The banality of evil: It’s an R.N. now

Email from HR: Never, ever good news. In this case the exciting update that our “deny your health care” company is being upgraded.

Dear VixenCo Health Plan Participant:

Effective September 1, 2006, Nationwide Better Health (“NBH”) will replace SHPS Healthcare Services as the disease management and medical management vendor for the VixenCo Health Plan.

NBH will be an important part of your health coverage. Youl call NBH to get your hospital stay or surgical procedure pre-certified. NBH will also provide access to other valuable services.

Over the next few weeks, you’ll get to know NBH. Watch your mailbox at home and your work e-mail for more information coming soon.

This message is being sent to you by the VixenCo Employee Benefits Department from an e-mail address that does not accept return messages. If you have any questions, please call the Benefits Hotline at (888) 555-1212 or send an e-mail to

I especially like “Over the next few weeks, you’ll get to know NBH.”

I have a special deep burning anger in my heart for Utilization Review “nurses.” They’re the Good Germans of the healthcare world, reducing cost by using their medical expertise to choose the cheapest option every time, deny anything they can, and talk people out of seeking care. Nowadays they don’t just keep you from getting surgery or tests, they also send out colorful brochures urging you to call them when you feel unwell so they can keep you from going to the doctor.

It just wouldn’t be the holidays

…without grim film noir news from Downtown Los Angeles. Of course the story doesn’t point out that the reason all the “services” for indigent people are in Skid Row is to keep them bottled up there, in one of the world’s most dangerous square miles. I used to talk to homeless guys downtown who wouldn’t go to the missions because they thought they might not make it through the murderers, stuff on fire, other murderers, etc.

Hospitals send patients to L.A.’s skid row

LOS ANGELES (AP) — Three hospitals acknowledged putting discharged patients with nowhere else to go into taxicabs heading to the city’s downtown skid row, the Los Angeles Times reported.

Representatives of Hollywood Presbyterian Medical Center, Kaiser Permanente West Los Angeles and Martin Luther King Jr./Drew Medical Center said they were helping patients because skid row offers their best chance of getting services and shelter. They said patients are sent to skid row only if they are healthy enough.

“One of the challenges is that there are very few places that will take patients coming out of the hospital, even when they are medically cleared,” said Mehera Christian, a spokeswoman for Kaiser Permanente Metro Los Angeles. “There are just a scarce number of places in the community to assist our homeless.”

The hospitals were the first to acknowledge delivering people to skid row. A Los Angeles Police Department report had accused the three hospitals and several suburban law enforcement agencies of leaving homeless people and criminals downtown. The suburban departments deny the accusation.

LAPD officials agreed that the hospitals have few other choices, but said the practice only adds to grim conditions on skid row. They disputed the hospitals’ assertion that the patients were always ready for release.

Earlier this week, city and state officials pledged a new fight against problems in the neighborhood, including drug dealing that police say generates roughly one-fifth of the city’s drug arrests.

Officials at the three hospitals said they don’t simply dump the patients.

Hospital social workers usually meet with patients to try to connect them with agencies or groups that could help them, then provide them transportation, Christian said. She said about half of patients say where they want to go, and none are forcibly taken anywhere.

Joseph Epps, an attorney for Hollywood Presbyterian, said hospital policy calls for homeless and indigent patients to be transported by hospital van to the Los Angeles Mission on skid row or to receive taxi vouchers to go wherever they want.

LAPD Capt. Andy Smith said patients don’t always reach their destinations, and that he often sees “individuals with not one but sometimes two different hospital bracelets, and people with bandages on, people who are barely ambulatory, and we’ll end up calling an ambulance. Sometimes they are in such bad shape they are incoherent.”

LAPD Assistant Chief George Gascon said services should be spread across the area so skid row doesn’t bear too much of the load.