Work(s) in Progress

Learning some HTML part 2

2009-11-03T23:32:28-07:00

I registered my own domain about 6 weeks ago.

I'm making progress learning some HTML & CSS. I still can't always get the code to do what I expect, but it does seem (at least to me) that I'm getting there.

My big project recently has been assembling and organizing resources for businesses that want to locate or grow in Downtown Denver. I'd love feedback on this test resource in terms of usefulness, format, missing items, etc.

Thank you in advance!

A Little Lasik

2009-10-30T22:38:11-06:00

I had Lasik done this morning at Spivack Lasik. The doctor and clinic were recommended to me by many including my assistant at work. Of course, once my assistant saw the appointment on my calendar, she asked only "what time and where am I picking you up?" Thank you BP.

I had two complete complementary pre-op visits to ensure that I'd be an OK candidate. Even this morning they retested my ability to make sufficient tears as dry eyes are not compatible with great Lasik outcomes. My eyes are still dry even though I take Flax Oil daily - I never had this issue before I started using contact lenses - and the doctor inserted collagen plugs into my tear ducts earlier this week. I'm not sure why doctors (especially my gynecologist) always want to give the play by play..."I am about to touch you now..." but really, stop already, and just do whatever, especially if a foreign object is going where it was not meant to go. Just do it; I really don't want the second by second description.

So for about 15 minutes at the clinic today I'd worried that I'd paid for the surgery and stressed over it but would not in fact be getting the Lasik done today or ever. Ultimately I was led back to the surgery waiting area - imagine dimmed lights and a ring of lazy boy chairs with people with hair nets, sterile booties and closed eyes. Oh, and hot blankets. There is nothing like a hot blanket while waiting for an unpleasant experience. About 20 minutes prior you have the option to take an Ativan (say yes) before surgery. I had valium in a IV push when my wisdom teeth were taken out. Ativan was not as potent as valium in dissociating the experience or memory but did help to diminish my anxiety in the moment and had the advantage that I fundamentally still felt like myself.

So Lasik takes maybe 10 minutes, tops. I was laid flat and still had my warm blanket. I was then offered a stuffed animal. My side of the conversation conveyed that um, I didn't even like dolls as a kid. The nurse conveyed that some folks find it helps, "here" she said as she shoved a stuffed puppy under the blanket with me. While there is an eyes held open aspect that reminded me too much of A Clockwork Orange (warning image is disturbing), it was over quickly. And the doctor used his hands to hold my head/chin as much as possible. There are two laser zapping sessions per eye: flap creation & correction. And two sessions of the doctor moving the flap - away & back. Zap zap zap OK; forceps near eye.....yiiiieeee! And yes, the dumb stuffed dog under the covers with me was held very tightly. Feel free to send stuffed animals for Christmas, apparently I have a fondness...

Slept for 4 hours post surgery as recommended. Lots of eye drops required over the next 2 weeks, steroids, antibiotics, artificial tears, and even cyclosporin (and why cyclosporin helps tear formation I have NO idea...for organ transplantation I get it, daily on my eyes because they are dry, huh? but OK I will do, for months apparently). And I can now see leaves on trees again. Less than 12 hours post-op and my vision is better, much better. I am hopeful!

And while the surgeon won't be at my 24 hour post-op appointment in the AM, he called me earlier this evening to see if I was OK, or had questions or concerns. Nice touch Dr. Spivack. And apparently, so long as I get a complete annual eye exam, my surgery has a lifetime warranty. Cool.

Short Takes

2009-10-20T23:01:23-06:00

I think twitter and text messaging are training me to think and communicate in short bursts of thought.

I recently heard a DC journalist say that if you couldn't capture the audience with your story or message in 25 words they would just tune out. I'm not sure what that says about our nation's ability to maintain a meaningful dialog on complex topics.

I'm looking forward to Clay Lowe's book - A thousand bullets gone astray when I can get it in the USA.

I'm wondering when we begin to associate connotations with the images with see. My life was fairly uncensored as a child. And while I now view many images or situations as having a moral (good/bad) connotation, I know that early on that all images were neutral in my brain. Sunny day = Pithed Frog = Crucified Man = Sleeping Puppies. I don't know whether this is because I saw A Clockwork Orange when I was six or whether I was just a late bloomer in terms of developing empathy.

I was supposed to attend the annual GCEC (global consortium of entrepreneurship centers) meeting at Rice. The meeting program looked amazing. I had everything lined up. I'd even pre-printed my boarding pass for my flight. And then I drove myself to the Emergency Room at 2:30AM when I got slammed by the flu. Since I had an annual flu shot, it was perhaps H1N1. My local ER was no longer testing as the test results had no bearing on treatment - (just not cost effective). I'm not sure how this impacts the H1N1 maps you can find online. In my case 4 days of fever, mostly GI symptoms, 2 bags of IV saline and various medications. During the worst of it, I think I slept 36 hours during a 48 hour period. Not fun.

Today is the one year anniversary of the judge signing my divorce decree. It is also the one year anniversary of getting my tubes tied. Two major life changes in one day. No regrets.

Next week, I'm having Lasik done. My heart is racing just thinking about it. It took me years to even work up the courage to switch from glasses to contact lenses. I did my evaluation visit yesterday (at Spivack) to see if I was a good candidate. Aside from dry eyes (it is Colorado), everything looks good. They have patient "counselors" who help with scheduling, financing and also hand-holding as I heard the doctor tell my counselor in a hushed voice "she is very frightened" as in "hold her hand but close the deal." There are two doctors at this office who do the Lasik surgeries. One is substantially cheaper. I understand wanting generic or discount on prescription drugs or routine doctor visits but on EYE SURGERY?! Give me the rockstar please.

I went to Get Motivated! again this year as I did in 2006. Unlike 2006, I did not attend the entire event. My assistant and I heard Robert Schuller, Laura Bush, Colin Powell (why I bought tickets), Phil Town (I love Rule #1), and Tamara Lowe (one of the founders of Get Motivated). While I remembered that the 2006 event had a "God Bless America" theme and "seemed to use some cult-like techniques to capture the audience" I did not remember all of the "take Jesus as your savior" rhetoric that occurred this year and caused me to leave.

Tamara Lowe has now written a book, Get Motivated!: Overcome Any Obstacle, Achieve Any Goal, and Accelerate Your Success with Motivational DNA, the focus of which she presented. It seemed like a useful tool for determining how to best motivate yourself and others. However, her presentation then veered into the surreal starting with a religious rap. To best share the experience, I will quote a review from Amazon.com " I was then teletransported to another dimension and I'm suddenly at a Christian Convention. A big old Jesus-fest. To the point that she asks us (if we want to to be anything in this world and not go to hell thereafter) to each silently affirm that we each need Jesus in our hearts and need to reconnect with our love for Him. Huh? I check my ticket and it is still proclaiming to be a business seminar. I look at my employee, who is Jewish, and she is staring painstakingly at the floor. I mouth, "I'm SO Sorry" and she gives me an uncomfortable nod. It made me pretty angry that at a business seminar with nationally acclaimed speakers, she would be so presumptive as to assume that the 10,000 people in the room not only agree with her beliefs, but cares what she thinks on the topic. It was a total insult to the professionals who follow other faiths or belief systems and mind their own business about it. No wonder half the world thinks we're arrogant and disrespectful of their religious beliefs." Yeah. What S/he said.

In spite of this, Laura Bush was charming, someone with whom you'd want to have tea or a glass of wine; Colin Powell was as inspiring as I'd remembered; and, I will most likely buy Phil Town's new book which is coming out in March 2010: Payback Time: Eight Steps to Outsmarting the System That Failed You and Getting Your Investments Back on Track.

I'm finally planning my trip to Hawaii. Smiling just thinking about it.

My First Trip to Napa Valley

2009-10-10T00:32:42-06:00

A few months ago I mentioned that I needed a traveling companion for an excursion to Napa Valley that I "won" in a silent auction at an event for Dani's Foundation.

Wow! I returned early Tuesday morning and I am still thinking about what a wonderful time I had.

I flew into Los Angeles on Thursday evening. My flight was delayed and just about every flight mishap that could happen did. In spite of the ominous start, the rest of the trip was simply outstanding. The weather was terrific - mid 70's or mid 80's and sunny the entire time. Everything else transpired without mishap.

My traveling companion and I drove up route 1 stopping in Big Sur at Nepenthe for lunch. What a magnificently pretty drive. We arrived in Sonoma in time for a delicious dinner at the Eldorado Kitchen before settling into the Fairmont Sonoma Mission Inn & Spa. I learned later that Boyes Spring is a bit past its prime, but the Fairmont was a beautiful place to stay and had a terrific fitness center.

Friday we drove around the Sonoma & Napa Valleys stopping in at Hess (to see the museum), Stag's Leap, Clos du Val, and Twomey. Of these, Twomey was by far our favorite for the quality of wine and the tasting experience. Just about all of the vineyards charge for a tasting; however, we learned that if you just wanted to taste a single varietal (e.g. "just the cabernet please") or ended up buying some wine that these fees might be waived. In general, portions are large enough to share so I highly recommend doing that as some vineyards had more that one tasting package and many are willing to pull together a package that suits your tastes (e.g. "just the reds please").

Friday afternoon we checked into the Meritage, the resort & spa I "won" in silent auction. The Meritage was tucked into an office park and so one view faced office building and the other a vineyard. In spite of the location it was new, immaculate and had all of the amenities one might hope for as a business traveler (bare bones gym, free wireless internet, 24 hr everything, etc.). That evening we enjoyed our Wine Train experience. I'd recommend doing this at lunch or mid-summer so you can enjoy the views out of the windows. It was fun if kitschy. And while great wine can be purchased on board, you might be better off bringing your own and paying the corkage fee.

The next day we explored Napa Valley in the back of a comfortable sedan hosted by Beau Wine Tours again as part of the silent auction package. I suspect that this may have led to the first and I hope last time I start drinking at 10AM. We started at Duckhorn, which makes several wines that I knew I loved. In terms of easy to access vineyards, Duckhorn was the highlight of the trip for me. Great wine, wonderful experience, terrific service, etc. From there we moved on to Prager Port Works, Cakebread & Salvestrin. The people at Salvestrin were terrific, giving us a tour of their wine making areas and process. The tawny port at Prager was excellent but not a part of their normal tasting package. Cakebread was somewhat disappointing. I've enjoyed their wines at several restaurants but the experience (and wine) was not on par with some of the others we had on this trip. Service matters and while I was a customer in the past, I suspect that I will not be in the future. Their loss really as I went in expecting to buy and to have a wonderful experience.

If the trip stopped here it would have been excellent, outstanding even. However, from this point forward, the trip veered into the surreal. So utterly outstanding that I barely have the words to describe it.

Sunday evening was filled with wine and a tour at the Napa Valley Reserve - beautiful grounds, an inspiring cellar & caves in process and incredibly delicious wine. We followed this treat with dinner at the Press in St. Helena. I never thought I'd say this but have the chicken! Really. Amazing.

We woke up early Monday morning to head to the Infineon Raceway in Sonoma where I enjoyed the Audi Sportscar Experience and got to drive the Audi R8 5.2 FSI quattro with its "soul stirring" 525 hp V10 engine on the track.

My traveling companion and I shared a private lesson. We each had our own car. I really did not want to get out of mine.

This was a very high tech experience. We inserted flash drives into the cars' computer for our final laps on the track. In theory they'll send an email when we can view our laps on-line. I suspect they'll look something like this: You Tube. The goal is to keep 1 to 1.5 car lengths between your car and the instructor's car. I know that my gap was too large for most of my laps (much like the linked video). The cones on the track mark the turns and apex. Helpful. As you can hear, the instructor coaches you (or in my case, makes fun of you!) through the track, commenting or giving guidance or encouragement as needed. I had no clue I'd enjoy this sort of thing, but I'd put the experience among the top ten days in my life.

Joy. Bliss. Fun.

I want to do it all again!

Learning some HTML

2009-09-18T20:55:01-06:00

I finally claimed (acquired) my personal domain name http://www.catherinekunst.com and of course my personal domain branded email address (catherine-AT-catherinekunst.com). There is nothing there yet as I'm still actively reading tutorials on HTML and CSS style sheets. So far, I'm very impressed with the guides available on HTML dog. My goal is to at least get a placeholder up this weekend that is not built on a free or commercial template and is not created with anything other than notepad and a WYSIWYG viewer - and yes I had to google that to even discover what one was.

I registered my domain on FatCow.com because they were currently listed as the best host on hosting review and as a reminder to keep my fitness goals in mind! Moo. So of course I also just downloaded (and started this AM) Turbulence Training Hotzone (not sure how long this link will stay active or free...so get it now). Day 1 workout was definitely fun.

I am not yet certain what I want to put on a static website, but advice and suggestions (especially for tutorials and free tools) are most certainly welcome.

Coming up for air

2009-08-18T01:15:26-06:00

I never thought the day would come that I felt like I was too busy to blog. I am not exactly certain what happened.

Fitness: I am holding steady at 13x and 23 to 24% (Omron) body fat. My most recent 3 mile run, at sea level, was done in 27 minutes, pretty much my fastest run ever. I can still run a 10K in about an hour. None of this is bad for a geeky 41 year old but I can do better.

Dating: I'd previously tried two free online dating sites (date hookup and plenty of fish) and went silent after my less than optimal experiences. In late spring, I decided to rework my profile, being very clear about what I was looking for, and put it back out there. I met the person who caused me to delete all of my online profiles on fitness singles (a paid site). I was completely and utterly swept off of my feet on May 16; hmm, last post occurring on May 12, could be related. We've been traveling a bit, check my flickr account for the sites we have seen in Carmel, Monterey, Big Sur, Bryce Canyon & Zion National Park.

Random: I keep getting invited to participate in things for which I cannot seem to say no: One last scientific review panel (autoimmune) for DOD; co-chairing a sub-committee on small business development and higher education for the economic development council of the Downtown Denver Partnership; co-chairing a sub-committee on Enterprise programs at the Business School for our annual strategic planning event; co-authoring what may be one of my last pure scientific research papers on work I started back in 2000; continuing on as a scientific collaborator for just a “few” more months; a strategic planning session for my friend's latest non-profit venture (Dani's foundation); and ironically, a few months back I sat on a panel for women in higher education administration about “Making Institutional Service part of YOUR Plan, or How to Say NO and When to Say YES.” I'm not so great at the NO.

Work: On top of those things for which I can't say no, work has been busy. We received 76 entries from across Colorado for our 8th Annual Business Plan Competition. We awarded our winners with a variety of cash and in-kind services from local businesses:

Olomomo Nut Company 1st Place $12,000

The Organic Dish 2nd Place $5,000

VibraLung, Inc. 3rd Place $2,500; Bioscience Award (Fitzsimons Redevelopment Authority& We Work for Health) $5,000; Bioscience Award (CoreLogic) $1,000

Also Energy Finalist $1,000

Global CaféNation Finalist $1,000; International Award (CIBER & the Institute for International Business) $1,000; Non-Profit Award (The Ward Family) $1,000

Western States Biopharmaceuticals Finalist $1,000

Larry Nelson of w3w3.com took many terrific pictures at the awards luncheon for our competition. You can view them here (registration required).

Our finalists received a lot of press:

The Bard Center and our 2009 business plan winner(s) were also featured on KMGH-TV (ABC) channel 7 news. You can watch the segment here: Small businesses finding room to grow

We're already thinking about our 9th Annual Competition on June 10, 2010.

The founders of the Bard Center, Pamela & Richard Bard, recently co-produced a movie, Homecoming, starring Misha Barton & Jessica Stroup. There was a limited release in Denver at the Starz Film Center on the Auraria campus. I was honored to be able to attend opening night with the producers.

On August 1, Jung Park of Metroboom, the 2004 Business Plan Competition Winner, is hosted his annual Enthuse event, a unique social networking event incorporating fashion, music, dance, fine cuisine, & fundraising. I keep trying to get all of my advisory council members (well at least the men) to become customers. I love his custom shirts & suits.

We renovated our Center to better segregate our academic program from our incubator offices. Our renovated incubator spaceat the Bard Center has only 1 vacant office (320H). Our incubator is open to all early stage Colorado companies. Contact me if you are interested.

Our Bard Entrepreneurship Network (BEN) Meetups have grown up: cocktails & content. Join us August 26 at Elevated Third from 6 to 8PM. This month, Justin Perkins the CEO of Olomomo Nut Company & our 2009 Business Plan competition winner will be there to answer questions & let folks taste his products. Jim Kirchheimer, the Director for Economic Development for the Downtown Denver Partnership (DDP) will be there to talk about the benefits of membership and the resources available at the DDP. RSVP: http://www.meetup.com/Bard-Entrepreneurship-Network-Meetup/

I'm always on the lookout for other opportunities for entrepreneurs in our community.

Need $100,000 to start your company? The nationally run MillerCoors Urban Entrepreneurship Series is open to 21 to 35 year olds. http://millercoorsmues.com/
My friend Stephen Miller launched a new clean tech incubator and is helping to bring the Clean Tech Open to Colorado. He gotten some great press: Local Clean Tech Incubator opensmore information at www.cleanlaunch.com
Finally, biotech companies should consider attending or Consider presenting your company at the 1st Annual Rocky Mountain Life Science Investor Conference

Our business school orientation is going virtual. We’ve recorded a segment promoting the Bard Center which can be previewed below.

It's been a busy summer...

10+ years of ALS research

2009-05-12T23:32:49-06:00

I am looking backwards today. I moved to Colorado with my first husband in 1995. I've been thinking of him recently. It was his birthday on Saturday (Happy Birthday rb). A friend of mine is making a video for his son's wedding and I recommended that he use a song from when I married this former husband of mine, Chet Atkins & Suzy Bogguss, "you bring out the best in me." (you can play it here.) And no, this song is NOT jinxed or unlucky. My ex sent me a note today that reminded me that even though we've been divorced now for almost 10 years, he continues to inspire me to be the best I can be. His email is a post for another day. Today I have ALS (amyotrophic lateral sclerosis; Lou Gehrig's disease) on my mind.

When I've taught students about ALS, I generally have had them read a few posts from BrainHell - a wonderful first person account of experiencing ALS from diagnosis until death. I'm often asked why Stephen Hawking is still alive if he has ALS. Um, not exactly ALS, more likely a variant motor neuron disease know as spinal muscular atrophy type IV.

I started working on ALS in 1995. Soon after I established my own laboratory a few years later, or perhaps before, I met Ian Pearson who had recently been diagnosed with ALS. Unlike the majority of people with this diagnosis Ian has lived with this disease for many years. Tonight I received a number of emails from Ian about his current plight and changes to the Colorado Health Care system that may cut his life short. For this reason, I am going to copy his various emails into this post in their entirety. Please contact me if you would like Ian's contact information (it's the only thing I'm going to redact).

One of Ian's emails ended with this post script "The preceding text has been written using Ez-keys by Words plus, a communication program for people with physical disabilities. I use switch scanning and a piezoelectric sensor switch, mounted on a headband and activated with my eyebrow muscles. This document took roughly 40 hours to write. "

In my mind, the most horrible thing about ALS is the LACK of cognitive loss. Imagine, your brain is working perfectly; you cannot talk; you cannot move; if you are lucky, you might be able to blink or move an eyebrow that manages a cursor on a computer screen. Imagine now a decade of this. As you are thinking of these things, I ask you now to read Ian's letters.

Thank you.

May 12, 2009

Dear friends, family and other worthy souls,

For those of you who didn't already know, on Monday April 27, one of the local TV news stations ran a short piece about a change in Colorado Medicaid reimbursement policy that has effectively ended the program under which the facility where I live operates. If I have to go out to a hospital for an extended stay, I won't be allowed to return to where I have lived for more than the last five years and my only option for health care to stay alive. If the policy isn't reversed the entire program will end on July 1, 2010 and I will have to find a new place to live, possibly outside Colorado.

Here is a link to the story written out with the video on the top right corner: http://cbs4denver.com/health/medicaid.problems.patients.2.995937.html

Below is my reply to the reporter who did the story. As you can read, I was very disappointed and frustrated with all that wasn't said and the missed opportunities of the piece. I've also attached the letter that I wrote back in March to the policy makers and affected parties. It explains the problem and gives my perspective on the situation. On March 10, a patients' father here, Doug Paris (in the video), held a meeting that he organized, to call attention to this critically important issue. He invited representatives from the state Medicaid board, hospitals, nursing homes, the media, local politicians and family members. That is how the TV news got involved. My letter was distributed at that meeting, the initial interviews were conducted (including with Kate), and Kate recommended that the reporter interview me. Unfortunately the reporter showed up without notice so I didn't have time to prepare anything to say (it takes a long time to write anything using my eyebrow).

I have a lot of things going on right now but I wanted to get the word out about this. I may follow this with information how you can help. I just got word today that the HCPF board is reviewing the financial statements from the two HBU facilities in Colorado. I am drafting a letter to the HCPF board to emphasize the key points against this flawed policy and may solicit your help to write your own versions of request that they reverse their Medicaid reimbursement policy for the HBU program. Please stay tuned for more information. Thank you for your interest, support and possible activism.

Thankful for all I've got and not letting it go without a fight,

Ian

April 30, 2009 (letter to the reporter Rick Sallinger)

Dear Mr. Sallinger,

Thank you for your efforts. However, for all of the time elapsed and information that was provided and available to you, I was very disappointed in your finished product. Perhaps your piece is just reflective of the sad devolution of television news into its current state of info-tainment. Both local and national coverage is light on useful information and heavy on sensationalism and triviality. In that vein, I thought that your piece was pretty thin on providing useful information; just a sympathy story with no sense of outrage. In general it's true that there is less substantive material to fill a local broadcast than national coverage but in this case, a paucity of substantive information wasn't the problem. This Medicaid reimbursement issue is somewhat complex and multi-dimensional but you missed providing the most critical information. Given that there is such limited material to fill the daily broadcast, the viewers' attention spans are brief and individual stories don't exceed 4 or 5 minutes; I think that you could have developed this story into a multi part series. Each episode could have examined one specific aspect; the historic context and nature of the issue (what was the motivation and justification for the State's policy change?), the personal impacts (as your piece focused) and the actions and consequences of the new State policy and the future implications.

The State HCPF is acting irresponsibly. The bottom line is that the State prematurely made an unnecessary policy change that is ethically, logistically and fiscally unsound. Colorado is effectively trying to save money by exporting and pawning off this patient population on other states. ALL of the affected parties including hospitals, nursing homes, the two existing hospital back up facilities and families/patients are unanimously opposed to it.

If you're going to condense the rather involved and complex issue down to a three minute piece, you have to chose a specific focus. Quite predictably, you chose the "Look at those poor people" track. Unfortunately this approach left out the most important points to communicate;

1) it didn't accurately describe the problem,

2) it didn't state that HCPF has changed the policy to save money without first reviewing with prospective new care providers (there aren't any) to determine whether the new plan was logistically possible (it isn't achievable, and a small pilot program would have revealed that) and,

3) no evaluation of the actual financial consequences was planned or conducted.

It didn't explain that people will be forced to go out of state BECAUSE the only two facilities in Colorado now with the remaining patients won't and can't afford to operate under the fixed rate schedule. The State's proposed alternative is to send us to nursing homes (none of which accept vented patients). The consequences are already being seen as patients who would normally go into the hospital back up program are stacking up in area hospitals, in some cases in ICUs (because their only vents and qualified staff are there), and racking up much greater expenses and consuming critical care staffing and resources unnecessarily. Someone has to be paying for these greater expenses. How are the hospitals passing through these costs? Don't they have enough of a financial stake to lead this fight with a PR blitz, if not with a legal suit?

This was the whole reason why the Hospital Back Up (HBU) program was established; to provide specialized care units for long term patients on ventilators with minimized costs and maximized efficiency. Only full service hospitals are capable of providing the same level of required care but at much greater cost. The two facilities in Colorado with HBU units operate on very thin financial margins. The imposition of a fixed rate reimbursement schedule (rather than being reimbursed for per patient operational expenses with all of the statutory Medicaid restrictions) is shutting down the HBU program without providing an alternative. The fixed rate reimbursement schedule was developed for Medicaid patients in nursing homes and doesn't take into account the additional expense of long term full time respiratory care of ventilator dependent patients.

Another dirty little secret about the HBU program is the demand for HBU beds exceeds the capacity of the two Colorado HBU facilities. Both facilities had waiting lists under cost basis reimbursement. The fact that there were no other HBU facilities operating prior to the State's policy change demonstrates that even cost basis Medicaid reimbursement isn't profitable. The two programs were established when governmental compensation more closely coincided with operational expenses and remain as vestiges of that time. It's shameful enough that Colorado has left it to market forces and a grossly inadequate state managed Medicaid program to care for a small vulnerable patient population with no other alternative for medical care. In a 2007 study by Public Citizen that evaluated Medicaid as administered by each state, Colorado was ranked 43rd overall. The individual ranks of the four parameters: eligibility, scope of services, quality of care and reimbursement were 41st, 40th, 42nd and 21st, respectively (p. 58, Unsettling Scores: A Ranking of State Medicaid Programs (2007), http://www2.citizen.org/hrg/medicaid/assets/reports/2007UnsettlingScores.pdf). The summary noted that the low Quality of Care score was attributable to very low quality nursing home care and very low rates of childhood immunization. The relatively moderate Reimbursement score was calculated from all providers under Medicaid (of which, the HBU program is too insignificant to affect an overall reimbursement score). It's worth noting that this assessment was done before the current economic crisis and state budgetary limitations. The effective elimination of the HBU program defies belief on the basis of ethics, responsible governance, viable logistics and intelligent fiscal management.

I will use the video of your piece with substantial supplementary information in an e-mail PR campaign to my personal and professional contacts to barrage the HCPF representatives with calls and e-mails until they see their wayward ways. I only wish that your reporting had more substance, carried a sense of outrage for bad governance and a message and vehicle for social activism to a much larger audience. I suppose that was too much to expect but for a man in my position, eternal optimism is standard operating procedure and, ultimately, I've learned to be my own best advocate.

Most sincerely,

Ian Pearson

March 8, 2009 (ironically my Birthday)

To all concerned,

Background I have been a Hospital Back Up (HBU) patient of the Skilled Nursing Facility (SNF) Unit at North Valley Hospital (recently renamed with the oxymoronic pleonasm, Vista View Care Center) since April 2004. Prior to coming here, I was resident at three other hospital facilities during the preceding eleven months. Over the last nearly six years I have come to a clear understanding of what is required to keep me (and others who require a comparable level of medical care) alive with an acceptable quality of life. I am writing this letter so that those who are making changes to the Medicaid reimbursement policy for facilities like this one better understand those medical requirements and the inevitable impacts of those policy changes. I am also writing to all other interested parties who may be able to influence and affect change to reverse this policy decision.

The Reimbursement Issue

The Colorado Department of Health Care Policy and Financing (HCPF) reduced reimbursement for new HBU patients, effective October 1, 2008. Existing patients were granted an exemption to the reimbursement change until July 1, 2010. The essence of the change is that reimbursement will now be made according to a fixed rate fee schedule rather than the existing restricted cost basis.

Historic Context and Existing Conditions

In order to understand the impacts of a reduced reimbursement one must understand the historic and current conditions under the cost basis reimbursement status.

For years, the SNF Unit here had been operated at a financial loss because of restrictions of Medicaid reimbursement, even under a cost basis, didn’t fully cover operational expenses. The hospital had other facilities that had a sufficient profit so that the extra cost of the SNF Unit was offset enough to be deemed acceptable. This mode of operation provided higher staffing levels, more auxiliary patient services (full time psychologist on staff, a comprehensive speech therapy department with an assistive technology program, a comprehensive and personalized physical therapy program and facilities, etc.), more frequent restorative therapy and showers and a more extensive recreation program than exist now.

After Vibra Healthcare purchased the hospital they fired many employees and closed or greatly reduced entire departments and facilities. Under this mode of operation the financially losing SNF Unit became a greater financial liability. In 2007 Vibra managers announced that they intended to close the SNF Unit, citing the financial burden. They later reversed their decision to close the SNF Unit and implemented a cost cutting strategic operation. Because the auxiliary patient services were already gone, cost savings were realized by increasing patient to staff ratios with reductions in Certified Nursing Assistants (CNAs), nurses and Respiratory Therapists (RTs) on all shifts. In addition, efforts were made to keep the patient population at capacity to minimize marginal costs and maintain more profitable economies of scale.

With fewer staff caring for more patients, stresses upon staff and patients increased and safely margins were reduced. Nurses were routinely required to care for 8 or 9 patients (many with complex, transient and extensive medical needs), CNAs, responsible for 10 to 12 and RTs, for12 to 14. Safe and reasonable patient to staff ratios should be roughly half these numbers for patients who require this level of care (and were under the previous management). Staff turnover required a greater reliance upon temporary agency staff, who individually vary considerably in competency and efficiency, and added to safety concerns.

After the announcement of the HCPF policy change, the Vista View management announced that they would no longer accept any new HBU patients under the new reimbursement protocol. In order to keep the SNF Unit filled to capacity, they began admitting patients with funding sources other than Medicaid. These patients have a wide variety of medical needs, often more complex and extensive than HBU patients and some have dementia, are belligerent or violent, or have other psychiatric issues. These conditions further tax the capabilities and resources of the already overworked staff and take them away from their regular responsibilities. There have been several instances when many, and sometimes all, staff on the unit have had to restrain one patient; on occasion, for up to an hour. During these times, the floor is left severely compromised, if not completely unattended. In addition, these patients have a high rate of turnover, adding a greater burden for nurses with frequent admissions and discharges.

Implications of Reduced Reimbursement

Even before the admission of non-HBU patients to the SNF Unit began, the staffing levels were marginally adequate. I can’t envision any scenario in which a facility could provide safe and adequate medical care to ventilator dependent HBU patients with less funding than under restricted cost basis reimbursement. There are no excesses to reduce or eliminate. If an established facility like Vista View, with well trained and experienced staff, isn’t willing or able to provide care to HBU patients with reduced reimbursement, what facility can? Nursing homes aren’t capable and regular hospitals don’t want us.

A handful of patients who have been discharged from here to facilities not oriented toward caring for HBU patients provide a vision of the future under the reduced reimbursement. All of these patients DIED within three months of leaving here. Lower staffing levels, less experienced and knowledgeable staff and the lack of full time RTs all contributed to the deaths.

Even if HBU patients don’t die within months of being transferred to a different facility under reduced reimbursement, our life expectancies and quality of life will definitely be diminished. What will be cut or reduced from existing programs like at Vista View? The only other facilities that are equipped to provide a comparable level of care are fully staffed/equipped regular hospitals. Operational expenses are much higher at hospitals and they aren’t set up for long term residency. That is why and how HBU units like at Vista View were established.

Personal Profile and Conclusions

I was diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, at age 34. My wife and I were basking in the joy of the arrival of our second child,, born just five months before. I was steadily progressing in my career as a hydrogeologist at a small engineering and consulting firm in Denver. I had worked as a carpenter before attending graduate school and earning my Master’s degree. I was an endurance athlete and had always been very physically and intellectually active and had boundless energy and stamina.

I worked for another two years until the progression of physical disability forced me to retire. My illness put a tremendous physical and emotional burden on my wife and family as my wife cared for me at home.

In May 2003 a bad chest cold sent me to the emergency room where I conveniently went into respiratory distress with a blocked airway (if it had happened anywhere else, I would have suffocated). The next day I was given the choice of having a tracheostomy and going on a ventilator or doing nothing and likely dying within a week. I chose to stay alive.

In order to qualify for Medicaid and pay for my care, we sold our home, property and material assets, liquidated our savings and investments and my wife and children moved in with her parents. I am now almost completely paralyzed, confined to bed and am on a ventilator full time. The transformation to my current condition has been extremely difficult and I know that few people would be capable of following a similar path. I accept the life that I have now and maintain a positive attitude. I continue writing my life story and thoughts and beliefs that I want to convey to my children. I want to watch them grow up and leave them an enduring legacy of love and strength. I remain confident in my resolve to live for as long as I can keep having a positive impact in the lives of others.

I have fought too long and hard and my family has sacrificed too much for me to let a bureaucratic policy change lead to my final demise. I know what is required for my care. This reduction of Medicaid reimbursement can only lead to a reduction in the quality of care which has already been cut to marginally adequate levels here and now.

ALS is a relatively rare disease with no known cause, treatment or cure. The likelihood that anyone will get, much less, survive as long as I have with, a rare debilitating disease and would require the level of medical care that I receive, is very low. However, there are many things that can happen to anyone that would put them in a similar situation; paralyzed and on a ventilator, if they wanted to continue living. Just consider that YOU are one bad lane change, one infected wound, one mosquito bite (i.e. West Nile virus), or any variety of accidents, diagnoses or infections away from living like me. What will become of other Coloradoans who meet such a fate? Will the State subject them to a de facto death sentence by committing them to an inadequate health care facility? If not that severe, what quality of life will those people have?

I understand the motivations of the state Medicaid administrators to find all reasonable ways to reduce costs during these difficult economic times. I can’t understand how anyone could impose a policy change, regardless of motivation, without a clear understanding of the full financial, logistical and social ramifications. Furthermore, if, in this case, the policy change is made with knowledge of those impacts, I believe that its time to examine the ethical and moral standards that allow a small vulnerable population to be dangerously compromised for the sake of relatively modest cost savings.

Most sincerely,

Ian Pearson

The preceding text has been written using Ez-keys by Words plus, a communication program for people with physical disabilities. I use switch scanning and a piezoelectric sensor switch, mounted on a headband and activated with my eyebrow muscles. This document took roughly 40 hours to write.

Songs of Hope & Glory

2009-04-18T19:49:12-06:00

A few years ago, I tried to maintain a separate blog, Songs of Hope & Glory, where I gathered all of the good I found in the news, in stories, and in my life. I haven't posted there in a year, not for lack of inspiration, but simply for lack of time. I've just imported all of those older posts here. I will be going back to tag each of those older posts as a Song of Hope & Glory. Look for more news of the good soon.

Awed by surveillance technology

2009-04-01T19:26:28-06:00

I am awed by surveillance technology. A friend sent me an email, one of those that had been forwarded a few dozen times.

It said:

"This is a photo from the 2009 Inauguration, In which you can see IN FOCUS the face of each individual in the crowd !!! You can scan, double click and zoom to any section of the crowd. . . wait a few seconds. . . and the focus adjusts. The picture was taken with a robotic camera at 1,474 megapixel. (295 times the standard 5 megapixel camera)"

Link here, or copy and paste the following html code:

http://gigapan.org/viewGigapanFullscreen.php?auth=033ef14483ee899496648c2b4b06233c

I used to read Robert Heinlein extensively. I think privacy is well and truly a thing of the past.

Digging out

2009-03-27T08:08:11-06:00

My University finally closed yesterday at noon. By that time the main road between where I live and Denver had closed. I'm very glad I chose to work from home and was able to skip the commute. People I spoke with yesterday who were down town made it sound like they were not getting hit quite as hard as my neighborhood.

It looked like this from my front door for most of the day yesterday. This was taken at about 11AM yesterday - so about 4 hours into the snow storm.

I dug out my driveway yesterday at about 2 PM. We probably got another 3 inches of snow between then and this morning. I'm glad I did. The snow was wet and heavy with about an inch of slush at the bottom. I'd estimate that we got about 12 inches of snow total. It difficult to be certain. We had very high winds so some areas had several feet and others just a few inches. My roof still has lots of snow while my neighbor's has none.

The sun is starting to come out. I love this about Colorado. By Monday I suspect there will be few signs of this storm, perhaps some very green grass.