The Cost of Competent Care Providers

The Cost of Competent Care Providers

Joined: April 30th, 2006, 1:38 am

November 14th, 2009, 3:50 pm #1

Steve Harris is back, with the same old argument, regarding providing competent care providers, for cryonics patients. To me, this is nothing more than propaganda, designed to maintain the status quo, and keep those LEF dollars rolling in to people, like Harris, who sometimes attempt to provide surgical and/or perfusion training to laymen, and get paid quite handsomely for something that is, to me, a total waste of time and money.

He wants to talk about how expensive it would be to provide professionals, and holds up the example of Baldwin's contract with the perfusion group, which is yet another example of the ongoing, extremely poor, management decisions being made in cryonics. Harris is correct, the tack Baldwin took is "very VERY expensive," and it was a stupid translation of the suggestion I made, at SA, three years ago. My suggestion was that I, (an SA staff member and qualified perfusionist, being paid a typical "RUP" salary), would take call 48 weeks a year, and that we would contract with a perfusion group, to cover call, during my vacation weeks. (Ironically, the group I suggested was the very same group Baldwin contracted with, full-time.) I live very near the SA facility, and I would probably consider working with them, again, if things were different, there. At any rate, I am not the only retired perfusionist in the country, and plenty of people would love to live in this area, and have the light workload and flexibility of schedule I had, at SA. If no one is finding such a person, for SA, they are either incompetent at recruiting, or not really interested in bringing a skilled person onboard. I suspect the later, since it was my experience that I would have only been welcome there, if I was offering praise for some very foolish endeavors.

In addition, there was no need for SA to lease the centrifugal pump setup, as I understand they are, unless the price is better than building their own system, which I doubt. I wanted to totally revise the system they had, when I was there, but the previous management chose to not only ignore my suggestions for centrifugal pumps, but to purchase ridiculous industrial pumps that were difficult to control, and not meant for perfusing humans.

Finally, there was no need for those ridiculous pig-training sessions. Any perfusionist could handle allowing the blood to flow out a "Y" connector, at the beginning of the case, with just that simple instruction. To think they had to be trained, on animals, was well-beyond ignorant. I'm sure the perfusionists enjoyed being paid for those "training sessions," and had a few laughs, at SA's expense, too.

The same tack should be taken, in regard to someone to femoral cannulations. SA should bring a licensed embalmer, (or some other person capable of competently performing femoral cannulations), on staff and research the related issues, of working in other states. Embalmers earn about half as much as the average RUP, and work twice as hard, so if SA is having trouble doing that, I must believe it is simply poor management and a total lack of recruiting skills. The description of Baldwin's cannulation attempts, in the SA case report for CI-95 read like a recitation of a textbook-like description of a procedure she very-obviously was not capable of performing. (More about that, on my blog, soon.)

I believe far more than half of SA's very substantial budget goes toward supporting ?six? staff members, and a few consultants. It's insane to pay six people an average somewhere in the neighborhood of $70K/year to sit around, 40 hours a week, for a handful of cases a year, especially when NONE of them are capable of performing cannulations, or perfusion. I firmly believe that, with half of SA's budget, I could have two staff members, one capable of performing femoral cannulations, and one competent perfusionist, on staff, a couple of low-salary "gophers" to pack ice, etc., and a crew of people on call. If THEY can't do that, it's either because they don't know how, or they don't want to.

I've been acquainted with someone who runs the perfusion company SA contracted with, and I am going to post something about that situation on my blog, later this weekend, here:http://cryomedical.blogspot.com/2009/11 ... nists.html

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Joined: October 2nd, 2004, 8:27 pm

November 15th, 2009, 3:59 am #2

You promise: "I've been acquainted with someone who runs the perfusion company SA contracted with, and I am going to post something about that situation on my blog, later this weekend, herehttp://cryomedical.blogspot.com/2009/11 ... nists.html"

So far that link is a Potvinesque empty hole, not surprising as you learned how to do blogs from him, at least so he says.

But in all fairness, "later this weekend" is not over. Will we see applause for SA actually contracting with a perfusion company? That is what you wanted, right? Or is it that they did not contract with you, is that the issue? Will we also hear some verification to the story being floated about that someone got wind of this pending contract, and in a manner only characterizable as a "dirty trick," called them and warned them against contracting with the terrible and awful SA?

Sure it will all be well covered,

FD
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Joined: July 1st, 2007, 8:16 am

November 15th, 2009, 4:26 am #3

“Will we also hear some verification to the story being floated about that someone got wind of this pending contract, and in a manner only characterizable as a "dirty trick," called them and warned them against contracting with the terrible and awful SA?”

WOW! Is it only intimidating anonymous FUD by F.D.U., or a real legal threat, A/K/A libel?
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Joined: October 2nd, 2004, 8:27 pm

November 15th, 2009, 5:06 am #4

Just wanna know the facts, ma'am.

Kindly,

FD
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Joined: June 10th, 2007, 4:26 am

November 15th, 2009, 9:15 am #5

Steve Harris is back, with the same old argument, regarding providing competent care providers, for cryonics patients. To me, this is nothing more than propaganda, designed to maintain the status quo, and keep those LEF dollars rolling in to people, like Harris, who sometimes attempt to provide surgical and/or perfusion training to laymen, and get paid quite handsomely for something that is, to me, a total waste of time and money.

He wants to talk about how expensive it would be to provide professionals, and holds up the example of Baldwin's contract with the perfusion group, which is yet another example of the ongoing, extremely poor, management decisions being made in cryonics. Harris is correct, the tack Baldwin took is "very VERY expensive," and it was a stupid translation of the suggestion I made, at SA, three years ago. My suggestion was that I, (an SA staff member and qualified perfusionist, being paid a typical "RUP" salary), would take call 48 weeks a year, and that we would contract with a perfusion group, to cover call, during my vacation weeks. (Ironically, the group I suggested was the very same group Baldwin contracted with, full-time.) I live very near the SA facility, and I would probably consider working with them, again, if things were different, there. At any rate, I am not the only retired perfusionist in the country, and plenty of people would love to live in this area, and have the light workload and flexibility of schedule I had, at SA. If no one is finding such a person, for SA, they are either incompetent at recruiting, or not really interested in bringing a skilled person onboard. I suspect the later, since it was my experience that I would have only been welcome there, if I was offering praise for some very foolish endeavors.

In addition, there was no need for SA to lease the centrifugal pump setup, as I understand they are, unless the price is better than building their own system, which I doubt. I wanted to totally revise the system they had, when I was there, but the previous management chose to not only ignore my suggestions for centrifugal pumps, but to purchase ridiculous industrial pumps that were difficult to control, and not meant for perfusing humans.

Finally, there was no need for those ridiculous pig-training sessions. Any perfusionist could handle allowing the blood to flow out a "Y" connector, at the beginning of the case, with just that simple instruction. To think they had to be trained, on animals, was well-beyond ignorant. I'm sure the perfusionists enjoyed being paid for those "training sessions," and had a few laughs, at SA's expense, too.

The same tack should be taken, in regard to someone to femoral cannulations. SA should bring a licensed embalmer, (or some other person capable of competently performing femoral cannulations), on staff and research the related issues, of working in other states. Embalmers earn about half as much as the average RUP, and work twice as hard, so if SA is having trouble doing that, I must believe it is simply poor management and a total lack of recruiting skills. The description of Baldwin's cannulation attempts, in the SA case report for CI-95 read like a recitation of a textbook-like description of a procedure she very-obviously was not capable of performing. (More about that, on my blog, soon.)

I believe far more than half of SA's very substantial budget goes toward supporting ?six? staff members, and a few consultants. It's insane to pay six people an average somewhere in the neighborhood of $70K/year to sit around, 40 hours a week, for a handful of cases a year, especially when NONE of them are capable of performing cannulations, or perfusion. I firmly believe that, with half of SA's budget, I could have two staff members, one capable of performing femoral cannulations, and one competent perfusionist, on staff, a couple of low-salary "gophers" to pack ice, etc., and a crew of people on call. If THEY can't do that, it's either because they don't know how, or they don't want to.

I've been acquainted with someone who runs the perfusion company SA contracted with, and I am going to post something about that situation on my blog, later this weekend, here:http://cryomedical.blogspot.com/2009/11 ... nists.html
Maxim:
The same tack should be taken, in regard to someone to femoral cannulations. SA should bring a licensed embalmer, (or some other person capable of competently performing femoral cannulations), on staff and research the related issues, of working in other states. Embalmers earn about half as much as the average RUP, and work twice as hard, so if SA is having trouble doing that, I must believe it is simply poor management and a total lack of recruiting skills. The description of Baldwin's cannulation attempts, in the SA case report for CI-95 read like a recitation of a textbook-like description of a procedure she very-obviously was not capable of performing. (More about that, on my blog, soon.)

COMMENT:

Can't wait to see it. Do post synopsis here.

Since some of the failure of CI-95's washout (which was, in the end, unsatisfactory) was due to the mortician on the scene, who did no better than Catherine had (I'll let you figure out why, from the report; some of it is more obvious than other parts, but far be it from me to spoil your fun).

So far as I can tell, no mortuarial person (from lofty funeral director to lowly embalmer) has yet succeeded in placing a venous cannula in a cryonics patient suitable for full body washout.

Why this should be, is not hard to figure out. Embalmers aren't trained to do anything like cryonics. Even dedicated licenced embalmers, who get the most practice embalming, aren't doing CPB. Even in a good split embalming, the emblamer has more or less succeeded when embalming fluid has gone through most capillary beds, and has reached and flushed out the venous system. Until this time, venous cannulae in embalming aren't even kept open. When they are opened, it's to remove clots or releave momentary pressure. Normal embalming venous cannulae are thus short, and rigged to remove clots, not reach the central point of the circulation so as to releave venous pressure using gravity drainage suction (as must happen in CPB).

The embalmer doesn't care about venous pressure in the same way a cryonicist does, and doesn't even care much about arterial pressure. Most embalming fluid which goes into the arterial system does NOT appear in the venous system. The difference, which in medicine would be a sort of tissue edema, is looked upon with favor by the embalmer, since the plumping usually improves appearance, and tissue retension of fluid is certainly necessary for fixation. The embalmer uses perhaps 15% of the body weight in fluid. In cryonics we use 25 to 50% of body weight in washout solution, and if you count closed circuit perfusion, far more goes into the arteries than that (something approaching body weight). If you tried that with emblaming fluid you would soon reach pressure you could not support at even fractional flows, and your venous drainage would fall toward zero. Which is why it isn't done, and why no embalmer worries about setting up venous drainage that would allow for it. Embalming quits just as medicine and cryonics are getting started, as about twice the circulatory volume of fluid has been injected, and perhaps most of the venous volume of blood has been returned. That part's easy-- it's going on from there, that is hard. At least it's hard if you care about blowing the lungs and causing gross edema.

Let me put it another way: embalmers simply never run as much fluid through a body as do cryonicists (or for that matter, perfusionists). And since they don't, they don't know HOW to. And the solution to this is not simply to hire perfusionists, because perfusionists aren't skilled at placing venous drains either. Perfusionists (or somebody doing their job) are necessary, but not sufficient.

Embalmers who are skilled at central drainage may be of some help to cryonicists, when it comes to slow cryoprotectant perfusion, at the very end of the cryonics process. CI employs them this way. Indeed Alcor doesn't need a perfusionist at this point, once access has been attained. But this sort of thing is of no help in the field, or for rapid washout or rapid cooling. Cryonics-wise, as an aim to advance the science of cooling, it's a dead end.

What's the use of pigs? Not only for practice in perfusion! They're also for practice in access. Are they perfect as a cryonics model? No. It turns out nothing is, but fresh human cadavers. However, we do what we can. Dog arteries and veins are easier than human ones, but again, they're still good training.

A cryonics washout for cooling purposes, done in the field (as opposed to the central cryonics institution) on a human being warm enough to benefit from it, has (as I said) to my knowledge never been done successfully by a mortician or embalmer. It has actually, for reasons related to speed and the difficulty of standby, been done very few times, even by cryonicists. Mike Darwin did it a few times. I personally have probably done it more than anybody. Other than Mike and myself, I can't think of anybody else who has.

Anybody reading this who has a case to jog my memory, or that I don't know about, feel free to chime in.

Meanwhile, feel free to profit from the experience of the person who has the most experience at field perfusion in cryonics, which I guess would be me. It would be a first if you did, but one can always hope.

Steve Harris
Last edited by StevenHarris on November 15th, 2009, 9:17 am, edited 1 time in total.
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Joined: April 30th, 2006, 1:38 am

November 15th, 2009, 2:21 pm #6

Harris: "Since some of the failure of CI-95's washout (which was, in the end, unsatisfactory) was due to the mortician on the scene, who did no better than Catherine had (I'll let you figure out why, from the report; some of it is more obvious than other parts, but far be it from me to spoil your fun)."

I would think that someone with a good knowledge of vascular anatomy, (such as an embalmer), would be easier to train than, oh say, a shoe salesman, in the art of femoral cannulation. If an embalmer won't do, go for a retired vascular surgeon, or a retired physician assistant (PA) with CV experience. Please don't tell me a well-funded organization, such as SA cannot find ONE skilled person to lie on the beach, (or sit at his desk, playing on the Internet all day, as some of the RUP's were prone to doing), waiting to be called out a handful of times a year, for a salary such as Baldwin's. It sounds like semi-retirement heaven, to me.

When I was at SA, I saw no evidence that anyone had ever even tried to recruit someone capable of performing femoral cannulations, or perfusion. (I only came to be there, by accident, not because they were looking for a perfusionist.) Have they tried to hire any skilled persons, since I left, or are they still singing the "real medical professionals won't play with us" song? Or, are they worried six unskilled people won't be able to get in 240 highly-paid man hours, a week, (on some rather ridiculous activities), if professionals were hired?

Then, there's the issue Mr. Ettinger, and I, have brought up...that it may be illegal in many states, for people who are not properly licensed in that state to inject, or make an incison into, a dead person. This is something that should be addressed, even in the event medical professionals are brought in, since even a cardiovascular surgeon might be breaking the law in some states, by performing a femoral cannulation, for cryonics purposes. Or, is SA going to run around, doing whatever they want, taking the risk that cryonics will be shut down, or regulated, due to their total lack of consideration for the law? I believe this cavalier attitude is traditional, in cryonics, and that it will probably bring about the demise of the cryonics industry.


Harris: "So far as I can tell, no mortuarial person (from lofty funeral director to lowly embalmer) has yet succeeded in placing a venous cannula in a cryonics patient suitable for full body washout."

How many have been allowed to try? Or, has there been a preference for attempting to train laymen? Personally, I think certain people in cryonics feel threatened by professionals, who know what they are doing. They seem to have a preference for ignorant people, because there's little chance of laymen criticizing their "medical" protocols and procedures.

Harris: "The embalmer doesn't care about venous pressure in the same way a cryonicist does,.."

Does an embalmer care about venous pressure the same way a golf pro and two metal fabricators, (all non-cryonicists), do? Because that's whom SA sent to take care of CI-81, and if I hadn't been around to bitch about it, those same people would have probably been sent to take care of all subsequent patients, without even so much as a weekend perfusion training session, at CCR! (Sarcasm...I'm not endorsing weekend perfusion-training seminars, for laymen...it was a dumb idea, and it made all involved look foolish.)


Harris: "What's the use of pigs? Not only for practice in perfusion! They're also for practice in access. Are they perfect as a cryonics model? No. It turns out nothing is, but fresh human cadavers. However, we do what we can. Dog arteries and veins are easier than human ones, but again, they're still good training."

I'm sorry, but it's just plain stupid to be training laymen to perform these procedures, in my honest opinion. I don't know, nor care, if Harris has "more experience at field perfusion in cryonics" than anyone else. Even if he does, that wouldn't mean he was good at it, or that he should be attempting to teach layman to do those procedures.


Harris: "Meanwhile, feel free to profit from the experience of the person who has the most experience at field perfusion in cryonics, which I guess would be me. It would be a first if you did, but one can always hope."

Maybe we both could have profited from each other's experience, if Harris hadn't let his "friend" derail that train, with nothing but lies designed to discredit a medical professional who criticized some rather foolish projects at SA. I am a person who would truly love to see some serious improvements, in the way of patient care providers, in cryonics. If Harris and his peers, in cryonics, are doing such a bang-up job, why have most cryonics patients been subjected to people botched cannulations, inappropriate pressures, macro-air embolism, and god knows what other atrocities? That plan for training laymen doesn't seem to be working out to well, if you ask me. It would be nice if someone, like Harris, would endorse a new approach. Harris can come here, all he wants, appearing to make semi-rational arguments against the hiring of medical professionals, in cryonics, but the truth is, some people in cryonics find medical professionals to be quite threatening, and I don't think anyone, currently working in cryonics, has made an honest effort to hire skilled people, because of that. Harris wants everyone to believe hiring medical professionals, in cryonics, is logistically impossible, but that's simply not true. I was willing to work in cryonics, and others would be, too, if it were not for the unethical behaviors of some who are in positions of power.

***Edit Note: I wrote the above post, before noting Dr. Harris' apology. With that said, I'm not going to change the content of my post. Hopefully, Dr. Harris and I will be able to "meet in the middle" of our differences of opinion, at some point not too far in the future.
Last edited by melmax on November 15th, 2009, 4:27 pm, edited 1 time in total.
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Joined: April 30th, 2006, 1:38 am

November 15th, 2009, 4:25 pm #7

You promise: "I've been acquainted with someone who runs the perfusion company SA contracted with, and I am going to post something about that situation on my blog, later this weekend, herehttp://cryomedical.blogspot.com/2009/11 ... nists.html"

So far that link is a Potvinesque empty hole, not surprising as you learned how to do blogs from him, at least so he says.

But in all fairness, "later this weekend" is not over. Will we see applause for SA actually contracting with a perfusion company? That is what you wanted, right? Or is it that they did not contract with you, is that the issue? Will we also hear some verification to the story being floated about that someone got wind of this pending contract, and in a manner only characterizable as a "dirty trick," called them and warned them against contracting with the terrible and awful SA?

Sure it will all be well covered,

FD
Oh...that's right...I think it's been since Day One of the cryonics adventure, where "loyalty" to lies counts more than a commitment to maintaining a good public image of cryonics organizations, abiding by the law, and providing quality patient care.

FD: "Or is it that they did not contract with you, is that the issue?"

I have never wanted SA to contract with me, and have never made such a suggestion. I would not work with three of the people there, under ANY circumstances. If Kent wants to fire those three, he can call me. I don't really need to work, but I do have a fascination with cryonics, and I really want to know if the arrest time of the "profound hypothermia with circulatory arrest" cases I've participated in, could be built upon, in cryonics. Even Dr. Oz, (a heart surgeon), recently expressed an interest in this, on his show, in response to a question from Perez Hilton. (Oooops...that reminds me...Why was Perez Hilton asking Dr. Oz about cryonics? Could it be that there is discussion, in Hollywood, about cryonics? I just found it curious that a Hollywood "gossip blogger" was asking that question.)

FD: "Will we also hear some verification to the story being floated about that someone got wind of this pending contract, and in a manner only characterizable as a "dirty trick," called them and warned them against contracting with the terrible and awful SA?"

I think it was a "dirty trick" of SA to post the name of the perfusion group on the SA website, without their permission, subjecting them to possible difficulties in their conventional medical positions. I think the perfusionists are at risk of losing their licenses, if SA does not clean up their act, do their homework, and protect everyone involved. Is that what SA, or others in cryonics want? For medical professionals not to be allowed to work with them? Maybe that IS what some of them want...more job security, for themselves, rather than improved patient care.

When it comes to medical procedures, honesty is ALWAYS the best policy. The perfusionists didn't want to stop working with SA, as a result of my contact with them, (which should tell FD something), but they did protect themselves by having the name of their company removed from the SA website.

http://cryomedical.blogspot.com/2009/11 ... nists.html
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Joined: July 1st, 2007, 8:16 am

November 15th, 2009, 5:17 pm #8

Just wanna know the facts, ma'am.

Kindly,

FD
... from an anonymous entity. Impugning the integrity of a person without supporting, admissible facts is called libel. Or you also subscribe to the legal theory "So sue me, baby"? It is admirable that you just want the facts, ma’am.

George
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Joined: October 2nd, 2004, 8:27 pm

November 15th, 2009, 6:05 pm #9

You are acting, of course, like you do not know already that Melody just posted an entire article on her blog clearly admitting that SHE is the one who called the perfusion service telling them stuff about SA.

If you would look carefully at my post, I did not name her as the one who was rumored to have done that.

So I guess Melody will just have to sue herself for libel, HA.

As for you, George, you continue to post some of the most idiotic nonsense I've ever seen on this forum. Your only purposes seem to be to spread FUD and try to discredit everything you see around you having to do with cryonics. Do us a favor and go away.

Love,

FD
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Joined: July 1st, 2007, 8:16 am

November 15th, 2009, 6:22 pm #10

You are acting as if accused herself of using dirty tricks. NO, you did not accuse her of that, you only clearly implied her using dirty tricks. As far as your wish goes, hold your breath until I go away and you will no longer have any problem with me or with anything else. As for your admiring “Love”, I have just the right place for it.

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