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  1. #16681

    Re: National, Regional and Local News

    It IS a massive HIPAA violation. As a physician, I would have gotten into huge trouble if I had told you what someone's blood pressure was at their recent visit. This only goes many orders of magnitude beyond that on EVERY patient. GH

  2. #16682

    Re: National, Regional and Local News

    Trump administration tells Supreme Court it owns termination of DACA program

    Robert Barnes
    November 12, 2019 at 12:42 p.m. EST

    The Trump administration told the Supreme Court on Tuesday that it has decided that the program that shields from deportation young undocumented immigrants brought to the United States as children should end regardless of its legality, and that there would be no point in asking it again to come up with additional justifications.

    “We own this,” Solicitor General Noel Francisco told the court during a more than 80-minute oral argument over the Deferred Action for Childhood Arrivals (DACA) program, which President Barack Obama authorized through executive action in 2012 to protect law-abiding immigrants brought to the United States as children.

    His arguments seemed to resonate with the court’s dominant conservatives.

    Nearly 700,000 people are enrolled in the program, which provides a renewable grant of protection from deportation and carries with it work authorization. But Francisco said the Department of Homeland Security disagrees with providing such a large classification of people with immunity from laws that usually would demand their removal.

    Lower courts have said that President Trump’s decision in 2017 to terminate the program was based on a faulty belief that the program was legally and constitutionally defective and that the administration has failed to provide reasons for ending it that courts and the public can judge.

    Francisco disputed that. While the first memo outlining termination of the program relied exclusively on the view that the program was illegal, he said, a subsequent agenda memo invited by a judge during the litigation supplied other reasons. There would be no point in requiring the administration to repeat that step, he said.

    Trump has said it is necessary for the Supreme Court to agree with the administration’s view to get congressional Democrats back to the negotiating table to come up with a more permanent solution.

    In general, the court’s liberals seemed highly skeptical of the administration’s actions, while the conservatives seemed open to the idea that it had the power to terminate the program. The court’s decision is likely to take months.

    Justice Sonia Sotomayor mentioned Trump directly and highlighted the president’s conflicting statements about DACA recipients.

    At one point, she said, Trump told the “dreamers” that “they were safe under him,” she told Francisco. Then, abruptly, the administration said it would be ending the program in a short time, giving them “six months to destroy your lives.”

    Other liberal justices also wondered whether the government has more of a responsibility to say why it was ending a program that, according to dozens of briefs in the case, universities, cities, employers and the recipients themselves have come to rely on.

    But Francisco said even Obama described the program as a temporary, “stopgap” measure. Recipients must reapply every two years, he said, or the benefits expire on their own.

    Washington lawyer Theodore B. Olson, arguing on behalf of a coalition of businesses, civil rights groups, universities and individuals, said DACA was different from most programs because the government “invited them into the program.” Olson, a former solicitor general under President George W. Bush, said the recipients have identified themselves and made their deportation easier.

    Chief Justice John G. Roberts Jr. said deportation was unlikely — the government wouldn’t have the resources to undertake such a mass action. The real issue, he said, was work authorization.

    The Trump administration moved to scuttle the DACA program in 2017 after Texas and other states threatened to sue to force its end. Then-Attorney General Jeff Sessions advised the Department of Homeland Security that the program was probably unlawful and that it could not be defended.

    Sessions based that decision on a ruling by the U.S. Court of Appeals for the 5th Circuit, which said that another Obama program protecting immigrants was beyond the president’s constitutional powers. The Supreme Court deadlocked 4 to 4 in 2016 when considering the issue.

    Olson said that advice from Sessions gave the department no other option but to end the program. The court should require the administration to start over and give reasoned arguments for why it is in the country’s best interests to end the program.

    But Justice Neil M. Gorsuch, who said the “sympathetic facts” about DACA recipients “speak to all of us,” wondered what would be the point. “What more would you have the government say?” he asked Olson.

    Justice Brett M. Kavanaugh also said a subsequent memo from then-DHS Secretary Kirstjen Nielsen seemed to list reasons other than Sessions’s view that the program was illegal.

    But Justices Elena Kagan and Ruth Bader Ginsburg said a presumption about the program’s illegality provides the backdrop for all of the administration’s actions.

    Lower courts have rejected Sessions’s view. They have kept the program in place, restricting new applicants but allowing those already enrolled to renew their participation. California Attorney General Xavier Becerra (D), who is among those fighting the administration’s decision, said that about 400,000 two-year renewals have been approved since January 2018.

    The program is open to those who were brought to the United States before they were 16, have lived here at least five years, paid for and received a background check and have a clean legal record. The program does not provide a path to citizenship, but it does allow recipients to work legally and to renew their two-year protection from deportation.

    A government study found more than 90 percent of recipients, who now are in the 20s and 30s, are employed, and about half are students.

    The Trump administration, which usually argues for broad executive power, in this case is arguing that the program is flawed and could not be defended against challenges from states that want to end it.

    The Supreme Court’s somewhat reluctant review of the DACA program — it waited for months before accepting the case — meant that, for the third consecutive year, the high court will pass judgment on a Trump priority that has been stifled by federal judges, this time in a presidential election year and in a case with passionate advocates and huge consequences.

    The Supreme Court ended its term in June by putting on hold the Trump administration’s plan to put a citizenship question on the 2020 Census. In 2018, it narrowly approved the president’s travel ban on arrivals from a handful of mostly Muslim countries.

    The consolidated cases the court heard Tuesday are Department of Homeland Security v. Regents of the University of California, Trump v. NAACP and McAleenan v. Vidal.
    There is more stupidity than hydrogen in the universe, and it has a longer shelf life.

    ― Frank Zappa

  3. #16683

    Re: National, Regional and Local News

    Two dead, at least 4 injured in shooting at a Los Angeles-area high school; suspect in custody
    The shooting happened at Saugus High School in Santa Clarita.

    By Mia Nakaji Monnier,
    Moriah Balingit and
    Katie Mettler
    November 14, 2019 at 5:15 p.m. EST

    SANTA CLARITA, Calif. — A 16-year-old student pulled a gun from his backpack and opened fire on classmates at a high school north of Los Angeles on Thursday morning, striking five people before turning the gun on himself, law enforcement authorities said. Two students, a 16-year-old girl and a 14-year-old boy, died at a hospital.

    The shooter, whose attack unfolded at Saugus High School in Santa Clarita in front of surveillance cameras, survived his self-inflicted gunshot wound and was in grave condition at a hospital, authorities said at a news conference shortly before noon local time. Police said he turned 16 on Thursday.

    The shooting victims who survived include a 14-year-old girl, a 15-year-old girl and a 14-year-old boy. The shooting took place in the quad, a popular outdoor gathering spot for students, a place with trees and picnic tables.

    “We need to say ‘no more.’ This is a tragic event that happens too frequently,” said Capt. Robert Lewis of the Santa Clarita Valley Sheriff’s Station. “When are we going to come together as a community … to say ‘no more’?”

    Deputy Armando Viera of the Los Angeles County Sheriff’s Office said the shooting was reported at 7:38 a.m. at Saugus High. When authorities arrived two minutes later, they found six students with gunshot wounds and later learned the shooter was among them. They also recovered a .45-caliber semiautomatic pistol at the scene. There were no more rounds in it.

    Four people were taken to Henry Mayo Newhall Hospital in Valencia, including the male and female student who died. The two other students were being treated Thursday afternoon, officials said. One was in critical condition and the other was in good condition.

    Providence Holy Cross Medical Center received two patients related to the shooting, both female students, according to a hospital spokeswoman. The spokeswoman said one girl was in fair condition and the other in good condition and that both were talking when they arrived. A seventh person was treated for injuries that were not critical, authorities said.

    Authorities would not say where the shooter was being treated.

    The shooter was identified through witness statements and school security footage, law enforcement officials said. No additional victims were found at his home, and the sheriff’s department is working to obtain a search warrant.

    “At this point we have no indication of any motivation or ideology,” said Paul Delacourt with the FBI’s Los Angeles Field Office.

    The suspect’s mother and girlfriend were being interviewed by law enforcement.

    Outside Saugus High, the scene was quiet except for the thwack of helicopters overhead and the rumbling of idled firetrucks and police cars. The area around campus had been blocked off with police tape. On a quiet street nestled beneath a wooded hill three miles from the campus, police barricaded the street near the house where they say the suspect lives, roping off one home with police tape. In the middle of the day, only a dog’s ferocious bark could be heard punctuating the stillness.

    Ryan Payad, a 14-year-old freshman, was across the street from the campus when he heard shots — and then heard screams pierce the air. He turned and ran, joining students fleeing the campus. He ran into his friend Adolfo Ramirez, and the two spent time at Adolfo’s house, reeling from what had transpired that morning.

    “I’m just shocked right now,” Ryan said in an interview with The Washington Post.

    Adolfo, also a 14-year-old freshman, was blocks away from the school when the shooting happened. He was struggling to come to grips with how a shooting could take place at his school, in the heart of an affluent suburb of Los Angeles.

    “I never expected this to happen in the middle of a neighborhood like Santa Clarita,” Adolfo said. “I felt protected.”

    Two female students told CNN in an interview that they heard five shots, one initial bang followed by four rapid shots. Voices shaking, the girls told CNN that students still inside the school were hiding in closets and texting updates to friends who had made it outside.

    Another three students told the network on air that they were by the library at the school and saw a wave of classmates running from the quad. They began running, too, leaving campus through a gate and rushing to the first house they could find in a nearby neighborhood, the girls said.

    They also heard five shots, and said they could immediately tell the bang they heard was not the sound of a popping balloon or a falling binder. They said it was a “gut feeling.”

    “It took us a minute to process that we needed to run,” one of the female students said on air.

    The girls said they knew it wasn’t a drill because the school holds drills only after the school day has started. The mayhem unfolded as students were still making their way to class early Thursday morning.

    Another student told KABC in an interview that she and other students huddled in an office when gunfire opened. The student said she texted her father to say, “I love you.”

    Saugus High, on a campus lined with palm trees, has about 2,400 students, according to federal data. Earlier this year, a half-dozen students from Santa Clarita were detained on charges stemming from violent threats they posted online, the Los Angeles Times reported.

    Television footage showed students evacuating the school and emergency vehicles responding, with people in gurneys being loaded into ambulances on the school campus.

    Sen. Kamala D. Harris (Calif.), a Democratic candidate for president, spoke with CNN’s Anderson Cooper live on air and called shootings at schools “the new normal."

    “Our kids are living in fear, wherever they live, they are living in fear,” Harris said. “This is yet again another reason why they are so afraid, that literally they will die. It’s tragic in the most fundamental way. It is tragic. It is senseless. It is unnecessary. It is devastating.”

    Harris also called for “reasonable” gun safety laws in the United States. “Enough is enough,” she said.

    This is at least the seventh shooting at a U.S. school this year, according to a Post analysis. More than 233,000 schoolchildren have been exposed to gun violence in their schools since the shooting at Columbine High in Colorado in 1999.

    Balingit and Mettler reported from Washington. Mark Berman in Washington contributed to this report.
    There is more stupidity than hydrogen in the universe, and it has a longer shelf life.

    ― Frank Zappa

  4. #16684

    Re: National, Regional and Local News

    Michael Moore

    Last year Santa Clarita, CA recorded its lowest crime rate in history. It is listed as “One of the 50 Safest Cities in America.” It is in the top ten of having the least number of crimes against property in the nation. Why is there a gun in anyone’s home? What are you afraid of?

    There is more stupidity than hydrogen in the universe, and it has a longer shelf life.

    ― Frank Zappa

  5. #16685

    Re: National, Regional and Local News

    3 Indiana Judges Suspended After White Castle Brawl That Left 2 Of Them Wounded
    November 14, 20194:28 PM ET
    Laurel Wamsley at NPR headquarters in Washington, D.C., November 7, 2018. (photo by Allison Shelley)

    Judges Andrew Adams, Sabrina Bell and Bradley Jacobs were censured by the Indiana Supreme Court for their roles in a brawl outside a White Castle in May.
    Indiana Supreme Court

    Back in May, three Indiana judges got into a fight. It was the crescendo of an incident brimming with colorful details: a gaggle of judges drinking the night before a judicial conference, a failed attempt to visit a strip club called the Red Garter, a brawl in the parking lot of an Indianapolis White Castle.

    The altercation apparently started sometime after 3 a.m., when one of the judges, Sabrina Bell, raised a middle finger at two men yelling from a passing SUV, and ended after one of those men shot two of the judges.

    In between, the three judges took a number of actions that "discredited the entire Indiana judiciary," according to an opinion posted by the Indiana Supreme Court this week, suspending the judges.

    The court found that the three — Andrew Adams, Bradley Jacobs and Sabrina Bell — had "engaged in judicial misconduct by appearing in public in an intoxicated state and behaving in an injudicious manner and by becoming involved in a verbal altercation." Adams and Jacobs engaged in further judicial misconduct "by becoming involved in a physical altercation for which Judge Adams was criminally charged and convicted."

    The document lays out the events as soberly as possible, but the details remain spicy:

    "While in town to attend a statewide educational conference for judicial
    officers, 10 hours before the program convened, Respondents walked the
    streets of downtown Indianapolis in a heavily intoxicated state. When
    Judge Bell extended her middle finger to a passing vehicle, neither Judge
    Adams nor Judge Jacobs discouraged the provocation or removed
    themselves from the situation."

    The three had ended up at a White Castle after trying to go to a strip club at 3 a.m. and finding it closed. A fourth judge went into the White Castle, while Bell, Adams and Jacobs stood outside.

    Two men in the passing vehicle, Alfredo Vazquez and Brandon Kaiser, parked their car after the gesture from Bell.

    Bell and Vasquez traded further insults. A physical altercation ensued among the four men, with Adams and Vasquez allegedly hitting and kicking each other as Jacobs and Kaiser wrestled on the ground. Kaiser then allegedly pulled a gun and shot Adams once in the stomach and Jacobs twice in the chest.

    Adams and Jacobs were both seriously wounded and required emergency surgeries; Jacobs was hospitalized for two weeks.

    Bell tried to stop the fighting by pounding on the door of White Castle for help and calling 911 once shots were fired.

    While at the scene, Bell was recorded on video telling police detectives something akin to "I feel like this is all my fault," though the opinion notes that Bell "was intoxicated enough that she lacks any memory of the incident."

    Kaiser, who allegedly shot Adams and Jacobs, has been charged with 14 crimes related to the brawl, including four charges of felony aggravated battery, according to The Indianapolis Star.

    The court suspended both Jacobs and Bell for 30 days without pay. Adams, who pleaded guilty in September to one count of misdemeanor battery, is suspended for 60 days without pay. He was sentenced to 365 days in jail but was required to serve only two.

    In the White Castle incident, the court said, the three judges "gravely undermined public trust in the dignity and decency of Indiana's judiciary."

    The court says its penalties are designed "not primarily to punish a judge, but rather to preserve the integrity of and public confidence in the judicial system" and, when necessary, to remove those who are unfit.
    There is more stupidity than hydrogen in the universe, and it has a longer shelf life.

    ― Frank Zappa

  6. #16686

    Re: National, Regional and Local News

    Quote Originally Posted by Ti-Amie View Post
    The three had ended up at a White Castle after trying to go to a strip club at 3 a.m. and finding it closed. A fourth judge went into the White Castle, while Bell, Adams and Jacobs stood outside.
    Two or more in this group is having an affair. This reads like an Onion article.

  7. #16687

    Re: National, Regional and Local News

    I thought at first it had happened in Florida...
    There is more stupidity than hydrogen in the universe, and it has a longer shelf life.

    ― Frank Zappa

  8. #16688

    Re: National, Regional and Local News

    The most remote emergency room

    Avera eCare employees sit at virtual emergency room workstations at a telemedicine center in Sioux Falls, S.D. (Michael S. Williamson/The Washington Post)

    Eli Saslow
    November 16, 2019 at 7:00 p.m. EST

    If anything defines the growing health gap between rural and urban America, it’s the rise of emergency telemedicine in the poorest, sickest, and most remote parts of the country, where the choice is increasingly to have a doctor on screen or no doctor at all.

    The number of ER patients in rural areas has surged by 60 percent in the past decade, even as the number of doctors and hospitals in those places has declined by up to 15 percent. Dozens of stand-alone ERs are fighting off bankruptcy. Hundreds of critical-access hospitals either can’t find a doctor to hire or can’t afford to keep one on site. Often it is a nurse or a physician assistant left in charge of a patient, and for the most severe cases many of them now hit a red button on the wall that connects directly to Sioux Falls.

    In less than a decade, the virtual hospital has grown from a few part-time employees working out of a converted storage room into one of the country’s most dynamic 24-hour ERs, where a rural health-care crisis plays out on screen. Each month the monitors show an average of 300 cardiac episodes, 200 traumatic injuries, 80 overdoses and 25 burns. There are patients suffering from heat stroke in South Texas and frostbite in Minnesota — sometimes on the same day. There are drowning deaths in summer, gunshot wounds during hunting season, car accidents on icy roads, and snakebites in spring.

    And now there was a video call coming into the office park from the latest hospital to seek virtual help, a critical-access facility in Onawa, Iowa, which had just finished installing its cameras a few hours earlier.

    “Are we live?” asked Karla Copple, the hospital’s director of emergency services. She stood in an empty hospital room in Onawa, a farming town of 3,000 on the Missouri River, and looked up at a screen on the wall.

    “Yes, I can see you,” said a nurse at the virtual hospital. “How are you today?”

    “Just making a test call,” Copple said. “It’s all working?”

    She had been trying to set up a partnership with the virtual hospital for the last year, ever since a car crash in Onawa sent four patients to the ER in critical condition when there was only one registered nurse on site. The hospital had a few doctors on staff, but they usually commuted into Onawa from their homes in Omaha, which was an hour away.

    “In emergencies, every second counts!” read an introductory brochure from the virtual hospital, and Copple began researching telemedicine and sharing data with her staff. Doctors at the virtual hospital could begin treating a patient an average of 21 minutes faster than doctors on call, who often lost time driving from home to the hospital. Telemedicine helped hospitals retain and recruit doctors because it gave them more support and allowed for more time off. It also allowed hospitals to treat more patients on site rather than having to transfer them to bigger facilities, resulting in increased billing charges and more hospital income.

    Late in the summer, Onawa had signed a subscription deal with the virtual hospital for the standard annual rate of about $70,000 per year. A charitable foundation offered to pay $170,000 to help cover initial equipment and technology costs, and an IT crew spent the next months outfitting two trauma rooms with fiber-optic cables, cameras and a microphone over the exam table, which Kopple was talking into now.

    “You can hear me?” she asked.

    “Loud and clear,” the nurse said. “We can hear you from anywhere in the room. These microphones are amazing.”

    “Okay then,” Copple said. “Next time it’ll be for real.”

    There are 15 doctors and 30 emergency nurses who rotate through shifts at the virtual hospital, and while all of them have trained for years inside regular ERs, nothing compared to the intensity of the industrial park. During one 24-hour shift, they often saw more critical cases on screen than most ER doctors encountered in a month: an average of one severe heart attack each shift, one suicide attempt, two pediatric emergencies, three traumatic injuries, four intubations, and five patients whose hearts had already stopped beating and needed immediate resuscitation.

    “Do you feel a pulse?” Dr. Kelly Rhone was asking into the camera one morning, as she watched a team of nurses perform CPR on a middle-aged cancer patient at a small hospital in North Dakota. The patient’s shirt had been ripped in half, and his body shook from the force of the CPR compressions.

    “Pulse?” Rhone asked again.

    “I don’t have one,” a nurse said.

    “Pupils?” Rhone asked.

    “Fixed and dilated,” the nurse said.

    “Okay. Let’s do one of epi,” Rhone said, instructing them to inject the patient with epinephrine, a medication used as a last resort to restart the heart. She zoomed in on a camera to look at a bedside monitor of the patient’s vital signs and counted off the seconds using a clock at her desk. An emergency nurse sat next to her in the office park and worked on a separate computer to arrange for helicopter transport to a trauma center, in case the patient’s heart started beating.

    “Nice CPR,” Rhone told the nurses in the room. “You’re doing great.”

    “I’m going to go talk to the wife,” one of the nurses said to Rhone, pointing toward the hallway. “She’s kind of hysterical. Any update you want me to give her?”

    “Just that we’re still working on it,” Rhone said, even though she already suspected how this would end. There was statistically almost no chance the patient could be revived after several minutes without a heartbeat. “Tell her we’re doing everything we can.”

    She ordered another injection of epinephrine and watched as the nurses injected him. She called out for another pulse check, and watched as the nurses in the room found none. She zoomed in to see the patient’s cardiac monitor and saw a flat line indicating no cardiac activity. “Eight minutes since arrival,” she told the nursing staff, as they continued CPR. “Twelve minutes since arrival,” she said. “Would his wife like a chance to come in?”

    She believed one of the worst things she could do was withdraw care too quickly. Even if she already knew the patient was dead, she wanted the medical staff in the room to come to that realization on its own time. The hospital served a community of fewer than 2,000, which meant someone on the nursing team probably knew the patient personally. Rhone wanted staff members to feel they had done everything they could.

    “Fifteen minutes since arrival,” she said, hoping to urge them toward a decision, and after another moment a few of the nurses stopped administering CPR, stepped back from the bed and went into the hallway to get the patient’s wife. Rhone watched her come in and kneel at the bedside. She watched as the wife gripped her husband’s jeans and buried her head into his chest. “Oh, God. That’s it. That’s it,” the wife said, as Rhone pushed her chair back from the computer monitor and checked the clock on her desk.

    “It’s 11:06 a.m.,” she said quietly, speaking to one of the nurses in the room, so she could mark that down as the official time of death.

    She watched as a paramedic pulled a white sheet over the patient’s body. Everyone in the room circled around the bed, and the wife started to pray. Her prayers turned to cries and her cries became louder, until after a few seconds the camera felt to Rhone like an intrusion, and she reached to her desk and switched the monitor off.

    “Is that TV talking?” asked Silas Gruen, age 4. He adjusted his glasses and sat up on his hospital bed in Abilene, Kan., looking at a television screen mounted on the wall. He could see a woman in blue scrubs smiling at him as she typed into a keyboard.

    “I think that’s actually your doctor,” said his mother, Amy.

    “My doctor’s a TV?”

    “Well, kind of,” Amy said, but before she could explain more the doctor on TV was talking again.

    “So what exactly brought you in here today?” the doctor asked.

    “You mean in here?” Amy asked, pointing down at the floor of the only hospital within 40 miles of her house, where she knew many of the employees. A sign near the doorway read, “Local Care Is Loving Care,” and soybean fields stretched in neat rows out the window. There was no doctor on site at the hospital during the day, so a physician assistant was attaching monitors to her son’s chest and pricking his finger for a blood sample while a nurse tried to distract him by offering a juice box.

    This was the first time Amy had seen a virtual doctor in the ER, but at the moment she was more concerned about what had been happening that morning. She took a step closer to the screen and explained that Silas had woken up with nausea and a fever — common symptoms that concerned her because of his complex medical history. He had been born with a cleft lip and an eye condition, which meant they traveled every few months to find the specialized medical care that didn’t exist in most rural areas. Silas’s primary-care doctor was an hour away. He had regular appointments with specialists across the state. Already this morning, Amy had taken him to a walk-in clinic and then to the hospital, where a physician assistant who saw him had pushed the red button.

    The doctor on the screen introduced herself as Katie DeJong. She said she could see on the bedside monitors that Silas’s blood sugar was dangerously low. She asked the physician assistant to give him medication and a chest X-ray, and then she turned her attention back to Amy, who was holding her son’s hand and sitting on the edge of his hospital bed.

    “What do you think, Mom?” she said. “What’s your intuition?”

    “He doesn’t seem like himself,” Amy said. She watched DeJong take notes on the screen. All Amy could see was a doctor, a nurse, and a blank yellow wall behind them. “Where are you, anyway?” she asked. “Kansas City?”

    “Actually, South Dakota.”

    “South Dakota?”

    “Yep. Believe it or not.”

    Amy rubbed Silas’s back and waited for DeJong to finish her evaluation. “My concern here with the blood sugar is we don’t know what’s causing it,” DeJong said. She explained that Silas needed further blood testing, specialized scans and maybe even an endocrine specialist — none of which was available at the moment in Abilene.

    “I would definitely go ahead and transfer this,” DeJong said to the physician assistant in the room, and a little while later Amy and Silas were riding through soybean fields in an ambulance on their search for adequate medical care again, as a new wave of emergencies took their place on the monitors in Sioux Falls.

    A farmer had fallen into a grain elevator and injured his head.

    A drug addict was foaming at the mouth and turning blue.

    A woman with pneumonia and a life-threatening sepsis infection was lying motionless on her hospital bed as her oxygen levels dropped.

    “Who is our most experienced emergency provider in the room?” DeJong asked, speaking to five staff members surrounding the patient with sepsis, who was rolling her head from side to side and had signs of a possible brain bleed. They needed to protect her airway by inserting a breathing tube.

    “Who has the most experience to perform the intubation?” DeJong asked again, louder this time, and finally a nurse stepped away from the bedside and looked up at the camera.

    “I can try,” she said.

    “Great,” DeJong said. “That’s terrific.”

    She moved her camera around the hospital room, zooming into cabinets and drawers to help point out necessary supplies for the staff to gather at the bedside. She ordered them to give the patient a sedative and then a paralytic. Then she held up her fingers to the camera to demonstrate the best technique for intubation.

    “You’re doing great,” she said, as she watched the nurse try to insert a breathing tube for what DeJong could tell was probably the first time. The nurse leaned over the patient’s throat, twisting the tube back and forth without advancing it down the airway.

    “I’m not exactly sure what I’m seeing,” the nurse said.

    “No problem,” DeJong said, as the patient’s oxygen levels began to drop on the bedside monitor. “Let’s bag up and try again.”

    “I still can’t seem to advance it through,” the nurse said, on a second attempt, as the patient’s oxygen level dipped again.

    “That’s okay,” DeJong said. “This is hard. Is there a more experienced provider who wants to make our next try?”

    “I think I almost had it,” said the more experienced provider, after taking over and failing on the next attempt. They had been trying to intubate for 15 minutes. A nurse stepped away from the bedside and rubbed sweat from his head. “We’re doing fine,” DeJong said. “We just need to focus on technique.” She held up a pencil and pretended it was a breathing tube to demonstrate. She tilted her neck to show the proper position of the patient’s head.

    They began another attempt as she moved the camera around the hospital room, hovering over the patient’s throat and zooming in on the oxygen levels, pushing the boundaries of technology and bumping up against its limitations. She wanted to reach into the screen. She wanted to be at the bedside. She wanted to be using her own hands to intubate, but instead she was 400 miles away, and for the moment all she could do was remain calm and reassuring as she pressed in closer to the monitor.

    “You’re doing great,” she said, as the tube began to slide into place. “You’re giving the patient everything you can.”
    There is more stupidity than hydrogen in the universe, and it has a longer shelf life.

    ― Frank Zappa

  9. #16689

    Re: National, Regional and Local News

    I've been aware of these places for a fair number of years. As weird as it sounds, these virtual ER's are a lot better than not having anybody at all. And the people on site (the nursing staff, physician's assistant, or both) get pretty good at emergency care as well. So I suspect they do a pretty good job.....not ideal, but far better than nothing, which is what most remote places get otherwise.


  10. #16690

    Re: National, Regional and Local News

    Right. Far from ideal, but probably an improvement. If they took a snapshot of the 5-10 years prior in this article, it is likely an unfortunate trend of preventable deaths and more serious illnesses than necessary because they couldn't get care quick enough, or delayed getting care because of their remote location. Hopefully they will be able to perfect the system from where it is now, because I imagine this kind of care will be on the rise.

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