With great sorrow for my friend Kurt Kolstad

"Freedom"

Author unknown.
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Freedom and I have been together 11 years this summer. She came in as a baby in 1998 with two broken wings. Her left wing doesn't open all the way even after surgery, it was broken in 4 places. She's my baby.

When Freedom came in she could not stand and both wings were broken. She was emaciated and covered in lice. We made the decision to give her a chance at life, so I took her to the vet's office. From then on, I was always around her. We had her in a huge dog carrier with the top off, and it was loaded up with shredded newspaper for her to lay in. I used to sit and talk to her, urging her to live, to fight; and she would lay there looking at me with those big brown eyes. We also had to tube feed her for weeks.

This went on for 4-6 weeks, and by then she still couldn't stand. It got to the point where the decision was made to euthanize her if she couldn't stand in a week. You know you don't want to cross that line between torture and rehab, and it looked like death was winning. She was going to be put down that Friday, and I was supposed to come in on that Thursday afternoon. I didn't want to go to the center that Thursday, because I couldn't bear the thought of her being euthanized; but I went anyway, and when I walked in everyone was grinning from ear to ear. I went immediately back to her cage; and there she was, standing on her own, a big beautiful eagle. She was ready to live. I was just about in tears by then. That was a very good day.

We knew she could never fly, so the director asked me to glove train her. I got her used to the glove, and then to jesses, and we started doing education programs for schools in western Washington. We wound up in the newspapers, radio (believe it or not) and some TV. Miracle Pets even did a show about us.

In the spring of 2000, I was diagnosed with non-Hodgkin's lymphoma. I had stage 3, which is not good (one major organ plus everywhere), so I wound up doing 8 months of chemo. Lost the hair - the whole bit. I missed a lot of work. When I felt good enough, I would go to Sarvey and take Freedom out for walks. Freedom would also come to me in my dreams and help me fight the cancer. This happened time and time again.

Fast forward to November 2000...

The day after Thanksgiving, I went in for my last checkup. I was told that if the cancer was not all gone after 8 rounds of chemo, then my last option was a stem cell transplant. Anyway, they did the tests; and I had to come back Monday for the results. I went in Monday, and I was told that all the cancer was gone.

So the first thing I did was get up to Sarvey and take the big girl out for a walk. It was misty and cold. I went to her flight and jessed her up, and we went out front to the top of the hill. I hadn't said a word to Freedom, but somehow she knew. She looked at me and wrapped both her wings around me to where I could feel them pressing in on my back (I was engulfed in eagle wings), and she touched my nose with her beak and stared into my eyes, and we just stood there like that for I don't know how long. That was a magic moment. We have been soul mates ever since she came in. This is a very special bird.

On a side note: I have had people who were sick come up to us when we are out, and Freedom has some kind of hold on them. I once had a guy who was terminal come up to us and I let him hold her. His knees just about buckled and he swore he could feel her power course through his body. I have so many stories like that...

I never forget the honor I have of being so close to such a magnificent spirit as Freedom.


Hope you enjoyed this! 

Cancer is a strange cell. You can go along for years in remission and then one day it pops its head up again. If you ever have it you will never be free of it. A small request...93% won't forward, but I'm sure you will. All you are asked to do is keep this circulating. Even if it's only to one more person. In memory of anyone you know who has been struck down by cancer, or is still living with it, or just someone who enjoys a great story.

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Force Majeure?

I posted a comment about the Newtown Connecticut bloodbath on Facebook tonight.

Was this tragedy a "Force Majeure"? The act of an extremely deranged young man whose mental illness and consequent nihilist and malevolent moral incapacity rendered him essentially the human equivalent of a tornado or meteorite striking that school? And consequently, in viewing it that way, can we simply argue that placing any ostensibly "reasonable" restrictions on the acquisition and use of assault weapons would not have made any inhibitory or preventive difference?

Shit happens?

Are we simply left, then, with dueling antagonistic, frequently epithet-overloaded speculative arguments, many of them based on the weakest (and most cherry-picked) of empirical evidence, buttressed and amplified by the most fevered illogic ? Some of them that hark to a time of a frontier nation comprised of less than 1% of today's U.S. population, a new nation still smoldering from the flames of war on its soil, a nation where the relative "balance of power" expressed via citizen vs government armaments was orders of magnitude smaller compared to that of today?

Are we left to simply argue that the ONLY thing preventing our self-government from devolving into despotism is our putatively prophylactic "Right to Bear Arms"?

I Don't Buy It.
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UPDATE, MAY 9th 2013

I really tire of the massive glandular Straw Man thinking around the 2nd Amendment.

The second amendment in effect prevents the national government from destroying the militias of the states and preserves a personal right that is centuries old. Joel Barlow, the Connecticut wit and writer, in 1792 sagely declared that a tyrant disarms his subjects to "degrade and oppress" them, knowing that to be unarmed "palsies the hand and brutalizes the mind," with the result that people "lose the power of protecting themselves." But arms privately held can be dangerous to society. President George Washington once reminded Congress that "a free people ought not only be armed but disciplined." He meant that the militias of his time had to be under military authority or, in the frequently used phrase, should be "a well-regulated" militia. However, we no longer depend on militias, a fact that in some respects makes the right to keep and bear arms anachronistic. An armed public is not the means of keeping a democratic government responsible and sensitive to the needs of the people. As the Supreme Court said in 1951, in Dennis v. United States: "That it is within the power of Congress to protect the government of the United States from armed rebellion is a proposition which requires little discussion." Whatever hypothetical value there might be, the Court said, in the notion that a "right" against revolution exists against dictatorial government "is without force where the existing structure of the government provides for peaceful and orderly change." The Court added, "We reject any principle of government helplessness in the face of preparations for revolution, which principle, carried to its logical conclusion, must lead to anarchy."

The right to keep and bear arms still enables citizens to protect themselves against law breakers, but it is a feckless means of opposing a legitimate government. The so-called militias of today that consist of small private armies of self-styled superpatriots are entitled to their firearms but deceive themselves in thinking they can withstand the United States Army. The Second Amendment as they interpret it feeds their dangerous illusions. Even so, the origins of the amendment show that the right to keep and bear arms has an illustrious history connected with freedom even if it is a right that must be regulated.

Professor Leonard W. Levy. Origins of the Bill of Rights (pp. 148-149). Kindle Edition.

apropos,

Click the image and save. Pay it forward.

See also SharronAngle.blogspot.com

Advocating Treason because you don't get your way on every issue of passionate concern to you is the very definition of juvenile idiocy.

Committing Treason will quickly get you justifiably culled from the Herd. Count on it. I will not be holding any Candelight Vigil for you.

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Socioeconomic Drama

There is a long-established, conceptually simple, cogent cognitive psych model of dysfunctional interpersonal behavior known as "Script Theory." It emanated decades ago from Eric Berne's work on "Transactional Analysis." Within this model is the Rescuer-Victim-Persecutor concept:

• I, the benevolent intervenor, arrogate to myself the right to and imperative of "rescuing" you, the "Victim" from your plight(s);
• You, the "Victim," irritated by (or just apathetic toward) my putatively altruistic and unsolicited ministrations, react with insufficient gratitude and attitude/behavior change;
• which then give me the right to demonize and persecute you.

Think about it.

The supportive psych literature is rather voluminous.

I pretty much buy it. Occam's Razor simplicity and all that. Think about the drama you repeatedly witness (or participate in) within your family and social circles. 

Shorter Claude Steiner: to the extent that you live a "scripted" life, you are not free.

Of late I can't help but observe that our society in the aggregate is now in the "Persecutor" phase of socioeconomic dynamics, in the wake of our recent disappointments. Ironic, given all this hyperbolic talk about "freedom" of late.

It's probably cyclical. We tend to oscillate between maxima and minima of concerns over "social justice."

Unless you've been off incommunicado in a cave of late, you've seen it.

• Presidential Candidate Ron Paul gets loud, angry cheers during a GOP primary "debate" wherein he summarily shrugs off the moral implications of allowing the destitute to die at the ER curbside (and, he's a physician, no less).
• The fatuous writings of the late Ayn Rand (raging against "Moochers" and "Looters") have risen to new popularity.
• A nationally known AM radio host loudly demeans a woman as a "slut" and a "prostitute"because of her advocacy for contraceptive rights.
• The long-term jobless are described as "lazy." It is argued, among other things, that they be subjected to drug testing as a condition of eligibility for unemployment compensation. Ron Paul's senator son Rand claims in late 2013 that extended employment insurance is a "disservice" to the jobless.

I could do a very long bullet list.

But, you get the idea. The "failures of liberalism" give us convenient license to blame the the unfortunate, poor, and inept.

The adversity POV:
Ich, Du, Sie

• I innocently suffered a misfortune.
• You should have done more to avoid calamity.
• He is is a parasite, a Moocher.

We tend to attribute our successes to acumen and initiative, while declaiming responsibility for our misfortunes, which are proffered to be the result of bad luck or the machinations of more powerful adversarial others.
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More to come...

Whitney Houston, 1963-2012

Notwithstanding all of the incessant tabloid drama surrounding her tragic human failings, this woman's voice incontrovertibly made the world a better place. It's really that simple. My heart goes out to her family and friends.

On "Envy"

So, tonight, I'm watching the SAG Awards on TV with one eye/ear as I tend to other stuff. I just had this tangentially connective thought as I ruminate on the 2012 presidential campaign.

MITT ROMNEY: "This country already has a leader who divides us with the bitter politics of envy. We must offer an alternative vision. I stand ready to lead us down a different path, where we are lifted up by our desire to succeed, not dragged down by a resentment of success."

"The bitter politics of envy?"

Well, apropos of Mr Romny's facile assertion, the graphic above pretty much sums up my "religious" beliefs, in addition to the "Thou Shalt Not Covet" admonishment of the Ten Commandments. Not that I'd fully assimilated all of that by age 5 or 10 or so. It took a remorse-precipitating, reflective whack upside the head by Kant and others in Grad School to fully drive the point home.

Well, so, yeah, of course, Mr. Romney's comment is the to-be-expected low-road hyperbole characteristic of much of American politics any more. Newt Gingrich and Rick Santorum and others have expediently riffed on this same shallow and dishonest anti-Obama theme ad nauseum as well.

to wit:

(Jan 29th, ABC News) House Speaker John Boehner defended calling President Obama’s economic message “almost un-American,” saying that the president is dividing middle income and wealthy Americans.

On Tuesday before the State of the Union address, Boehner criticized the president’s calls for increasing taxes on the wealthy, telling a group of reporters, “This is a president who said I’m not going to be a divider, I’m going to be a uniter, and running on the politics of division and envy is — to me it’s almost un-American.”

In an interview on “This Week,” Boehner told me, “What I’m talking about here is the politics of dividing America, the politics of envy. This is not the American way.”

Right.

As I watch the latest annual tripartite mutual love feast celebration of the Hollywood gliterati (Globes, SAG, and Oscars), I am struck by the extent to which we, in the aggregate, love our cinema stars and those who produce their works, people who mostly live lives of luxury utterly beyond our comprehension. Yeah, we'd all like to experience such comforts and perks. But, we don't begrudge them theirs.

NOTE: I am more in love with the work they do. It never ceases to amaze me that any film every gets made. The technical, logistical, financial, and ego-management requirements make the mind boggle if you are a diligent student of film at all (e.g., Google "Heaven's Gate").

Mr. Romney, we don't resent "success," we resent those who obtain it via slick zero-sum subterfuge that adds nothing to the advancement of a just, sustainable civilization.

People like you.

A generation passes

Above: I shot this in March 2007 at the assisted living place in Palm Bay, FL where I'd moved my Ma to in January 2005 after she could no longer safely stay in the house just a couple of miles away, where they'd retired in 1973. In July I moved her to Vegas (I'd moved my late Dad in May that year; he had serious dementia and was already in nursing home care since the fall of 2001). Below: she managed to clutter up that apartment pretty quick. That ugly roll-out bed couch was my swell recurrent Delta red-eye bunk 'til I moved her and Pop to Vegas.

My Dad came home from the war in Europe (minus a leg) and married my Mom in August 20th, 1944. I was then born in February 1946. Pop died in May 2008. I will miss them both greatly. They were loyal to each other and loyal to me and my sister and all the grandkids.

I owe everything to them. Above, circa 1974 or so. Below, Mother on her 88th birthday, January 18th, 2010. We took her to Olive Garden in Henderson, "Awlive Gawdin," as she put it in her finest Long Island accent.

That was her last marginally decent year. Below, Mom and Dad visiting at the nursing home where he resided in Melbourne FL prior to my bringing them both to Vegas.

A good, long run, both of them. UPDATE We had a celebratory supper Sunday evening at the Olive Garden in Henderson where we'd last taken Ma, for her 88th birthday. My sister Carole read for us a reflection she'd composed.

Marion Elizabeth (Dittus) Gladd, January 18, 1922 - November 10, 2011 How do you describe the life of your mother when you don’t pay attention to the details while you are a child and it’s all about yourself and not about the person who chose to bring you into this world? After having 5 children, I realized what my mom must’ve gone through raising two children. And she (and my dad) did a pretty decent job when you read about what goes on in families nowadays. I often think -- how did they manage to raise two children who generally are compassionate and reasoned people? It must’ve been their lifelong concern for us and our families. Selfishness was not part of their character when it came to their kids. My first recollection of my mom was in Morristown, New Jersey (George Washington’s stomping grounds!). I remember her taking me to a birthday party -- I remember being shy and not wanting to go but I didn’t have a choice. I remember kindergarten and her leaving me there and I remember being scared. Never gave one thought to the fact that she was now alone, both children in school. I wonder what that was like for her. My next recollection was our “farmhouse” in Hanover, New Jersey. What a wonderful home that was -- a big old home, with a wrap-around front porch and a walk-around attic to die for. Interestingly enough, years later as an adult, I was talking to my mom about that house and she said that she hated that house. Once again, what she must’ve given up so Bobby and I could have this interesting outdoors experience -- I think Bobby even built a log cabin in the woods and I remember scooping up frog eggs in this jellylike glob form from the pond in the woods next to our home. And that was the house where I got my first “cat” addiction—our landlord, Mrs. Weber, gave me a cute little black and white kitten and the same day she ran over it with her car! No pets after that one! That’s why I’ve been making up for it ever since -- in fact, Bobby has a bigger zoo than me. The next move was to Hillsborough right before I started 4^th grade. We moved into a brand new development with the ranch homes and the split-level homes. Already, you knew the people who had split-levels had to have more money -- or that’s how I perceived it. My mom was the typical 50-60’s stay-at-home mom. Little did I know what a gift she gave to me. She made my lunches, she was always there when I got home from school, and I always had a very well balanced meal with the dreaded green vegetables. My mom was a great cook -- and I mean great when I compare it to my paltry cooking skills. And I hated to eat--I didn’t like anything -- I know it’s hard to believe when now there isn’t much I dislike. And both my parents were adamant that we clean our plates. And Bobby always got away with murder at the dinner table—pushing his mashed potatoes out of his mouth to make me laugh -- which I did -- and which I got punished for. My parents somehow got across to Bobby and I that you don’t get a free ride and you take care of yourself and be kind to others. It was expected that we do well in school. I know I feared both my parents -- but I can’t really remember getting disciplined except for the occasional swat on the behind with the rolled up newspaper -- and that was dad. I don’t remember Mom ever physically disciplining me -- but I knew when I disappointed her and that was enough punishment. Now it’s coming back to me -- mom was not happy when I said “shit” -- which is minor to what I’ve said in front of my kids. And mom never liked me calling her “Ma”. I guess it was considered slang, and not proper. Growing up, I thought my mom and dad were too strict and too “proper.” I remember having to go to St. Paul’s Episcopal Church in Somerville, New Jersey; Dad never had to go -- and I used to wonder, why did I have to go and he doesn’t? But I never really questioned or fought the idea -- I just obeyed. And mom made sure I had all the fixings for church--dresses and white gloves. And the dreaded hats at Easter! I always wished my parents had done more fun things with my friend’s parents. Their houses were the fun houses. They had pools -- I wanted one in our back yard—but, no, couldn’t have one because of liability. Something I didn’t understand until I had children of my own. But I spent a lot of time at my friends’ homes. But here’s the kick -- while I was enjoying my free time at their houses away from my “strict” home, their families were falling apart. Little did I know at that time, that what I perceived as “being too strict” was that they were giving me security -- actually life long security. And then I went off to Bowling Green, Ohio, for college. Once again, it never occurred to me the loss for my mom -- having both her children, who she devoted her life to, moving so far away. And then Dad retired and made the decision to move the both of them to hot and humid Florida. And then my mom rose up out of her compliant 50’s mode, and started speaking up for herself. A lot of fights ensued between the “happy couple” but they miraculously persevered as a couple to become the most unselfish grandparents on the planet. Mom never gave me raising children advice. I remember when we had our first child David in 1975. And Tony and I knew nothing about raising babies. And mom was just as puzzled as us -- never made me feel guilty if I used a pacifier or picked David up whenever he cried. That was the first time I felt closer to my mom. My parents never missed one of my children’s birthdays, Christmases, Easter or the first day of school. There was always a check in the mail or a box filled with gummy worms, little Debbies, and all sorts of treats and clothes -- and it really helped us financially since I too was a stay at home mom. I remember in 1989 when April got so deathly ill and Tony had to drive with 4 kids to Ann Arbor. The brakes went on the car and Mom and Dad stepped up to the plate and gave us $2,000 for the repairs (must’ve been a few other things wrong with the bomb!). I know my mom was the moving force when it came to helping Tony and I. They came for every event in our lives too -- when Tony graduated, when he got his Master’s, when the kids were born, and finally for high school graduations. They always made the effort even if their visits sometimes drove me crazy. Regardless of all the pain my mom endured in her life, she somehow managed to carve out good lives for Bobby and I -- we wouldn’t be the people we are and we wouldn’t have the loving families we have if it hadn’t been for her love from the first moment we were born. She did a good job and I thank her from the bottom of my heart for what she gave unselfishly to my family and I. I will miss her silliness, her friendliness, her jokes and her patience. I will never forget the “digitized” TV, the trips to Patrick Air Force Base, the walks on the Officers Club boardwalk, the endless restaurants such as Friendly’s—you know, the one who banished my mom!!! And I remember my mom’s meatloaf -- a recipe I have from her--that I will make when I get home in her honor. Nathan will wonder what is wrong with his mom -- “she’s cooking a meal—really?” Well, mom, you obviously gave me the gift of gab, so until I see you again—I love you.Your daughter, Carole Elaine

Wow. SUNDAY, NOV 20th They Married in August 1944. Pop died in May 2008, my Ma ten days ago. Feeling rather sad today. Got my Mother's ashes Friday. I just shot that out on my driveway, on a piece of wood on my sawhorses. Good light today with the overcast.

The little blue and red thing beneath this photo arrangement is my "blankee" -- one of the few surviving physical artifacts from my young childhood.

My heart goes out to Steve Jobs' family and friends

I hope others can step up to fill this void.

To Nevada Governor Sandoval

Subject: Your proposal to eliminate the UNLV Department of Philosophy
From: Robert Gladd
Date: April 3, 2011 3:11:32 PM PDT
To: president@unlv.edu, neal.smatresk@unlv.edu, regentjamesdean@aol.com, jgeddes@sbcglobal.net, malden@nevada.edu, andrea_anderson@nshe.nevada.edu, william_cobb@nshe.nevada.edu, cedric_crear@nshe.nevada.edu, mark_doubrava@nshe.nevada.edu, ronknecht@aol.com, kevin_melcher@nshe.nevada.edu, jack_schofield@nshe.nevada.edu, michael_wixom@nshe.nevada.edu, michael.bowers@unlv.edu, chris.hudgins@unlv.edu
Cc: dschrade@udel.edu, Jon Ralston , mike.campbell@lasvegassun.com, brian@lasvegassun.com, danny@lasvegassun.com
___

Good day,

I first learned of the Nevada budget reduction proposal advocating the elimination of the UNLV Philosophy Department in the Las Vegas Sun on March 29th in an article by J. Patrick Coolican. I was aghast. I ask that you reconsider, and take this proposition off the table. It could not be more antithetical to the very purpose of an institution otherwise positioning itself as an "Up and Coming Urban Research University" with a goal of attracting excellent faculty and students via whom to help make this state and our world a better place. You have other viable alternatives at your disposal.

Let me first cite a salient excerpt from the March 23rd, 2011 letter from David E. Schrader, Executive Director of the American Philosophical Association:

"The AAC&U has done substantial work surveying the needs of America's businesses. AAC&U data indicate that 81% of employers want universities to place greater emphasis on Critical Thinking and Analytical Reasoning skills. 75% want universities to place greater emphasis on Ethical Decision Making. These are precisely the areas in which philosophy plays the most significant role."

Indeed, and the irony here could not be more acute. That we are now find ourselves in this painful circumstance of acute economic travail, both nationally and in nearly every state, is in large measure the direct result of a political, legal, and economic culture run amuck in Gresham's Law fashion, where -- absent effective and rational regulation driven by ethical acuity -- the Bad inexorably drives out the Good. The examples are by now legion (and dispositive, in my view). I need not cite them, but I do need to emphatically add my voice here for the ongoing -- no, heightened -- importance of critical thinking and ethics coursework offerings at the university level. We have no shortage of trade schools and otherwise career-dollar focused curricula. This is absolutely not the time for retrenchment in the reasoning and ethical arts and sciences.

I am a quantitative analyst and writer of long, broad, and deep experience spanning multiple domains (see www.bgladd.com/papers). I am also a mid-career 1998 graduate of the now-moribund UNLV Institute for Ethics & Policy Studies (comprised of faculty drawn mostly from Philosophy). I count the upshot of my experience there as an invaluable, cherished asset, and simply the best academic dollar value I ever received. It served to appreciably leaven my otherwise native polemical, iconoclastic tendencies with an indelible sensitivity to the continuing challenges posed by the inseparable attributes of both objective analytical reasoning and moral/ethical inquiry. I now try daily to bring these skills to my work in health care information technology as part of the national effort to improve our health care system. I blog about these topics here:

http://regionalextensioncenter.blogspot.com
http://bgladd.blogspot.com (see health care post links in the upper right links column)

I am also a Senior Member of the American Society for Quality (ASQ), a 22 year veteran of that organization, and a person long committed to the ideals, strategies, and tactics of continuous improvement. The organizational literature is by now fairly replete with solid evidence of the significant cost-saving opportunities available to organizations of every stripe, public and private. Systematic, carefully implemented process improvements have repeatedly been shown to result in operational cost savings of as much as 30% or more (and I would speculate that academic institutions in general are in the upper range of quantifiable process improvement opportunity). This is wherein lies your opportunity for sustainable improvement and subsequent institutional budgetary viability (and not just at UNLV).

Let me be clear: I am by no means a reflexive apologist for the administrative or curricular status quo at the UNLV Department of Philosophy nor its parent institution. Nonetheless, what you are proposing will achieve little if anything of long-term benefit while introducing much of real short- and long-term harm. Please reconsider, and strike this proposal.

Thank you for your time.

Sincerely,

Robert E. (Bobby) Gladd, MA/EPS
www.bgladd.com

Las Vegas: The next Anasazi Ruin?

Lake Mead, which now supplies the Las Vegas Valley with 90% of its water, has dropped 128 vertical feet since January 2000, and is now at roughtly 43% of capacity (I track these data monthly and drop them into Excel, from which I generate the above graph). It came back up 4 feet in December 2010, owing mainly to severe and sustained west coast and Rocky Mts watershed rains and snows, but, will likely again continue to decline. I shot the photos below in June 2009. The lake has dropped another 9 feet net since then.

When my wife and I relocated to Las Vegas in 1992, 1/3rd of the area's water came from the Spring Mountains watershed to the west of the valley, but the western watershed groundwater levels comprising that resource have declined significantly as well (for the most part owing to our sustained drought and -- until recently -- intense population influx). Below, Lake Mead at Hoover Dam during happier hydrological times.

In response to the dramatic lake level decline, the Southern Nevada Water Authority has proffered a plan to construct a pipeline into Lake Mead via which to obtain water from the northern rural ranching and mountain areas of eastern Nevada along the Utah border. But, the political pushback against this proposal has proved quite formidable. Critics call it another "Owens Valley" debacle, arguing that rural Nevadans (and nearby rural Utah residents). should not be sacrificed for the benefit of even more Las Vegas urban growth just to further enrich developers and the gaming industry.

Clark County, NV (the greater Las Vegas metropolitan area) is now home to some 2 million residents.

It is, long-term, an ecologically unsustainable region, and, absent gaming, would likely be another (perhaps slightly larger) Barstow -- one more dessicated, hardscrabble truck and rail stop of 30 to 40,000 people along the route between Los Angeles and Salt Lake City. Everything is brought in here by truck, rail, or aircraft. With the exception of water (for now).


AN EXCELLENT SERIES FROM THE LAS VEGAS SUN

[Click above to go to the story]

"Las Vegas was first settled for its springs, springs that made it an oasis in the desert. Although those springs have decades since run dry, water is still the most import resource to Las Vegas and the dry Southwest.

And by all indications the region is only going to get dryer. Scientists predict devastating effects from global warming, conservationists are calling for a halt to growth in Southern Nevada as a way to preserve supplies and water managers are looking to ever more creative ways to reduce reliance on the overburdened Colorado River. A Colorado River reservoir at Lake Mead is the source of 90 percent of the valley's water supply. Water levels there have fallen steadily for nearly a decade..."

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DESALINATION TO THE RESCUE?

Consider some attributes of sea water.


One acre-foot of sea water (325,851.4 gallons) weighs roughly 1,390 tons and contains about 40 tons of salt, and another 7 tons of lesser chemical constituents. The technologies for transforming salt water into potable fresh water are relatively mundane (albeit energy intensive). A net 96,500 acre-feet of potable desal water (100,000 acre-feet less the brine constituents) could serve perhaps 300,000 household per year. But, beyond the KwH energy cost of production, there would remain [1] the considerable expense of transporting it to the destinations of need, and [2] environmentally benign disposition of the 4.76 million tons of the residual chemicals (mainly salt), which are typically simply slurried back into the oceans proximate to the desalination plants.

You can just to a little transport arithmetic starting with a gallon of fresh water (post-desal processing) at 8.35 lbs: equivalently ~1360 tons per acre-foot. Use the rough rail freight shipping estimate of a nickel per ton-mile. Haul it 300 miles. About 20 grand, plus the cost of desal production. Pretty expensive alternative to the natural (and, of late in the west, chronically inadequate) hydro cycle.

Given that pipeline pumping of desalinated water several hundred miles up to higher elevations such as Las Vegas (2,160 ft above sea level) is a non-starter (as would be the use of rail tank cars; we don't have enough for just this singular "rolling pipeline" purpose), trade-off/diversion proposals have been floated in recent years in which Nevada would fund additional desal capacity in California in return for diversion of an equivalent volume of downhill-flow water from the Sierra Nevada range watershed inventory. But, myriad California agricultural, environmental, and energy concerns have thus far sufficed to stifle such initiatives. 
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BARCELONA'S DROUGHT

News from May 2008:

Spain's worst drought in decades has forced the city of Barcelona to begin shipping in drinking water in an unprecedented effort to avoid water restrictions.

For the first time ever, tankers began to deliver desperately needed drinking water to the parched region of five million people. Incredibly, Spain has seen almost no rain in the last eighteen months. Water levels have dropped so low in local reservoirs that a long forgotten medieval village has emerged from beneath a rapidly drying lake.

Sixty six tankers are expected to deliver water over the next few months. Meanwhile the Spanish government appears to have given up relying on rainwater. They are now constructing a desalination plant that will supply 60 billion litres of water a year to the parched region.

 
2015 UPDATE

California drought: Can railroads come to the rescue?

(CNBC) As California's four-year drought worsens and water supplies dwindle in the state, an old technology—railroads—could play a role in alleviating some water shortages.

"We certainly have that capability today," said Mike Trevino, a spokesman for privately held BNSF Railway, which operates one of the largest freight railroad networks in North America. "We carry chlorine, for example. We carry liquefied commodities."
Experts say the East Coast's plentiful water could cost cents per gallon to Californians and provide a stable, potable water supply for small communities. Obstacles include identifying a state willing to share some of its water, and securing the construction funds for key infrastructure work, including terminals that can handle water....

See also my KHIT post "Upstream, downstream; what happens to health when there IS no more stream?"
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More to come...

This is not a Black Swan

I am aghast, angry, and depressed over the events in the Gulf of Mexico that began with the catastrophic, tragic fiery destruction of the British Petroleum Deep Water Horizon oil drilling platform and the unimaginably horrific deaths of eleven of its workers.

This will very likely turn out to be far and away the most severe man-made environmental calamity of my lifetime. The Gulf of Mexico (and perhaps far beyond) faces biological and economic ruination that may well be at this point beyond human capacity to truly remediate.

"Act of God"? As more than one fatuous politician has lamely proffered? No "God" that I would care to consort with or submit to. Forget it. This was the culmination of a series of acts by identifiable men (All of them by now all suitably lawyered up).

WELL, PERHAPS A "BLACK SWAN" EVENT?

Citing Nassim Nicholas Taleb:

What we call here a Black Swan (and capitalize it) is an event with the following three attributes. First, it is an outlier, as it lies outside the realm of regular expectations, because nothing in the past can convincingly point to its possibility. Second, it carries an extreme impact. Third, in spite of its outlier status, human nature makes us concoct explanations for its occurrence after the fact, making it explainable and predictable. I stop and summarize the triplet: rarity, extreme impact, and retrospective (though not prospective) predictability...

Notwithstanding my extreme affinity for the philosophical/theoretical/empirical insights and works of Taleb, I would have to seriously demur were anyone to argue Black Swan here. To wit:

1. First, it is an outlier, as it lies outside the realm of regular expectations...
2. Second, it carries an extreme impact.
3. Third, in spite of its outlier status, human nature makes us concoct explanations for its occurrence after the fact, making it explainable and predictable.

Only the second of these proffers legitimately obtains here.

"Black Swan" is an analogy, perhaps to the point of metaphor. So, let me offer another.

RUSSIAN ROULETTE

Six chambers, one live round. Place your bet, load the weapon, spin, place the business end of the barrel against your temple, pull the trigger. The probability of blowing your brains out in the wake of each attempt is one in six. Would you do it?

Of course not (unless you're suicidal). The negative "expected value" (obliteration) -- i.e., probability times the "payoff" -- remains essentially "infinite" irrespective of the well-below 50/50 (1/6th) nominal, non-accruing independent "chance" (a concept which utterly explains fear of flying).

Now, assume the revolver has not six, but, say, 10,000 chambers. Moreover, the barrel is pointed not at your temple but at beaches, marshes, pelicans, turtles, shrimp, shrimpers, and the rest of the inhabitants of a region writ large.

Place your bet. By the time you "lose," you will have made plenty of bank. Unlike those uninvolved in the game.
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"Years of Internal BP Probes Warned That Neglect Could Lead to Accidents"

A series of internal investigations over the past decade warned senior BP managers that the company repeatedly disregarded safety and environmental rules and risked a serious accident if it did not change its ways...

No, this horrific event fails Black Swan postulates 1 and 3 above. It may indeed have been "outside the realm of regular expectations," but only to the conveniently, expediently dilettante executive mind. And (3), there is nothing to "concoct" here. There exists a record -- one that points to criminal negligence. (see 2 - "extreme impact").
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For now, consider an earlier post of mine. We have alternatives. BTW, I am in fact a "Drill, Baby, Drill" kind of guy.

No need to idle all those drillers. There's plenty of heavy industrial work to be done.

UPDATE

This is hard to watch.

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MORE TO COME

Opportunity for collaboration? ASQ and the RECs

On March 2nd, 2010 I returned to work with my twice former employer HealthInsight, the highly regarded long-standing not-for-profit Medicare QIO (Quality Improvement Organization) serving the states of Utah and Nevada in the wake of their being awarded a federal "Regional Extension Centers" (REC) contract by the U.S. Department of Health and Human Services (HHS) as part of the Obama administration's stimulus funding initiative to spur the widespread adoption and "meaningful use" (MU) of health information technology (HIT).

It is a most ambitious, pedal-to-the-metal, high-velocity program (unrealistically so, say some of its critics), one whose goal is to bring the vast majority of medical providers into the digital information world, a world the rest of commerce finds at once unremarkable and indispensable.

Above, the still-predominant information storage and retrieval model for medical information. It is functionally untenable. Prohibitively expensive in ways significantly under-appreciated. It is dangerous. It could cost you your life in an exigent circumstance. It cries out for extinction. Yes, conversion will be difficult, and exasperatingly rife with logistical and legitimate, vexing policy problems.

Nonetheless...

I have been writing a bit about this on one of my other blogs. See "Irrespective of national health care policy reform legislation, the medical sector is going full-steam-ahead HITECH," initially written prior to the passage of the Obama "Health Care Reform" legislation (with updates still to ensue, mostly pertaining to the complex data security issues bearing on patient privacy).

ASQ

The American Society for Quality. My wife and I have been members since the mid-1980's. We live and breathe "quality" concepts and issues, having both come together out of the same legacy-era "quality control" paradigm. We have both served as Examiners for our Nevada state-level Baldrige Award assessments (ASQ administers the national Baldrige program). My friend and ASQ colleague Fred Schwager and I co-founded the Nevada Quality Alliance (NvQA.org), which administers the Nevada Baldrige model program.

When I returned to work, I renewed my optional special interest sub-membership in the ASQ Health Care Division. Shortly thereafter, I had the fine fortune to strike up an internet and phone conversation with the Chair-Elect of the Division, Dr. Joseph Fortuna. Joe is an enthusiastic supporter of the REC effort, and was intimately involved in DC legislative support for health policy reform.

We share some concerns, which we have by now discussed at some length; e.g.,

• Critics bemoan a lack of prior HIT deployment and QI experience among some REC awardees (as well as the heterogeneity of business models);
  
  
• While 60 REC contracts have thus far been awarded, with the newly chartered RECs frantically ramping up to meet the rather compressed Stage One Meaningful Use incentive payment timelines, both the requisite Meaningful Use reporting criteria and the EHR (Electronic Health Record) certification regulations remain unresolved at this writing. The cart is seriously out in front of the horses in many respects;
  
  
• Notwithstanding that HHS is spending hundreds of millions of dollars on REC contracts, physicians and hospitals are not required to engage REC services in order to qualify for federal incentive payments. Consequently, RECs are having to spend significant time and money hawking their services (the polite term being "enrollment." I did not know when I signed on that I would be required to do what amounts to hastily and minimally trained cold-call sales). Moreover, REC services are not fully subsidized, the upshot of which is often skeptical "we'll pass" pushback, especially in light of the hyperbolic claims of virtually all major EHR vendors "guaranteeing" that their products will get the provider to MU (with the glossed-over disclaimer, well down in the fine print "When Used As Directed");
  
  
  • At this writing, the aggregate Final Rule for MU criteria is still under HHS consideration, with myriad professional stakeholder groups arguing for relaxation of both the compressed compliance timelines and the all-or-nothing approach, countered by a broad array of equally vocal consumer/patient advocacy organizations arguing for MU criteria adoption "as-is" as set forth in the Interim Final Rule.
    
    I would have added another MU criterion: require working with the RECs as a condition of incentive money eligibility;
  
  
• The relatively sparse per-provider federal REC funding may force the RECs to focus simply on assisting their client physicians with hitting the MU criteria in pursuit of the incentive reimbursements -- to the practical exclusion of broader and more sustainable, internalized quality improvement efforts;
  
  
• There is to be a "Health IT Research Center" funded by HHS and intended to "gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Extension Centers (RECs) collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support. The HITRC will build a virtual community of shared learning to advance best practices that support providers’ adoption and meaningful use of EHRs."
  
  It is not even slated to be up and running until FY2012.
  
  

Notwithstanding our concerns, we see potential opportunities for win-win synergistic REC-ASQ collaboration via which to help improve health care.

THE ASQ HEALTH CARE DIVISION "MARSHALL PLAN"

Dr. Fortuna is a Champion of the ASQ "Marshall Plan."

"...In different areas of the country, ASQ members, under the leadership of the ASQ Healthcare have teamed up with the local healthcare community and medical organizations to help improve healthcare delivery. Being that we are all stakeholders in this system and that there is much opportunity to apply quality and lean methodologies, this is a great place for ASQ members to use their skills for the betterment of the system. The focus is on primary care doctor offices..."
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Click the link, Read all of it. An extremely worthy volunteer effort with the potential to deploy a large number of experienced QI professionals in pro bono service to the healthcare community in a manner complementary to and reinforcing of the work of the RECs.

The Regional Extension Centers could certainly benefit from the help, and ASQ in return would be made visible to a large source of potential new members, given the projected HIT-related and health professions employment growth across the decade.

I would also favor inviting several other ASQ Divisions to collaborate: Biomedical, Software, and Service Quality.




There is a lot of experience and relevant expertise upon which to draw. I would even surmise there might be interest and value adding input from and collaboration with the ASQ Quality Management and Statistics Divisions.
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"LEAN? THAT MAY BE OUT OF OUR SCOPE"

Such was a reaction from one of my skeptical HealthInsight HIT Adoption Support team members during a recent meeting in which I'd recommended that we consider deploying aspects of "lean methods" for workflow analysis and re-design, as proffered most recently in the new Quality Press book "Lean Doctors." He didn't say so explicitly, but his implication was clear: in light of our finite FTE resources and the huge scope of the project, our necessarily circumscribed task will be to drive providers toward MU and the incentive money riding on it [PDF], period. Point taken, to an extent, but, it should be equally clear that I don't regard the MU goal contractual imperative as inexorably being at odds with the utility of lean re-design tactics. Neither do I buy the implicit, gauzy HHS assumption that clinicians hitting the MU targets amid the money chase constitutes focused, adequate, and lasting healthcare QI of the kind we are incontrovertibly in need of.

This (highly recommended) book rightly points out, ever so politely, that the term "workflow" -- particularly in the medical setting, can be seen as having become something of a cliche, i.e., there's typically very little in the way of smooth "flow" in the daily "work," which is more aptly typically characterized as a series of "push" processes rife with bottlenecks caused by lack of coordination and waste. Any method that can demonstrably abate that simply has to be worthy -- whatever you choose to call it.

In the words of the publisher's blurb, Lean Doctors posits

"six proven “success steps” for implementing lean in any healthcare environment:

1. Create physician flow
2. Support physician value-added time
3. Visually communicate patient status
4. Standardize everyone’s work
5. Lay out the clinic for minimal motion
6. Change the care delivery model

"Why go through such a transformation? Because it works. Tell a doctor that he can see the same number of patients, offering the same high quality and personal care, and have an extra 90 minutes at the end of his clinic day – and that means something. Tell the staff that they can look forward to actually ending on time, with satisfied patients, no backlog, and having focused their attention completely on quality patient care – and they will listen..."

"They will listen." Really? Making that sale is perhaps not as easy as it might appear. But, in my view, such is our mandate, given that the elimination of process flow roadblocks and the waste they comprise cannot but provide, among other QI benefits, the availability of the requisite time for MU compliance.

A useful quote from the text for now:

Lean is a science for creating flow in a system—whether of a physical product or of a service. In healthcare, this would mean that we aim to create patient flow, without wait times, through any given area. As we focused on patient wait times in the clinic we found that no other metric brought the varied root causes of inefficiency so clearly into focus. When patients were moving through the process promptly, a lot of things were going right. However, when patients waited in the exam rooms or waiting rooms or at supplying processes, then any one of a great number of things could be going wrong...

And, one more:

As you consider undergoing a Lean transformation process at your own practice or clinic (or hospital or larger healthcare setting), you might think that a minute shaved off here and a minute saved there does not seem worth much. Change is difficult, time-consuming, and cumbersome. So why would you literally analyze every step a nurse takes? Why take the time to have technicians or nurse practitioners describe in detail the reality of their jobs, when you need them to simply get the work done? Why? [again] Because it works...

Color me a believer, based on what I have thus far learned. However, our REC reality may be that we will largely be limited to predominantly a prescriptive/advisory/auditing role. We will necessarily be developing SOPs via which to guide clinicians and their staffs toward accurately and routinely documenting in their EMR systems the structured data required for their MU Stage 1 attestations (and eventual data reporting). The current draft of MU criteria contains 25 outpatient items, many of which require numerator and denominator data for calculating percentages that must meet or exceed MU thresholds, e.g.,

• 1.01 Computerized Physician Order Entry (CPOE): Use computerized CPOE for at least 80% all orders (e.g. medications, consultations, labs, diagnostic imaging, etc.);
• 1.02 Medication Interaction/Contraindication Checks: Enable functionality in EHR for automated drug-drug, drug-allergy, and drug-formulary checks;
• 1.03 Patient Problem List: Maintain an up-to-date problem list of current and active diagnoses (recorded as structured data) based on ICD-9-CM or SNOWMED CT® for at least 80% of all unique patients;
• 1.04 E-Prescribing: At least 75% of all permissible prescriptions written are transmitted electronically (eRx) using an EHR;
• 1.05 Active Medication List: Maintain an active medication list (recorded as structured data) for at least 80% of all unique patients;
• 1.06 Active Medication Allergy List: Maintain an active medication allergy list (recorded as structured data) for at least 80% of all unique patients;
• 1.07 Patient Demographics: Record demographic data (including preferred language, insurance type, gender, race and ethnicity coded by federal guidelines, and date of birth) as structured data for at least 80% of all unique patients;
• 1.08 Vital Signs: Record and chart vital signs (including height, weight, blood pressure, calculated and displayed BMI, plotted and displayed growth charts for children) for at least 80% of all unique patients;
• 1.09 Smoking Status: Record smoking status for at least 80% of all unique patients 13 years old or older;
• 1.10 Lab Results: Clinical lab results captured as structured data for at least 50% of all labs ordered...
  
  

...and so forth. SOPs driving toward uniformly capturing such subsequently queryable information will necessarily be EMR platform-specific, and will comprise substantial work to derive and implement. Consequently, I may in fact be asking too much to insist on inclusion of "Lean" principles in our REC workflow re-design effort during this initial phase.

But, before I leave this issue (regarding which I welcome commentary/feedback), consider a few screen clip excerpts from a recent Lean project study posted on the ASQ Healthcare Division web page:


While I know that a lot of QI has gotten a sometimes deserved rep of being "soft" touchy-feely dubious flip-chart fad-of-the-moment social "science," the outcomes here are expressed in (verifiable, I assume) bottom line "hard dollar annual savings" on the order of $90k.

Annual.

Now, consider: the maximum HHS MU physician incentive payments are $44,000 over 5 years for Medicare providers and $63,750 over 6 years for Medicaid providers.

Think about that, in the context of leaning up one process at a net of 90 grand a year.

The basic issue, visually:

More to come...
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