The Honorable Mike Hatch is presently the Attorney General of the State of Minnesota. I have lived in Minnesota nearly all my life. Circumstance has found me confined within a radius of about 30 miles. Working seven days a week at two jobs can be confining. Vacations and the things I used to enjoy, fishing, ball games, the State Fair etc. are not any longer considerations. What does this have to do with the Honorable Mike Hatch?

Mr. Hatch wants to be our next Governor. He has wanted this very much for a very long time. Some call him ambitious for this. I call him "hollow". He is one of the "hollow men" I encountered on my journey of discovery.

I only considered approaching him when the Star Tribune wrote a story about "Casey who died from bedsores". The article claimed that the Attorney General had brought a lawsuit against the health care provider responsible for this travesty. I went to see Mike. I thought I might help him with this action. I know something about bedsores.

Entering the State Capitol is a big deal to me. The place is awesome. The Attorney General's office is equally impressive. After announcing the purpose of my visit I sat waiting for someone to respond. Next to my chair was a table with a very interesting brochure. It described anecdotal evidence of little people that had found a champion in the Attorney General. Its theme was that the little guy was best served by this man and his staff. I was encouraged. Certainly Casey was a little guy and this office was going to do justice by him.

A staff person gave me the name of the staff attorney who was handling the case. I called her and we talked for more than 30 minutes about my finding and its relevance to the case she was working on. She asked me to call her back, that she needed some time to process the material I had offered. I did. She was no longer available.

Many calls later she actually picked up the phone and was not cordial at all. There was nothing to be done, no relevance whatsoever in my offering. What had happened? The Honorable Mike Hatch intervened. So I tried again to see him. Many calls and a few letters finally forced a response, a letter on his private stationary with a terse comment of no thanks, I should try the new administration about to enter office. Maybe Republicans would be more open to my offering. A remarkable letter. A subsequent visit to his office found the brochure about the little guy gone. I failed to notice what happened in the State's case on behalf of Casey. I was now broken and scrambling to save myself from oblivion.

Mike Hatch cares nothing for the little guy. He puffs himself up daily but he is an empty suit, hollow at the core.

The National Pressure Ulcer Advisory Panel was formed in order to insure that only treatment of bedsores was deemed appropriate. The cash cow of the "woundcare industry" was bedsores in increasing numbers. Baby boom demographics insured supply and regulatory rules insured the severity of each case. A single stage four pressure sore can cost the health care system more than $25,000 to treat (some cases exceed $100,000) and the beauty of the existing system is that these conditions will recur after successful treatment as long as the person survives.

Now the National Pressure Ulcer Advisory Panel will deny vigorously that this is the purpose of their organization. They have long claimed to be be dedicated to the reduction of the numbers of bedsores. However their existence depends upon funding from the companies that provide the products and devices designed to treat existing bedsores. Medical professionals secured research grants and significant status by being "sponsored" by member firms. Any question that challenges the idea that bedsores are inevitable receives no welcome in this body. If bedsores were preventable by less costly means this entire coalition of health care professionals and industrialists would have no basis for existence.

What happened to the Hippocratic Oath? How did we get to this place where prolonging a persons agony in order to secure a steady income stream or a new clinical specialty was considered acceptable? And what about a public that sees the opinion of doctors and nurses as sacred? In my early life it was the Hippocratic Oath that secured my confidence in the medical profession. In my later life I discovered the very painful truth that this oath has lost its binding property to those whose claim to be practitioners. Something dreadful has happened. The "hollow men" are ascending.

My need to understand how and why bedsores could be responsible for a growth industry in the booming medical-industrial-complex led me to the biomed library at the University of Minnesota. I had a hunch to follow and much to learn. I picked the year 1965 (Medicare's inception) and several medical journals. I reviewed every issue for three items. First, articles about bedsores. Second, ads for products and devices designed specifically for them. Third, editorial comment on any issue that might shed light on the nature of the times.

There were days that found me transfixed from the moment the library opened until the doors closed at night. Much of what I read was disturbing, extremely so. But a finding emerged with a clarity that resonated loudly. This finding has never once been challenged by any healthcare insider. Most, with embarrassment, admit that it sounds quite true. Most then go completely dormant and realizing that I am a non-factor ignore me altogether. Something is amiss in managed healthcare. The Hippocratic Oath no longer obtains. Doing harm is lucrative as long as most of the victims are near death anyway.

The bedsore results from blood flow at the capillary level being occluded or stopped. The force of gravity is enough to stop blood flow at the capillary in tissue near the bone. We toss and turn in our sleep naturally in order that blood flow in occluded areas be relieved. Not all people are able to toss and turn on their own. They get bedsores, unless...

Bedsores were once rare. They are today very common. One in four of you know someone who is suffering or has suffered from them. This was not the case when the nursing profession was less professional. Before the inception of Medicare Dr. Michael Kosiak published results of his studies that established regular repositioning intervals of two hours as adequate preventive care for bedsores. Nurses new this anyway. Dr. Kosiak's work just validated their instinctual understanding. They were distributed in patient populations and accustomed to routines that meant bedsores were very rare. The literature mentions ratios of less than 3% of patients at risk. But something was about to happen to the nursing profession that would alter this dramatically.

The post-1965 years were full of articles about the runaway inflation in healthcare in general. The nursing profession was under assault and felt threatened with their very existence. So confident were we in the beneficial properties of technology that some wondered if nurses were needed at all. The nurses, taking a page from the book of how the physicians before them gained credibility, decided to pursue licensure with a vengence. Nurses would have to return to school in order to get baccalaureate degrees in the science of nursing. One third quit, one third went back to school and one third attempted to breech the gap at the bedside. When nurses returned with B.S. degrees and R.N. distinction they demanded more compensation and less menial labor. They became chartists and drug administrators more than hands that fed, bathed and cared for those unable to care for themselves. Healthcare specialization exploded and so did the numbers and severity of bedsores.

Medical device and product manufacturers filled this breech with a breathtaking array of items. All of these came with claims but the problem intensified. The flaw in the early analysis was the fact that patients were no longer being repositioned of a regular enough basis to prevent bedsore development. The system preferred to pay for technology more than people. Nurses demanded more and different work and capillary occlusion ate away healthy tissue near the bone of thousands of patients every year. The rationale given most often to explain these facts were that  the breakthroughs in medicine, particularly in technology had caused people to live longer. These conditions were therefore an inevitable consequence of progress. We would just have to live with it. As a prominent gerontologist once told me over lunch, "What does it matter if a person gets a stage four ulcer (tissue rot exposing bone) in the sacrum the last six months of their life?"  What indeed. The hollow men (and women) were making names and lot's of money. Baby boomers were entering the years when 25% of them would get bedsores and the math was most compelling. Nothing would stand in the way of this. Certainly not someone raising their hand and saying enough already.

My next post will reveal a surprisingly effective defensive measure the industry employed to secure this golden goose for the next 25 years.

My journey of discovery began the moment I set foot in the Hotel Fountainbleau in Miami Florida in April 1994. I was attending my first wound care convention and this was the big one. The convention floor was anchored in four corners by two big dressing manufacturers and two big specialty bed companies. Arrayed around the perimeter were tables laden with food and drink. Crowds of health care professionals, mostly nurses, fought for freebies of food and trinkets given away by salespeople hawking their wares. It was a shock but it set in motion a hunger to learn. My first question was how could bedsores generate so much money?

My company Universal Hospital Services Inc., had dispatched me to this convention to help our Florida District Office with our own exhibit. We were introducing our own specialty bed offering. Actually, we represented the manufacturer of a mattress overlay powered by a small compressor that had acquired a patent making it unique in important respects. The inventor claimed that his mattress overlay would reliably prevent the development of bedsores for a fraction of the cost of treating them. This claim sounded good to us but we as yet had no evidence to support it. That would come later. As for me I was just ignorant altogether.

Circumstance would provide me opportunity to spend many hours in the biomedical library of the University of Minnesota. I had a hunch. Something odd had happened to cause this explosion of demand for these products and services. The woundcare products catalogue listed over 2000 separate items. New specialists had been birthed to deal with bedsores. These conditions were no longer called bedsores but were now pressure sores or decubitus ulcers. What had happened?

I embarked upon a journey that led to a finding. This finding has never been seriously challenged. When its implications are realized the person receiving it concedes and often goes completely silent, refusing then to answer my calls.

The implications of the finding are enormous. One would hope that they are perceived positive as well but that has not been my experience. Bedsores consume billions of health care dollars every year to treat. There are no credible dollars dedicated to their prevention because conventional wisdom stipulates that this is not possible. But I can prove otherwise. That I am an antagonist is telling. Who benefits when the flesh around the sacrum of a person rots away?

It is my contention that bedsores represent a pristine reflection of healthcare's systemic quality. To the extent they exist in a healthcare setting we can assume that the quality of care delivered generally is questionable. To the extent bedsores are rare occurrences we can infer that the overall quality of care delivered in that institution is of a high order.

This idea is anathema to healthcare professionals, particularly the nursing professional. They believe that bedsores are an inevitable consequence of "improvements" in healthcare, the consequence of people living longer than they used to. I have experienced the attitude reflected in the comment of a hospice nurse who views the bedsore as a blessing that shortens the length of a persons suffering. "Compassion fatigue" can have perverse implications.

These early posts must necessarily involve me making my case by way of some setting the context somewhat, establishing some historical basis for my position. Ultimately, I hope to establish some interest in this issue and make it a real time, dare I say it, journalistic effort by commenting on the news as it breaks locally in Minnesota and nationally.

In my next post I will introduce the reader to who I am, how I stumbled upon this problem and what it has meant to me. I will introduce you as well to a few of the many "hollow men (and women)" I have encountered along the way. Modern managed healthcare is littered with them. The bureaucratic mind is hollow. That these are in the ascendency is a problem that may doom us all.

This being my first blog I will identify my purpose in entering this new media environment. My intent is to comment upon the trends in healthcare that warrant increased public scrutiny. My backround and experience of more than 25 years have led me to conclude that "managed healthcare" is not either. It has certainly failed in its original goal of controlling cost. And the quality of the care delivered is often found wanting as well.

My particular area of interest is the bedsore. This condition is a pristine reflection of systemic quality and the public knows next to nothing about it. The keepers of the gate prefer that. They depend on the publics ignorance, they have a baby boom generation to exploit first.  Perhaps, once this demographic is gone they can allow a more rational solution to intrude. But not yet. Bedsores generate billions in revenue annually. The "treatment" of the bedsore is the only acceptable modality. Prevention is not considered possible or cost effective. This is bunk.

A quantum paradox exists. Health care cost can be reduced as quality improves. This message is the point and purpose of this blog. I will develop it and endeavor to encourage others to comment and perhaps even act as a result. Bedsores kill and cost billions. The "mean sheets" need changing. We might start by eradicating the bedsore altogether.