and water, even full IV feedings, can‘t be removed. Texas law didn’t even mention DNRs, but last session, we passed an amendment with explicit procedures and informed consent language.

SB 2089 ends the ability for a doctor to “refuse” medically inappropriate treatment, only allows “recommending,” (while being legally required to act against her conscience, harming the patient, prolonging death and increasing side effects, requiring more treatments.)

There’s no leeway, at all, in the new Bill.

SB 2089 specifically says anyone can file a lawsuit in any Court in the County, the Court can’t charge the patient (or surrogates) any fees, and the judge is required to rule in 5 days.

More doctors will limit the number of older or sicker patients to keep from falling under the dispute process and the Court battle.
Even tertiary hospitals – teaching hospitals and big City referral hospitals – will find that their doctors don’t want to accept patients from outlying hospitals.
It will kill tort reform, because it’s designed to get all these cases into Court.
It’s like the Masterpiece Cakeshop case, only bigger, in my opinion, because if doctors lose here, we lose the right to conscience in everything.

If you believe that even doctors have the right of Conscience, and that infringement of the right not to be forced to act against your will is wrong, please contact your Texas Senator and Lieutenant Governor Dan Patrick and respectfully ask that SB2089 not be brought up.

You can let me know if you disagree on my Facebook page.

Another kind of lawyer joke

“[T]he doctor/bioethics committee thinks the patient should die.” Wesley J. Smith, Esq., Texas Senate Health and Human Services Committee, 4/10/2019 LifeNews.com

Wesley Smith is a rarity among the many lawyers who chased bioethics to the bedside late in the last century: he actually believes in the sanctity of human life and in the right of conscience. I’ve attended and reported on his debates and encounters with proponents of intentional euthanasia. And even happily defended him.

Unfortunately, Lawyer Smith was not above spinning the truth this month when he came from California to once again misrepresent the Texas Advance Directive Act (“TADA,” “the Act,” or “166.___”), an attempt to balance conflicting rights when doctors disagree with a patient or his surrogates about actual medical procedures and treatments that the doctor believes harms the patient.

On April 10, 2019 Mr. Smith gave invited testimony to the Senate Health and Human Services Committee in favor of SB 2089 (Hughes) and
SB 2129 (Creighton). LifeNews.com published part of his testimony online, under the title, “Texas Rule Allows Hospitals to Essentially Euthananize Patients After a 10-Day Notification.”

Mr. Smith doesn’t just contradict multiple Supreme Court rulings since Cruzan (1990) affirming that withholding or withdrawing treatment is not equivalent to euthanasia. Paradoxically, he echoes arguments that anti-conscience activists use to justify abortion on demand, Physician Assisted Suicide and intentional euthanasia by a third party by claiming that the principle of autonomy supercedes “First, do no harm,” or non-malevelence, and the right to conscience.

(You can watch all of Part I and Part II of the April 10, 2019 Health and Human Services Committee meeting addressing SB 2089 by Senator Bryan Hughes and SB 2129 by Senator Brandon Creighton online. Part I includes Mr. Smith’s testimony beginning at 33:00/1:01:10.)

We’ll skip Mr. Smith’s assertion that there is a right to force others to provide everyone medical care in general, not just in emergencies or at the end of life. I’ve covered these assertions and his attacks on the Texas Conference of Catholic Bishops I’m, back in 2007.

Today, let’s just look at his spin on the current version of TADA.

Lawyer Smith uses emotionally weighted terms that aren’t in TADA, such as, “life-extending,” “futile care,” “permitting the institution to force its will on patients and families,” “invidious discrimination,” and “inappropriate care.” He contrasts patient’s “rights” with doctor’s “values,” and is the first that day to raise the specter of doctors willing to kill when patients are “expensive.” And, reflected in the LifeNews.com headline, Mr. Smith flatly says that TADA allows euthanasia – intentional acts to kill patients – equivalent to the administration of injections or medications that he wrote about this week.

As I’ve stated so many times in past WingRight.org and LifeEthics.org posts, TADA doesn’t allow us to remove or withhold care for patients, only treatments that are “medically inappropriate.” There are no futile patients, only futile treatments that cause harm to the patient over and over, without any expectation of reversing organ failure after organ failure.

Mr. Smith also ignores the multiple attempts by the medical and pro-life community and Legislature to improve the law’s timeframe and communication, much as Senator Creighton’s Bill. One example from 2007, SB 439 by Senator Bob Deuell, would have required written notice and an offer of a private ethics consult to take place at least seven days before the hospital committee meeting. That Bill had a schedule for giving the patient or surrogates written information about the dispute process, copies of medical records, and lists of resources. The family would have been given access to the committee meeting, with their own advocates. When the committee agreed that the treatment requested was inappropriate, the family would have receive assistance in searching for7⅞ another doctor or facility for at least another 21 days. I believe that the Bill bogged down in the House because of opposition from Texas Right to Life to any Bill that did not include liability for doctors and the indefinite “treatment until transfer” in this year’s SB 2089.

In the last five minutes of the Part I video, another lawyer, Texas Right to Life General Council Emily Cook, gave us the best clue about the ultimate goal of her organization: “judicial review.

Ms. Cook and Mr. Smith would have every one of these disputes settled by a Court. This is the Texas trial lawyers’ dream: a huge weapon against our State’s tort reform.

Today, the law specifically allows an appeal to a County probate judge when the Committee agrees with the doctor’s decision. SB 2129 allows a request for an injunction in any Court in the County, enabling “judge shopping.” Since it also prohibits the County from charging the patient or his surrogates any fees, the costs would fall solely on the County.

Ultimately, SB 2129 would make it much, much easier to sue the doctor and the hospital, moving Medical decision-making into the courtroom.

Most of the “stakeholders” for patient rights in Texas (including Texas Alliance for Life, Texas Baptist Christian Life Commission, Coalition of Texans With Disabilities, Texas Medical Association, Texas Hospital Association, Catholic Hospital Association, Texas Nurses Association, and the Texas Conference of Catholic Bishops and many others) oppose both of the Bills that Mr. Smith favored. Since SB 2129 would mandate that the County pick up any Court costs and that the judge make his ruling within five days, don’t be surprised if we hear objections from representatives of these parties, too.

So what’s the “joke?”

It could be the ridiculous notion that Lawyer Smith is a mind reader, able to discern the “invidious” motives for the “discrimination” he feels doctors and hospitals routinely practice:

“To fully comprehend the unjust nature of Texas law in this regard, realize that these “futile care” or “inappropriate care” decisions do not terminate treatment because it won’t work, but because it does. It is keeping the patient alive when the doctor/bioethics committee thinks the patient should die.” (Emphasis from LifeNews.com’s transcript.)

He repeatedly comments that physician’s decisions about medically appropriate treatment are subjective and that they (we) might “project their fears and their desires onto the patient” based on our “values,” rather than medical judgement based on repeated, at least once a day examination of the patient, reports by the nurses and staff and our education and experience.

The joke might be that Lawyer Smith volunteered that the indefinite, repeated evaluation and medical decision-making against the medical judgement of doctors would not be “slavery.” I would like to know what Lawyer Smith calls the legal requirement to use one’s body and brain to carry out actions, including writing orders for nurses and other medical staff, against your will.

It might be tragically funny to watch “judicial review” end up with the two sides hiring expert witnesses – doctors – to give the judge opposing views. There’s dark humor in the realization that ultimately the judge would order the original doctor to use her medical judgement to provide treatment – against her best medical judgement.

But the real joke is that “judicial review” risks the unintended consequence of decisions made by judges like the late t Judge George Greer, who Mr. Smith wrote about in this article.

Comments are closed. Please comment on my Facebook page.

Texas Advance Directive Act 2019 Legislature

The Texas Advance Directive Act is being attacked in the State Legislature, again, as it has just about every Session for the last 10+ years. In my opinion, one group is doing the bidding of the trial lawyers to destroy Texas’s tort reform by attempting to force every end of life treatment disagreement into the Courts.
Here’s my explanation of the Act, written in 2016, as an “effort to balance” patients’ rights and the rights of doctors to practice Medicine according to their consciences, using our best medical judgement. And here is an example of a previous attempt to truly improve the Act.
The opponents of TADA would force doctors to ignore their consciences to continue performing procedures and writing orders – for nurses and staff to carry out – against our best medical judgement, while faced with the moral distress of continuing acts that hurt our patient, as organ system after organ system fails, faster than we can compensate, prolonging and increasing his suffering and death.
For example, yesterday, the House passed a useless Amendment to a useless amendment to HB 1504, the Sunset review and reauthorization of the Texas Medical Board.
(22) in complying with the procedures outlined in Sections 166.045iand 166.046, Health and Safety Code, fails to make a reasonable effort to transfer a patient to a physician who is willing to comply with a directive.
Amendment No. 5
Representative Toth offered the following amendment to Amendment No. 4:
Amend Amendment No.4 by Toth to CSHB 1504 on page 3, line 25, between “Code,” and “fails”, insert “willfully”.””
The amendment is useless because doctors don’t handle or arrange transfers between facilities; the hospital social services staff and nurses do. The only possible exceptions might be ER docs in outlying areas, transferring to a larger medical center or a rare phone discussion between doctors about the patient’s course after the two separate staffs have worked out the logistics. Neither of these would apply in the TADA cases.
Importantly, how would the accusation of “willfully fails to make a reasonable effort” be made? Could there be more vague terms in that sentence than “willfully” or “reasonable?” (Especially in light of TRTL’s claim that 60 attempts weren’t reasonable in the tragic case recently ruled moot and dismissed by Texas 1st Court of Appeals, covered here and here.) Is this an attempt to criminalize the actions of doctors, an excuse to sue in a Court of law?
After the amendment passed, one of the lawyer lobbyists paid by Texas Right to Life tweeted a mean little remark:
The lawyer said that doctors who begin the process in TADA “set the 10 day count and sit on their hands.”
I understand that he never had to ask (to order) a nurse to cause pain to a dying patient, but he should understand that doctors don’t “sit on their hands” during the waiting period. We still perform those life sustaining procedures, write orders, and interact with the patient and family.
In order to push their view point they oppose not only other pro-life organizations, but the Texas Catholic Bishops, the Texas Baptists, and Texas Medical Association. Bills such as SB 2129 or SB 2089 would destroy TADA and undermine Texas’ tort reform.
Of course, once in the Courts, the lawyers would have to hire doctors to testify and the judges would decide between the two sides and order doctors to act against their consciences.
That, or lawyers and judges would be placed in the position of practicing medicine: writing medical orders for nurses and staff to carry out.
In the long run, the risk of civil and even criminal liability of caring for patients at the end of life would drive most doctors away from not only intensive end of life care, but increase the risk for any of us who care for trauma, oncology or geriatric patients.

Edit 19 April 2019 BBN: Comments are disabled here. Please comment at my Facebook page, “Beverly Nuckols.” https://m.facebook.com/story.php?story_fbid=10218835564657861&id=1163711361&refid=52&_ft_=mf_story_key.10218835564657861%3Atop_level_post_id.10218835564657861%3Atl_objid.10218835564657861%3Acontent_owner_id_new.1163711361%3Aoriginal_content_id.2226941544065344%3Aoriginal_content_owner_id.110756395683880%3Athrowback_story_fbid.10218835564657861%3Apage_id.110756395683880%3Astory_location.4%3Astory_attachment_style.share%3Apage_insights.%7B%22110756395683880%22%3A%7B%22role%22%3A1%2C%22page_id%22%3A110756395683880%2C%22post_context%22%3A%7B%22story_fbid%22%3A2226941550732010%2C%22publish_time%22%3A1555527649%2C%22object_fbtype%22%3A32%7D%2C%22actor_id%22%3A1163711361%2C%22psn%22%3A%22EntStatusCreationStory%22%2C%22sl%22%3A4%2C%22dm%22%3A%7B%22isShare%22%3A0%2C%22originalPostOwnerID%22%3A0%7D%2C%22targets%22%3A%5B%7B%22page_id%22%3A110756395683880%2C%22actor_id%22%3A1163711361%2C%22role%22%3A1%2C%22post_id%22%3A2226941550732010%2C%22share_id%22%3A0%7D%5D%7D%7D%3Athid.1163711361&__tn__=-R

Immunologist denies Imunology (Vaccines)

Here’s a review and critique (with live links, by Skeptical Raptor) on one of the anti-vaxx advocates, an “immunologist” who exaggerated her credentials, makes her money through the big-money scam “Vaxxed,” and who wrote this ridiculous lie:

“”Immunology does not attempt to study and therefore cannot provide understanding of natural diseases and immunity that follows them.””

“KITTENS,” before humans

I didn’t believe the opinion article by Tony Perkins of the Family Research Council, that claimed that a Democrat who voted against last month’s S311, the “Born-Alive Abortion Survivors Protection Act,” had then submitted a Bill to prevent the euthanasia of kittens used in scientific research. I assumed it was a spoof or hyperbole.

KITTENS before babies

But no, a simple search proved that Oregon’s Dem Senator Merkley absolutely opposed the Act, even posting a press release and giving his reason in Twitter, @SenJeffMerkley

The Act would not have criminalized anyone. It would only reinforce and clarify the 2002 “Born Alive Infant Protection Act,” by requiring the doctor performing an abortion to provide the same care for a born infant who is unexpectantly delivered alive during a late term abortion that would be provided to any other child in the same circumstances.

The CDC estimates that about 150 babies are born alive during abortions, each year, while acknowledging that the estimate may be low.

Merkley came up with a cute name for his Bill: “Kittens in Traumatic Testing Ends Now.” It’s a shame he didn’t give as much thought to human babies.

“KITTENS,” before humans

I didn’t believe the opinion article by Tony Perkins of the Family Research Council, that claimed that a Democrat who voted against last month’s S311, the “Born-Alive Abortion Survivors Protection Act,” had then submitted a Bill to prevent the euthanasia of kittens used in scientific research. I assumed it was a spoof or hyperbole.

KITTENS before babies

But no, a simple search proved that Oregon’s Dem Senator Merkley absolutely opposed the Act, even posting a press release and giving his reason in Twitter, @SenJeffMerkley

The Act would not have criminalized anyone. It would only reinforce and clarify the 2002 “Born Alive Infant Protection Act,” by requiring the doctor performing an abortion to provide the same care for a born infant who is unexpectantly delivered alive during a late term abortion that would be provided to any other child in the same circumstances.

The CDC estimates that about 150 babies are born alive during abortions, each year, while acknowledging that the estimate may be low.

Merkley came up with a cute name for his Bill: “Kittens in Traumatic Testing Ends Now.” It’s a shame he didn’t give as much thought to human babies.

“KITTENS,” before humans

I didn’t believe the opinion article by Tony Perkins of the Family Research Council, that claimed that a Democrat who voted against last month’s S311, the “Born-Alive Abortion Survivors Protection Act,” had then submitted a Bill to prevent the euthanasia of kittens used in scientific research. I assumed it was a spoof or hyperbole.

KITTENS before babies

But no, a simple search proved that Oregon’s Dem Senator Merkley absolutely opposed the Act, even posting a press release and giving his reason in Twitter, @SenJeffMerkley

The Act would not have criminalized anyone. It would only reinforce and clarify the 2002 “Born Alive Infant Protection Act,” by requiring the doctor performing an abortion to provide the same care for a born infant who is unexpectantly delivered alive during a late term abortion that would be provided to any other child in the same circumstances.

The CDC estimates that about 150 babies are born alive during abortions, each year, while acknowledging that the estimate may be low.

Merkley came up with a cute name for his Bill: “Kittens in Traumatic Testing Ends Now.” It’s a shame he didn’t give as much thought to human babies.

Please comment on my “Beverly Nuckols” Facebook page.

Designer slaves

Brave New World is still in the future, but we have the technology to create betas and gammas, etc. And with potential laws that deny personhood or any rights at all under the law to the preborn, we have the legal climate.

The question is, do we have the social climate?

Tell me: Why not manipulate our offspring any way we want if they aren’t human-enough to possess human rights?

Let me know what you think on my “Beverly Nuckols” Facebook page!

Transgender First Principles

This weekend, the debate concerning the ethics of medical and surgical intervention for transgendered men and women, more properly called “gender dysphoria,” heated up again. The New York Times published an essay by a man who wishes to become a woman so much that he is about to undergo a 6 hour surgical procedure to fashion an artificial vagina, although the author admits that the surgery may not produce happiness and, indeed, will most certainly cause lifelong pain and the necessity of further intermittent, painful procedures.

In answer to my assertion (in an online private group) that transgender ideation is a pathology, a pediatrician said that I might as well claim that being black is a pathology.
While I’ve never heard of a black person seeking medical or psychological treatment to make his body more or less in concert with his race or body image ( or maybe I have..), there has to be some perception of a problem on the part of the transgendered person who seeks intervention.
Back in the’90’s, when I was in medical school, the definition included a lack of pleasure from the “wrong” genitalia. While it appears that this requirement for intervention has gone by the wayside, at the least, gender dysphoria makes leading their lives difficult. This seems to be a fair, if simplified, definition for “disorder.”

In addition, one of the early leaders in the development of surgical procedures for trans persons, Dr. Phil McHugh, agrees that transgender ideation is a “Pathogenic meme.”

The fact is that the treatments sought or offered are based on biologic sex and are essentially bimorphic: MtF (Male to Female), FtM (Female to Male). The treatments themselves are described as “feminizing” or ” masculinizing” – one or the other.
The incidence of transgender ideation in the US is less than 1% (probably about 0.5%), with as many as 80% of those who claim to be transgendered in childhood “desisted,” changing their minds at a later date, usually around puberty.
The known association with autism
and schizophrenia, along with the “clusters” of peer-group rapid and late onset, as well as the rate of reversals, suggest caution when it comes to treatment that might later be considered disfiguring and permanent.
The author of the NYT piece states that the traditional “First Principle” of medical ethics, “First, do no harm,” is only a way for doctors to be “little kings” who deny what patients “want,”
“”Nonmaleficence is a principle violated in its very observation. Its true purpose is not to shield patients from injury but to install the medical professional as a little kings of someone else’s body.””

If doctors truly forget the First Principle, what’s to stop us from “First, doing harm?” Who decides the “harm” in that case? Better hope we don’t give up our consciences.

Certainly, in this case, I would be one of those “little king” doctors who would not carry through on surgery, based on what appears to be atypical reaction to the cross-sex hormones.
Just as it’s malpractice to affirm the anorexic girl’s body image as correct and help her avoid food, it’s unethical to pretend that transgender ideation is normal or even something we can “affirm.”

Please comment on my Facebook page, Beverly Nuckols.

Health care poll

Today, I came across a poll of likely Texas voters, conducted by the University of Texas and Texas Tribune that said that for Texans, health care is a distant third in importance, behind border security and immigration. This was in contrast with frequent news reports in the last week that an unnamed “recent poll” had found that health care is the number one issue in the 2018 election for voters. That first, UT/TT, poll was more consistent with other recent news coverage and the issues that I keep seeing pop up on Twitter and Facebook.

So I did some research….

It turns out that the first poll (“KFF,” download pdf file,with results) was conducted by the Kaiser Family Foundation, a nonprofit based in San Francisco, California. In fact, approximately 30% of the respondents listed health care as their number one issue and were designated “Health Care Voters” by pollsters. 70%, designated “non-Health Care Voters,” chose other issues, including the economy and jobs (21%).

The demographics of those polled were heavily slanted toward Democrats, with registered Democrats and “Independents” who are identified as “Independent Lean Democrat” adding up to 68% of the “Healthcare Voters.” “Non-Health Care Voters” came in at 49% Republican or “Independent Leans Republican.”

While KFF is considered one of the “Least Biased” polling bodies, they are still subject to sampling errors. It appears that this might be one of those times.

Comments are disabled. Comment on my Facebook page, please.

Health Insurance Choice Is Bad?

Health insurance choice is bad?

The San Antonio Express News picked up a Washington Post op ed on those big, bad Republican plans to repeal Obamacare. Originally titled, “The reason Republican Republican health-care plans are doomed to fail,” by the editorial board that declared, “There’s no way to replace Planned Parenthood.”

And it’s bunk, even as prudently renamed and appropriately filed in the Opinion section.

What we are *actually *seeing *today is that costs are rising and insurers are withdrawing from States. Choices are certainly limited if there’s only one insurance company on the exchange and routine screening costs are “free” — But the care for treatment discovered at screenings is subject to high deductibles.

Limited coverage plans with major medical for extraordinary costs – rather than a wish list covered with other people’s money from first dollar – encourages personal responsibility and will cut costs. It would also allow people to own their insurance, rather than have it controlled and limited by current employers.

“Different” (Transgender at 4?)

The TexasGOPVote website chronicles the complaint by a “Conservative, Christian” mom  that her male to female (supposedly) transgender 6 year old shouldn’t be treated differently. I agree with the underlying sentiment that it is not the child’s fault.

The child is treated differently – by parents, peers, school nurses, and any educator, doctor or other professional or official who is complicit with this abuse of a 6 year old child – because the child *is* different. Medicine, physics, and the rest of the observable, measurable and verifiable universe don’t change because a child declares that cold is hot, up is down or boys don’t feel like “she” feels (at the highly experienced age of 6). 

It is disturbing to read about the apparent mistreatment of depression that this mother describes in her earlier blog. So disturbing that I’m inclined to ignore – or at least put off to another post – commenting on the stereotype in the description of “girly girl, Kai, in pink and sparkles” or of  the suggestion in mom’s earlier blog about Joseph as “gay” (at 2!)  for displaying supposedly “flamboyantly feminine mannerisms and love for all things girly.” 

How could anyone so misinterpret the repeatedly voiced desire of a 4 year old to be taken away to heaven because another 4 year old said her father called him a freak as equivalent to hating hair cuts ( or more “feminine mannerisms“)? How can she compare her “secret” research with the proper treatment her son needed?

Unfortunately, a 6 year old claiming to be transgender is different because he or she has had his or her perceptions of the world colored by the same adults who would not allow a child they loved to play with fire or jump off the highest point of the school building. 

The fact is that genetic and phenotypically female girls will always be “different” from Joseph. From the first penetration of the zona pellucida by a sperm bearing a Y chromosome, to the differentiation of the Wolffian duct, to the first time he urinated over someone’s shoulder into the air after birth, Joseph has been a male. Stereotypes aside, he will remain a male, however he acts or is medically or surgically manipulated. The genetic and phenotypical reality of his body will always affect any future medical or surgical treatment.

Hopefully, no one will be complicit with medical or surgical castration or other mutilation until this child is legally competent to consent. In that case,  his body will still be phenotypically male, entering puberty, when he enters middle school, whether as as Joseph or Kai. Now, that will be a  “difference” evident to all the girls, including the ones who have never seen male genitals. 

It will be very evident to the survivors ​of sexual abuse. Hopefully, they called the police after they were abused.

Contrary to the claim in the blog,  Lt. Governor Patrick and the “Bathroom Bill” didn’t start the trans debate.  School districts in Texas were changing policies, entire cities have passed ordinances, and the last President issued an Executive Order that threatened Federal education dollars. 

And preditors are taking advantage of the increased access available due to the transgender debate: men like Paul Witherspoon, Levandus Gacutan, Christopher Hambrook, Richard Rodriquez, Jason Pomare, Sean Patrick Smith, or the many unnamed men who have been not reported to the police when they enter previously gender-segregated areas like poolside changing rooms, shower rooms or gym locker rooms. (I’ll let you research those names.)

Thanks to “Conservative, Christian” mom, the world is being misrepresented to other children who are encouraged to consider pathological behavior as not “different.” Because of “feelings” the rest of us are repeatedly told to ignore the difference –  and observable,  measurable, and verifiable facts. 

And this specific child is being abused. 

Beverly B Nuckols, MD. 

Law makers to doctors: “Keep the patient alive” 

If only we doctors – or legislators, lawyers and probate judges – really had the power to “keep the patient alive” as this article claims two new Bills  (  HB 4090 & SB 1213) in front of the Texas Legislature will (force doctors to) do. 

The article is misleading in its claim that a committee or a hospital decides whether or not a therapy is given: Texas doctors practice medicine in Texas. Even the Bills make it clear that the “attending physician” makes the decision whether or not to follow the patient’s (or more likely, the surrogates’) medical request.

We – Texas doctors, hospitals, and legislators – have tried repeatedly over the last decade to amend the law, Texas’ Advance Directive Act,   to increase the time frame. Last Session, we helped to ensure that food and water can’t be withheld. The lawyers and those who would have Estate (probate) judges involved in every dispute – even at the bedside of the dying – have blocked effort after effort because the Bills did not include liability for the doctor. 
These Bills are just the camel’s nose under the tent of Texas’s tort reform. Worse yet, we’d end up with medical expert testifying against medical expert in court, with the judge eventually telling the doctor how to practice medicine. It would also severe the “ethicists” who actively seek to undermine conscience protections for health care professionals.
If you’ll notice, the Bills also remove the requirement for the patient to pay for any transfer, too. I don’t suppose that the tort lawyers ​will pay for the ambulance or plane ride.

Do you want Texas law to force doctors to practice against our consciences​? 

How long and how far should any man or woman be forced by law to act against his or her will?

​Would you like to refuse?

Shocking Bill from Texas’ Jason Villaba, Republican State Representative from Dallas’ District 114 :  HB 1938 would make organ donation after death “opt out” for anyone applying for a driver’s license in Texas.

Texas would be the first State to pass such a law.

Organ donation is a public good for those who wish to do so. However, there is no ethical or legal precedent for treating human bodies – living or dead – as public property or commodities.

From the Bill as introduced:

 (2)  for an applicant who is 18 years of age or older:
                     (A)  specifically ask each applicant the
  question, “Would you like to refuse to join the organ donor
  registry?” and state, “If you answer ‘no’ to the previous question
  or do not answer the previous question, you consent to join the
  organ donor registry by performing either of those actions.”; and
                     (B)  if the applicant does not affirmatively
  refuse to be included in the registry under Paragraph (A), provide
  the person’s name, date of birth, driver’s license number, most
  recent address, and other information needed for identification
  purposes at the time of donation to the nonprofit organization
  contracted to maintain the statewide donor registry under Section
  692A.020, Health and Safety Code, for inclusion in the registry.

http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB01938I.htm

Honk if you love pizza and abortion!

​Perfect pro-abortion slogan: “Honk if you love pizza and abortion!”


Because, equivalent, yes? And illogically proud of it – see the young woman in the left lower quadrant. That sign certainly is evidence that “reproductive rights” advocates are, indeed, “pro-abortion.” 

The Texas Tribune is providing its usual biased coverage of the Texas Legislature. The editors allowed the banality of a pro-abortion sign equating the love of abortion and pizza to creep into their report on the fears of the groups who make a profit from ending the lives of the most vulnerable humans and their advocates. 

There’s no logic in claiming that an abortion doesn’t end the life of a human. With current science and technology, it’s anti-science to make such a claim. Proponents of elective abortion deny that every human is endowed with inalienable rights. Instead, they defend the falsehoods that embryos and fetuses are less than human and definitely not human-enough to possess inalienable human rights. 

As to the complaints about insurance coverage for abortion? It’s called, “Elective abortion.” Insurance shouldn’t pay for “elective” procedures. And seriously: “a rider” to pay for elective abortion?  How fiscally responsible is that?  

“Heart” if you (heart) graphic proof of illogic and irresponsibility

Pay attention: it’s policy, not bias

screenshot_20161109-175849The consensus of media pundits and bloggers, as well as quite a few liberal and even Conservative op-ed authors, is that Donald J.Trump was elected President out of some misguided national populism and anger at Congress, fueled with a lot of racism, misogyny and hate. The fact that those same voters elected a Republican majority in the House and Senate  – sending virtually every eligible Republican incumbent back to DC – is glossed over.

The idea that Conservatives really believe in small government and equal opportunity supported by personal responsibility is rarely voiced. That we might actually vote, not only for President but consistently down ballot, in order to defend the Bill of Rights and the right to life is ignored while we are accused of xeno-, homo-, and poly-whatever-phobia. I read that I am “afraid” of other lifestyles, religions, and losing my “privilege” based on being a White Christian.

Personally, I approve of most of the Republican Platform, especially where it addresses core Conservative issues, such as low taxes and equal treatment under the law. I want a Legislature that will uphold the Constitution as it’s written and defend against the infringement of inalienable rights. I don’t want activist judges nominated or confirmed at any level of the Federal Court system, especially the Supreme Court. I hope President Trump and the Republican Congress majority will decrease the hassle factors and threats placed on the practice of medicine and business in general by an overreaching Federal bureaucracy.

And, yes, my sense of fairness hopes that our existing immigration laws will finally be enforced, as an outcome of the”equal treatment under the law.”

Instead of facile clichés fed by cherry-picked sound bites and the latest talking points from the Left, try looking at and listening to the 59 Million voters across the country who elected a Republican candidate for President, and ensured a Republican majority including all those “establishment” candidates in both the House and Senate. 

It’s the Republican platform and Conservative policy that we Conservatives voted for, not one man.

Obama’s Abortion Cronyism 

Obama’s new Health and Human Services regulations will prohibit consideration of whether a provider does abortions – or sells body parts – or not.

Kansas and Texas, among other States, attempted to prioritize their limited tax dollars, preferring to steer money – and patients – toward continuing and comprehensive caregivers – primary care providers- over  reproductive health “boutiques:”

When PP sued, they lost. But Obama arbitrarily stripped the State’s Title X funds and gave the money to PP, anyway.

The “most transparent Administration ever” went further:

 In New Hampshire, the administration even refused to disclose information about its direct Planned Parenthood grant, claiming disclosure would harm the nonprofit’s “competitive position.”””

What competition??? That’s pure cronyism and blatant support of the Democrat’s  – and Obama’s – pro-abortion political ideology.

Edited 11/12/16: misspelling of Services in first sentence BBB

Department of Defense Transgender Plans – Bottom Line

United States Secretary of Defense, Ash Carter, declared the US military Independence Day from biology and human development. There will be a necessary increase in the military’s dependence on medicine, however.

“In an historic and controversial move, the Pentagon on Thursday lifted its longstanding ban on transgender troops and began outlining how the military will begin allowing — and paying for — service members to transition, medically and officially, from one gender to another.

“Now transgender troops will no longer be considered “medically unfit” for military service. By October, transgender troops may begin an official process to change gender in the military personnel management systems.”

****

“”The most common treatment for gender dysphoria is hormone therapy.”

This shouldn’t be a problem, other than a few hot flashes here and there – wherever.  After all, the American Medical Association has decided that neither genetic nor physical sex – also known as”anatomy,” trump feelings – or official birth records.

““Breast implants may be medically necessary” for some individuals, said another defense official familiar with the medical aspects of transgender treatment.

“Cosmetic surgery for gender transition, however, would in most cases be considered an elective procedure and not be covered by the military health system, defense officials said. Many transgender individuals do not opt for a full sex-change operation to include “bottom” surgery that changes genitalia.” (Emphasis mine.)

So, the DOD may buy some estrogen and testosterone and a few “medically necessary” breast implants, they don’t plan to pay for “bottom surgery.”.   In light of current insurance criteria, a huge of ” the standard practice in the civilian medical community,” however, I’m not sure how long that plan will last. (See the excellent and thorough discussion of medical necessity for gender reassignment surgery, provided online by Aetna, here.)

Right now, the question seems to be more about what the well dressed transgendered soldier, sailor or Marine will be wearing next year.

I haven’t served, but it seems to me that the solution is a truly *uniform* we of “grooming standards and uniform-wear,” job descriptions and fitness requirements. If genetic or physical sex is irrelevant to”gender identity,” then they should certainly be irrelevant as to readiness standards.

BTW, this may just be the justification for “access to 100 percent of America’s population” for future drafts.

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