Letters for the week of April 14-20, 2004 

Readers object to the trivialization of protest at Caterpillar dealer, except one reader, who applauds. And John George officials respond.

Page 2 of 3

To Jewish Voice for Peace, International Solidarity Movement, and all the protesters that took part I say: Thank you. This reader is not chuckling but moved to tears.
Robin Lindheimer (Jewish American), Berkeley

Just the facts
I really feel that Justin Berton did a poor job of reporting the Jewish Voice for Peace protest story.

It seems he should be writing fiction. Just the facts, please. Where does he get off supposing he knows what people are thinking, writing "why do these people ... Caterpillar" as if it's what they said?

What's the point of diminishing what these protesters did with superfluous mention of where they got gas and how fast they walked?
Martie Steele, Berkeley

"The AXT Way," Feature, 3/24

Criminal disregard for worker safety
With a background in industrial medicine and workers' comp cases, I found the cover story on AXT interesting, if discouraging. There was an error in the statement: "Nor did she realize the legal import of the following phrase printed in the center of the sheet: 'American Xtal Technology assumes no liability in connection with any use for the products discussed, and it makes no warranty in that respect. The user must assume full responsibility for all required safety measures in the use of these materials.'"

AXT is the employer. AXT has chosen to use certain materials. Ergo, the employee is obliged to use these materials. AXT has complete liability in their use, except in the case where an employee, knowing the correct techniques, persists in deviating from the normal standard.

AXT's little broadsheet is just so much eyewash. I helped oversee many of the Bay Bridge workers who were removing rivets, a lead-rich environment. There is no way that the employer could say, "There's lead out there, but that's not my concern." Likewise, as a former ER doctor, I could never have prospective patients sign a form excluding me from any liability or blame regarding their ER treatment.

Of course, if the person reading AXT's sheet is a recent Chinese immigrant, they could be fooled. The story, as described in the article, presents a company that shows callous regard for their workers. Since the company knew that they were working with a toxic material, failure to take appropriate precautions would be criminal.
Robert Winshall, MD, MPH, Fremont

Awful story but wonderful reporting
I was excited to read ["The AXT Way"] by Mr. Chris Thompson. His persistence to run after people for AXT., Inc was excellent! I also understood he really felt the pain of workers of the company. The story terrified me, but on the other hand, the writer's real journalist's spirit made me optimistic.
Renge Jibu, Tokyo, Japan

"Revolving Doors at John George," Cityside, 3/17

Saving money at all costs
Alameda County not only pays big bucks to purge patients from its mental hospital (John George), it also directs the county's suicidal, depressed, uninsured clients to a psychiatric crisis clinic. There is a psychiatrist on duty there, but Alameda County Behavioral Healthcare services has established the "standard that if a client is not already on antidepressant then do not begin prescribing them. Refer them ..." to a primary physician in a clinic where they don't prescribe antidepressants. Antidepressants cost too much money, apparently. That's why it takes two weeks after discharge to the suicide attempt.
Sharon Morrison, RN, Ruth Tucker, RN, Alameda

Doing our best in a difficult situation
While we assume your article was written out of concern for patients, we believe the article contains misunderstandings that we want to correct about policies, procedures, and patient treatment at John George Psychiatric Pavilion:

  • Alameda County contracts with the Alameda County Medical Center to provide services to patients who are suffering from acute psychiatric illness. ACMC contracts with the Waraich group of doctors to provide acute care. Nearby facilities, Eden or Villa Fairmont, provide care for subacute patients.

  • California state laws limit the ability of hospitals to hold patients against their will. Hospitals must document that patients are acutely ill to justify the involuntary holding of such patients. These laws may be of debatable benefit for patients, but they also protect patient rights. In any case, the Alameda County Medical Center must follow the law.

  • The focus in the contract on "denied days" is designed to ensure adequate documentation, not early discharge. The contract clearly does not directly reward early discharge. Under this contract, individual physicians are never rewarded for an early discharge. If the treating psychiatrist and treatment team feel that further acute hospitalization is needed at any time, the contract design allows for full payment with adequate documentation.

  • The contract does not incentivize physicians to discharge patients to an inappropriate level of care after the hospitalization. Patients who are waiting for a bed at a subacute level of care are put on "administrative days," not "denied days."

  • The attending physician, while ultimately responsible for the patient's treatment, does not provide treatment or make discharge decisions in isolation. A team of health care professionals, including registered nurses with psychiatric training, licensed occupational therapists, and psychiatric social workers, routinely is involved in every discharge decision.

  • There is a serious scarcity of resources for the care of severely mentally ill patients. While we strongly seek additional resources, we are also obligated to ensure that every aspect of the system is as effective as possible.

  • No cure exists for most severe psychiatric illness. Grievous outcomes occur in all systems of care everywhere. The Alameda County Medical Center is actively involved in continuous quality improvement efforts to improve our quality of care at all levels.

  • Therefore, we conclude that the charge of unethical behavior made in your article is unfair and incorrect. Our physicians and treatment teams are working to create the best possible outcomes in a very difficult situation. Our belief is that Alameda County residents and patients have a right to expect both the best possible care to patients and appropriate justification of each and every day of acute hospitalization.
    Kurt Biehl, MD, interim chair, department of psychiatry, and James Mittelberger, MD, president of the medical staff, Alameda County Medical Center

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