Wednesday, September 30, 2009

Wayside Waifs Wednesday

This is fun, this Wayside Waifs Wednesday stuff. Because I get to put cute pictures of companion animals on my blog without any guilt whatsoever. I'm doing a public service, you know.


Just one critter today. Meet Sassy the cat. Sassy is about two years old, semi long hair "torbie" which means she is a brown tabby with red highlights. Sassy is a special cat. She has an interesting gait. Whether from injury or nerve problem, Sassy's rear legs don't work in the usual way. I say it that way because she can get around without any problem whatsoever. She is outgoing, verbal, playful and affectionate. The photo below shows her playing with a chase toy--she had a blast--and catching it while standing on her hind legs. You can tell she doesn't stand up normally, but she can stand up, and chase and play like any young cat. Plus she's beautiful; her silky hair and red highlights are pretty to look at.

In addition to Sassy, there are lots of other adoptable animals at Wayside Waifs--over 300 of them. There are kittens and puppies as well as adult animals. So check it out. Web: www.waysidewaifs.org Phone: 816-761-8151 Address: 3901 Martha Truman Road, Kansas City, MO. Hours: Weds-Fri 2 pm-8pm Sat-Sun 12noon-6 pm. Closed Mon-Tues.

The 80-20 Rule and Emergency Health Care

Have you ever heard of the Pareto Principle? It is the interesting observation that not everything is proportional. The first time I heard it was in a seminar on church growth from John Maxwell, a Wesleyan pastor. It was back in the late 1980s before Rev. Maxwell wrote a bunch of books and became a famous author. At that time, he was listened to because his church was a fast growing megachurch.

In the church context, it was put thus: 80% of the work needed to be done in the church is done by 20% of the people who attend. (Here is a link with more detail on the rule--and there's lots more about it--just google 80 20 principle.) I got to thinking about this principle due to these blog posts from ckemtp and happy medic about "frequent fliers"--people who use emergency services on a very frequent basis, either requesting emergent aid for non emergent situations, or failing on a repetitive basis to do the simple things that would keep them from needing emergent aid. The posts got me to thinking about frequent fliers I have known. Ask any paramedic, EMT, or ED nurse, they could give you names of people they see at least once per week if not more.

The majority of people may go the ED less than ten times in their lifetimes. Some people will get a chronic condition that may cause them to appear more often, but they manage their condition properly, and at most, require an ED visit once every three months. That's 80% of the population. The number of people who become "frequent fliers" is quite small.

Maybe 20%.

But what does this 20% cost the health care system?

This 20% that should take their meds, keep their appointments, quit drugs and alcohol, and stop fighting; this 20% that could keep themselves healthy and out of the ED for quite a bit less money than each of their ED visits--this 20% hurts our system badly. 80% of the costs? Maybe, maybe not--but definitely costs higher than their proportion of the population.

And, unfortunately, some of these people are shall we say?--hard to love. Some are intoxicated and combative. Some have unpleasant prickly personalities. Heck, some of them need to take a friggin' bath and/or change their clothes every so often! So in addition to the financial cost, they cost caregivers important emotional capital; the empathy needed to do the job of caring for others well. This 20% takes time, strength, empathy and resources out of the system disproportionate to their number.

What to do? Good question. Happy Medic covered the failures very well. Unfortunately, emergency services cannot "fire" a patient. We can't say, "Sorry, not bringing the ambulance over to your house."; "Sorry, not letting you in the ED tonight."--it's against the law. And how much time to spend on each person as a society, trying to "make them change"--because it is their choices that make them frequent fliers.

Like Happy Medic (and I strongly urge you read the post), I don't have any easy solutions. A few ideas: Change insurance so that patients are somehow responsible for ED visits not medically indicated. Teach, cajole and urge until the caregiver is blue in the face. Give very specific instructions for alternatives to calling 911 and/or going to the ED. Increase primary care provider availability. Remove the Sword of Damocles of lawsuits from over the heads of ED providers trying to make decisions about frequent fliers.

Bottom line, it comes down to personal responsibility and choice on the part of the patient. Each of the above ideas might take a percentage point or two off of the 20% and they all should be part of health care reform. If we can get the 20% down to 15% or 12%, it would save a bunch of money and resources. But because humans are finite and sinful, there will always be people making bad choices, always. Alas, frequent fliers, like the poor, will always be with us.

That has implications for the caregiver, especially those health care workers who call Jesus Christ their Savior and endeavor to follow Him. Jesus loved and touched the leper, told his disciples to forgive "seventy times seven", and hung out with tax collectors and "sinners". It's a high standard He set, doing all this loving and forgiving. The only way I have a chance to even get near this standard is to allow Him to fill me with His love and power through the Holy Spirit. This is the way I can persevere through the difficult times and remain empathic and caring. (The health care worker who wishes to stay in the game must remember to care for and restore their own body, mind and spirit; there must be resources in you to give you strength as you care for others. That goes for everybody, not just Christians.) The only chance some of the "frequent fliers" have for real change is through the power of that same Holy Spirit.

Because at bottom, this is a spiritual issue as much as it is a health care issue.

Monday, September 28, 2009

Your MAST posting of the week...

Q&A How will the MAST takeover by Kansas City change service?

 Dyer
Dyer
 In the next few months, Kansas City plans to meld MAST emergency services into the city’s Fire Department. Fire Chief Smokey Dyer says the cost of that service should not increase as a result and the quality of care will be maintained.  Wright

The Kansas City Council’s recent vote to merge the MAST ambulance service into the city’s Fire Department left many questions.

Fire Chief Smokey Dyer said the new system can maintain quality, eliminate redundancy and cost no more than the old system. “I don’t see how we could increase the cost,” he said.

But skeptics said the council’s Sept. 17 vote was hasty and left too much uncertainty.

The Star talked with the city’s budget officer, other officials, Dyer and consultants who will design a new citywide emergency services plan.

Key questions and answers:

When will MAST become part of city government?

The transition should start in the next few months. A consulting firm, Emergency Services Consulting International, is being paid as much as $116,000 to recommend a new system. The consultants should begin next month and finish in about four months. This is no end of annoying that we have to pay someone to tell us how to reconstruct a perfectly good system...

Will this really save taxpayers money?

The city expects to save money on insurance, marketing, outside legal fees and administrative duplication. But critics warn savings could vanish if the ambulance employees cost considerably more in employee pensions, health care, overtime, workers’ comp and liability claims. Potential savings won’t be clear until consultants do a financial analysis. So we are going ahead and making this radical change without a full analysis of the possible savings. Does this make sense to you? Is the savings worth the risk of compromising patient care. We don't know; we haven't done the analysis yet. I say again, does this make sense?!

What about additional pension costs?

The initial estimate is $17 million, which might be spread over many years. But some people worry MAST employees will be folded into the more costly firefighter pension system. Louie Wright, president of Local 42 of the International Association of Fire Fighters, says folding MAST workers into the firefighter pension system would be cost prohibitive, and he does not believe it would be legally permissible. How they are incorporated into the city employee pension system and at what cost are likely to be issues. This is no small issue. John Sharpe himself said MAST employees will not be vested year for year in the city pension plan. So they lose out money for (questionable) pension security. And local 42 is not the only local involved; the union that covers people like Parks Department employees might have something to say about how MAST people are folded into the pension plan.

Will my MAST membership be honored?

Those memberships — $59 to $99 a year, depending on whether the household has insurance coverage — will be honored. But how the memberships will work will not be known until the new system is designed, Dyer said. He’s certain the city can continue the non-emergency service, “but it may not be in the fashion we’re doing it now.” We hope so. Many rely on these memberships to contain the cost of ambulance services.

Will MAST continue to serve other cities?

Dyer said he’s already visited with those cities to let them know that the service will continue. Instead of having a contract with MAST, they will contract with the city. “I’ve let them know we have no intention of terminating their service,” Dyer said. The municipalities and Platte County have indicated that they were and are not in favor of this change; I think they fear service will not be as good.

Will every MAST employee be absorbed into the city?

Dyer notes that he told the council “substantially the entire work force” would be taken into the city. But jobs not involved with patient care would be reviewed. For example, a custodian might not be taken because the city contracts those duties. As for administrators, “substantially” all will be needed, at least for this transition period. After the one year period, it's a total crapshoot for MAST employees.

Some people remember when the firefighters went on strike nearly three decades ago. Would the city be without ambulances if another strike occurred?

Highly unlikely. It currently is illegal for firefighters to strike. But it may not be illegal for MAST employees to strike. Bringing them into the Fire Department would make it illegal for ambulance workers to strike, Dyer said.Wright of Local 42 said the strikes of 1975 and 1980 occurred in a much different era, when many public employees across the country were striking. He said the union’s relationship with city management has improved dramatically since then. We hope so. I had never heard of firefighters going on strike until I came to Kansas City. Dennis Smith wrote a novel about this possibility in New York City. Thank God it never came to pass. It has always been illegal for FFs to go on strike in New York.

Should Dyer oversee emergency medical care given that he questioned a change in how to treat heart-attack victims?

In 2006, the city’s emergency medical director, Alex Garza, ordered a dramatic change in the way emergency responders treat cardiac patients. Dyer said he asked Garza for more time to react to the new order, but Garza declined. Dyer acknowledges that Kansas City, as a result of the change, has one of the nation’s best cardiac save rates. The incident shows the medical director will be in charge of medical decisions, Dyer said. “He’s the czar. And I’ve proven it.” Smokey Dyer is a good man, caught in the middle. A good man can always admit when he is wrong.

Will the Fire Department seek more funding from the city’s health levy, which currently subsidizes MAST?

Dyer doesn’t relish competing with the city’s indigent health providers, such as Truman Medical Center, in seeking more funds from the health levy.

Budget Officer Troy Schulte says MAST gets about 40 percent of its budget from the city: $11 million from the health levy and $1.5 million from the public safety sales tax. In the short term, he does not anticipate more health levy money going to MAST. But if MAST sees a drop in its other revenues (from customers and insurance), then it could require additional city funding. Not only has MAST been performing in an outstanding way in the field, it has been doing a good job collecting payments from insurance, Medicare, Medicaid and patients. MAST must continue to get the monies from billing for services rendered as effectively as now. There will be no savings if the income from these sources drops off due to incompetence in the billing office. Also, MAST needs to be ready for changes in health care reimbursements due to changes on the federal level. There will be changes; will the new structure be the best to deal with them?

How long will Dyer be around to oversee this new system?

At 61, Dyer says he has no plans to retire. The Fire Department has no mandatory retirement age. Good health to Smokey for a long time. The trust in him is the reason the takeover passed City Council. And even then, he's not primarily a EMS guy. There will be culture shock in the firehouses. And there are already indications that a change in philosophy about response time is in the air.

What if people still oppose the consolidation?

Kansas City voters may have a say next year.

Opponents are gathering petition signatures to try to put a measure on the April 2010 ballot that would keep MAST as a separate, nonprofit agency and preclude the city from operating it.

Petitioners say they have about half the 4,200 signatures needed to qualify for the ballot. This change was made in haste, with limited public participation and comment, and without sufficient information. If you think that this change of MAST's governance is a bad idea, or you would just like a chance to slow the process down, the petition drive is going hot and heavy. People will be out and about gathering signatures at retail locations and other spots throughout the city. If you would like to contact Citizens to Save MAST, email savemast09@att.net. Put in the subject line, "I want to save MAST!" You can also contact this blogger through the trusty comment portal, and we'll get right on it.

Postings from Fellow Bloggers on Pets

I laughed--I was reading a little book called "Go Tweet Yourself: 365 Reasons Why Twitter, Facebook, MySpace and Other Social Networking Sites Suck." and the author complained about people who put 27 gazillion pictures of their cat on their blog. This after I put a picture of one of my cats on the blog! So pets can be an overdone topic on a blog. However, indulge me, and check out these links to bloggers blogging unabashedly about their companion animals.


Meow!

A Sports Post

This is not primarily a sports blog. Although I am quite interested in sports and have lots of opinions, it is not the main point of this blog. However, there are sports topics that just beg to be discussed this fine fall Monday. (KC metro readers: Did you notice the Autumn sky today? So blue it made your eyes hurt.)

First, the Kansas City Chiefs: They are bad. Really bad. No offensive line. No defensive line. And the coach gave up yesterday. All those runs in the second half. I remember one series: Larry Johnson, Larry Johnson, Larry Johnson, punt. Not good. Could be a long year. Right now in the NFL, there are 6 teams 0-3 (pending the Panthers-Cowboys tonight). Will any of them go 0-16? I'm not a gambler, but I wonder what odds are coming up in Vegas on the Chiefs going 0-16.

Next, Zach Greinke and the Cy Young Award. The Cy Young is like the MVP--do you give it to a player on a losing team? A pitcher whose win totals are less than other pitchers? There are several strong candidates for the award in the AL: Justin Verlander, Felix Hernandez, and CC Sabathia--and all can make a case. Whoever wins will deserve it, they have all had good years. There are a few opinions that Greinke is being pushed due to his being a white guy. No, he has had a great year. Let him stand on his merits. Whoever wins will deserve it--there is not a dud in the bunch.

We had a very nice Friday night in high school football down here in South KC: Ruskin, Hickman Mills and Center all took care of business against their foes in home games this past week. Center and Warrensburg got together for a game with a thrilling ending--Center getting the winning score with about 2:00 left, then stuffing Warrensburg and getting the ball back on downs. Only Grandview lost, taking it on the chin from highly rated Fort Osage. Really, if you like football, go see a high school game. But keep your eyes on the field; there's no big instant replay board.

And we have to acknowledge the winning ways of Mizzou and KU--both teams won well in trap games before the start of Big 12 conference play. A mixed bag of news with our smaller college teams--MidAmerica Nazarene University lost its first game, while Avila and Evangel won.

That's it from the sports desk, back to you...

Saturday, September 26, 2009

Oh, My God, I Can Put Pictures From the News on the Blog!!!

It's a new toy, and it could be dangerous in the wrong hands...

KUUSM

University of Kansas Coach Mark Mangino talking with referee Ed Ardito during the KU-Southern Miss game Saturday 9/26. Photo Kansas City Star.

I'll be careful with it...

Funny Stuff

From the fine folks at www.icanhascheezburger.com.

funny pictures of cats with captions
New blog skill...there does appear to be a small technical problem. When published we lose some of the right side of the picture. We will endeavor to figure it out.

funny pictures of cats with captions

And this POLICE FAIL is brought to you by www.failblog.org:
epic fail pictures

Yes, it's all terribly lowbrow...but it's darn funny too.

A Good News Story

Here is a genuine good news story...okay, all you cynics out there just sit down.

An organization in Vermont that rehabs cars and gives them to people who need them got a wonderful windfall courtesy of a law suit settlement. Check out the links:



Pretty cool stuff.

Polydactyl Cats

I was just browsing around when I came across this video about kittens with many toes. Cats ordinarily have five toes on the front feet and four toes on the back feet. Polydactyl cats have more than the average number of toes. They are also called Hemingway Cats, as the great author had a number of them at his Key West home. They still live there, a living part of the museum.

So here's the link to the video from NBC, and below, a picture of my polydactyl Hannah. She helps keep Observer Kitty in line!

Weinberg Calls it Quits


I was sorry to hear of Weinberg Motors (ne Weinberg Dodge) throwing in the towel starting October 1. They have been in business since 1967, selling Dodge cars and trucks to folks in Kansas City. I recall looking at the responses to the Chrysler dealer closure list back in June, that Weinberg's reputation was not the best, but I never had any difficulty with their service department. In fact, their service department is involved in a most fun story of car repair.

At the time, I had a 1987 Plymouth Sundance. It was a manual transmission car. I went out of town for a time, and left the car at home, which, at that time, was in Grandview. Grandview, like much of the south part of the metro, has lovely mature trees, which are full of squirrels. (This is important to know...) After I returned from my vacation, and resumed normal life, I noticed that the shifter (the part inside the car that you take hold of to change gears) was getting harder and harder to move. It was getting difficult to change gears. One day, there was a most disconcerting pop! and the shifter started just flopping around, even with the clutch pedal not pushed down. The car was stuck in neutral. A tow truck was called and the car towed to Weinberg. I was thinking the worse--new tranny, new clutch, many dollars. After awhile, Weinberg called to let me know it was fixed. So I walked over to get the car.

The mechanic came over to the service manager's desk and said, "This is what was wrong with your car." He opened his hand and showed me a walnut the size of a golf ball. "This was stuck in the linkage, and eventually the linkage came apart. So I put it back together, and it works great now. " I settled up with the service manager. The mechanic says, "You want this?" I laughed. The tow and repair totaled $85. "Yeah, I'll take it," I said, " the 85 dollar walnut." I still have it.

Best wishes to Steve Weinberg and his family.

Some links--videos are worth watching to see the memorabilia that Weinberg has.

Thursday, September 24, 2009

Some Interesting Links for the Evening

Just some quick links and commentary for the evening...

Tony of www.tonyskansascity.com wrote a nice column wrapping up what has happened with MAST ambulance on The Missouri Record. Don't forget, we are still gathering sigs for the petition. Use the comment portal if you would like to get in touch to sign petitions.

KU football and KU basketball players got in a big fight, over a girl. How high school. Apparently, they are fussing over which team is more important. If I were Mangino and Self I would take the names off the back of their uniforms--both football and basketball unis and remind them it says "KANSAS" on the front, and that's who they represent. Link from the Kansas City Star--Brawls at KU were simmering for a long time.

Earlier this week, Tony found himself thinking about the homeless in Kansas City. He wrote a thought provoking entry on his blog. Read the whole thing and the comments. Homelessness is a multifaceted problem, not easily solved. Joe Colazzi of the Kansas City Rescue Mission advises not to give money to a homeless person; rather direct them to one of the ministries in town. And no, the mission do not "keep the problem going so they have a job"; it's just one damn hard problem to solve. You have to get an individual to actually be responsible and accountable, and be open to changing their life. Not the easiest thing. Most times, turnarounds are totally due to God's grace and His intervention.

That's about it for the day...

I Have an Addiction...

I have an addiction. I'm not addicted to drugs, or alcohol. I might be addicted to Pepsi. But I am definitely addicted to...the scanner. Oh, I can go without it. But I definitely miss it when I can't listen.
Maybe its my small town rescue roots, when everyone had one, and everyone knew everything. When you were asked, "Why was the Rescue Squad out at _____'s house?" every time the ambulance was seen around town. (Even before HIPPA, I knew not to answer that question with too much detail.)

I had one when I lived in suburban Philadelphia. I had one when I lived in Burlington, Vermont. I still remember when I had to go to work and couldn't go and photograph the big grain elevator fire in Burlington. I've had scanners whose frequencies were controlled by crystals. You would go to Radio Shack with a list and get the crystals for the freqs you wanted. I found out that police talk way more than firefighters or EMS people. I heard an ambulance instructed to turn left at the tree stump next to the old barn. (That wasn't Vermont, it was someplace south; it was skip on one of the very low freqs the fire and EMS services used to use--around 46 MHz. I actually heard that in in PA.)

I actually got up at 0600 on Black Friday to pick up a trunking scanner from Radio Shack for $150.

The scanner was in its glory yesterday morning. I heard a dispatch for Kansas City Fire to go to 33rd and Main for a building collapse. Of course, I listened more attentively. My scanner has programed into it the Kansas City MO trunk and the Grandview trunk. KCMO is usually what you hear when the scanner is on, but then I heard Grandview real quick say the collapse was in that city. As the response moved to the correct address, I worked the scanner to listen to Grandview Fire on the scene, and KCFD and MAST providing mutual aid. It was totally fascinating! I was glad to hear there were not many casualties or anyone trapped. The neat thing with the scanner is the look behind the scenes; you can hear the command making decisions and thinking things out.

It' s not the first time I've heard news in the making and breaking on the scanner. But I don't listen just to be the first to get the news. I listen more because the process of coming to emergency aid of another just totally draws my interest. It's a little "adrenalin rush by proxy". I admit it, I like being "in the know" too. And I love it when the good guys win, like about a week ago when KCPD saw a burglary on Grandview Road, watched, followed the bad guys and nabbed them at 44th and Indiana. That was so cool!

So I'll keep listening as long as they let me.

Product detail on the photo: That is the Radio Shack scanner I picked up that Black Friday about 5 years ago. It's a PRO-94 model. The display is showing a talk group on the Kansas City MO trunk. No, I'm not going to teach you about trunking or tell you the freqs. You can do that research yourself!

Wednesday, September 23, 2009

Wayside Waifs Wednesday

Yup, shameless plug alert, Strutt with Your Mutt, this Saturday in Brookside. Register in advance at http://www.waysidewaifs.org/. Borrow a dog if you have to!

Cute puppy pic to remember why you strutt with your mutt! Boxer mixes--still a couple left, but they'll be adopted quickly. So go, already! 3901 Martha Truman Road in Kansas City, open 2 pm to 8 pm Weds-Friday, 12-6 pm Sat-Sun, closed Mon-Tue.

Cats and kittens too...

Tuesday, September 22, 2009

NFL Football

Well we have had two wonderful weeks of NFL professional football and I have come to a couple of conclusions:

1. The Kansas City Chiefs are not very good, but will improve as the year goes on, and bite some good team in the butt sometime during the season.

2. It's going to be a long year for Browns, Bucs, Panthers, Lion and Jaguar fans, as well as Chiefs and Raiders fans. Raiders could bite some one's butt too, like the Chiefs.

3. San Francisco will win the NFC west. Seattle can't win without their QB Hassleback healthy, and the Cardinals will regress and disappoint.

4. New England may just have too much to overcome this year with Brady rust and too many changes on defense.

5. The New York Giants are the class of the NFC east; Tony Romo kills Dallas with turnovers and inconsistent play and the Redskins need a real QB. Philly could surprise, but a lot depends on their four headed QB monster.

6. Denver has surprised so far, but they haven't played anybody.

7. Baltimore and Pittsburgh are still tough.

8. Detroit will win at least one game. Matthew Stafford looks like the real deal at QB.

9. Titans are 0-2 and something of a defensive mystery at this point.

10. Green Bay will lose out to Minnesota if they cannot keep Aaron Rodgers upright and in one piece.

11. Which Jake Cutler? (Maybe it's his blood glucose!)

12. Miami looked over matched at times with Indy, but almost won due to good strategy. Never count out a team in the Parcells family tree. Colts' Payton Manning is Payton Manning; they might as well start on his HOF bust now.

13. New York Jets look good right now. Defense is awesome. Can rookie QB lightening strike again?

14. Some teams, it's hard to tell how they'll go--Buffalo (buried behind Jets and Pats, but improved team), San Diego (will win AFC west,as it is not likely Denver will continue at current pace), Bears (see #11), Falcons (no soph jinx for Ryan?) and Houston (the team that burns prognosticators every year).

15. New Orleans' offense is sick. Drew Brees is as good as I have always thought he was. If the Saints play middling defense that can rise up at times, they'll go all the way.

16. It's possible that the Mizzou Tigers are a better football team than the St. Louis Rams.

Okay, fearless prognostications forthcoming--well seasoned in case I have to eat them.
NFC East: Giants
NFC North: Vikings
NFC South: Saints
NFC West: 49'ers

Wild Cards: Packers, Falcons

NFC Champion: Saints

AFC East: Jets
AFC North: Ravens
AFC South: Colts
AFC West: Chargers

Wild Cards: Steelers, Texans

AFC Champion: Ravens

Super Bowl: Saints

Mark Funkhouser was on KMBZ

Kansas City Missouri Mayor Mark Funkhouser was on KMBZ with Shanin and Parks...and was completely annoying. The mayor's problem is that no one trusts him. So even when he says something sensible or truthful, the reaction is still "oh, ugh".

Topics to the Funk:
MAST takeover--he majored on the working conditions, that MAST people complained about not having a pension and problems with the posts. How come this item doesn't come up until this last minute, just before the vote last week? (It also got blog action.) I think some mildly discontented MAST folks were coached by Louie Wright and his minions. Since the saving money angle was not working.

Bannister Mall--not surprised, but out gunned by KCK. Mayor stated he was reassured by Cerner that the office complex would be built. And mentioned some silliness about building 12 soccer fields without the stadium.

Gloria in the office--he stonewalled it.

Article by staff member that stated he was ready to divorce Gloria to get around the volunteer ordinance--stonewalled again.

Running for mayor again--didn't want to discuss it.

TIF Commission--his view is just as I thought; he wanted someone who was a little off the beaten track to join the commission. He views Stretch as a businessman who has met a payroll. He's not that far off here, but Stretch may have stretched the definition of outsider just a bit more than some are comfortable with.

A caller called noting that all the workers he saw at City Hall were black and was City Hall practicing reverse discrimination? Funk noted the city is 40%...now, my memory is failing, because I can't recall if he said "black" or what. 40% seems high for a percent of KC's population being black, maybe "people of color"? Anyway, Funk denied reverse discrimination at City Hall.

Union Station--Funk was brutally honest about Union Station--its failed initial model, its current poor state, despite strong leadership and a willingness to cut to the bone. He hoped a way that involved all the metro and did not involve taxes could be found to continue operation at that beautiful space. It's hard because it is so big. If you go to other towns with old central railroad stations like this, they are usually much smaller. Indianapolis is a good example.

Some guy called in and talked about what a wonderful job the mayor was doing. WTF?!

An interesting, and maybe only occasionally annoying, hour with Mayor Funk.

Monday, September 21, 2009

Best License Plate in the Union

I've lived in the Kansas City area since 1989, and no car I've owned since 1994 has had one, but I still feel that Vermont license plates are the best in the nation. Bright, simple and distinctive, (they are the only plates where the numbers and letters are imprinted, rather then raised), I just love seeing them.

P.S. There is no ridiculous personal property tax on cars in Vermont.

Joe Biden

Joe Biden is a loose cannon--or more accurately, a loose mouth. We have known that since Barack Obama nominated him to be his vice president. Remember how he urged the paralyzed Missouri State senator to stand up at a rally in Missouri? I suspect he has this problem due to the brain surgery he has had in the past, to remove a brain tumor. Anytime you physically change the brain, these types of personality shifts and quirks can occur.

So Slate online is collecting them--"Bidenisms: A collection of the vice president's gaffes and head slappers." Have fun!

About the New York Times

When I was growing up in New York City, The New York Times was seen as a great newspaper. Nowadays, The Times is a favorite whipping boy for the conservative punditry. Mark Levin calls it the "Slimes". Michael Savage regularly rags on its administration. It is a liberal newspaper, not just in terms of the editorial pages, but in its decisions on what to report and what not to report. For example, my mother, who consumes every news source except the Fox News Network, had never heard of ACORN when I asked her about it back in May. The paper's recent reporting (or lack there of) on the problems surrounding Van Jones and ACORN is terrible.

However...The New York Times can still be part of a balanced news diet, even for a conservative. First, it is probably one of the widest ranging news sources, with a lot of interesting reporting on many subjects. It used to do more of this, and be stronger in coverage abroad, but it has had to cut back on the number of reporters it has. It reports from one of the largest and most cosmopolitan metro areas in the world. It still has considerable influence on the overall news gathering in our country. So I read the New York Times. I know what I am reading when I read it, and I don't read it with a blind eye. I read it and lots of other things too. (That's why I know what ACORN is, and why Van Jones quit his czar post.)

So, here is something slightly silly and fun, and thought provoking from the New York Times. Right wing talk show hosts and rap artists? Enjoy.

Saturday, September 19, 2009

Stopping a Minute and Seeing Where We're At

When I started this blog I really wasn't 100% percent sure where it would go. I wanted it to stay fun, not a obligation, and be a place where I could be creative and expressive. It's still fun, it's a mild obligation, and it went in a newsy direction I didn't anticipate.

After Thursday's events, I realized the effort to save MAST was now a matter of the hard work of getting out with people and gathering signatures to get the issue on the ballot. It's not as cool as going to City Hall; it means going out among the folks and asking them to do something, namely sign the petition. So I am now on the lookout for opportunities to gather signatures.

The effort to save MAST has sucked a lot of the air out of my life at times. This has been a good time to stop and take care of some urgent personal matters that are causing me stress. Once I have these cleared up, I will be able to focus better on some of these other items, including the effort to get these petitions signed.

Also we've been missing some news...there was a meeting about the Bannister Mall site I would have liked to have gone to...I haven't really focused on the college or pro football that just started. I have made it to a couple of high school games though, reminding me that I do like football!...healthcare on the national stage is still a live issue...reactions to Jimmy Carter's statement...the murder rate in Kansas City MO...spiritual considerations going on in my own life...some evaluation of my basic political stand is going on...more fun stuff with cars...etc.

So, things may slow down on this blog, but never in life!

Observer Kitty at about 8 months old.

Friday, September 18, 2009

I Admit It, I Like Sunsets

On Interstate 435 at sunset.
I'd probably like sunrises too, but I just don't get up that early.

Thursday, September 17, 2009

MAST to Fire Department part 3--the devil in the details

The devil is in the details...here are some:

Residency requirement for MAST employees. If waivers are granted, how do other city workers feel about that?

Pension issues--not just local 42 and vesting, but what about the city workers of local 500?

Medical supervision and protocols--making sure we are doing the best evidence based efficient emergency care.

The women of MAST in the mostly male firehouses. (A woman firefighter came to me and said women were fine in the firehouses--but history tells us otherwise...)

Static/fixed posting (ambulances in firehouses) VS dynamic posting (ambulances moving).

Response times for advanced life support personnel. If you only have EMT-B, EMT-AED and EMT-I on fire trucks and ambulances are further away, you might have basic care arrive in 8 minutes, but have advanced care and the transporting vehicle 15 minutes away. This matters to the patient's outcome! Viva the Golden Hour (especially for trauma cases).

Same number of personnel on duty all the time VS variable numbers of personnel on duty at different times. (A model used in hospital ERs--you need more nurses and doctors at 3 p.m. than at 3 a.m.)

24 hour shifts VS shorter shifts (12, 10 and 8) Busy ambulance units will have tired people if staffed on a 24 hour shift. Study data is relentless on how bad 24 hour shifts are for performance. Driving, intellectual performance and the medic's home life all suffer.

Oh, there's probably more, but that's all I can think of now.

I think that's enough.

MAST into the Fire Department--for now part 2

Well, what happened today was only surprising in one way, that it did happen today, and with such quickness. I really expected the ordinance, with its two amendments, to be tabled. But they went ahead and did it, despite the testimonies from the public and the strong opposition of Ed Ford.
Smokey Dyer did a good job, considering the material he had to work with. We still have no specifics--really. Phase I will run for a year, with the fire department running MAST just as it is run now, while the situation is studied by various parties, plus a EMS Committee. I have no beef with the Chief. He's in the middle. In fact, I think there was some CYA too from the chief, as he reminded the Council that they had the authority ultimately. He knows he is in a tough spot.
The petition drive will go forward. The petition drive will fix two things: One, the process has been opaque to the public. Three short opportunities to testify, that is all. And no input from doctors and hospitals. So if the situation goes to a vote, there will be info and campaigning and all that. Much more than now. Secondly, it will slow things down. Even though you may say, "Well, eight months, that's enough." the debates, public hearings and votes were very intensely concentrated in August and September. There was little action before that, just one committee meeting with public testimony in late March.

It just strikes me as a change that doesn't need to be made. If you change management, you will change performance, even with the same "field staff". Philosophy, pressures, style all cause changes. Also, the plan is to wait even longer before a concrete plan is made. And Chief Dyer wants to start from scratch, "a blank sheet of paper"--here is a company that works pretty good and we are going to start all over?

Nothing is perfect, everything can be improved. For example, one of the working condition issues is the mobile post in isolated places, or in bad neighborhoods. MAST could study the post structure, and see if some posts are not suitable and should not be used. They could find the posts that are geographically advantageous, but are not near a 24 hour store (for example) and perhaps add some amenities to these posts. The movement of the ambulances has probably been studied, but revisiting it and making sure that post moves are truly needed may not be a bad idea.

A good company is always looking to improve. Rarely does a good company improve by merger or change in management.

One thing is they know we are watching now--watching to make sure it's done right, no matter what happens.

MAST into the fire department should not happen. If it screws up the ambulance service, lives could be at risk. Aside from the question of city government competence and political influence increases, do we want a change in management that ends up looking like Sprint-Nextel or Chrysler-DaimlerBenz? Remember, the latter ended in divorce, with Chrysler weakened. Part of the reason it failed is that the cultures of the two companies never meshed. Culture is a live question when firefighters and emergency medical personnel are put together.

The people can have a say with the petitions and votes.

Lives are at stake.

MAST Part of the Fire Department Part 1

I spent another afternoon at City Hall, following the events surrounding the change in MAST ambulance's governance from a independent 501 (c)3 organization to under the purview of the city. The ordinance in question as originally proposed, was to have MAST in the city government as an independent ambulance or EMS department. Last week, the ordinance was amended to have MAST immediately become part of the fire department. This was held for a public hearing. However, as part of the public hearing, Fire Chief Smokey Dyer was to present some details from his point of view.
Smokey Dyer got to speak for about one hour, and then took questions, probably until 2:15 pm, so not much time was left for public comment. About 10 people got up to comment, including Lesa, Susan, and others. One person of note was a MAST employee named Neal Wilson, who testified about how the change will help working conditions and he had his group of 20 or so MAST people who came in favor of the merger stand up. Ford Nelson spoke of how the process violated the city charter due to the rapidity it was passed through.
Next came the meeting itself. The ordinance was amended again, to create a distinct "bureau in the fire department." John Sharp attempt to pass a hold on the vote, but this lost by an 8 to 4 vote (Cathy Jolly was ill today, and not at the meeting). Then there was more debate. Another vote. The ordinance passed, 10-2. So MAST will become part of the fire department.

Chief Smokey Dyer and Mayor Funkhouser visit before the public hearing.
The Chief with a reporter from channel 4.
The gang of MAST employees at the hearing and meeting. The gentleman at the end with the peace sign is Neal Wilson.
Meet the Press: Chief Dyer with Jim Flick (KMBC) and Mike Mansur (The Star)
Lesa Gonzalez with Bill Grady of KMBZ (yes, that's the face behind the voice!)
Just two links, both from the Kansas City Star: KC Fire Department will take over MAST
Check out this gallery of photos from The Star: Council approves 10-2 vote...

Wednesday, September 16, 2009

Two Items from Today's KC Star

The first: This item about survival rates in hospitals for patients with cardiac arrest, noting that black folks don't have as high a survival rate. Your link: Survival rate for black cardiac arrest patients patients is far less than whites As a health care provider, I have periodically seen these types of articles. I personally have never seen a patient treated less due to race. I have seen other factors come in, but race--not really. This bears further study--are black people sicker when they come into the hospital? Do some of the drugs used in cardiac life support not work as well on blacks as they do on whites? Is there subtle prejudice? Need more study. Back in July of this year, an article came out on a study of how much variation there was in US hospitals of time of first defibrillation--here's a link to an article about that. A point that can and must improve throughout the system.



Stretch and the TIF commission: Is this man qualified to make decisions about development and tax increment financing in Kansas City?

Background: Council members question nomination of artist to TIF commission.
Okay, looks aren't everything...

Wayside Waifs Wednesday

Welcome to this week's edition of Wayside Waifs Wednesday, whereby this blogger deviously works on getting the reader to go to the shelter and look at adoptable (and adorable) companion animals--and maybe even take one home!

Look at this dog's funny ears! You really have to see them in person to get the full effect. He's a young dog who has only been available for adoption for a little while. He'll probably be high energy and need some training. So, go meet him already!
Fall kitten season is here! The shelter has several kittens up for adoption, all completely adorable and full of cuteness. The nifty thing is, properly nurtured, they grow up to be beautiful and handsome cats. This little orange dude is about three months old, but there are kittens of every color. Check them all out.
Wayside Waifs is located at 3901 Martha Truman Road in Kansas City. Hours are 2pm-8 pm Wednesday through Friday and 12 pm-6 pm Saturday and Sunday. The shelter is closed on Monday and Tuesday. website: www.waysidewaifs.org .

Tuesday, September 15, 2009

A Very Short (I promise) Entry about MAST

The vote on the proposal to merge MAST in with the Kansas City Fire Department is Thursday, September 17. That meeting will be preceded by an opportunity for public comment and testimony, starting at 1:00 pm. That meeting may be on the 10th floor of City Hall or on the 26th floor. Note the time change from the previous blog on this!

A couple of links for your reading pleasure:

from the KC Star--Fire Chief Smokey Dyer's Agenda


From Prime Buzz--The Kansas City Chamber of Commerce resolution on the matter
Money quote:
WHEREAS, there was no opportunity for adequate public input and reflection on the implications of such action regarding the budgetary and operational impact of the merger, and
WHEREAS, additional time for deliberation and dissemination of public information would prove beneficial;
THEREFORE, The Chamber's Executive Committee requests that no further action be taken on the matter until there is adequate opportunity for public content and discussion.


An editorial from Yael T. Abouhalkah--Mayor, council and the shameful takeover of MAST
Money quote:
But when Mayor Mark Funkhouser and six other council members did something crazy last week, they also made a decision that could imperil emergency medical care and cost KC taxpayers a lot of money.
The sudden, tentative decision to let the Fire Department take over MAST was made without a public hearing and in unprofessional haste.
Funkhouser's supposed appetite for data was nowhere in sight. The ex-city auditor didn't have one scrap of paper to look at when evaluating whether it made sense to dissolve MAST, deep-six the idea of having a separate ambulance department and place the EMS personnel in the Fire Department.


A take-no-prisoners editorial from the Kansas City Star's editorial board: After City Council's backroom deal, 3 questions for Smokey Dyer
Money quote:
On a 7-6 vote last week, elected officials blindsided Kansas Citians by tentatively approving the Fire Department takeover of ambulance service next May — without sending the idea to a committee for public discussion and without any debate of the plan by Dyer, medical experts or consultants for the city. The council majority thus brazenly killed another proposal, recommended by a panel of medical and financial experts in March, to establish a separate ambulance department at City Hall.

Blogger comment: If MAST is brought into the city as a separate city department, what's to stop a subsequent City Council from folding it into the fire dept?

More from Mr. Abouhalkah--on the pension mess and printing a letter he received from a MAST administrative employee.

Prime Buzz--Putting MAST on the ballot?
Money quote:
Citizens to Save MAST -- a group trying to keep MAST as it is, an outside non-profit ambulance service -- gathered about 50 signatures of residents of Westport House on Tuesday after an information session on the City Hall maneuvering regarding the city's ambulance service.
"In my opinion, the city can't run themselves now," said John Pickett, president of the Westport House tenants association. Placing MAST into the city "would concern me tremendously."


When we gathered with the citizens at Westport House, there was no doubt that the concern was high. After we were done, several sought us out to sign the petition. The vast majority of people seriously doubt that the city can run MAST well. And many of them completely understand the politics and power grabbing going on.

Well, sort of short...

We'll try and keep Wednesday a "MAST Free Zone"!

Monday, September 14, 2009

Yeah, There was Football Last Friday...

Last Friday night, Ruskin High School played Platte County in football. Ruskin has struggled in football these last few years, but the first few games this year showed promise, with a strong offense. Platte County was a tough assignment though, and Ruskin would have to play perfect football to have a chance. Just looking at the two squads told you that there was quite a difference in talent and depth. A few photographs from the night.
While there was still hope: A fan/dad watches pregame warm ups.
Cheerleaders stand at attention during the National Anthem.

The Color Guard presents the colors. (Well, duh!)
After Platte County scored 21 quick points, there was some serious coaching going on.
Girls like football, but mostly girls like seeing and being seen at the stadium. There were many more students at this game than at the Hickman Mills game. It makes a difference that the stadium is on the school grounds.

There was a good number of adults there, too.
It's pretty discouraging to get beaten very badly. You can tell it from the demeanor on the bench. One young man went all Serena Williams, losing his composure and got ejected from the game. The final score was something like 48-6 Platte County.

On Photography

I have been taking pictures of the world around me since I was 10 years old. In the song "Kodachrome" Paul Simon sings "I love to take a photograph"--well that's me. My dream job was to be a news and sports photographer. I used to actually go out and about in New York City just for the purpose of taking pictures--I still have some of those pictures and negatives. In 2007, I got my first cell phone with a camera in it, and now I have a camera in my pocket. I love having a camera in my pocket. I am working on my second memory chip (granted, I don't use the huge ones that cost $30!) and now, my second cell phone with a camera in it. And I'm still enjoying having a camera with me all the time. I see something that catches my eye, and sometimes, I can get a photo of it. That's part of the reason there are pictures on my blog. I enjoy taking them and sharing them. And sometimes, a picture is worth a thousand words.


Plaza landmark and sun reflect off the back of a bus, eastbound Emanuel Cleaver Blvd.

I was just going along, when I noticed this view through the windshield. Quick, grab the phone!

Saturday, September 12, 2009

Just a BIT out of my Comfort Zone

The observer is not quite a basement creature, but my ability to collar people and do a cold type of sales call is...limited. Definitely not comfortable for me! But when you feel that something is important, you sometimes make yourself stretch your limits and do things that maybe are not the easiest for you. I have taken time to speak to strangers about my faith in the past--I always reminded myself that I was one beggar telling another beggar where to find bread--but it is not a natural thing. Today, I went out with another Citizens to Save MAST person and solicited signatures to place the issue on the ballot so the people can have a say. Again, reminding myself that the management of our city's ambulance service impacts the way it is run, and that has a direct effect on the care given and the lives of patients, I stretched myself and collected 20 signatures. It was not easy, and sometimes I was riding the coat tails of my partner, but I did it.

The next events in the great MAST odyssey are the public hearing on Thursday, September 17th at 1:30 pm at city hall. Normally this is the business session, held on the 10th floor of city hall, but if you plan on going, be alert for a location change. If enough people come, the room on the 10th floor may not be big enough. Then the City Council will be meeting on the 26th floor for their regular council meeting, around 3:30 PM. Dockets and ordinances will be available on the city's web site www.kcmo.org. Go to the city clerk's section or pick meetings from the menu. Also if you park in the garage at 11th and Oak, you can go to your city council person's office and have your parking stub validated.

There will be a meeting at the Southeast Community Center, 4201 E. 63rd St., Friday September 18th starting at 7 pm. There will be more information shared about the situation, and an opportunity to sign the petition if you have not yet done so. We will continue the petition drive, no matter what happens on Thursday.

Finally if you can't get to city hall (and let's face it, most people are not able to come to weekday meetings held during business hours), you can call 816-513-1368, the city council office. For more info on the city council click this link here. You can use that info to determine who is your council representative and to read about the council members. When you contact them, tell them you want the decision regarding how the ambulance service put to a vote of the people, not done without true public input by the city council and the mayor.

Proper management of the ambulance service means excellence in patient care. In its current configuration, MAST is one of the best ambulance services in the country. Any changes to MAST's administration need to be carefully considered. Putting the issue before the people will insure a full airing of the facts. This change is not one to be taken lightly or done quickly.

Lives are at stake.

Friday, September 11, 2009

September 11th, 2001

Warning: The following blog entry contains vivid photographs of the deadly terrorist attacks of September 11th, 2001. Those who have been overcome with political correctness should probably view the photos, because then a sense of reality will return, but you may experience emotional discomfort with that viewing. The remainder of us upon viewing the images will again remember that day--the horror, the uncertainty, the heroism, the anger, and the sadness.
Small children, with their vivid imaginations should only see the images in the company of responsible adults.
Thank you for your attention. NEVER FORGET.


New York, NY








Washington, D.C.


Shenksville, PA
NEVER FORGET...