Charles C. Anderson's Blog, page 3

Interview With Author Charles C. Anderson

Interview With Author Charles C. Anderson

http://www.bestsellersworld.com/interviews/charles-anderson-thefirsttosayno.htm

UNCLE SAMDUSKY

Even if you don’t believe a word of what I have to say today, it may come back to you as events unfold.  From reading most newspapers, you would not think that the world financial system is crumbling. Sure, Europe has big problems now, and the U.S. is probably entering another recession.  But we have always recovered from these periods of economic trauma.  Why shouldn’t we come out of this one eventually? Almost no one in America understands what the FED is doing to give us the appearance of recovery and stability in this election year.  In reality, our economy looks stable only because many other countries in the world are in even sadder shape, and we have “resources” that they don’t have.  Eventually I believe that more Americans will come to realize that Uncle Sam is really Uncle Samdusky.

Uncle Samdusky has been giving us candy bars for so long that we have become comfortable with him sitting next to us.  In fact, as a nation, we crave Uncle Samdusky’s candy. The filthy rich folks, Wall Street, the corporate welfare folks, the corporate farmers, the “too big to fail” banks like Uncle Samdusky’s Santa Claus money just as much as the “poor”.  Neither Republicans nor Democrats are interested in distancing themselves from Samdusky.  Both parties game the system for different reasons.  Both parties mostly represent the interests of different people who want money or benefits that they did not earn and someone else has to pay for.

I believe that almost every financial calamity in my lifetime can be traced back to the Federal government choosing winners of Santa Claus money.  Whatever the government meddles in with Santa Claus money ceases to be a free market, whether it’s housing or manufacturing motor vehicles. Most of the gyrations of our stock market and our economy can be traced back to massive intrusion of the government on the laws of supply and demand.  The Federal government causes bubbles when it dumps huge amounts of Santa Claus money into the economy for any reason.  Congress initiated the housing bubble by forcing lenders to lend money to people who had little chance of making monthly payments.  Sub-prime loans and the housing bubble would not have existed if Uncle Samdusky had not decided that almost everyone was entitled to a house, even if he had no down payment and little chance of making monthly payments.

Much of the years of prosperity we enjoyed before 2008 were built on the illusion of endless credit and Santa Claus money from Uncle Samdusky.  Any time you hear someone start a sentence with “Any country that can send a man to the moon and bring him back safely can afford……,” grab your wallet and run.  Another of my favorites is, “Every other civilized country in the world has national healthcare, so we should be able to do it.”  Excuse me, aren’t those other countries either bankrupt and/or pay as you go national healthcare?  Obamacare is not pay as you go.  The U.S. can’t pay anything as we go.  We haven’t even had a budget for the last three years.  Uncle Samdusky has no savings whatsoever.  Many people in America don’t understand the difference between Santa Claus money and tax revenue. And they apparently don’t care as long as they “get theirs.”

Santa Claus money gives Uncle Samdusky the opportunity to control more people, to pick winners and losers in business, and reward people for being lazy and self-destructive.  Santa Claus money has allowed such things as “earmarks,” pork money for the voters, campaign contributors, and friends back home.  Our government has subsidized self-destructive behavior and laziness for decades, while Congress lined its own pockets.  Guess what? We have more self-destructive and lazy people than ever.  In truth, we have not had a free market in this country in many years.  Do you actually believe that individual investors have a chance against the Fed and Wall Street, holding hands in some high rise building in NY, trying to think up another way to rig the game?  Our government’s accounting practices would get any legitimate business thrown in jail. Their behavior discourages honesty everywhere.

To all those who depend on Santa Claus money from Uncle Samdusky, party on while you can, both Republicans and Democrats.  But you are ignoring history.  Our slide has been a long one, but we are near the end.  Don’t take my word for this.  Read the evidence I will present and decide for yourself.  No country in the history of the world has been able to save its currency having reached this point.  Our greenback has lost 95 per cent of its value since it was first issued.  Most of that damage was done with Santa Claus money, money printed and borrowed far out of proportion to U.S. economic activity or the tax revenue we take in.  Most of this money went to satisfy some special interest, an ideological adventure, or greed.  Our founding fathers had in mind limited government, pay as you go.  Only in times of war was deficit spending to be temporarily tolerated.

In 1887 Alexander Tyler, a Scottish history professor, had this to say about 2000 years of experience with prior democracies:

“A democracy is always temporary in nature; it simply cannot exist as a permanent form of government.  A democracy will continue to exist up until the time that voters discover that they can vote themselves generous gifts from the public treasury. From that moment on, the majority always votes for the candidate who promises the most benefits from the public treasury, with the result that every democracy will finally collapse over loose fiscal policy, (which almost) always is followed by a dictatorship.”

The average age of the world’s greatest civilizations from the beginning of history has been just over 200 years.  We are right on schedule.  Think about the enormous power our government already has, the businesses it owns, the banks it sleeps with every night, the mortgages it holds, the land that it owns, the resources it controls, the new powers that our president has created for himself, the imminent takeover of healthcare, and the enforcement arm of the IRS.  I dare you to look up the definition of Fascism.

Never mind, I’ll help you.  Fascism is a system of government that advocates a dictatorship, typically through the merging of state and business, together with an ideology of belligerent nationalism.  Keep in mind that America spends more than ten times as much as the next ten largest countries combined on “defense.” We can’t seem to enjoy peace. One could argue that America has more in common with Government Fascism now than capitalism or socialism.  I believe that the current experiment with democracy is coming to an end before our eyes.

While we are watching artificially low interest rates controlled by the Fed and reading the lies of government accounts of GDP, CPI, and unemployment, taxpayers have been robbed blind by the loss of purchasing power of the dollar.  Americans have been somewhat shielded from the effects of our government’s reckless creation of Santa Claus money, for reasons I will explain.  We have been slowly boiled like frogs, which will stay in the water if the temperature rises slowly.  The rest of the world is wounded every day by this monster, Uncle Samdusky.  I realize that many people have never looked at our government this way, but let’s look at the evidence.

I am not predicting that America is going to cease to exist.  However, the majority of us will feel real pain when Christmas (Santa Claus money) is over.  The world has not seen such a fall since the Roman Empire and the Soviet Union collapsed.  If history is any judge, ultimately price inflation will follow out-of-control monetary inflation.  Mr. Obama and Mr. Bernanke account for one-third of our national debt, in only three and a half years. These dollars may soon come home to roost.  Any number of events could be the trigger, but history says that the U.S. will join much of the world, especially democracies, in a long period of depression, where Uncle Samdusky will require more and more power to control us.  Violence and lawlessness will become an every day event.  Lots of people will be seeking help in emergency departments.  That’s why I started this blog, to get our emergency departments secure and protect the caregivers as violence breaks out in every community.

History teaches us that our government must collapse before we can start over with sound fiscal and monetary practices.  There is nothing wrong with our Constitution.  Uncle Samdusky has corrupted and doomed this version of democracy by debauching our currency.  There are no checks and balances among thieves.  All three of our branches of government have failed miserably to preserve the real Constitution.  Sooner or later, we will go out like every other country that took the Santa Claus path.  We can’t grow our way out of it, producing more tax revenues, because our president is committed to withholding from the country our only possible source of massive honest amounts of money, the energy underneath our own soil and off-shore.  We can’t tax our way out of it even if we eliminated all tax breaks. And lastly, we will eventually be unable to borrow to continue our lifestyle, for reasons I will outline.

Since the taxpayer is already nearly maximally screwed, and interest rates are near zero, government will likely screw the bondholders next, anyone who holds a security backed by the U.S. government.  We can’t hold interest rates down once inflation gets out of control.  Interest rates must rise above the level of inflation to halt hyperinflation.  We are only able to pay the interest on our national debt because of extremely low interest rates. When rates rise to 10 per cent or 20 percent, the interest we must pay on that debt will consume much of the nation’s “budget”.  How do I know that hyperinflation will follow this deflationary period we are in?  There is a sinister process that has already started that you will not read about in the mainstream media.  Once you understand it, I challenge you to come to a conclusion different from mine.  I believe that the entire world is going to cut up Uncle Samdusky’s credit card. I will discuss exactly how and why this will occur, and you will have the opportunity to disagree, but first I would like for you to take a peek at what lies ahead when our creditors have no incentive to lend us more money.

Government employees and their unions should prepare to get screwed soon.  The number of government employees, state, federal, and local, will have to be cut to a fraction of today’s bloated payroll.  Entire federal government agencies will have to go.  We will park some of our aircraft carriers and ground part of our air force.  We will be forced to gut the manpower of the Marines and Army.  Even after cutting entitlements to the bone and making Medicare and Social Security means tested (screw the old folks who saved anything), eliminating all tax breaks, confiscating private 401(k) and IRAs, and instituting wage and price controls, Uncle Samdusky will default on the debt and interest that he can never repay, probably by using his printing presses.  Helicopter Ben is going to be busy.

The coming bad years, as painful as I believe they will be, are necessary to make Americans angry enough to throw out every aristocrat in Congress and reign in the Federal Reserve.  Most of the world will hate America for its irresponsibility for years to come.  But then, much of the world hates us already.  Nobody will lend us any money for a long time.

When massive unemployment hits us and the cost of everything doubles, our society will lose a portion of its civility.  Can you see why a dictatorial government is almost always necessary to maintain order when democracies collapse?  Last week I promised to tell you the most important country in the world to the U.S. and our position of global domination. It is Saudi Arabia.  Just recently, while almost no one noticed, Saudi Arabia demonstrated to the world how America would collapse. That’s next week’s post.

Charles C. Anderson

http://www.amazon.com/author/thrillerguy

SANTA CLAUS IS VERY SICK

In the history of mankind, no nation with a fiat currency (a currency not backed by something of value, like gold) has been able to resist the temptation to inflate its currency to benefit certain parties.  There is really no difference between the government stealing from future taxpayers to benefit corporations, or industries, or farmers, or green energy and stealing from taxpayers present and future to pay for entitlements.  It is still stealing. The leaders in a democracy must derive their power continuously from the consent of the people.  That is one of the purposes of having a budget, and for having our elected legislators vote on it in real time.  Our founding fathers envisioned patriotic Americans rotating through Congress, keeping it honest.  Instead we prefer that every Congressman and Senator stay in Washington for the longest possible time.  Why?  The longer you stay, the more Santa Claus money you can send back home. Santa Claus money allows governments to tax future taxpayers without their consent.  Wasn’t taxation without representation the principle issue that our founding fathers found so intolerable that they organized a revolution?

This Santa Claus money has robbed our nation of its self-reliance and industriousness.  It now encourages class warfare.  When Obama says that taxes need to be dramatically raised on the rich to benefit the poor, he is ignoring the fact that even if he took every dime from the rich, he could not balance our budget and service our debt at the same time without drastically cutting existing entitlements.  He does not say that the absorption of all that capital by the government hurts real businesses, which create real jobs, and pay real wages and taxes.  We already have the highest corporate tax rates in the world, driving businesses to other countries and actually lowering total tax revenue collected.  We are watching European countries even now come to grips with their addiction to borrowed money.  We not only borrow money, we create it with a stroke of a computer and print some more when we need it.  That’s one big reason we have been able to avoid disaster as long as we have.  No other country in the world has the capacity or the gall of the U.S. government and the Federal Reserve to ignore all honest accounting practices and all checks and balances to manipulate markets, interest rates, and money supply.

The current president appeals to class warfare and envy in order to take everyone’s eye off of the basic systemic dishonesty in our government.  I believe that inequality of income in America is shameful. The greediness of CEOs in America is egregious.  All of this was made possible by a dishonest government giving handouts and tax breaks to its friends with Santa Claus money.  But this is a side issue that, even if reversed tomorrow by paying every CEO $1 per year, we could not balance our budget or pay off our debt. I’m afraid I would be tossed out of a Republican rally or a Democratic rally.

Most Americans will gladly look away from Europe and believe that it can’t happen to us.  They have forgotten that the mighty Soviet Union went down the same path that America is on until its currency was worthless.  Did it matter that they spent printed money trying to keep up with Ronald Reagan’s defense buildup, or their war with Afghanistan, or for socialist programs?  Of course not.  The Soviet empire crashed. Americans, rich and poor, want to continue to game the system at the expense of taxpayers in the future and other countries using Santa Claus money. This is nothing new.  It has ruined countries and civilizations for more than 2000 years.  For example, I don’t care if you are a fireman or a teacher or a policeman or a garbage collector or a paramedic.  You did not earn a pension that equals or exceeds your yearly salary when you retire early.  If you have such a deal, you got it because governments and unions agreed to rip off those people who are not employed by some level of government.  I put in 38 years of incredibly stressful work in trauma centers and emergency departments and the government never provided me with such benefits.  I didn’t expect them to.

Whatever the government chooses to subsidize in the name of “help” creates a dependency class.  Many middle class Americans would rather have two years of unemployment benefits than a job.  So many Americans want to be paid for contributing nothing to society.  Do you believe that the number of truly disabled Americans increased five-fold since 2008, or that many people will use any excuse to game the system if Santa Claus money is freely available? Since the war on poverty began in the 1960s, we have spent trillions of dollars subsidizing single mothers.  What incentive does she have to get married or finish her education or get a job when she would lose eight different types of government aid by doing so?

Some say that having 47 per cent of Americans now on some type of government assistance is not doing enough.  Others think that allowing families to earn up to $47,000 without paying any federal taxes is not enough help.  Our president has already stated publicly that he did not care if taxing the rich produced any increase in government revenue.  He knew that the rich would avoid the taxes with loopholes paid for by Santa Claus money.  He wanted to do this out of “fairness.”  He wanted to punish rich people because they are successful. It doesn’t matter to him how they earned their money, or that without these rich people, there would be no non-government employers.

In Obama’s view, the government should decide who is successful.  This level of class warfare and abandonment of the family values of our past, as well as our Constitution, is unprecedented from a president of the United States. Of course big business and big banks and Wall Street are corrupt.  Our government caused much of this corruption with Santa Claus money.  Real capitalism, not adulterated by phony, stolen, borrowed, or created money from the government is the best system for prosperity that man has ever created.  We are now more socialist than capitalist.  Just look at where big government has brought us.

The fact is that the fifty-three per cent of Americans who do pay taxes are way overtaxed and over-regulated.  The problem in America has never been the lack of taxation.  It has always been a lack of control over spending.   Of course Mr. Romney wants to keep his tax returns private.  He has used every tax break and loophole financed by Santa Claus money to pay the least amount of taxes possible.  Although Obama has a socialist agenda and Romney has a capitalist agenda, it no longer matters. They are both liars, neither one willing to tell America that recovery from addiction is going to be painful.  Our creditors are not going to let us continue to turn out Santa Claus money much longer. If you follow this blog, I will tell you why.

I am a physician.  In an ideal world without Santa Claus money I would like the concept of nationalized single-payer health insurance on one condition.  We should pay for it as we go.  Is it too much to ask that the government make the necessary decisions to balance our budget?  When we pay as we go, we have to make those difficult decisions that Santa Claus money allows government and individuals and families to avoid indefinitely. We have avoided making any rules limiting the amount of money that can be spent on an elderly person who is dying.  We spend more money on lost causes than any nation on this earth.

The government doesn’t want to be attacked by every person who wants to live to be 100.  Families often want everything done for elderly parents and grandparents, no matter how futile it is.   These kinds of decisions can be avoided by everybody if the government prints more money and pays for doctors, medications, nurses, mechanical ventilators, and dialysis for everyone to live the last three months of their life in an intensive care unit. Santa Claus money doesn’t require honest discussion about end of life issues.  I’m not advocating euthanasia. I’m calling for a return to sanity in healthcare, spending the money we can afford where it will do the most good.  I want an honest president to face the cameras and tell America that we cannot have all of the medical care we want at government expense using Santa Claus money.

All social programs would have to be drastically reduced to afford Obamacare as a pay as you go program. Adding another gigantic Santa Claus program now, without making the drastic cuts necessary in our bloated budget, simply increases the size and control of government over us all, and hastens our financial Armageddon.

How many addicts are going to vote for someone who pledges to cut off their Santa Claus money? What possible incentive due the 47% who pay no federal taxes have to vote for someone who pledges to cut taxes?  There is no difference between the Republicans and the Democrats on the most critical issue of all, Santa Claus money.  Neither wants the pain of withdrawal.  Neither wants to tell Americans that we face gigantic cuts in all government programs once the election is over regardless of who is elected.  Why?

It is impossible to borrow your way out of debt. We know that instinctively, but we keep doing it because we are addicts.  Our government keeps throwing stolen money after stolen money.  All of the bailouts in this country and all of the bailouts in Europe will ultimately fail, each bailout making the final collapse more painful.  Nobody wants to hear this.  I don’t know who will win this election, but the winner will be the man who organizes the most addicts of Santa Claus money.  Obama has a real advantage here, since he can create dependency groups by decree.

Not only can he create new dependency classes, the Federal Reserve has long ago crossed every line of honesty to keep the country from crashing before the election.  We have been in the twilight zone of corruption since 2008.  There is no level of dishonesty and fraud that our government will not stoop to in order to keep the music going.  Even the dying European countries are laughing at America’s creative financing.  Countries in Europe would not sink to our level of deceit even to keep their country viable.  We have been committed to continuous rounds of “stimulus” with Santa Claus money.  Think of a dying patient who needs a larger shot of epinephrine every five minutes to stay alive.  Not one American in a hundred could explain how our government could possibly buy its own bonds with money it printed in its own mint.  Our Federal Reserve has been doing this since 2008, trillions of dollars of bonds, to manipulate the global bond market and lower long term interest rates.  This is called quantitative easing.  Since the FED cannot lower interest rates to less than zero, they can only try to hold them down by manipulating the bond market.  Don’t you love Fed-speak?

In the Fed’s first round of QE (quantitative easing) in 2008 through early 2010, it bought $1.25 trillion worth of mortgage-backed securities and $300 billion of Treasury securities and debt issued by Fannie Mae and Freddie Mac.  Does it bother you that our Federal government “owns” the majority of all mortgages in America now?  In the second round of QE in 2010 and 2011, the Fed bought $800 billion of U.S. treasury bonds.  A third round of QE is planned for later this year, sooner if necessary.  Wait, there’s more.  If the stock market begins to falter, the FED has a plan to buy stocks and stimulate a “recovery.” As one person in a FED meeting commented, “Buying stocks during an election year would favor the incumbent President.”

Somebody recently pointed out to the FED that it was not authorized to buy stocks.  No problemo.  They buy them through “intermediaries,” says Bernanke.  Imagine how much money the intermediary can make knowing in advance that he is going to buy billions of dollars of stocks with Santa Claus money.  To minimize the profit to any one brokerage, they would buy indexed funds and raise the entire market.  Of course, many index funds are weighted by capitalization.  A novice would know which stock in any index would profit the most.

The most important thing to know about the stock market is when to buy and when to sell.  If you are a Wall Street insider, you know exactly how to play this game with the Fed.  Before TARP funds were handed out, the government reportedly told Goldman Sachs exactly what they planned to do in advance.  Goldman Sachs executives reportedly pocketed millions of dollars from this advance information.  Any bull market between now and the election would not be the first time the FED has created a bubble in the stock market, or the first time it has bought stocks through intermediaries.  It is clear that our government does illegal things, and then quietly passes a law to make what they have already done legal. Wall Street banks don’t represent real capitalism.  They represent crony capitalism and the rape of the American individual investor.

Every time the FED creates money and injects it into the world, it further devalues the dollar.  Countries holding the dollar or dollar assets are screwed.  Commodity prices worldwide are being driven up while the FED creates yet another bubble in the bond market by buying its own bonds.  I’d be getting a little “fed-up” if I lived outside the United States.  Why is it that almost all nations on earth continue to buy U.S. treasuries even though they yield one per cent or less?  This is something you really need to understand because it is the source of much of our Santa Claus money.  Do other nations really feel their money is safer in America than anywhere else?  Do you know which country on this planet really holds the fate of the United States in its hands?  This country could send America into a financial death spiral in one day if it wanted to.  I’ll give you a hint.  It’s not China.  Let me explain. Next week.

Charles C. Anderson

 

 

FREE eBOOKS FROM THE THRILLER GUY

Since publishing The Farm in April 2012 my debut novel has been reviewed by 25 reviewers. Twenty of these are posted at http://www.amazon.com/author/thrillerguy. Ctrl + Click to follow link. Many of these 25 are top Amazon reviewers. The Farm has never received less than a 5-star review from any reviewer anywhere, to my knowledge. I’m sure that some day I will find a review less than 5-star, but not so far.

My second novel, The First To Say No, was released several days before The Farm.  I have seen 25 reviews so far, at least 20 on Amazon.  23 of these reviews rated this book 5-star and 2 rated it 4-star.  You can read all of these reviews at my author site, http://www.amazon.com/author/thrillerguy. Ctrl + Click to follow link.

But wait, there’s more.  You can download a free ebook of either title at Glenda Bixler’s blog, Book Reader’s Heaven,  http://gabixlerreviews-bookreadersheaven.blogspot.com/  Ctrl + Click to follow link.

All you have to do is leave a comment about one of my blog posts, which are available on her site. Now why would I do that?  Because I love you, and so does Glenda Bixler. We want you to get to know her website and get familiar with mine, http://www.thefirsttosayno.com.  Ctrl + Click to follow link.

I recently changed my blog banner, added a picture, and modified my tagline to reflect the broader topics I discuss. Please check out Glenda’s site first and download your first book.  Sneak back to her site (save it in your favorites) in a few days, make another comment and get the other book free. What a deal!

Last week an Amazon and Goodreads reviewer named Marilyn Rondeau posted this review of The Farm on multiple sites:

Five Stars AWESOME – SHOULD BE #1 ON A BEST SELLER LIST

Andy Carlson was a Navy SEAL but when he realized that representatives of the U.S. Government were secretly buying old Soviet tactical nuclear weapons for purposes other than disarmament, he did what any red-blooded American would do – he basically told the government to take their job and shove it! Resigning his commission and having been thoroughly disillusioned, Andy decided to settle down at his family’s Virginia farm and resume his career as an emergency physician. However, as he decides to take a chance on love, or a reasonable facsimile, he finds himself in the middle of a covert operation where he and a colleague (later found to be a female operative sent to ensnare him) find themselves caught between a Russian arms dealer and his own government.

*** Exciting and chock full of action to say the least! Wow, and double wow! I could not put this book down and read it in one sitting – I just couldn’t lay it down. (I actually tried to go to bed, but was so caught up in the story, I got back up and finished it). Author Charles Anderson has written an amazing fast-paced and enormously action-packed volume. I loved the way his hero (and mine), Andy Carlson used his intelligence and gifts of warfare, weapons, and medicine to create this action-packed tale.

There are many facets to Andy, and Charles Anderson unveiled them all.  Having lost his best friend in the war, Andy not only suffered from PTS but seemingly tried to drink himself to death with binge drinking. Although, he only binged when he was not practicing medicine so that he could function brilliantly to save lives.  And he also didn’t drink when his “ward”, a teenaged Saudi girl he just happened to smuggle into the U.S., was around.  Other than his binge drinking, I could really go for our fabulously capable and fearless hero!

The plot of the arms dealing with Russians and our government playing games with one another to the detriment of our country was a real explosive and compelling story-line.  Couple this with the author’s exceptional knowledge in the areas of weaponry and medicine, along with age-old secrets and glimpses of the author’s actual farm in Virginia and this turned into an absolutely stellar read for me.

Bottom Line: The Farm should be on a best seller list somewhere – I positively loved it from start to finish!

Marilyn Rondeau

To be honest, I felt uncomfortable pointing out all of my great reviews until yesterday.  One of my trusted advisors asked me why I didn’t post the fabulous reviews I have on my own blog and to online sites of readers groups and reviewers groups I belonged to.  When I said that I felt uncomfortable doing this she replied, “Screw your humility! In this business you have to learn to sell yourself.  Your reviews are too good not to be advertised.  Now get on with it.” Or similar words to that effect.

I have completed the sequel to The Farm, and Andy Carlson is on fire in this one as well.  Unfortunately, I can’t release it until enough folks become familiar with my hero to build a fan base.  So you are welcome to tell your friends to go to Book Reader’s Heaven and load up.

Charles C. Anderson M.D. FACP, FACEP

 

 

SANTA CLAUS MONEY

Each morning I get up and read at least three newspapers.  I want to put these papers down and sit at my writing computer, polishing my third novel.  Unfortunately, the information I get from the newspapers in so disturbing that I feel guilty about spending my time writing about imaginary heroes and villains.  Books are important to me.  Both creative writing and reading are so enjoyable because they allow us to escape from the real world, from what is going on around us.  I belong to several book clubs, online reviewers groups, and online readers groups.  It is so easy to jump-read from one promising new author to another, back to a favorite author with a new book, then to my Amazon author site, http://www.amazon.com/author/thrillerguy, to see if I have any new reviews on my own books.  I have a Facebook and Twitter presence to keep up and my blog, which began as a study of healthcare violence and unpreparedness for disasters in our nation’s emergency departments.  But the size of the national calamity I see in the back of my mind grows everyday, and I feel guilty.

How can I justify all this time devoted to escapism and to my own needs and dreams, while our country disintegrates before my eyes?  Instead of going to my writing computer I do Google research on my desktop computer, sometimes for eight hours at a time, on such things as the history of fiat currencies, the causes of financial collapses, the causes of inflation and deflation, the principles of Marxism and communism, the history of currency in the United States, the evolving fiscal and monetary policy of the United States, and the history of the Federal Reserve.  This is pretty dry stuff until you begin to understand some of it.  The more you understand, the more frightening it is.

History is my first love.  Americans in general are so famously ignorant about history.  If you stopped ten people on the street, like Jay Leno, and asked them the difference between fiscal and monetary policy, how many people would have a clue? But why should I take on these problems in my blog?  I do believe that there is great civil violence coming to America, and we will need secure emergency departments.  But that’s not the main reason that I write now.  I write because most of the mainstream media won’t even get near the truth of what we face as a country.

The people who cry for more and more government benefits have no idea what they are asking for, or what they are going to get. No one wants to publicly connect the dots between our nation’s startling transformation from a country of self-reliant, industrious people to hundreds of millions of people, rich and poor, Republican and Democrat, who are addicted to government handouts.  These handouts are financed with borrowed money, money created by the stroke of a computer key, or money printed at the U.S. Mint.  I am not advocating any presidential candidate or party.  Under other circumstances I would be alarmed at the rise of socialism in America.  But I know from my study of history that all forms of socialism end when the government runs out of other people’s money to spend and the rest of the world refuses to lend them any more money or accept their depreciated money in payment. We are almost there already.  Obamacare will never be implemented in its present form.  If it is, it will hasten our demise.

I have already outlined in my last post the inevitability of financial disaster due to our national debt, our entitlement time bombs, our budget deficits, the interest on our debts, and the ultimate rise of interest rates.  Here is the most important question for our time: What is the common thread that has corrupted both parties?  Could it be that the same reason that we face financial calamity is the reason that so many other things are wrong with America?  Is the same thing that corrupted Congress responsible for the corruption and greed of government at every level? Is the greediness of the filthy rich, the cycles of bubbles and bursting bubbles in housing and the stock market related to the dependency of the “poor,” the staggering increase in the “disabled,” the steady rise in the number of people unemployed by choice, the demise of the American family, the dramatic rise in the number of single mothers, and the fact that almost half of all Americans pay no Federal income taxes?  Humor me for a moment.  This may be a light bulb moment for you.

Look at the trillions of dollars over-budget we have spent over the last four decades.  One third of that total amount has been borrowed from bond holders, created digitally by the FED, or printed with paper and ink since Mr. Obama took office.  This money did not come from taxation, as it should. It did not come from real growth in the economy, as it should.  This is the money that has corrupted us all from the filthy rich to the poorest sole.  Instead of a nation of industrious, self-reliant people who were the envy of the world, we are a nation addicted to handouts from the government, handouts that will bring our nation to its knees soon.

Our Congress, our presidents, plus the private monster Congress created, called the Federal Reserve, must approve every dime the government spends, borrows, creates digitally, or prints.  These are the ultimate villains.  These criminals have voted for or created all of our national debt and our budget deficits, using money that was never earned by anyone or collected in taxes. Nobody held a gun to their heads.  Lots of people stuffed money in their pockets.

This money could be called funny money, or Santa Claus money, or stolen money from future generations of taxpayers. This is not a Republican or Democrat problem.  Almost all of us are guilty of taking every penny we could get of it.  The financial Armageddon we face is not a racial or ethnic problem.  It cannot be blamed entirely on the filthy rich, or corporate welfare, or Wall Street, or the middle class, or the entitlement classes.  We have all been corrupted by Santa Claus money.  We are as addicted as heroin addicts.  Every class in our society will do most anything to prevent the loss of their Santa Claus money.

Santa Claus money has destroyed our currency while destroying our middle class values, setting us all up for the greatest financial and social calamity of our lives.  Santa Claus money creates thousands of perverse ways to game the system and convince ourselves that we deserve all of the handouts Congress promises us to get elected.  The House of Representatives bears the greatest responsibility because spending bills can only originate in this body.  For decades, these 545 elitists at a time have checked in, made themselves fabulously wealthy, and retired with outrageous pension benefits and their own high dollar healthcare program.

The states’ and city governments saw this and voted outrageous pension benefits and lifelong healthcare benefits for themselves and their employees, as well as the opportunity to retire early.  Neither our federal government nor other governments were concerned that these benefits must be paid for by taxpayers in the future or with Santa Claus money.  All over America, many of our states, cities, and towns are already going bankrupt paying outrageous retirement benefits and healthcare benefits to local government employees. Alas, states cannot create Santa Claus money.  California’s economy is many times larger than Greece’s economy, but they both have the same financial condition caused by the same evil.  Human greed is the ultimate cause of Santa Claus money, the desire to get something for nothing.  Americans prefer that a union justifies their system of early retirement and pension benefits that often double or triple the employee’s salary per year when he was working and ultimately exceeds all of the money he earned while he was working.  As long as each addict gets his fix he does not care about future taxpayers.  The goal of most Americans is “to get mine”; that is, my share of Santa Claus money.

When you have plenty of Santa Claus money available, a government doesn’t have to balance a budget.  For the past three years we have operated our country without a budget. They have only been able to do this because the media has its own perverse reasons for supporting handouts.  Meanwhile, Congress, the president, and the Federal Reserve have shamelessly supported as many addicts as possible and created new constituencies of addicts.  When the crash came in 2008, Santa Claus money was used to bail out Wall Street, the big banks with connections, a motor vehicle company, and two of Congress’ worst inventions, Fannie and Freddie. Screw the taxpayer.

Free Santa Claus money allows the government to pick winners and losers in America, rather than the free market.  Free money allows the president to give billions of dollars to his favorite ideological causes without restraint.  When government picks winners of Santa Claus money on the basis of ideology or bribery (think $535 million to Solyndra, promoted by an Obama megacontributor), the collective decision of the free market that there was too little demand for solar panels to justify this use of capital is ignored.  Like almost every other green project Obama has paid for with Santa Claus money, it went belly-up.

The success of our country in the past was based on the collective wisdom of participants in economic markets.  These markets almost always do a better job of allocating real capital from investors than Santa Claus money allocated to ideology and campaign contributors.  Those people who hate honest capitalism grew up benefiting from free markets that are now so distorted by Santa Claus money that they invite scorn.  I hate crony capitalism too. Please note my use of the term “honest” capitalism.  Not much of that anymore.  Crony capitalists are sucking on the government’s Santa Claus money at a ferocious pace, leaving less and less capital in the system for honest business.  It doesn’t help that the president hates even honest capitalism.   In his view, government is responsible for the past accomplishments of our country.

The media allows this president to get away with outrageous violations of the Constitution.  Even as we sink further and further past the point of no return, the current president has created new classes of addicts to ensure his reelection.  We are now giving food stamps to illegal immigrants, whom the president feels should have the right to vote for him without proof of citizenship.  “Illegal immigrants, come on down! We’ll feed you and give you free medical care and allow you to vote for more benefits.”  If I lived in Mexico, I would take Obama up on this offer.  There is no shame in Washington because potential legislators must buy into the system of Santa Claus money to get elected.  Thieves and liars control our country.  Hope and change was nothing but a campaign slogan.

Does any rational person think that the president’s estimate of the cost of Obamacare is even one-tenth of the eventual cost?  Our government has missed the actual cost of every social program ever enacted by a factor of ten or greater, still counting. More Santa Claus money is supposed to pay for this, because no level of taxation can support what our government spends and owes now.   Our total national debt and unfunded liabilities were recently pegged by an economist at $70 trillion dollars, rather than the equally hopeless $16 trillion nobody wants to talk about.  It no longer matters whether Obamacare is a good idea or a bad idea.  We have already bankrupted ourselves with Santa Claus money.

Sometimes we refer to Santa Claus money as tax breaks.  When the government steals from future taxpayers to benefit any cause, good or bad, it is still stealing.  Our entire tax system is rigged to steal from one person at the expense of another person.  Again, winners and losers are chosen by ideology or by bribery.  Santa Claus money pays for all of our tax breaks. An addict has no restraint and no scruples.  A flat tax with no tax breaks would eliminate this practice, but that would take power away from the thieves in Washington.  Santa Claus money and bribes give government the power to rule over us.

In next week’s post I will discuss our fate, how it will evolve, and how it is inevitable.  I can’t give you the exact date the music of Santa Claus money will stop.  But it will stop.  And we will see riots in our streets and lawlessness from those addicts who, unlike Romney, have no offshore hundreds of millions to convert to a stable currency or precious commodity. Both Republicans and Democrats are going to need those secure emergency departments.  Mark my word.

Charles C. Anderson M.D. FACP, FACEP

A DIRE WARNING FOR AMERICA

When I began writing this blog on violence in healthcare I focused on the direct causes, which included EMTALA, hospital policies, loss of funding for mental health and addiction, and the number of alcohol and drug-related patients seen in our emergency departments.  These problems did not appear to be unsolvable.  As I began to dig further and further back into the history of violence in healthcare I began to understand its proper perspective. Please bear with me while I trace the history of this problem and why it is likely to get much worse before it gets better.

Violence in healthcare is only part of much larger problems.  The first problem is best described as National Unpreparedness for Disaster.  In 2003 Dr. Art Kellerman of Emory University clearly outlined that our nations EDs (emergency departments) were unprepared for any kind of disaster— natural, terrorist, or biological. In 2006, The Institute of Medicine’s Committee on the Future of Emergency Care released a similar report on the unpreparedness of America for disasters.  As I studied these two articles I was stunned by the fact that the requirements for preparing our nation’s EDs to manage disaster have been identified for almost a decade.  During that decade, our government has further increased our vulnerability to disasters.

There is an old saying, “Follow the money” when you don’t understand what is going on. In order to respond to national disasters, we must have some surge capacity within each hospital. In other words, we need more hospital beds.  Trauma centers need more surge capacity than general hospitals.  Unfortunately, our government has been on a three decade mission to reduce the number of hospital beds and psychiatric beds.  While the number of patients visiting EDs has increased steadily, augmented by the concentration of potentially violent patients mandated by EMTALA, the number of hospital beds in America has decreased by hundreds of thousands.  Between 1993 and 2003, the number of hospital beds declined by 198,000.  There was a 25 per cent decrease in the number of hospital beds from 1980 to 2000.  Most of these lost beds have never been replaced.  In 2002, according to AHA, there were 5,810 hospitals.  There are 5,754 hospitals in the U.S. as of 2012.  The U.S. has a comparatively low number of hospitals per 1000 persons, 2.7, and physicians per 1000 persons, 2.4.  The average among thirty other countries is 3.3 per 1000 persons for both hospitals and physicians.  As the number of beds has decreased, the number of patients requiring admission increased, welcoming in the era of boarding admitted patients in the ED and diverting ambulances.

For three decades hospitals have been squeezed by the government to cut costs.  To make sure that hospital beds decreased, the government began to steadily ratchet down reimbursement rates to hospitals and insurance companies. We must consider that the failure of hospitals to provide adequate security is at least partly due to cost control.  Dr. Paul Biddinger, Director of Operations for the Department of Emergency Medicine at Massachusetts General Hospital summed it up in 2006, “Reimbursements to hospitals is structured in a way that it’s not financially possible for hospitals to add more beds.”

So, let’s get this straight.  The government and its gaggle of health agencies have had the problem of nationwide hospital and ED unpreparedness pointed out to them repeatedly by researchers and emergency physician leaders like Dr. Kellerman and Dr. Billinger long before I showed up.  These two emergency physicians screamed to our government in 2006 that it had achieved its goal of efficiency and needed to increase capacity for the sake of disaster preparedness.  The reduction of hospital beds did improve individual hospital efficiency, but left America totally unprepared for any kind of disaster, not to mention the coming baby boomer surge.

Many hospitals have very high occupancy rates and essentially no surge capacity for disasters.  Of course, not all beds in a hospital can be used as surge beds.  During this long period of reduction of hospital beds, emergency departments have become more and more crowded.  Remember that when a hospital closes, an emergency department closes.  Psychiatric beds have decreased so dramatically that mentally ill patients have nowhere else to go but the local ED, where they frequently need one on one care during the long wait to find a psychiatric bed.   Street drunks have been given a government VISA card to sleep overnight in the ED every night at no cost to them.

I think that if the terrorist attack of September 11, 2003 had produced 3,000 trauma patients instead of 3,000 dead, the inadequacy of our nation’s EDs would have been clearly demonstrated.  I have worked in three trauma centers.  None could handle more than about five or six major trauma patients requiring surgery at one time.  There are not enough trauma surgeons or anesthesiologists or operating rooms or nurses or support personnel or CT scanners in any one city to accommodate such a disaster.  Any plan to distribute 3,000 trauma patients to many hospitals would have exposed our inadequate number of ambulances and helicopters.

Homeland Security incorporates FEMA (Federal Emergency Management Agency). You remember FEMA; the folks who could not bring water to the Astrodome for five days after Katrina struck and had no evacuation plan.  The management of disasters is FEMA’s reason for existence, yet they have done nothing about ED vulnerability to disasters.  ED security is no priority to them.  I have been searching for some plan from FEMA, CMS, or JCAHO that addresses emergency departments, the point of intake for most victims in a disaster.  So far, I see none.   The fight over Obamacare has only taken our eyes off of the big picture.

I never intended for this blog to be any kind of political statement.  I could see no reason why Democrats and Republicans should not agree that our nations EDs need better security to protect the caregivers as well as prepare for disasters.  But, as I have worked on this problem, and struggled just to arrange a meeting with agencies like FEMA, it has become clear just how dysfunctional our government is.  Currently, it appears that Democrats and Republicans cannot sit in the same room and have a civil discussion.  Nobody is interested in anything except the coming election.  The agencies controlled by our Congress have, in some cases, thrown up their hands and stopped trying to fix problems.  Every course they take results in a partisan fight or a fight between two powerful lobbies.  Good ideas cannot be voted on because no one wants to be identified as a legislator who cooperated with the enemy.  This limits what OSHA, CMS, and JCAHO can do about healthcare violence.

Even if I could blast my way through all this hatred and mistrust and daily bickering between people who publicly express their contempt for each other, I would still have to overcome the lobbyists from AHA, who oppose hospital and ED security for reasons that I have already dealt with in other posts.  The point I want you to appreciate is that this congress is incapable of overcoming the huge divide between the left and the right on anything, including a budget for our country for the last three years.  This divide is tearing our country apart right before our eyes.

The next elephant in the room that you must prepare for is our country’s suicidal fiscal policy.  If you are looking for a source of civil violence in the future, look no further.  We are living in a surreal nation that refuses to alter its course no matter what the obvious consequences.  Our president and his economic team appear comfortable with the fact that no nation has ever debauched its currency like the USA without precipitating anarchy, civil wars, hyperinflation, and/or depression.  The same president refuses to enforce federal laws that he does not like. I have heard a president of the United States stoke the fires of class warfare and envy even as he single-mindedly pursues his own agenda at all costs and against all warnings.  I have never seen anything like this in my lifetime.

Even if the members of Congress did not act like they hate each other, they are hopelessly corrupted by corporations and special interests. They have excused themselves from the very laws they heap on the people, creating a new class of aristocracy.  The elimination of aristocracy was one of the cornerstones of our nation’s fight for independence.  This ruling class is not what our founding fathers had in mind.  Our founding fathers did not give the executive branch the authority to make up its own laws when frustrated by Congress.  But this is exactly what we see in the newspapers on a regular basis.  Our president is governing by executive decrees.  Would you have ever predicted that individual states would sue the federal government?  Would you have predicted that Congress would charge the chief law enforcement officer in the country with criminal contempt?

I could not imagine our country sending thousands of guns into an already unstable Mexico for any reason.  But the ATF did just that even before Obama took office.  The current attorney general’s refusal to answer questions about Fast and Furious and our president invoking executive privilege to keep documents concerning the operation suggests that he has something explosive to hide.  When have we seen individual states prevented from enforcing federal laws by the federal government?  The ineptitude and corruption of our government and our national bankruptcy are creating a perfect storm for disaster.

The Republican candidate is really not much of a choice, another aristocrat who cannot change the culture in Washington or the divide between left and right.  We, the people, are not the right stuff who built this country, a country that most of the world once admired.  We are divided into narrow interest groups who want to use the government to force our views onto those who disagree with us. We have long since forgotten President Kennedy’s charge:  “ask not what your country can do for you; ask what you can do for your country.”

I believe that we are witnessing the last days of the USA as we have known it post WWII. This life was based on individual hard work and initiative, which reaped rewards in proportion to how hard we worked.  We are now a nation dependent on a corrupt and dysfunctional government. I fear that our country has reached the limits of democracy, the point where the government can no longer give us what we demand or honor its commitments of the past. Our individual interests have become more important to most Americans than our country.  We must bear a large part of the blame for our broken society.  We did not limit government’s power.  We showed no restraint with our demands for more and more benefits.  We made bribery legal for our elected representatives by renaming the money campaign contributions.  I doubt if any government agency or Congress will address violence against healthcare workers.  They will be too busy trying to control the angry mobs in our own cities.  We are a broken nation facing a future as indeterminate as the one President Lincoln spoke of in the Gettysburg Address. I do not think that we can long endure.

I will continue to pursue congressmen, senators, and government agencies about healthcare violence, but the fact that no government agency has addressed the vulnerability of our nation’s emergency departments to disasters despite a decade of clear warnings is profound and discouraging.  The healthcare violence problem is a tip of the iceberg of a dysfunctional government in denial.  While we fiddle with the latest smart phone, our experiment in democracy is rolling toward a giant waterfall.  Our president is sitting in the canoe “America” facing backwards, totally preoccupied with his own agenda, as “America” plunges into the abyss. At this point, I don’t believe we can avoid the outcome of generational fiscal irresponsibility by both parties.  I see no leader who inspires me to think that we can avoid a worse fate than Greece.  In many ways, we have been even more irresponsible than the debtor nations of Europe.  Think it can’t happen here? American cities are lining up to declare bankruptcy. At every level of government, politicians promised too much and spent too much.

If I am correct in my assessment of the need for armed, uniformed security in our nation’s emergency departments based on the current vulnerability of our ED staffs, imagine the need for security when our streets are filled with angry people whose green checks are worth less every day.  Interest rates only have to tick up a few points and we will be unable to fund the interest on our government debt and pay out government entitlements at the same time. Even if the government taxes every American who has an income over $250,000 at a rate of 100 percent, we would be unable to balance a budget and our national debt would continue to climb. Our government has created multiple unsustainable expenditures that represent people who will likely resist violently when their entitlements are decreased or inflated away.  This is not just my assessment.  This is the history of the rise and fall of nations worldwide.  Our house of cards is shaking.   Mr. Obama is reassuring us that we will be the first nation in history to tax and spend its way to prosperity through dependency on larger government.

Romney wants to see Obama’s college grades and Obama wants Romney to “come clean” about Bain Capital.  This is leadership? The Republican presidential candidate and the current president are arguing over the arrangement of the deck chairs on the Titanic.  As important as managing healthcare violence is, I believe that the next person who is assigned to maintain order in most emergency departments is more likely to be a member of the National Guard than an employee of the hospital.  I sincerely hope that I am wrong, that somehow we can re-invent America. It was good while it lasted, but I fear that it is gone with the wind, as gone as the old South.

As a student of history, I’m betting against a bloodless transition to smaller government and individual responsibility.  I am reminded of General Buford, the Union cavalry officer who arrived first on the battlefield at Gettysburg.  He spoke of the anguish of ordering men to make a fruitless charge, knowing in his heart that the charge would fail and his men would be slaughtered. As a career soldier, he could recognize the signs of impending disaster.  Ironically, it was General Longstreet, the Confederate Corps commander, who had to live General Buford’s nightmare.  General Lee ordered Longstreet to plan Pickett’s charge on the last day of the battle.  General Longstreet knew that the charge would fail, but he could not refuse to follow an order from General Lee.  He was doomed to watch his own Corps decimated in predictable fashion. It was the beginning of the end for the Confederacy.  I feel this same anguish and helplessness as I watch the demise of my own country.  There is nothing I can do about it except warn you of very hard times ahead.  I can’t predict the future, but I can tell you what has happened when other countries have tried Mr. Obama’s and Mr. Bernanke’s formula for prosperity.  Every single effort has failed, with catastrophic results.  There is no one who can bail us out.  The results of the coming election won’t change our fate.  Our own debt and the printing presses have already inflicted a mortal wound on America.  I am so very sorry.

Charles C. Anderson M.D. FACP, FACEP

WE ARE JUST GETTING STARTED

There are times when a situation seems so hopeless that you are tempted to just walk away. Violence toward healthcare workers does not seem to incite urgency or enthusiasm from nurses, emergency physicians, JCAHO, CMS, or the nameless congressional committee supposedly working on “Healthcare Violence.”   After more than a decade of rising violence focused in emergency departments none of these groups have come forth with any recommendations for minimum standards of security for every emergency department.  This is pathetic, with all due respect to those who have good ideas but never open their mouths.  I’m sure that there are some nice people in all of these organizations, but the facts speak for themselves.

The recent meeting of the Emergency Nurses Association in Chicago could have been a wonderful opportunity to develop consensus and an action plan.  Instead we heard a conglomeration of speakers, most of whom were not brave enough to endorse anything.  I didn’t think that the architect or the non-clinical speakers added anything useful.  We had a colorful speaker show nurses how to deflect the forearm of a man pointing a gun at them, but no one wanted to talk about how this armed man got into the emergency department to start with.  Not one minute was spent on what the nurse was supposed to do with this man after his forearm was deflected.  This is not education.  It is an invitation to disaster.  Having a military background, I found it tragic to watch.  Any man who has a gun in his dominant hand will not be disarmed by deflecting his forearm. If you are not trained to follow up on your split second advantage, this man is likely to bring the gun over the top of the extended arm of the nurse, and, well, God help her.  She has now provoked him.

I am hopeful that no one bought into these simplistic maneuvers.  This is not how to teach self-defense.  It takes months of training and one-on-one practice against other professionals to hope to disarm an attacker without getting killed.  It is not prudent for any nurse who watched a child’s play demonstration one time to go back home and attempt any of the maneuvers illustrated.  This man had some good advice about giving angry people their space, but he seemed to be under the impression that doctors and nurses could develop black belt skills in karate by watching a demonstration.  From my viewpoint, almost all of the speakers’ time was wasted because there were no priorities set at the beginning of this meeting.  What we needed were speakers who had analyzed our major risks for violence and had a plan of action that they were willing to defend to the audience.  It is okay to have two speakers who disagree, but each must have the courage to defend his position.

The second major flaw in the program was the failure to outline what was necessary to make each kind of change.  Some problems can be solved locally by changes in hospital policy. As I noted in my last post, no one even brought up the subject of boarding admitting patients.  I’ll bet there was not a nurse there who wouldn’t agree that this practice is bad for the admitted patient, bad for the incoming ED patients, and bad for the ED staff.  It is dangerous for everybody and plays a critical role in ED violence, which mostly occurs on evenings and nights.  It contributes to that critical mass that often results in a violent outburst from someone who is tired of waiting for the nurse’s attention.  It is disappointing that not one nurse could be found who was willing to endorse the obvious.

No act of congress is necessary to hire real, armed, certified security officers.  Just like metal detectors, these issues should have been debated by experienced clinicians in front of us.  If no one can find a medical director of an inner-city ED who doesn’t endorse these security measures, that should tell the audience something.  Your comfort with no security may simply be a function of the neighborhood your hospital is located.  Wouldn’t it be prudent to invite someone who sees a gun-shot wound every day?  This type of debate gives the audience a chance to weigh issues properly, not come and go with the same old biases.

I thought that the man from JCAHO was a joke.  He was incredibly unprepared.  He was supposed to be working with a congressional committee, CMS, nursing organizations, and physician organizations on healthcare violence.  He couldn’t think of the name of the committee or the name of anyone on the committee.  He had no advice regarding consensus, or any information to give us about what members of this committee thought or what information they had or where they got it.  We would not even have known about the committee if someone had not pressed him as to why JCAHO and CMS had done nothing so far about a problem getting progressively worse for ten years. This man embarrassed the federal government, if that is possible.

With all of these highly trained and experienced nurses present, there were no surveys to determine who supported what.  There was no objective information collected to correlate attitudes toward individual security measures and the amount of violence in a given ED.  There was no survey asking the attendees to rate the priority of their issues or their degree of support for each type of response.  We wasted all that knowledge and experience.  Only one speaker was willing to make a recommendation, the security expert.  He suggested that we start by getting uniformed officers in every ED.  This was an achievable goal that did not require a congressional committee.  This man understood that the most effective way to avoid out-of-control behavior is a consistent show of credible force.  Sadly, no one picked up on his theme.

One of the most important issues that we face is our chief defense mechanism—DENIAL.  If most nurses in attendance really believed that their department was susceptible to a Columbine-type incident, they would not be taking the risks they do so calmly.  In February 2010 a gunman marched into a trauma room at a North Carolina hospital and opened fire.  Another man in Georgia walked right in and killed one of his mother’s nurses and another employee.  Last year a gunman shot an ED physician at Johns Hopkins and then killed himself and his mother. Those who give no priority to making emergency departments free of weapons and do not think that they need armed security are in denial.  For a fresh look at the consequences of denial, consider what happened to the Republicans last week.

I was not in favor of Obamacare, mostly because it was enacted by legislators from one party who admitted that they hadn’t even read it. Suffice to say, our government is so dysfunctional that we have sunk to unbelievable lows.  “We have to pass it in order to find out what’s in it.”

Having said that, my hat is off to you, Mr. Obama.  You may have created a nightmare for us, our children, and our grandchildren, but that remains to be seen.  You will certainly increase the number of patients in the emergency departments in our country.  But I’m giving you credit for recognizing the vulnerability of denial.  You have accomplished something momentous against overwhelming odds in an arena that has taken down many a warrior.  You have done what no other president or party has been able to do since LBJ.  The Republicans were in denial.  They had legions of lobbyists and obstructionists that had held back change for decades.  Republicans were so sure that they could defeat Obamacare that they didn’t bother to negotiate or compromise. They were so arrogant that they misjudged the President and the Chief Justice of the Supreme Court.

There is an important lesson here.  It is about setting priorities and leaving denial behind.  Both Mr. Obama and Mr. Roberts knew that the universal mandate was the key to the entire bill. They both had the guts to go for it.  I believe that nurses can impact the plague of healthcare violence, but only if they show more organization, ingenuity, and backbone.  This is not an issue where everyone is going to agree on everything.  However, if nurses do not agree on something soon, they face a frightful future in the ED.

I can’t supply nursing leadership. Perhaps the nursing community is not the right tool.  I’m a physician.  The emergency physician organizations are capable of making wonderful lists of problems and possibilities, but so far they have been incapable of endorsing anything definitive or showing the resolve to buck the system.  I realize that both nursing and physician groups have political issues to worry about.  That’s why I feel that I can help.  I don’t care who is insulted by my remarks. Nobody can fire me and no one can convince me that what I am doing is wasted effort.

My next stop is Homeland Security.  I’m going to keep knocking on their door until somebody responds.  I have already contacted them.  You never know when you will run into someone sensible and honest in the government. It’s possible. The little guy can win. If healthcare workers are unable to come up with any consensus or action plan, perhaps someone at Homeland Security will understand the connection between natural disasters, terrorist disasters, and the need for security at the local emergency department when the lights go out.  You might be surprised at what powers Homeland Security has.  As Mr. Obama and Mr. Roberts just illustrated, there is more than one way to win.

While I’m in Washington I’m going to visit the senators and congressmen from my home state of Virginia.  I’m going to find out who is on this congressional committee.   I want to testify before this group.  I’m not going to stop pointing fingers and calling people out until I see results.  There are certainly more diplomatic physicians with better qualifications than mine.  But they don’t have the time I do and they still have political risks.  I loved my career.  I have been director of three emergency departments, two trauma centers, nine EMS agencies, and one intensive care unit. I have developed and directed city-wide and regional-wide EMS systems. I have been elected President of the Medical Staff twice.  I have personally designed two emergency departments and three urgent care centers.  I have worked in Atlanta, Washington D.C., and Richmond, Virginia.  In the last thirty-eight years I have seen it all and done it all in the pit. These congressmen need a dose of reality.

I’ve been assaulted several times and intervened in the assault of several nurses.  I make no apologies for doing what a security officer should have been doing.  While I took no pleasure in it, I have rendered several violent patients unconscious with my fists, metal bedpans, and infusion pumps.  I think that God made me a big man for a reason.  In each case, I felt that my actions were the quickest way I could stop the patient from killing the nurse.  I don’t care whether you approve or disapprove of my actions.  The nurses were grateful.

The best qualification I have for this job is that I have been working in the ED when gang members emptied their weapons into the surgical emergency department, killing my friends, patients, other gang members, policemen, and nurses. This occurred forty years ago while I was a medical student.  I have survived several other ED shootings.  There has been no significant improvement in the security in most emergency departments during my career.  In fact, in many ways, ED employees are even more vulnerable.

I’m afraid that for some of you reading this post, who like the status quo; I’m what you call a troublemaker. Stay tuned.

Charles C. Anderson M.D. FACP, FACEP

THE EMERGENCY NURSES’ ASSOCIATION HEALTHCARE VIOLENCE SUMMIT

The Emergency Nurses’ Workplace Violence Prevention Summit in Chicago ended today, leaving me at base camp.  There were some good things that happened here.  There were representatives from the Emergency Nurses Association(ENA), the emergency physicians (American College of Emergency Physicians), the International Association for Healthcare Security and Safety (IAHSS), an expert of current trends and risk management for Healthcare and Emergency Department Violence, an expert in the safe way to manage aggressive behavior, a representative from OSHA, an emergency department architect, a representative of JCAHO (The Joint Commission on the Accreditation of Hospital Organizations), and one independent physician advocate for the safety of nurses in the emergency department (me) in the group. Only two physicians attended. I would guess that approximately 110 emergency nurses attended.  Most of these were experienced nurses or nursing directors with years of experience with violence. For some unknown reason, these groups had never gotten together to discuss this topic before.  Give the ENA and its 2012 President Gail Lenehan, Ed.D, MSN,RN,FAEN,FAAN credit for this.  I think she was also MVP of the National League a couple of years ago.

The most surprising thing to me was that almost all of the attendees and speakers agreed on the gravity of the problem, which was illustrated with article after article and slide after slide, followed by several touching personal experiences.  A few nurses presented original pearls that they had developed and that looked promising as small solutions.  All of the nurses seemed to agree that better security was overdue, but the conference ended without any action plan or endorsing any specific measures.  The group would like to meet again.  There are still some nurses who would rather take a chance on being shot than have a security officer present in their ED with a gun.  I respect their right to have those views but I believe they represent a fear of all guns coupled with a dose of denial.

Having been in the ED when a maniac decided to kill as many people as he had bullets in his gun, I would rather have at least one gun in the hands of someone on my side, like the security officer.  For some reason the idea of curling up in a ball in the floor waiting for my turn to be shot in the back of the neck doesn’t appeal to me.  To each his own.  Some day I predict that every ED will have an armed security guard.  Before that happens there will have to be more blood on the floor, lots of it. This is not what I want, but it is what nearly four decades of working in the ED and a lifetime of watching our government tells me.  It is not a question of if.  It is only a matter of time before some deranged person turns an ED into a Columbine.  American government can barely function at all.  Only a crisis can get them to do anything.

It was estimated that less than 5-10 per cent of hospitals have metal detectors, bullet-proof glass, and armed, certified, uniformed guards. Interestingly, those nurses who have this protection love it.  I don’t believe that anyone thinks that metal detectors and armed, uniformed officers are going to solve all of our violence problems.  We cannot change the nature of man. We must, however, grasp what we can control when we can do it, and we must have an action plan that prioritizes our efforts.  We do not need any more studies.  Just because we cannot prove how many fights do not occur because there was an officer on duty does not mean that the officer isn’t an integral part of the overall plan.   Almost all of the speakers preferred to let each individual hospital decide whether they needed these measures.  I have already discussed in a previous post why this is folly.

I thought the smartest man there was the security expert from NIOSH, Dan Hartley.  Knowing the scope of the problem and all of the political minefields required to completely address the problem, he suggested that we concentrate on the most important thing first, especially since we would not need Congressional approval to do it.   His proposal:  Put a real security officer into every ED 24/7.  This would provide something for most of us who have nothing useful for security.  Even if this security officer only had the authority to use pepper spray or a taser, he could help restrain out-of-control patients.  Just his presence would solve and prevent a lot of our problems.  This is what the anti-gun crowd does not understand.  A show of credible force prevents people and even countries from acting out.  Let’s face it.  Violence against healthcare workers is never going to stop.  The ED is Grand Central Station for violence prone people, and will only get worse until definitive changes in design, policy, and procedure are clawed out.  Then we will only manage violence better.

I did clarify a couple of things.  The representative for JCAHO said that Congress (the same Congress that couldn’t pass a budget the last three years) has a committee that will give JCAHO and CMS advice in this case.  I don’t know why this is necessary, since JCAHO and CMS undertake initiatives all the time that they take to Congress to rubber stamp.  This JCAHO representative could not name a single voting member of the committee, but he thought they wanted to pass a “healthcare safety act”.  This is the guy who is supposed to be presenting our safety needs to Congress, according to JCAHO’s mission statement.  He added that there would likely be a big turnover in the makeup of this committee due to the November elections and no bill was on the table.

I realize that I am often too goal oriented and prone to force other people into confronting the lack of logic in their position.  Nevertheless, I was left speechless by this tidbit.  No one at this conference had ever testified before this committee and no one even knew what information the committee had on the problem of violence against healthcare workers. In other words there has been essentially no line of communication between those emergency department (ED) nurses who are being assaulted and the only committee that can address the problem.

The ENA has a “legislative affairs” person, but she did not have any explanation.  This pathetic state of affairs only came out because I asked the representative from JCAHO why JCAHO and CMS had not collaborated and produced some new regulations years ago.  After all, there have been good studies published as far back as 2001 on this problem.   So, the bad news is that our government is terminally dysfunctional and that the emergency nurses don’t  know the names of the legislators or the committee who control their fate.   I’m sure that they will be more aggressive with their legislative agenda in the future.

The good news is that the clinician nurses present were in remarkable agreement on most issues.  All were fed up with the diplomatic immunity of the professional street alcoholic.  Almost all thought that our administrators did not understand how desperate we were, nor did they understand the many ways they made our job in the ED harder.  I didn’t even bring up the problem of boarding admitted patients in the ED, which could have been addressed and eliminated by JCAHO and CMS years ago.  An occasional ED nurse director actually had a sympathetic administrator and a good relationship with the police department, but the majority of EDs still struggled with what to do with the violent patient brought in by the police, who took off the patient’s handcuffs and then got back on their horses and rode away. The closest thing to a plan from this conference was to do more studies.  Anyone who does not understand the problem now is not going to understand it after one more study.

Most nurses understand that the administrators do not want to pay for changes to their physical plant and they fear slowing patient flow.  The administrator is terribly concerned that those metal detectors might leave the impression that there is something unsafe about the ED, other than it being the most dangerous workplace in America.  There may be someone out there who has a more positive view of this summit than I, but I don’t anticipate any significant change in ED violence soon.  If there is another summit, there needs to be a lot more physician input.  We are certainly in this together. Physicians are right behind nurses as victims of assaults. I am sorry that I cannot give you better news and I am sorry that I could not have made a difference at this meeting.  I did meet some nice, very-well-educated and sensible people who agreed with me on most issues.  I had hoped for consensus on an action plan.

One more thing, the most common perpetrators of violence in the ED besides the patient are friends and family.  You know, the people sitting in the waiting room and wandering in and out of the treatment area where there is no security.

Charles C. Anderson M.D., FACP, FACEP

The Emergency Nurses’ Association Healthcare Violence Summit

The Emergency Nurses’ Workplace Violence Prevention Summit in Chicago ended today, leaving me at base camp.  There were some good things that happened here.  There were representatives from the Emergency Nurses Association(ENA), the emergency physicians (American College of Emergency Physicians), the International Association for Healthcare Security and Safety (IAHSS), an expert of current trends and risk management for Healthcare and Emergency Department Violence, an expert in the safe way to manage aggressive behavior, a representative from OSHA, an emergency department architect, a representative of JCAHO (The Joint Commission on the Accreditation of Hospital Organizations), and one independent physician advocate for the safety of nurses in the emergency department (me) in the group. Only two physicians attended. I would guess that approximately 110 emergency nurses attended.  Most of these were experienced nurses or nursing directors with years of experience with violence. For some unknown reason, these groups had never gotten together to discuss this topic before.  Give the ENA and its 2012 President Gail Lenehan, Ed.D, MSN,RN,FAEN,FAAN credit for this.  I think she was also MVP of the National League a couple of years ago.

The most surprising thing to me was that almost all of the attendees and speakers agreed on the gravity of the problem, which was illustrated with article after article and slide after slide, followed by several touching personal experiences.  A few nurses presented original pearls that they had developed and that looked promising as small solutions.  All of the nurses seemed to agree that better security was overdue, but the conference ended without any action plan or endorsing any specific measures.  The group would like to meet again.  There are still some nurses who would rather take a chance on being shot than have a security officer present in their ED with a gun.  I respect their right to have those views but I believe they represent a fear of all guns coupled with a dose of denial. 

Having been in the ED when a maniac decided to kill as many people as he had bullets in his gun, I would rather have at least one gun in the hands of someone on my side, like the security officer.  For some reason the idea of curling up in a ball in the floor waiting for my turn to be shot in the back of the neck doesn’t appeal to me.  To each his own.  Some day I predict that every ED will have an armed security guard.  Before that happens there will have to be more blood on the floor, lots of it. This is not what I want, but it is what nearly four decades of working in the ED and a lifetime of watching our government tells me.  It is not a question of if.  It is only a matter of time before some deranged person turns an ED into a Columbine.  American government can barely function at all.  Only a crisis can get them to do anything. 

It was estimated that less than 5-10 per cent of hospitals have metal detectors, bullet-proof glass, and armed, certified, uniformed guards. Interestingly, those nurses who have this protection love it.  I don’t believe that anyone thinks that metal detectors and armed, uniformed officers are going to solve all of our violence problems.  We cannot change the nature of man. We must, however, grasp what we can control when we can do it, and we must have an action plan that prioritizes our efforts.  We do not need any more studies.  Just because we cannot prove how many fights do not occur because there was an officer on duty does not mean that the officer isn’t an integral part of the overall plan.   Almost all of the speakers preferred to let each individual hospital decide whether they needed these measures.  I have already discussed in a previous post why this is folly. 

I thought the smartest man there was the security expert from NIOSH, Dan Hartley.  Knowing the scope of the problem and all of the political minefields required to completely address the problem, he suggested that we concentrate on the most important thing first, especially since we would not need Congressional approval to do it.   His proposal:  Put a real security officer into every ED 24/7.  This would provide something for most of us who have nothing useful for security.  Even if this security officer only had the authority to use pepper spray or a taser, he could help restrain out-of-control patients.  Just his presence would solve and prevent a lot of our problems.  This is what the anti-gun crowd does not understand.  A show of credible force prevents people and even countries from acting out.  Let’s face it.  Violence against healthcare workers is never going to stop.  The ED is Grand Central Station for violence prone people, and will only get worse until definitive changes in design, policy, and procedure are clawed out.  Then we will only manage violence better.

I did clarify a couple of things.  The representative for JCAHO said that Congress (the same Congress that couldn’t pass a budget the last three years) has a committee that will give JCAHO and CMS advice in this case.  I don’t know why this is necessary, since JCAHO and CMS undertake initiatives all the time that they take to Congress to rubber stamp.  This JCAHO representative could not name a single voting member of the committee, but he thought they wanted to pass a “healthcare safety act”.  This is the guy who is supposed to be presenting our safety needs to Congress, according to JCAHO’s mission statement.  He added that there would likely be a big turnover in the makeup of this committee due to the November elections and no bill was on the table.

I realize that I am often too goal oriented and prone to force other people into confronting the lack of logic in their position.  Nevertheless, I was left speechless by this tidbit.  No one at this conference had ever testified before this committee and no one even knew what information the committee had on the problem of violence against healthcare workers. In other words there has been essentially no line of communication between those emergency department (ED) nurses who are being assaulted and the only committee that can address the problem. 

The ENA has a “legislative affairs” person, but she did not have any explanation.  This pathetic state of affairs only came out because I asked the representative from JCAHO why JCAHO and CMS had not collaborated and produced some new regulations years ago.  After all, there have been good studies published as far back as 2001 on this problem.   So, the bad news is that our government is terminally dysfunctional and that the emergency nurses don’t  know the names of the legislators or the committee who control their fate.   I’m sure that they will be more aggressive with their legislative agenda in the future.

The good news is that the clinician nurses present were in remarkable agreement on most issues.  All were fed up with the diplomatic immunity of the professional street alcoholic.  Almost all thought that our administrators did not understand how desperate we were, nor did they understand the many ways they made our job in the ED harder.  I didn’t even bring up the problem of boarding admitted patients in the ED, which could have been addressed and eliminated by JCAHO and CMS years ago.  An occasional ED nurse director actually had a sympathetic administrator and a good relationship with the police department, but the majority of EDs still struggled with what to do with the violent patient brought in by the police, who took off the patient’s handcuffs and then got back on their horses and rode away. The closest thing to a plan from this conference was to do more studies.  Anyone who does not understand the problem now is not going to understand it after one more study.

Most nurses understand that the administrators do not want to pay for changes to their physical plant and they fear slowing patient flow.  The administrator is terribly concerned that those metal detectors might leave the impression that there is something unsafe about the ED, other than it being the most dangerous workplace in America.  There may be someone out there who has a more positive view of this summit than I, but I don’t anticipate any significant change in ED violence soon.  If there is another summit, there needs to be a lot more physician input.  We are certainly in this together. Physicians are right behind nurses as victims of assaults. I am sorry that I cannot give you better news and I am sorry that I could not have made a difference at this meeting.  I did meet some nice, very-well-educated and sensible people who agreed with me on most issues.  I had hoped for consensus on an action plan.

One more thing, the most common perpetrators of violence in the ED besides the patient are friends and family.  You know, the people sitting in the waiting room and wandering in and out of the treatment area where there is no security.

Charles C. Anderson M.D., FACP, FACEP

WISHING AND HOPING

By far the best summary of violence against ED nurses was published in the Journal of Nursing Administration July/August 2009 by Jessica Gacki-Smith MPH, et. al. Their documentation of the scope of the problem, their identification of the causes, their identification of the barriers to change, and their documentation cannot be faulted, in my opinion.  I would like to quote from their conclusions,

“Most important, federal and state laws to protect ED nurses from violence are needed to address this issue.  Whereas some states have made assault of a nurse a felony, other states do not have such stringent laws in place to adequately protect nurses.  Unfortunately, legislation such as this is often passed only after a tragic incident against a nurse takes place. To make this a legislative priority, leaders of nursing organizations need to use their government affairs departments to heighten legislator’s awareness.  Without legislative action at the state and federal level and innovative strategies at the hospital and department level, there can be no realistic hope of significantly decreasing ED violence.”

As helpful as this summary position is, it lacks an action plan.  Without an action plan, nothing happens.  It’s second flaw is it fails to set priorities. We are not going to solve all the issues of ED violence with a list of everything that needs to be done by somebody else.  Unfortunately, almost nothing has changed since the publication of this landmark study in 2009.  Healthcare violence is at an all-time high.  Let me ask you a simple question.  Would you rather have strict laws punishing someone who assaulted you, or would you rather not be assaulted in the first place?  Prevention is more important than punishment. That is why you should concentrate on armed guards, metal detectors, and bullet proof glass first.

I believe that it is time to make decisions and stop expecting a state by state solution.  This is incredibly time-consuming and requires a patron saint in Congress from most states.  Changes usually do not come about that way in medicine in this country.  There are so many agencies in our government that could have taken a leadership role with this violence problem, but they failed to do so because we, the healthcare workers, would not agree on an action plan. It doesn’t help that all of these agencies are filled with people who represent the groups that the agency is supposed to be regulating.

To solve a problem somebody or some group must take ownership of it.  They must make it their priority and single-mindedly push for its implementation.  Let me give you one example.  Emergency nursing organizations and emergency physician organizations have been sitting on the fence over the issue of armed guards, bullet-proof glass, and metal detectors for a decade.  Every position paper calls for an evaluation or consideration of these basic steps at preventing violence. I have already covered in a previous post the irrationality of saying that anyone or any group of people can predict where the next disaster will occur, or where a mentally ill person with lots of bullets will want to share his pain.  In short, all hospitals, big and small, need the same protection for their staff.

Doesn’t it make sense, after an entire decade of evaluation by Homeland Security, that we accept the reality that physical barriers, metal detectors, and armed guards are remarkably efficient at preventing violence and loss of life?  If these measures are good enough for every airport in the country and every government building, shouldn’t they be proficient in hospitals?  We need these measures to prepare for those unpredictable disasters, when the lights go out, more people carry guns, and local anarchy breaks out.

The argument that having an armed guard somehow causes violence has been thoroughly discredited by a decade of safe air travel in America. The concept of controlling bad behavior by showing strength has been verified years ago. Hospitals, of course, do not want to pay for such alterations or three shifts of certified, uniformed armed guards.  They don’t want employees to sue patients.  They don’t want to be sued themselves by patients.  They want to pretend that the waiting room and treatment area are safe places when statistics say just the opposite.  Their position is entirely motivated by their view of the financial implications of installing these security features, not by concern for employee safety.

Physicians have fears that their contract with a hospital will be in jeopardy if they support something that will cost their hospital millions. They are concerned that having stretcher patients checked with a wand and having everyone who enters the waiting room pass through a metal detector will slow down patient flow.  I would say that the national average waiting time of several hours leaves plenty of time for patients to be screened.

The nurses want protection but they will not endorse the only tools we have that have proven effectiveness for the job.

Is there anyone out there who doubts that JCAHO and CMS could have forced these changes if the nursing organizations and physician organizations had demanded them?  Medicare is the major facilitator of patient-safety improvement in hospitals.  Because hospitals must be accredited by JCAHO and undergo regulatory review by the CMS to participate in Medicare, and because Medicare accounts for at least 40 per cent of hospitals’ total revenues, hospitals must meet JCAHO’s requirements.

Part of JCAHO’s mission statement says “To transform healthcare into a high reliability industry by developing highly effective, durable solutions to health care’s most critical safety and quality problems in collaboration with health care organizations by disseminating the solutions widely and by facilitating their adoption.  “Facilitating” means they fine a hospital for not conforming to their regulations.

CMS pays the bills. Because it pays the bills it can enforce just about any change that it wants onto every hospital in the country.  Have you forgotten DRGs?  Years ago Medicare began adopting regulations that reduced the payments to hospitals under certain conditions. Perhaps you recall the program to reduce certain hospital infections and medical errors which began in 2007.  My point is two fold.  First, hospitals should bear the financial cost of making their workplace safe.  OSHA says that they are responsible for the safety of their employees. They have failed miserably at this because no one has given them an offer they could not refuse.

Second, CMS and JCAHO already have in their mission statements the authority to make new regulations that affect safety.  It is the job of doctor and nursing organizations to be specific about what we want, and have the data to back up why they must have it. We have the data to back up our need in this case, but we have not taken a stand for specific action. First we need a list of those things that we believe are minimum requirements for a secure working area.  Then we must sell this list to JCAHO and CMS.  They must refine our work and produce their own list in the form of new regulations. Hospitals could be given a period of time to present their plans to meet the new regulations and a period of time to make the changes.  If these changes do not occur, CMS can withhold payments to any non-compliant hospital.

Are you waiting for your hospital to spend big money out of the goodness of their hearts to protect you, the employee? Without question, hospital resistance to change has been the major factor in our arrival at the point where our workplace is the most dangerous in America. We, those who work in the pit, need the leverage that only these two agencies can apply.

Boarding admitted patients in the ED has been a constant thorn in the ED for decades.  Hospitals save money by dumping the management of admitted complex ICU and floor patients onto an already overburdened ED nurse. This causes delays in the treatment of new ED patients, often resulting in confrontations and violence.  The ENA has got to say “No more” loudly.  All it takes is one JCAHO or CMS regulation making boarding patients illegal and punishable by fines and there would be a huge decompression in EDs.  We can’t be all things to all people all the time.

At the present time, hospital marketers seem to look for ways to make the ED more difficult to work in.  Without a thought about the potential violent consequences of relatives and friends wandering in and out of the treatment area without armed guards or metal detectors, hospitals are forcing more lenient visitation practices on overstressed EDs.  Do any of these marketers realize that this policy needlessly exposes people to the largest collection of the most deadly and resistant organisms in the community? Do they know that most people who are murdered are killed by someone they know?  Hospitals are not going to stop doing these things until someone with the muscle to back it up forces a visitation policy that recognizes both infectious disease risks and violence risks.  We now have boyfriends insisting on sitting in on their girlfriend’s pelvic exam.  This prevents the doctor from asking about abuse.  Medical directors have less and less to say about how their ED is run.  The marketers have taken over.  They do not have a clue regarding the implications of the policies they are shoveling.

In previous posts I have plainly outlined how EMTALA, diplomatically immune alcoholics, and the loss of funding for addiction, homeless, and psychiatric programs continue to concentrate potentially violent patients in the ED.  Boarding patients is no longer defensible.  It is not safe for the patient, whose ED nurse does not have time to complete all of the admission orders and do her primary job at the same time.  JCAHO and CMS should have ended this practice a long time ago, but they won’t as long as emergency nurses are not willing to stand up for what is best for the patient.  Hospitals want to continue doing this, and they will fight it tooth and nail.  For them, it is a financial decision.  Emergency nurses should seek what is best for the admitted patient and new arrivals.  If you insist, CMS and JCAHO have the authority to promulgate and implement regulations against boarding.  They can force your hospital to support your case for assault by a patient.  They can change the attitude of hospitals toward safety for their employees.

If there was a way to insure a safe workplace for nurses without armed guards, metal detectors, and bullet-proof glass I would certainly endorse it.  But there is no such thing.  I wish that people didn’t try to steal babies from the nursery. I wish that half of all the patients in the ED after midnight were not intoxicated.  But wishing and hoping are not going to produce any results with violence toward healthcare workers.  The old days of allowing visitors nearly unlimited access to patient areas are over.  We must accept the reality of violence lurking everywhere and stop wishing that things were like they were thirty years ago.  Nothing is going to change unless nursing leaders get together with CMS and JCAHO and have a list of specific things that they endorse in hand.

Do not expect that every member of your delegation will like the final list.  But once the list is produced, those who cannot support it should resign from the delegation.  You will not convince an agency to act by bringing a bunch of bickering people to the table.  While I think that physician input would be an important part of redesigning patient flow with physical changes in every department, I would not count on physician organizations in general to be your ally with regard to JCAHO and CMS.  They just have too many incestuous relationships with hospitals and hospital corporations.  The physician organizations have had decades to stand up for you, and they have failed to take any effective leadership role.

I believe that we must act before your situation gets worse.  I have no dog in this fight.  I’m retired. I can’t be fired.  I owe nothing to any organization.  I don’t want money.  I want to see emergency nurses and all healthcare workers receive the kind of protection they deserve.  They stood by me through thick and thin for 38 years. I’ve got a lot of flaws, but one of them is not lack of gratitude.

Charles C. Anderson M.D. FACP, FACEP