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Don’t mess with Texas Republican Women!

Mama had surgery for Thymic carcinoma back in 2004. She voted early and scheduled the surgery for the day after the election, so her daughters could work as election clerks.

On the 6th of November, the on-call neurologist made disparaging remarks about the man Mama called “My George Bush,” who was on TV when he walked in. He then began his exam, asking a standard memory question: “Name as many animals as you can in a minute.”
Mama’s answer: “… Lions & tigers & bears… horses, jackasses and Democrats!”

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.

Sanctuary City Swimming in Other People’s Taxes

From the Mayor of the home town of La Joya Independent School District, the “independent” school system in Hildalgo County, Texas with the water park, a 22K sq ft natatorium, tennis courts, a planetarium, and a golf course,enabled with money from Texas taxpayers:

My position was why should the city of La Joya, or any city in the Valley, detain any ICE illegals when ICE already has cages for them?”Salinas said Sunday. “Maybe they have a better place for them than we do and, of course, we’re totally against what they’re doing; I think we should unite the families, not divide them.”

“If it hadn’t been for that I would not have reacted this way,” he said, “but I’m a Mexican-American and I support my people.”

It’s not just “that.”

Last year, Mayor Salinas led La Joya to join the lawsuit against Texas’ Senate Bill 4, that penalizes cities that refuse to cooperate with Federal immigration laws and authorities. So far, that lawsuit has been upheld in Court.
Yet, the Mayor has no problem with the budget of his school district accepting accepting over $51M from the Federal Government.
Of course, that’s only 15% of the “Independent” school district’s funding. Texas Taxpayers pay 75% or $251,737,388.

The City also receives Federal funding through the Operation Stonegarden Program from the Department of Homeland Security, but the Mayor says they don’t use those funds to detain anyone for ICE.
I wish the Mayor respected non-hyphenated Americans and Texans, even if he doesn’t count us as his

people.

Edited to correct spelling. BBN

Happy Birth Parent Day

screenshot_20180616-075345_chrome5005037694364168408-e1529155414475.jpg
Google Images for “Baby Daddy” card

That lawsuit I wrote about yesterday would not only would put an end to Texas’ Medical and legal regulations on abortion – including informed consent, waiting periods, and sonograms – the plaintiffs go out of their way to redefine mother and father, too.

From Footnote 1, page 2:
“”1 Most people with the capacity to become pregnant identify as women. Historically, both jurisprudence and public health data have focused on women when addressing reproductive rights and health. But there is an emerging recognition in the law and society more generally that not all people who may become pregnant identify as women. See generally Glenn v. Brumby, 663 F.3d 1312, 1316-19 (11th Cir. 2011)
(holding, consistent with the weight of authority, that the Equal Protection Clause prohibits discrimination on the basis of “gender nonconformity”) (collecting cases); Robin Marantz Henig, How Science Is Helping Us Understand Gender, National Geographic (2017), https://www.nationalgeographic.com/
of all individuals to end an unwanted pregnancy, regardless of gender identity.”
 (I’m sorry, but can’t find a link to the lawsuit on line. It’s “Whole Woman’s Health Alliance et al v Paxton et al, U.S. District Court, Western District of Texas, No. 18-00500.)

From the UK, we see the inevitable results in a time of identity and personal choice :

Lawyers have told a judge that he had been biologically able to become pregnant but had legally become a man when the child was born.

“They say the transgender man wants to be identified as the child’s “father” or “parent” on a birth certificate.”

And, in Ohio:

“Explaining their unusual parenting arrangements, Amy said: “We went through a lot of fertility treatments, until we finally reached a point where we needed to make a decision as to whether we were going to do more medical intervention or if we were going to switch bodies. (emphasis mine)

“We were fortunate enough to have two uteruses. So, after a lot of thought and emotion and difficulties we switched to Chris.

“And while Chris lived as a man and didn’t feel female, he was willing to use his womb for the good of their family.”

Of course, neither Chris nor Amy could donate sperm. So, who is really — is there even — a father?

Or a parent, of either gender or any identity, who sees the child as his own person, human-enough to possess inalienable rights, rather than a political statement and a means to an end?

Open letter to RPT Convention delegates on censure

I am writing to ask you to vote against censure by the Convention of named Republican, elected, officials.

How often have we complained about the elites who get in power only to ignore us to follow their own agenda? How many of you are at the Convention because you got tired of the establishment working against you?

Well, guess what? If you make it to the State Convention, you’re the elite establishment! Don’t be that kind of elite establishment.

For the first time in years, I couldn’t participate in the 2018 Republican Party of Texas Convention process. I still follow your efforts and have read the resolutions submitted to the Platform Committee. One Senate District has submitted resolutions demanding that the RPT State Convention censure specific legislators.

I appreciate the work you’re doing this not just this week, but over the last few months. Having served as a Delegate to the Republican Party of Texas State Convention and on both the Platform and the Rules Committees, I know you have a week of long walks to simply get to your meeting rooms, heated discussions, long waits, and many re-votes, one after another. The Committees and sessions start early and go late. (Wear comfortable shoes and take snacks!)

Through all of this, please don’t forget that you are in San Antonio as the grass roots embodiment of our Nation’s representative democracy, our Republic. You are not simply individuals expressing your own will and opinion. You are there as representatives of your constituents: the Republican voters from your Counties, Congressional Districts, and Senate Districts.

In the same way that you expect legislators to represent their voters, your voters expect you to represent us.

While it may be appropriate for the local SD Convention to censure their own legislators, especially before the Primary or run-off, many people in our Party disagree. But now, these are elected candidates. I don’t believe that it’s appropriate for the State Convention to censure them in opposition to the local electorate’s wishes.

When the votes on censure of any Republican elected official comes up, please take a look at their constituents’ votes, especially in the last Primary. Did he or she win? Was it by a substantial margin? Was he or she unopposed in the Primary because no one even challenged them?

These men and women deserve your respect, just as President Donald Trump should be given the respect he deserves after being elected President. In the same way that it was wrong for Hillary to deride Republican women as voting the way their husbands told them to, it’s wrong to dismiss these voters as illegitimate.

In addition, as this is an election year, you are writing the campaign ads for the Democrats.

Please do not oppose the voters you represent by voting in favor of public censure of Republicans.

Beverly B. Nuckols, MD

Comal County, SD 25 and CD 21

(Edited because some of the formatting got lost.)

Response to criticism about Texas Advance Directive Act

I’ve been having a long Facebook discussion with representatives of organizations, people who claim that I support coercion and killing patients because I defend the Texas Advance Directives Act, 166.0046. (TADA).

I want to respond as fully as I can. ( I’m bandwidth deprived today and will gradually add more links when I reach better signals. See here, here, and here for more explanations from earlier WingRight posts. Links to the law, the press, and previous blog posts by others can be found in those articles.)

First, no one withdraws or withholds *care* of the patient. The patient still receives food and hydration, pain medicine, oxygen by tube or mask, if needed, and other medical treatment.
The 10 day period is the only recourse allowed under Texas law when a doctor refuses a treatment requested by the patient. All legislative attempts to increase the times have been blocked.
For hospitalized patients, the Act is the only way for a doctor to refuse a patient’s request for medically inappropriate treatment without risk of abandoning him. If the doctor doesn’t follow the law, he becomes liable. Although no reason is required by law, in every case I know of the doctor has made it clear that the requested treatment is causing suffering and/or actual harm and violates the First Principle: “Cure when possible, but first, do no harm.”
I have asked who/where are the doctors willing to accept transfer. There must be some doctor willing to accept the patient in order for there to be a transfer. “Facilities” or hospitals can’t accept a patient without an accepting physician. For the most part, doctors in Texas don’t work for a hospital and can’t be ordered to admit or treat by the facility. That no other doctor can be found is actually evidence that the first doctor’s medical judgment is based on good medicine.
Transfer has happened in a couple of examples (that I know of because they have made the press or gone to court), where a doctor disagrees with the original attending physician. I’m sure this has happened in many others that we never heard about because of the transfer.
I didn’t want to cover a specific case, preferring to stick with the issues of ethics. However, my accusers repeatedly brought up Mr. Chris Dunn. His case is very typical of both my experience with patients dying of end-stage hepato-renal failure and the course of other patients I’ve been able to follow through public documents.

It was easy to follow this case. There was a video published by Texas Right to Life (TRTL), a lot of press, statements to reporters by family, lawyers, and TRTL staffers, as well as a couple of lawsuits. I spent the better part of two days once again reviewing the public records.

Virtually all of the hospital medical reports were made public record in the latest appeal by Mrs. Kelly’s lawyers, Joe Nixon and Trey Trainor, BTW. (Another BTW: Senator Nixon, please follow the gown rules for isolation rules in the future. There’s a reason for them.)
There have been many misleading statements and errors about the case in news articles, blogs, and press releases, including both condemnation and praise for the doctors and the hospital by the family members, TRTL, and repesentatives of Empower Texans (ET), (making this review pertinent as the conversation began on Facebook in response to another ET article). The affidavits of the attending doctor, the chairman of the Methodist Biomedical Ethics Committee, the social worker, and legal documents from Mrs. Kelly’s and Methodist’s lawyers have been public records at the Harris County court website and elsewhere online.
Mr. Dunn was transferred from another hospital to Methodist hospital after having a gastrointestinal bleeding episode that resulted in his becoming unresponsive and being placed on a ventilator. He had severe liver failure, kidney failure, and the build up of fluid in his lungs which his mother told a reporter about. His clinical diagnosis was obvious, and supported by records from an earlier hospitalization when he was diagnosed as having a metastic pancreatic mass. He had checked himself out of that hospital against medical advice after refusing a biopsy of his pancreatic mass or further treatment.
On admission, Mr. Dunn wasn’t able to make decisions, as he was suffering from hepatic encephalopathy (which causes delirium) and sedated due to pain and the ventilator. (Note the restraints on his wrists, his jaundice and swollen belly, and his sleepiness and confusion are evident in that video we’ve all seen.)
He didn’t have an Advance Directive or a Durable Power of Attorney for Medical Care. (TRTL’s lawyer John Seago claimed the mother had one.) The doctors turned to his divorced parents to make decisions as co-equal surrogates under Texas law.
Unfortunately, as his sister told one reporter, his dad agreed with the doctor, but his mother disagreed. According to court documents, the elder Mr. Dunn said that he believed that Chris didn’t want to die in the hospital and insisted on removal of the ventilator and transition to comfort care (not the administration of a deadly “serum” as the lawyers claimed in the lawsuit and media). Mrs. Kelly kept asking for more time to talk to family members before making a decision. in their affidavits, a hospital social worker and the Ethics Committe chair, each described the parents’ interaction with one another as a “firestorm.”

It

was obvious that Mr. Dunn needed a legal guardian. That he was unable to make medical decisions is supported by the affidavits of the attending doctor and a later court examiner, as well as the fact that his parents were agreeable to making those decisions.
The Ethics Committee chair and other members documented meetings with the parents and family at least five times over the month after admission, and given copies of the hospital policy on disputes. When the doctor invoked TADA, the Ethics chair met with them again and they were given 3 day’s notice of the committee meeting. (Dispelling the lawsuit and blogging claim that the family wasn’t informed and was surprised by the sudden notice.)
Mrs. Kelly attended the meeting and spoke with the Committee. Both parents were given information about the hospital policy on the TADA and told that the doctor would be allowed to remove the ventilator 11 days later. While Mr Dunn’s father agreed, his mother did not and filed her first lawsuit.
The hospital social workers contacted over 60 different facilities in attempt to transfer. They were able to find a hospice (and presumably a hospice doctor) willing to care for Mr. Dunn on the ventilator at home, but Mrs. Kelly declined that transfer.
The MICU intensivist doctors and hospital voluntarily agreed, without a court order or hearing, to continue the ventilator until a single legal guardian could be named. There was never a restraining order after the initial Agreed TRO. There was never any move to deny the Total Parenteral Nutrition or any other treatment. The doctors, the hospital and the court where Mrs. Kelly filed suit against the hospital requested that the probate court determine a legal guardian to settle the dispute between the parents. The hospital specifically asked for a family member to be named guardian. There never was a move to remove Mrs. Kelly as guardian since she never was the guardian. The probate court hadn’t named a legal guardian at the time of death.
At autopsy, the pancreatic adenocarcinoma was found in the pancreas, liver, lungs, and lymph nodes. There were 20 liters (5 gallons) of ascites fluid in the abdomen due to the liver failure which prevented the production of protein and blood clotting factors. The lungs showed evidence of fluid congestion, aspiration of stomach fluids and pneumonia. The kidneys had failed and were infected. There was wasting of fat and muscle tissue.
The clinical diagnosis was confirmed. Mr. Dunn died of his disease with 40 pounds of fluid in his abdomen, congested lungs, pneumonia and kidney infections, and on a ventilator with total food and hydration by IV. This is not “natural death.”
The court has dismissed the lawsuit(s) in favor of the hospital. The only coercion in this case was against the doctors who evidently gave extraordinarily good care in order to keep him alive while waiting for the surrogates’ decision, then waiting for the probate court to act. And yet, Mrs. Kelly’s lawyers have amended her lawsuit, since dismissed, and filed an appeal which demands a “fair trial” whenever disputes like this occur.
The demands we’ve heard about TADA, to mandate that individual doctors “treat until transfer” or face new civil and criminal liability – even jail time – for doctors who use their consciences and refuse to act against their medical judgment would not only infringe against a doctor’s right not to be enslaved by positively forcing his hand against his will. It would be a moving target, with advances in intensive care technology and the ability to keep a patient’s body functioning with increasing technology.
As to the “Doctors aren’t God” refrain by others: I agree. And I’ve agreed each time someone shouts (or writes) it at me when I won’t refer for an abortion or write that opiate perscription that they are certain is their right.
Inalienable rights are negative rights: the right not to be killed, the right not to be enslaved.
Doctors are human beings with inalienable rights, including the right to conscience and to not have their hand forced to cause harm to a confused and delirious patient who cannot consent to suffer.
As shown by the first month of the Chris Dunn case, we recognize that some times we must stretch our limits. However, not indefinitely and not all our limits.

(Edited 03/11/18 for typos, to add a link, and to clarify points originally made on Facebook in a long debate. BBN)

Latest story on ethical stem cells in Texas

Last week, in a story about another baby boy, there was a  a beautiful memorial to  the “Bubble Boy,” David Vetter, too. 

The story in the Houston Chronicle is also a tribute to the doctors and parents who keep immune compromised children alive while waiting for the cure or treatment to take effect. 

My granddaughter’s mother is one of those heroes, helped by doctors and nurses, my son and an extended family of friends. (I can’t help my prejudice that gives the mother most of the credit.) And then, there was a baby boy and his generous mother.

I told Roni’s story to the Texas Legislature back in 2007 and 2006. An anonymous baby boy and his parents saved Roni’s life in 2001. 

In addition to a very low white blood cells count, her bone marrow didn’t make enough red blood cells or platelets, either. She’s healthy and well, today, after one of the first cord blood bone marrow transplants in the world at the age of 15 months. 

Although no matches were found for Sebastian,  the baby in today’s story, Texas has a strong system for the  registration of both bone marrow and umbilical cord blood donors. The Texas Cord Blood and MD Anderson Cord Blood Centers collect, store s and manage the distribution of donated cord blood collected at birth from moms and babies all over the State. 

Families who store their baby’s cord blood privately are very unlikely to ever need it, except when there’s a known problem. The odds are less than 1:200,000. But if they donate to a public bank, the blood is much more likely to save a life and/or be used in life-saving research. 

Bravo to all the parents and caregivers in children’s lives and prayers for Sebastian. There’s a Go-Fund-Me account for Sebastian’s expenses, if you are interested. 

Edit: there’s a wonderful update: Sebastian was able to go home!

“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. 

Equal, but special

A Facebook friend, Michael Smith, made an excellent comment about the contrast between “separate but equal,” and “equal, but special.”

I spent some time yesterday at the Texas State Capitol Reagan Building discussing House Bill 2899 by Simmons, which would prohibit local governments and other regulatory authorities from creating a new “order, ordinance, or other measure to protect a class of persons from discrimination; to reduce or expand a class of persons protected under state law from discrimination.”

The consensus of a group of people waiting for the House State Affairs Committee to begin was that the Bill is a thinly veiled “attack” on the LGBT community and transgender persons in particular. The comment that made me go into my Don Quixote tilting windmills mode was about just wanting to “peeing in peace” and the false claims of fears for safety of women and children.

I pointed out that that it is reasonable for women to have fear when confronting a man in a closed space and that we all expected privacy and security in bathrooms, locker rooms and other public places where people disrobe. (Yes, I used the term “disrobe.” And “intimate spaces.” I’m a nerd.)

I was told that I was speaking from “privilege” (!) for my example of caution when entering an elevator with a strange man and objecting to the stereotype that the brains of men and women are different and the assertion that men and women simply think differently. I heard that segregation of the sexes in public bathrooms is a new phenomenon and that the Roman baths, such as those in Pompeii were completely different matters, mainly due to the religion of the time.  And of course, several of the group told of the danger of violence against gays or trans but that there has never been any crime against other people by transgender person

Two of the people claimed to be transitioned from male to female. While demanding “respect,” they told stories of having coworkers fired for refusing to use their preferred pronouns. and engaged in very real “hate speech,” mocking and assigning hateful motives and emotions to me. The same person who pointed out that little boys can be molested in men’s bathrooms then said that *I* was the one who must obviously consider anyone with a penis a predator.

The group was secure in the belief that the fears of violence and abuse of the LGBT community outweigh not only the fears of victims of sexual abuse or parents of children and thousands of years of social norms.

Cities, but claiming to write non-discrimination ordinances create environments where some people are “equal, but special” – or a specially protected class of persons. George Orwell put it another way: “Some animals are more equal than others.”

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?

Texas “Bathroom Bill”

(Photo of the men’s bathhouse at Pompeii, in contradiction to the claim that gender-segregated facilities are a modern concept.)

The Texas Senate State Affairs has another long day ahead, as testimony will be heard today on SB6, the so-called “Bathroom Bill.”

Here’s a rebuttal that I wrote in response to a facetious op-ed that appeared in the Austin American Statesman last month. The Opinion editor told me a shorter version would be published, but I haven’t seen it. 

Obviously, John Kelso isn’t a survivor of male on female sexual abuse or harassment. 

Many survivors (like me, at 3 years old) have strong reactions to the idea – the threat – of a man in the enclosed space of even a “public” bathroom. Just as as I worry about the safety of children, I also want a “safe space,” where I am not likely to be confronted by a male. 

If the transgendered individual doesn’t trigger that fear – and I have no doubt that I’ve shared bathrooms with some who didn’t –  then no problem. However, their ability to do so is no justification to engage in sweeping social experiments.

Representative Schaefer and Lieutenant Governor Patrick didn’t start this controversy. Individuals making policy decisions  in cities, school districts and the Federal government did, sometimes with the weight, fines, and penalties of law.

The fact is that at least 1 in 5 women have been sexually abused before the age of 18. (In my experience as a Family Physician, I would have expected the percentages to be higher.) More than 90% of those assaults are committed by males who prey on females. While “only” 20% or so are perpetrated by strangers, isn’t that enough?

And yes, some of us do consider innocence a value to be protected and wish to protect girls from involuntary exposure to the physical characteristics of anatomical males. Thus, our objection to co-ed bathrooms and the Obama Administration’s Department of Education guide lines that included locker rooms and overnight accommodations on school trips.

Significantly, Kelso claims to be ignorant of multiple abuses of by straight males, dressed as females or otherwise, who take advantage of the opportunity to exploit newly accessible, formerly same-sex, hygiene facilities. I suggest at least a bit of online research.

How dare commenters mock women’s “worry” and “FEAR(sic)?” Isn’t fear of assault the reason most often given to justify “gender neutral” policies?

​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

Trump can’t run 3rd Party in Texas?

Read the Texas Secretary of State information page on Presidential candidates, here. (http://www.sos.state.tx.us/elections/candidates/guide/president.shtml )

I’m not a lawyer, but it appears to me that Texas election laws will prevent Trump from placing his name on the ballot as a 3rd Party candidate in 2016.

Any lawyers disagree?

Texas’ Republican Platform 2016

RTPsymbolAbout 300 delegates to the RPT weren’t Republican.The Platform of the Republican Party of Texas is online under “Platform,” here: http://www.texasgop.org/2016-convention/ . The numbering in this version of the Platform is awkward, but the plank-by-plank votes are reported at the 3rd link, below.

110 even voted against Principle #5, “Personal accountability and responsibility”

Just under 300 voted consistently against what should be non-controversial issues, such as the plank against human trafficking.

(Numbering appears to be a typographical error, hopefully soon corrected. The hard copies we had were much clearer.)

https://www.texasgop.org/wp-content/uploads/2016/01/PERMENANT-PLATFORM-as-Amended-by-Gen-Body-5.13.16.pdf
https://www.texasgop.org/wp-content/uploads/2016/01/2016-Texas-GOP-Weighted-Totals-.pdf

Counting win before chicks are hatched.

image

If Ted Cruz wins Presidency, it leaves a huge blank if Cruz resigns before Obama is out.

A special election will be called for the next uniform election day or 32 days after election is called.

We’ll need Cruz to resign as soon as elected or wait until inauguration to prevent aggression by the “Office of the Lame Duck President.”

Posted from WordPress for Android. Typos will be corrected!

I’m quoted in Houston Chronicle about Supreme Court hearing

By 7 PM, there was a line of people setting up to spend the night in front of the Supreme Court of the United States building. They hope to be able to watch the Court proceedings on Wednesday when the Texas abortion law, HB2.

Here’s the coverage from Brian Rosenthal of the Houston Chronicle, about Texans, like me, who travelled to DC for the hearing. I’m quoted as ‘helpful about the future of the law in the last few paragraphs.

Beverly Nuckols, 60, a New Braunfels family doctor who flew in for the arguments, said she was happy that a long and just process finally could be coming to an end.

Nuckols said was hopeful about the ruling because she was confident in the law.

“I believe we will get a tie,” she said.

Texas Governor Greg Abbott endorses Cruz for President

Huge endorsement from Texas’ Governor Greg Abbott. This is one I had been wondering about.

In a video announcing the endorsement, Abbott said,

“Unlike far too many in Washington, the Ted Cruz we’ve seen in the Senate is the same Ted Cruz we elected and he’s the same Ted Cruz I served with when I was attorney general,” Abbott said.

I was very impressed and very proud of Ted Cruz back in 2009, on the day when Kay Bailey Hutchison announced that she would run one more time as Texas’ Senator. Within minutes, Cruz withdrew his bid for Attorney General, rather than run against General Abbott. Although later I became opposed to his campaign tactics, that moment showed integrity.

( I’m just barely cynical enough to think it also showed good political sense. In fact, that only just occurred to me. Doggone it! I want to believe it was character, not simply savvy politics.)

Cruz needs mentoring – to *accept mentoring* – from both Governor Perry, who has also endorsed Cruz,  and from Governor Abbott. I hope that he will.

Death Politics

Someone named Rich DeOtte has written a Facebook piece attacking friends of mine. Rich mocks Dr. Joe Pojman as “a rocket scientist” and “knucklehead” (needless to say, that’s not popular in the Nuckols household) and takes a slap at Kyleen Wright, of Texans for Life Coalition and the Texas Medical Association.

Dr. Joe Pojman, Ph.D., is indeed a “rocket scientist,” who gave up his original career path of aerospace engineering to sacrifice as founder and Executive Director of Texas Alliance for Life, an organization I’m proud to support and serve as a Board member.

Joe wrote the op-ed that Rich attacks in direct response to the “misrepresentations” in another, political op-ed piece by Emily Kebedeaux Cook on the Texas Right to Life Website. Joe only wrote about issues, and did not engage in name calling or derision. The only reason Emily and TRTL are mentioned is because she’s the author of the political opinion piece about the “decline in the Texas Legislature’s efforts to protect human Life.”

As Joe points out, the very document to which Emily refers refutes her position: Texas was named one of three “Life List All-Stars” for 2016 by the Americans United for Life.

Joe laid out the case that our Texas Legislature’s pro-life laws are most definitely not at a standstill: we are ahead of the Nation. Joe’s position that Texas leaders gave us many successes in the 2015 84th Legislature is supported by the similar list of “Wins” reported by the Texas Catholic Conference, representing the Bishops of Texas. In an earlier letter, TCC notes that many of the criticisms Emily makes in her February 8th blog post were not previously scored “equitably” by TRTL. For instance, Senator Bob Deuell received no credit for authoring much of what became HB2.

In fact, Texas’ Legislative leadership in passing pro-life laws is why many of us are going to Washington, DC on March 2nd to bear witness when the Supreme Court hears testimony on the abortion facility regulations in HB2.

Emily and Rich focus most of their criticism on the efforts of pro-life groups, including doctors like me, to reform end of life care and the Texas Advance Directive Act (TADA). Session after session since it was passed, we in the pro-life community have had our efforts repeatedly blocked by the “death panel” accusations Rich makes and the demands in Emily’s op-ed.

I was one of the doctors appointed to the Texas Medical Association ad hoc committee that evaluated last sessions’ end of life Bills for TMA approval. Our group of doctors agreed to and helped fine tune HB 3074, what Emily called a “modest protection”: prohibiting the removal of Artificially Administered Nutrition and Hydration, including food and water by invasive medical methods like IV’s and “Total Parenteral Nutrition.” We were called anti-life and pro-“death panel” (Rich’s words) for including medical exceptions for the rare circumstances when the patient can’t process the AANH and/or when it actually caused harm.

Those “three strongest Pro-Life bills” that Emily mentioned were included in the “Wins” listed by the TCC. The Bills not only would have forced doctors to continue to indefinitely perform acts that we believe are not medically appropriate as long as a patient or his family demands it. They would have forced all disputes between the doctors practicing medicine and patients or their families into court and add “liability”(civil and criminal penalties) for the doctor.

Forget if you can, that if all disputes go to court judges would be required to determine medical care – to practice medicine – probably based on the testimony of dueling, paid medical expert doctors. Malpractice rates will go up for doctors taking on the most vulnerable patients – the elderly, the trauma victims and the victims of cancer. Those doctors will spend more time in courts, rather than in the ICU. And so will more grieving families.

We found out what happens when malpractice goes up in Texas, before tort reform was passed. Because of the malpractice crisis, there were no neurosurgeons west and south of San Antonio and Houston – none at all in El Paso or all of South Texas. We were losing obstetricians and family doctors willing to deliver babies and offer prenatal care, all over the State.

I don’t know how to translate past physician shortages directly into the possible shortage of doctors providing end of life care. However, I will predict that fewer family doctors, internists, pulmonologists and the ICU intensivists will be able to afford to practice in the ICU. Just as a patient had to be flown to Dallas, San Antonio or Houston from most of Texas for a head injury, only the tertiary medical centers in those cities will be able to staff their ICU’s properly.

Physicians, not hospitals – and certainly not courts – practice medicine in Texas. Doctors must be allowed to practice medicine according to our medical judgment, which is a combination of education and experience, under the watchful eye of the community; not “death panels,” but fellow physicians, nurses, ethicists, lawyers (who may be any of the former) and lay people. In the end, if you force the hands and minds of doctors against their judgment, you will end up with doctors practicing without judgment, and humans with inalienable rights forced to act against our will and in violation of our conscience.

And, now, back to Rich’s Facebook post. Think twice when you read political posts full of  personal attacks and name calling. We should be able to discuss politics without, as Emily said in her blog post, “unnecessary, vicious, and vindictive fights inside the Republican Party.”

Edited to fix a name glitch – BBN

Jury Indicts Two Antiabortion Activists Linked to Planned Parenthood Videos – WSJ

Ethics 101: The man and woman who were indicted for their actions exposing the harvesting of baby parts by Planned Parenthood were doing our duty to protect the right to life.

Rights impose duties on third parties, privileges do not.

Abortion, especially elective abortion of healthy babies in healthy mothers, is not a right. It is an illicit privilege granted by an act of law. No one has a duty to enable or act to cause an elective abortion at the request of a woman.

It is an illicitprivilege, since the right not to be killed is an inalienable right. Each of us in society has a duty imposed by that right to prevent its infringement.

http://www.wsj.com/articles/grand-jury-indicts-2-anti-abortion-activists-linked-to-planned-parenthood-videos-1453761641

 

Edited 1/27/16 to clean up grammar and add links. BBN

Death, lies and video

Death, lies and video

Supported only by his imagination, what he saw in videos produced by Texas Right to Life lawyers, and a news article,Dr. Phillip Hawley, Jr., M.D., wrote “A Tragic Case of Modern Bioethics; Denying Life-Sustaining Treatment to a Patient Who Wanted to Live” about the truly tragic, but inevitable death of Chris Dunn. Hawley erred by pretending to read the minds of doctors and hospital representatives and calling complete strangers “utilitarian” “murderers.” Before discussing the ethics of his accusations, it’s necessary to explain the meaning of the documented facts, available in news sources, blog posts and court records:

  1. Dunn was not “alert and cognizant” as he had documented delirium secondary to hepatic encephalopathy and over a month on the ventilator with sedation and pain meds
  2.  The hospital voluntarily, without a court judgement, promised to continue life-sustaining treatments in place until the legal guardianship question was settled.
  3.  Food and water, legally termed as “Artificially Administered Nutrition and Hydration” or AANH and including total parenteral nutrition, cannot be removed against the objection of patients or surrogates, under Texas law.
  4. The doctors stated that they believed the “life-sustaining treatments,” were causing suffering.
  5. The hospital never sought guardianship for themselves, only for “a qualified family member,” and listed their names and locations in the original petition.

It is very unlikely that Chris understood his condition, the questions the lawyers were asking or the consequences of his “prayer.” That he was unable to make medical decisions is supported by the fact that his parents had been making his medical decisions. The Harris County judge agreed with the hospital’s request that a single legal guardian be named by a separate court.
“Life-sustaining treatment,” “medically inappropriate” and “Artificially Administered Nutrition and Hydration” are legal terms defined in the Texas Advance Directive Act (TADA), which outlines the exact procedure and language for communications between doctors, the hospital committee, and patients or their surrogates. The use, monitoring and adjustment of a mechanical ventilator is in the definition of “life-sustaining treatments.” TADA specifically excludes “Artificially Administered Nutrition and Hydration” (AANH) in the definition of “life sustaining treatments,” which would argue against the accusation that his doctors planned to withdraw “food and water.”
The only legal reason under TADA to remove any “life-sustaining treatment” is that it is deemed “medically inappropriate” by the attending physician and then only if the hospital medical or ethics committee “affirms” that decision. If and when they are withheld, the Act specifically prohibits “mercy killing” or otherwise intentionally intervening with the intent to cause death by artificial means.
Additional demands by Chris’ mother, Mrs. Kelly, and the lawyers in blogs and news articles would have also fallen under the legal definition of “life-sustaining treatment.” These demands included a biopsy in order to determine a definitive tissue diagnosis for the clinically apparent pancreatic cancer and liver lesions, a surgical tracheostomy and the removal of the ventilator (to be fair, I believe they meant the tube through the vocal chords), less sedation, searches for and trials of treatment of the cancer, and the non-standard use of an indwelling drain for the ascites (large exudates in the abdomen due to high pressures in the liver and the failure of the liver to make necessary proteins). These are invasive, potentially painful and, based on the reported size and effects of the mass, the extent of liver damage visibly evident in the videos as temporal wasting and copper-colored skin, ascites and the GI bleeding – they were very unlikely to lengthen his life, much less cure his cancer. In fact they could be very likely to hasten – or be the immediate cause of – his death.
Chris died in the ICU on full life-sustaining treatments, including the ventilator and intravenous AANH.
The doctors are on record as basing their decision on the suffering caused by the treatments to their patient, Chris. This is consistent with the known side-effects of the ventilator and even reports from Chris’ mother, who told reporters that Chris suffered from the treatments and fluid building up in his lungs despite the ventilator. And yet, Dr. Hawley made sensational statements such as:

“For patients with terminal illnesses, this standard often leads to the utilitarian question: Is the patient’s life still worth living?
“In Chris Dunn’s case, the committee’s answer was “no.” Relative strangers with little or no knowledge of his values and beliefs weighed his “quality of life” and decided that he no longer deserved to live.”
And,
“. . . How did these committee members who had only recently met the patient—if they ever met him at all—know that it was in his best interest for them to end his life?”
And,
“. . . But, somehow, we are to believe that these committee members were able to deduce existential truths about what was in Chris Dunn’s best interest?”

The physicians who cared for Mr. Dunn for over a month had certainly met him and members of the Methodist Hospital Biomedical Ethics Committee met with the family several times. Court documents are clear that the doctors believed the life-sustaining treatments were causing suffering and that the committee agreed that the treatments were medically inappropriate. There certainly is no evidence that the doctors or the committee members sought to intentionally “end” Chris’ life. “Medically inappropriate treatment” is not an “existential truth” and never in the patient’s best interest.
(Some may remind us that suffering can have benefits. However, Mr. Dunn couldn’t consent to suffering, much less benefit from the suffering, whether as a medical treatment or a willing religious self-sacrifice.)

Robert P. George is one of my heroes a conservative tenured professor of law and ethics at Princeton and one of the founders of the Witherspoon Institute, an organization known for its defense of Judeo-Christian ethics based on natural law, and the parent organization of Public Discourse. He has helpfully outlined a “key” to evaluate the withholding or withdrawing of life-sustaining care:

“[T]he key is the distinction between what traditionally has been called “direct killing,” where death (one’s own or someone else’s) is sought either as an end in itself or as a means to some other end, and accepting death or the shortening of life as a foreseen side effect of an action or omission whose object is something other than death—either some good that cannot be achieved or some evil that cannot be avoided without resulting in death or the shortening of life.”

George and Hawley each point to a value in medicine that is higher than autonomy or even preserving life at all costs: the duty of physicians to care for the patient. “Cure when possible, but first, do no harm.”
The lawyers didn’t just sue to maintain “life-sustaining treatments,” or even Mrs. Kelly’s right to force the doctors to treat Chris the way she wanted them to. The lawsuit, blog posts and public statements document the ultimate goal to have TADA declared unconstitutional and to force all doctors to give patients and surrogates the right to demand any and all desired treatment indefinitely. The power of State courts, law enforcement and licensing would be used to force Texas doctors to carry out acts against our medical judgment, education, experience and conscience.
What justification can the lawyers and Dr. Hawley give for not believing the physicians who care for patients daily and hourly when those caretakers document that the patient is suffering?

What kind of physicians will we end up with if the State can force us to act without judgement or conscience?

What kind of State would we have?

Based on a video and his imagined conversations between “malevolent” and “utilitarian” doctors and hospitals, Hawley declares Texas a “morally impoverished society.” Ignoring sworn statements from the physicians and misrepresenting TADA, he distorts the purpose of the Texas Advance Directive Act, which is to address the problems encountered when patients and surrogates disagree., Only by assuming evil intent is he able to force doctors to prove a negative and distract from any possibility of a conflict between the equal and inalienable rights of the patient and the doctor.

While the video of Chris apparently praying to be allowed to live wrenched at our emotions, it was used to tell a false story upon which Dr. Hawley built his harmful assumptions. We would all do well to remember my Mama’s advice: Don’t believe anything you hear and only half of what you see.”

Edited for grammar and decrease wordiness and formatting (1-15-16). BBN

Texas Advance Directive Act: What the lawyers really want

I’ll admit that I’m not a lawyer and have to do my homework to even attempt to understand lawyer-speak. (For example, see this definition of “Abatement”) How I wish more lawyers would admit they aren’t doctors, especially when they accuse doctors and entire hospital committees of killing patients.

Earlier this week, I reviewed the latest sensationalized case involving lawyers and lawyer-lobbyists playing doctor in the media and courts to overturn Section 166.046 of the Texas Advance Directive Act (“TADA”).

TADA outlines the process to settle disputes between an attending physician and the patient (or the family of a patient) when the medical judgment of the doctor about what is medically appropriate for the patient conflicts with the demands for treatment that the patient or family wants *that* particular doctor to perform.

Texas law prohibits the removal of “artificially administered nutrition and hydration” and pain medications unless the doctors determine they will cause further harm. However, a ventilator, intubation tubes in the throat, cardio-version (CPR), surgery and invasive procedures or tests are not ordinary or comfort care and are considered “life-sustaining” treatment that may be removed or withheld from a patient with a terminal disease if the patient’s doctor determines that are not medically appropriate. There is certainly no provision in Texas law to intentionally stop a patient’s breathing or to otherwise cause certain death.

The lawyers lobbying and suing against TADA admit in both public statements and legal complaints that they will settle for nothing less than “Due Process,” lawyer-speak reference to the Fourteenth Amendment clause, “due process of law.” They demand that every dispute about medically appropriate care between doctors and patients be argued – by lawyers – in court, preferably with a risk of “liability” for the doctor, any committee member who reviews the case under TADA, and the hospital where the patient is under care. Judges, and possibly juries, would determine the local medical standard of care, which medical procedures are appropriate for which patients, and liability. Lawyers and judges would essentially practice medicine instead of doctors.

To summarize this latest case, court records document** the affidavit from the attending physician of a 46 year old Pasadena, Texas man, Chris Dunn. Mr. Dunn was admitted to the ICU at Houston’s Methodist hospital unresponsive after a major gastrointestinal bleed due to metastatic pancreatic cancer led to his emergency transfer from a hospital in his hometown. Mr. Dunn was on a ventilator and suffering from liver, kidney, and respiratory failure. He had fluid in his lungs, necessitating higher and higher pressures on the ventilator. He had fluid leaking into the abdominal cavity due to the liver failure, ascites, that required intermittent draining. He also suffered from hepatic encephalopathy, a form of variable dementia and delirium.  His doctors and his father agreed that the repetitive, invasive treatments necessary to maintain the ventilator and treat the multi-organ failure should be stopped because they were causing Mr. Dunn harm, while comfort care would continue.

In their lawsuit against the hospital, a group of lawyers brought in by Mr. Dunn’s mother and Texas Right to Life sued the hospital in Mr. Dunn’s name, although there was a question about both Mr. Dunn’s ability to legally consent and the legal status of either parent alone to make medical decisions on Mr. Dunn’s behalf. In fact, the court ruled an “Abatement” or suspension of the lawsuit on December 4, 2015, until the legal guardianship for Mr. Dunn could be settled in another court. And, sadly, in spite of continued treatment in the Intensive Care Unit, on a ventilator, with IV and tube feedings, and all the repetitive blood tests, suctioning, and invasive procedures these treatments required, Mr. Dunn succumbed to his disease before that other court could meet to name a guardian.

In their lawsuit against the hospital, the lawyers even accuse “the facility” (not the attending doctor) of planning to actively euthanize Mr. Dunn by the deliberate use of injections intended to cause his death, rather than to relieve his pain:

“Defendant scheduling . . . and Defendant administering, via injection, a combination of drugs which will end his life almost immediately, thus warranting immediate intervention by this court.” (**p.2)

The lawyers further declared that the doctors and the Methodist Biomedical Ethics Committee – and every doctor or hospital committee – would be corrupted by their affiliation with the hospital:

“The statute does not provide adequate safeguards to protect against the conflict of interest inherently present when the treating physician’s decision is reviewed by the hospital “ethics committee” to whom the physician has direct financial ties.
“Texas Health and Saftey [sic] Code violates Plaintiff’s right to procedural due process by failing to provide an adequate venue for Plaintiff and those similarly situated to be heard in this critical life-ending decision. The law also fails to impose adequate evidentiary safeguards against hospitals and doctors by allowing them to make the decision to terminate life-sustaining treatment in their own unfettered discretion.” (**pp. 5,6)

And,

“Under Tex. Health and Safety Code 166.046, a fair and impartial tribunal did not and could not hear Dunn’s case. “Ethics committee” members from the treating hospital cannot be fair and impartial, when the propriety of giving Dunn’s expensive life-sustaining treatment must be weighed against a potential economic loss to the very entity which provides those members of the “ethics committee” with privileges and a source of income.” (**p. 7)

 

Lawyer-speak notwithstanding, I can’t figure out – and the lawyers don’t tell us – how to ensure that “unfettered” pancreatic cancer presenting with multi-organ failure followed “due process” in Mr. Dunn’s case. Other than lawyers from each side hiring and paying even more doctors to re-examine the patient and re-view the existing medical records, repeated clinical exams and nurses’ notes, lab work and non-invasive scans of the liver and abdomen, what would a judge or jury consider “evidentiary safeguards against doctors and hospitals?”

But in news article after blog post, lawyers (but no doctors) claimed that “the hospital wanted to kill” Mr. Dunn.  Lawyers (but no doctors) claimed there were un-named additional tests and treatments which could have changed the diagnosis, treatment or prognosis. Lawyers (but no doctors) disputed the medical judgment of the very doctors from whom the lawsuit demanded continued intensive care.

In their lawsuit, the lawyers also declared that, “Members of a fair and impartial tribunal should not only avoid a conflict of interest, they should avoid even the appearance of a conflict of interest, especially when a patient’s life is at stake.” (*p. 7) But that didn’t stop them from including an ironic and self-serving demand that Methodist hospital pay their “Attorney fees and costs.” (p. 12)

 

**(Protected “.pdf” “Images” of the original legal documents quoted below can be found online, here.  The document images aren’t link-able and can’t be copied or printed, so I will have to type up and share quotes. See Family case number 2015-69681. The quotes above are from document number 6796448.pdf, “Plaintiff’s Original Verified Petition and Application for Temporary Restraining Order and Injunctive Relief.”)

Texas Advance Directive Act, when the doctor refuses

Here’s Section 166.046 of the Texas Advance Directive Act,  the part of Texas Law that is in the news, these days. This part only applies when there is a disagreement between the doctor (whom the patient wants to continue treatment) and the patient or his surrogate about treatment decisions.

Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR TREATMENT DECISION. (a) If an 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, the physician’s refusal shall be reviewed by an ethics or medical committee. The attending physician may not be a member of that committee. The patient shall be given life-sustaining treatment during the review.

(b) The patient or the person responsible for the health care decisions of the individual who has made the decision regarding the directive or treatment decision:

(1) may be given a written description of the ethics or medical committee review process and any other policies and procedures related to this section adopted by the health care facility;

(2) shall be informed of the committee review process not less than 48 hours before the meeting called to discuss the patient’s directive, unless the time period is waived by mutual agreement;

(3) at the time of being so informed, shall be provided:

(A) a copy of the appropriate statement set forth in Section 166.052; and

(B) a copy of the registry list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer or to assist in locating a provider willing to accept transfer that is posted on the website maintained by the department under Section 166.053; and

(4) is entitled to:

(A) attend the meeting;

(B) receive a written explanation of the decision reached during the review process;

(C) receive a copy of the portion of the patient’s medical record related to the treatment received by the patient in the facility for the lesser of:

(i) the period of the patient’s current admission to the facility; or

(ii) the preceding 30 calendar days; and

(D) receive a copy of all of the patient’s reasonably available diagnostic results and reports related to the medical record provided under Paragraph (C).

(c) The written explanation required by Subsection (b)(4)(B) must be included in the patient’s medical record.

(d) If the attending physician, the patient, or the person responsible for the health care decisions of the individual does not agree with the decision reached during the review process under Subsection (b), the physician shall make a reasonable effort to transfer the patient to a physician who is willing to comply with the directive. If the patient is a patient in a health care facility, the facility’s personnel shall assist the physician in arranging the patient’s transfer to:

(1) another physician;

(2) an alternative care setting within that facility; or

(3) another facility.

(e) If the patient or the person responsible for the health care decisions of the patient is requesting life-sustaining treatment that the attending physician has decided and the ethics or medical committee has affirmed is medically inappropriate treatment, the patient shall be given available life-sustaining treatment pending transfer under Subsection (d). This subsection does not authorize withholding or withdrawing pain management medication, medical procedures necessary to provide comfort, or any other health care provided to alleviate a patient’s pain. The patient is responsible for any costs incurred in transferring the patient to another facility. The attending physician, any other physician responsible for the care of the patient, and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after both the written decision and the patient’s medical record required under Subsection (b) are provided to the patient or the person responsible for the health care decisions of the patient unless ordered to do so under Subsection (g), except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would:

(1) hasten the patient’s death;

(2) be medically contraindicated such that the provision of the treatment seriously exacerbates life-threatening medical problems not outweighed by the benefit of the provision of the treatment;

(3) result in substantial irremediable physical pain not outweighed by the benefit of the provision of the treatment;

(4) be medically ineffective in prolonging life; or

(5) be contrary to the patient’s or surrogate’s clearly documented desire not to receive artificially administered nutrition or hydration.

(e-1) If during a previous admission to a facility a patient’s attending physician and the review process under Subsection (b) have determined that life-sustaining treatment is inappropriate, and the patient is readmitted to the same facility within six months from the date of the decision reached during the review process conducted upon the previous admission, Subsections (b) through (e) need not be followed if the patient’s attending physician and a consulting physician who is a member of the ethics or medical committee of the facility document on the patient’s readmission that the patient’s condition either has not improved or has deteriorated since the review process was conducted.

(f) Life-sustaining treatment under this section may not be entered in the patient’s medical record as medically unnecessary treatment until the time period provided under Subsection (e) has expired.

(g) At the request of the patient or the person responsible for the health care decisions of the patient, the appropriate district or county court shall extend the time period provided under Subsection (e) only if the court finds, by a preponderance of the evidence, that there is a reasonable expectation that a physician or health care facility that will honor the patient’s directive will be found if the time extension is granted.

(h) This section may not be construed to impose an obligation on a facility or a home and community support services agency licensed under Chapter 142 or similar organization that is beyond the scope of the services or resources of the facility or agency. This section does not apply to hospice services provided by a home and community support services agency licensed under Chapter 142.

Added by Acts 1999, 76th Leg., ch. 450, Sec. 1.03, eff. Sept. 1, 1999. Amended by Acts 2003, 78th Leg., ch. 1228, Sec. 3, 4, eff. June 20, 2003.

Amended by:

Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0503, eff. April 2, 2015.

Acts 2015, 84th Leg., R.S., Ch. 435 (H.B. 3074), Sec. 5, eff. September 1, 2015.

Texas Supreme Court Rules on Judicial Bypass for Minors’ Abortions

I am glad that the rules are explicit about the duty to report sexual or physical abuse.

Here’s a statement from Texas Alliance for Life, with links to the ruling:

Austin, TX — Today the Texas Supreme Court released rules for how courts handle judicial bypass proceedings regarding secret abortions on minors girls without parental notification or consent. The rules were created in response to HB 3994, authored by Rep. Geanie Morrison (R-Victoria) and sponsored by Sen. Charles Perry (R-Lubbock) and strongly supported by Texas Alliance for Life.

The following statement is attributed to Joe Pojman, Ph.D., executive director of Texas Alliance for Life:

We are pleased with the Supreme Court’s strong rules regarding the judicial bypass process for abortions on minor girls. These bring to fruition a 10-year effort by Texas Alliance for Life and a coalition of pro-life organizations to protect minor girls in Texas from abortion. In 2005, the Texas Legislature passed a bill requiring doctors to obtain the consent of a parent before performing abortions on minor girls. In 2015, the Legislature passed, and Gov. Abbott signed into law, HB 3994 to reform the judicial bypass process by which a judge can allow abortions on minors without parental consent. The reforms closed loopholes and increased protections for the minors from abuse. The Texas Supreme Court has faithfully implemented House Bill 3994 in a way that will best protect the well being of minor girls.

Here is a link to the Texas Supreme Court’s order issuing the rules: http://www.txcourts.gov/media/1225647/159246.pdf.

HB 3994 was one of five major pro-life bills and numerous other pro-life provisions passed in 2015. Here is a summary.

 

Lawyers, politics, and end of life

      Two days before Christmas, 46 year old Chris Dunn died in the ICU at Houston’s Methodist Hospital. Almost everything you’ve read and heard is a deliberate, political skewing of the facts.

Texas Right to Life turned Mr. Dunn’s imminent death from metastatic pancreatic cancer into a crusade against the Texas Advance Directive Act (TADA or the Act). The Act is invoked by the attending doctor – not the hospital or ethics committee – when family members demand that he or she perform acts that go against the conscience because they are medically inappropriate, causing the patient to suffer without changing his course.

In this case, the mother and father disagreed with one another about the care plan and the patient was unable to make legally binding decisions. The father agreed with Mr. Dunn’s doctors that the treatment was causing suffering, objected to surgery to place a tracheostomy, and wanted hospice and comfort care. The mother wanted dangerous, painful procedures performed that would not change the medical outlook except to possibly hasten death.

And, unless you read the court records, you wouldn’t know that the judge ruled that Chris was not mentally competent to make his own medical decisions, that the hospital never wanted guardianship and had voluntarily promised to continue care until the guardianship could be settled.  In fact all the lawyers, including the Texas Right to Life representatives,  signed off on an agreement acknowledging this promise on December 4th.  Abatement agreed Dec 4 2015 ( The official court records are available to view free of charge online at the Harris County District Clerk’s website as protected pdf images. See Family case number 2015- 69681.)

Inflammatory headlines falsely claimed that “the hospital” had imposed a “death sentence,” and was actively trying to kill Mr. Dunn by refusing to diagnose, treat or even give a prognosis.  That same blog post mentioned non-standard treatments that some in the family were demanding.

First of all, of course there was a diagnosis. Several, in fact. From the signed affidavit of Mr. Dunn’s attending physician, filed December 2, 2015 in response to the law suit:

“Based on my education, training, experience, as well as my care of Mr. Dunn, I, and members of my team, have advised his family members that Mr. Dunn suffers from end stage liver disease, the presence of a pancreatic mass suspected to be malignant with metastasis to the liver and complications of gastric outlet obstruction secondary to his pancreatic mass. Further, he suffers from hepatic encephalopathy, acute renal failure, sepsis, acute respiratory failure, multi-organ failure, and gastrointestestinal bleed. I have advised members of Mr. Dunn’s family that it is my clinical opinion that Mr. Dunn’s present condition is irreversible and progressively terminal.”

The primary diagnosis was metastatic pancreatic cancer. The cancer was a mass that blocked the ducts and blood vessels coming from the liver as well as the normal function of the intestines. As liver excretions backed up into the liver and the blood pressure in the liver increased, Mr. Dunn suffered a life-threatening gastrointestinal bleed, fluid buildup in the abdomen and lungs, and sepsis (an overwhelming infection). All of these would aggravate respiratory failure, the necessity  of a ventilator and lead to the kidney damage. Liver failure often results in hepatic encephalopathy  and variable delirium.

There was definitely treatment given, including tube and IV feedings, antibiotics, the ventilator, and periodic removal of the abdominal fluid. Again, this was all publicly documented in Court documents, in the media and even on the Texas Right to Life blog that claimed that “Houston Methodist has invested no time or effort in Chris’s health, instead exerting their energies into trying to kill him instead.” [sic]

The Intensive Care doctors as well as the Biomedical Ethics Committee, met with the parents to explain Mr. Dunn’s condition and his prognosis. The family was given notice before the Committee hearing and met with the (not at all “nameless” or “faceless”) Committee to discuss their (differing) wants. Thirty days’ worth of medical records, a hospital case worker and assistance in finding alternative care were made available to the family.

Then, there’s the complaint about the limits on visitors and videotaping. It is not unusual to limit Intensive Care Unit visits to specific times and to allow only close family, especially when the patient can’t consent and there is contention among family members. It is certainly standard to prohibit filming in the Unit, since patients are visible from one area to the next, in various states of undress and undergoing constant or frequent *intensive* treatments.

(BTW, one of the lawyers in the TRTL ICU video proves the basis for the rules: he is not compliant with the usual isolation procedures. Former Senator Joe Nixon didn’t wear the protective gown at all correctly, risking the introduction of infectious contamination into the room and/or taking germs home with him.)

It’s very unusual for patients on a ventilator to be conscious because of the severe discomfort associated with the foreign body – the breathing tube – that is necessary in the airways. It’s difficult to believe that anyone would complain about sedating Mr. Dunn in order to bypass his gag reflex.

Finally, the standard of care in advanced metastatic pancreatic cancer is pain relief and palliative support. The surgery to remove a pancreas is extremely dangerous for even healthier patients. As Mr. Dunn had already had an episode of bleeding and both liver and kidney failure, it’s likely that even a biopsy of the pancreatic mass or liver, much less surgery, would have caused more life-threatening bleeding. With liver and kidney damage, he wouldn’t have been able to tolerate trials of radiation or chemotherapy, either.

In fact, the doctors and nurses gave excellent treatment all along, as shown by his survival beyond the average for patients who presented in such a precarious state and acknowledged by Mrs. Kelly in her statement after Chris’ death.

The truth is that Methodist never made plans to “kill” Mr. Dunn. Mr. Dunn was never in danger of the hospital “pulling the plug.” The real problem was a disagreement between Mr. Dunn’s divorced parents over who would legally make medical decisions. That rift is bound to have been made worse by TRTL and the lawyers turning Chris’ illness into a public political battle. The accusations about euthanasia, killing and murder may cause other future patients harm, if they are reluctant to seek care because of these stories.

“Quixotic crusades over substantive victories”

Today, the Conservative grassroots are shouting raw emotions, masses feeding off headlines, “Shares,” and “Likes,” rather than the meat of the story.

Paul Waldman, in “Why have so many GOP governor’s fizzled out in the 2016 race?”online at “The Week,”  astutely describes the insanity that has gripped the Party formerly consisting of Conservatives, but which is now infested with destructive anti’s.

From the article,

  ”

Over the past few years, the party’s grass roots have been gripped by an anti-politics fervor that values quixotic crusades over substantive victories, and equates actually accomplishing anything through ordinary political processes with betrayal.”

He continues…

“That’s why someone like Ted Cruz, a senator who has never written a law and who, if you ask him what he has accomplished, will tell you about the times he “stood up” and failed to stop Barack Obama and his own party’s leaders from keeping the government open or not defaulting on America’s debts, can still be considered unsullied and thus potentially worthy of the nomination. And those like Donald Trump and Ben Carson, their minds uncluttered by even the remotest understanding of how government works, are the most popular of all.”

Brutal. Truth. Insanity, where failure equals stature and inexperience and ignorance are lauded as qualifications.

Can we re-use the Know Nothing name for our party?

Once upon a time, the grassroots of the Republican Party, especially Conservatives,  were researchers, well informed, and capable of reason. It was a joke among us that the real news was hidden in the penultimate paragraph of any news story. 

Yet, 14 years of Governor Rick Perry’s Conservative leadership in Texas is mocked amid comments about glasses and his performance over a few months in 2011. Governor Scott Walker won and re-won elections in a Blue State and braved for-hire Union mobs willing to break windows in the Wisconsin State Capitol, but he was simply ignored. Each were treated more seriously by crooked Dem Prosecutors than by Conservatives.

There’s no way this latest crop could have exposed the Clinton’s of the 1990’s – or will be able to do so in the last half of the 2010s.  Sticking out the month long re-count in Florida, or defending the Governor’s Mansion in Austin?

Not while dragging that couch they supposedly got off of in 2009 and Tweeting about the “Establishment.”

I’m not being flippant when I say, God help us!

Don’t believe the lies!

And stop “sharing” them!

Remember who the real opponents are: the Dems!

No matter how juicy the gossip, consider waiting a few hours for the rest of the story to come out.

(BTW, this is a test of my mobile app.)

Posted from WordPress for Android. Typos will be corrected!

The Reporter’s the Story

Shame on Breitbart Texas and Bob Price for this luke-warm, back-handed slap at the Governor. Reality isn’t based on media wish lists or election cycles.

The report is a report on reporter’s association of events with election cycles, which completely disregards the actual legislative cycle. There is no mention of our State’s biennial budget cycles. And not one word about the necessity of the Governor or any leader to win the support of Legislators or the austerity imposed by our State’s Constitution when we had to balance the budget in spite of the 2003 and 2011 budget crises. Texas International Bridges

We learned that reporters were concerned that two of Texas’ law enforcement surges focused “only” on the Del Rio sector, but Mr. Price couldn’t spare the words to mention that the sector is the southern-most region of the Texas-Mexico border and includes the cities of McAllen-Pharr, Harlingen, Mission, Brownsville, and Corpus Christi – and close to half of Texas’ international bridges.

And second hBorderSectors Rankedighest in both border miles and apprehensions.

Security of the international border is a Federal responsibility. The Feds refuse to allow States to turn back illegal immigrants at the border or round up people who over-stay their visas. They sue us for any effort they deem to encroach on ICE or Border Patrol, while burdening us with the consequences of their failure to secure the border or track visas.

It’s true that we in Texas, led for 14 years by Governor Perry, did not “secure the border.” However, we – and he – did everything we could, including using Texans’ taxes to back up what the Feds were doing, even when we faced cuts elsewhere.

Edited to add second figure – BBN

Comal ISD and New Braunfels Early Voting Places and Times

There’s still 2 more days for early voting in the Comal Independent School District Bond and School Board Election. Regular Election Day is May 9.

 Here’s the times and places for early voting on Monday and Tuesday!
(Thanks to the New Braunfels Republican Women for the information!)

May 4 & 5Early voting

During early voting, you have the opportunity to cast both votes at one place!

You can cast both your votes for New Braunfels City Council (Districts 3 & 4) and Comal ISD School Board (Districts 1, 2, 5, & 6) and school bond locations at:

 

The Comal County Elections Office          May  58am to 5pm

178 E. Mill Street, Suite 10                                    May 47am to 7pm

New Braunfels  78130

Bulverde City Hall                                             May  48am to 5pm

30360 Cougar Bend                                                May 57am to 7pm

Bulverde  78163

 

Garden Ridge City Hall                                      May  58am to 5pm

9400 Municipal Pkwy                                              May 47am to 7pm

Garden Ridge  78266

 

 

Early voting for CISD School Board (Districts 1, 2, 5, & 6) and school bond only:

May 4 & 57am to 7pm

Bill Brown Elementary              Hoffmann Lane Elementary      Rebecca Creek Elementary

20410 Hwy 46 W.                       4600 FM 306                                  125 Quest Ave.

Spring Branch  78070               New Braunfels  78132                 Spring Branch  78070

 

Comal ISD Support Serv.           Indian Spring Elementary          Smithson Valley Middle

Admin. Bldg.                                 25751 Wilderness Oak                6101 FM 311

1404 I-35 N.                                  San Antonio  78261                      Spring Branch  78070

New Braunfels  78130

 

Church Hill Middle                     Kinder Ranch Elementary          Timberwood Park Elementary

1275 N. Business 35                  2035 Kinder Pkwy.                       26715 S. Glenrose

New Braunfels  78130              San Antonio  78260                      San Antonio  78260

 

Clear Spring Elem.                       M.H. Specht Elementary

550 Avery Parkway                    25815 Overlook Parkway

New Braunfels  78130              San Antonio  78260

********************************************************************************************************************    

 

Saturday, May 9 – Election Day – Polls open from 7am – 7pm

 

New Braunfels City Council (Districts 3 & 4)

Election Day polling locations at:

 

**NB City Council District 3 – Seele Elementary School, 540 Howard Street, New Braunfels

**NB City Council District 4 – Faith United Church, 970 N. Loop 337, New Braunfels

 

For City Council District Maphttp://www.nbtexas.org/DocumentCenter/Home/View/1480

(also listed on your Voter Registration Card)

 

Comal ISD School Board (Districts 1, 2, 5, & 6) and school bond only

Election Day polling locations at:

 

Single Member District 1                              Single Member District 2                  Single Member District 3

Clear Spring Elementary                                  Faith United Church                               Rebecca Creed Elementary

550 Avery Parkway                                           970 N. Loop 337                                      125 Quest Ave.

New Braunfels 78130                                       New Braunfels 78130                           Spring Branch  78070

Single Member District 4                              Single Member District 5                  Single Member District 6

Smithson Valley Middle School                      Bulverde City Hall                                   M.H. Specht Elementary

6101 FM 311                                                        30360 Cougar Bend                               25815 Overlook Parkway

Spring Branch 78070                                        Bulverde  78163                                      San Antonio  78260

 

Single Member District 7

Garden Ridge City Hall

9400 Municipal Parkway

Garden Ridge 78266

 

Texas Democrats’ “success?”

Only if you go by numbers, not content. Or Quantity, not Quality.  You know, the same false argument the Dems use to justify President Obama’s Executive Orders and Writs of Memoranda.

There’s a set of “statistics” going around on Facebook (and elsewhere, if you want to see the 10/2013 original), intended to criticize the current leadership in the Texas Legislature :

  Well, nearly HALF of all the bills enacted into law in the great Republican, red state of Texas were authored or co-authored by Democrats.

Actually, the most likely answer is that only the more conservative bills “authored or co-authored” by Dems are passed.  The question is what are the actual Bills we’re talking about?

For a look at what actually happens in the Texas Legislature, let’s go to the resource for following or researching current and past legislation, hearings, even witness lists: Texas Legislature Online.
To look at what sort of Bills coauthored by Dems were passed, look at the record of one of the most liberal Dems, Jessica Farrar.  Go down to the list of Bills authored or list of Bills “co-authored” by her in the 83(R) session.  Look at the ones marked “E” for “Enrolled.”

One of those Bills, HB 3677, was sponsored in the Senate by Lt. Governor-elect Dan Patrick and one, HB 970, was authored jointly with Representative Jonathan Stickland. Another, authored by Representative Harvey Hilderbran, HB 3572,  actually lowered tax rates. (Okay, HB 3572 created a new tax on alcoholic mixed beverages, but at a lower rate than similar taxes.)

Not all Bills are created equal, and certainly not all “statistics.” or “proof” that the Texas Legislature is not conservative. But we can add one more example to the statistics proving Mark Twain’s adage that there are “Lies, damned lies, and statistics.”

 

Harsh and critical

RPT Elephant shooting duoMy brother told me that if I want to make a difference in politics, I need to be more critical and stop trying to be “nice” or “balanced” with these posts. What do you think?

In the past, I’ve written open letters to our elected Republican legislators. I made up that little graphic, above and wrote post after post about the way we “Eat our own” and “Shoot our own.” I’ve written about “Susurrus I,”  “Susurrus II” and the “Deja vu.” (“Susurrus III” is still an unpublished draft in my files. When it came right down to it, I couldn’t bring myself to be that critical and air the dirty laundry of the Party.)

There was even one post headline where I cussed: “Lies, Damned Lies and Scorecards.”

However, those posts made me uncomfortable. I believe I will continue to try to follow the advice of these little Gems I’ve posted on my front page:

 Emotional noise is destructive to education according to David Horowitz. It’s just as destructive to government, politics and policy and getting along with our friends and neighbors.

We Conservatives can split hairs finer than Baptists – or the Galatians and Ephesians to whom the Apostle Paul wrote 2000 years ago. Apostle Paul had good advice when he admonished us to edify one another and to gently correct our opponents.

 

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