- Associated Press - Monday, June 25, 2018

Minneapolis Star Tribune, June 23

Questions linger about emergency medical responders’ independence after ketamine report

Hennepin County must ramp up patient education on ketamine, not take defensive tone.

A year-old video of a Utah nurse roughly arrested at a Salt Lake City hospital after refusing a police officer’s request to draw blood from an unconscious accident victim still inspires outrage.

The incident spotlights another critical issue beyond police misconduct. The nurse wasn’t just defending hospital policy. She was standing up for the health care system’s historic separate authority in the public domain.

Caregivers are not an arm of the police department. Their mission is each patient’s well-being. When health care and law enforcement work together, the relationship must be carefully calibrated to maintain providers’ independence - a vital component of the public’s trust in these professions and institutions.

Recent Star Tribune stories on the use of a drug called ketamine raise important questions about whether lines of authority have become blurred at calls in Minneapolis served by Hennepin Emergency Medical Services (EMS).

The stories, based on a leaked draft of an internal city investigative report, revealed that investigators found troubling instances where Minneapolis police have urged paramedics to use the sedative as a chemical restraint. The stories also reported that “documented ketamine injections during Minneapolis police calls increased from three in 2012 to 62 last year” and that the drug may have been used on people already physically restrained or may have caused serious adverse reactions.

In April, paramedics complained about police pressure; county officials relayed these concerns to police. Hennepin EMS has also called for an outside review. These are welcome steps. But the county response has been marked by a defensive approach - including a June 20 commentary - and a clinical “we’re the experts” tone. What’s needed is a “we hear your concerns” approach that acknowledges fears about an unfamiliar drug and mounting tensions over police use of force.

This is a patient education responsibility on which the county-run health care system is falling short. Public outreach needs to involve more than a guest commentary. Yet not even the most basic step has been taken - putting information about ketamine on the Hennepin EMS website or the website for the county-run health care system, Hennepin Healthcare.

The county’s medical and political leaders also need to more vocally assure Minnesotans that they take seriously concerns about health care independence and are weighing steps to ensure it, such as including the issue in paramedics’ ketamine training.

All that said, satisfactory answers may be available. A physician representing the American College of Emergency Physicians - Dr. Howard Mell of the Chicago area - suggests that ketamine is commonly used by emergency medical personnel in other parts of the country and that 62 uses may be low for a metro area this size. The rise in the number of uses here could reflect responders’ growing experience with the drug, an older medication whose versatility and safety has led to its use in far-flung field medical stations.

According to Mell, explanations for using the drug on people already restrained could include the fact that physical restraints also carry risk. And that the drug’s benefits address internal symptoms of severe agitation such as hyperthermia and rapid heartbeat.

The responsibility to educate the public and review potential policy changes isn’t limited to just the Minneapolis police and City Council. The state’s largest county and its leaders must step up and do better.


St. Paul Pioneer Press, June 24

Pension progress this year, but Minnesota’s repair is not finished

Unanimous passage of a plan to help stabilize pensions for Minnesota teachers, firefighters and other public workers earned recent praise in this space and on other editorial pages around the state.

We called state lawmakers’ work a model for the way legislative bodies, political parties and the governor can work together.

We remain convinced that’s so while acknowledging perspective last week from the respected Minnesota Center for Fiscal Excellence.

According to an article in its Fiscal Focus newsletter at fiscalexcellence.org: “The celebration over this session’s primary political achievement shouldn’t distract from the fact it’s not a solution to our biggest fiscal challenge.”

Executive Director Mark Haveman acknowledges lawmakers’ hard work on pension reform over three sessions. The bill that resulted “has helped to stabilize the situation a bit, which is good, which is what needed to be done,” he told us. But “the bigger structural issues - transfer of potential risk and cost to future taxpayers, to future consumers of public services, to future public sector employees - they’re all still there.”

The center makes the case that there’s more work to be done at a time there’s little will to take it on.

“There is likely to be zero interest or appetite for doing anything more on public pensions anytime soon,” the article says. “Stakeholders view the results of this session as a destination, not a first step as part of a bigger reform journey.”

Further, Haveman told us, there are indications that this is going to be another very good year for market return - so that, too, can be expected to help put a damper on urgency. Depending on what long-term rate of return you assume, pension funding can appear rosy or rotten. Haveman, as are we, is concerned that the 7.5 percent assumed annual rate of return on Minnesota’s pension investments, combined with other assumptions, keeps the fund at risk.

In tackling the matter, there’s no lack of things to look at, he said. “The question is first coming to grips with the idea that we have to do something more than what we’re doing right now.”

Among his observations, Haveman expresses concern about “one of the things we do to make the numbers work” - the effort to “reset the clock” for repayment of unfunded liabilities.

The 30-year reset, according to the article, “is crucial to be able to bend the PowerPoint presentation graph lines in the right direction and publicly claim the existence of that fiscal unicorn: the ‘path to full funding.’ “

The result is “bad pension policy,” Haveman told us, describing it as “the de facto transfer of cost and risk to future citizens.”

“We’re effectively saddling future taxpayers and future public employees with the obligations we owe our current workforce,” he said.

It should be noted that in the debate on these pages about public pensions, we long have favored moving away from the “defined benefit” plan that most public-worker retirees enjoy to, instead - like much of the private sector - “defined contribution” plans, such as the 401(k).

Haveman also suggests a serious look at terminating cost-of-living increases “for an extended period.”

“That would make a very appreciable dent in the finances of these things,” he said, while noting that such a move “obviously would be met with tremendous resistance.”

“It would be decried as unfair for legitimate reasons,” he said, noting that “equity issues” abound in such discussions.

Another student of Minnesota pensions, Kim Crockett of the Center of the American Experiment, concurs with Haveman’s points of view, calling the article “spot on.”

Crockett - who describes the unfunded-liabilities “reset” to 2048 as “kick the can on steroids” - attended the May 31 bill-signing celebration at the Capitol with mixed feelings. She describes agreement on the measure as a political victory - “getting the Democrats and the Republicans to agree on something and getting the governor to sign it.”

“The problem is these are retirement funds,” she said. “I don’t know about you, but I don’t want my retirement funds to be a political compromise.”

Her efforts now, Crockett told us, will include a focus on younger public employees. Why, she asks, should they “be subsidizing a benefit most of them will never get?”

Recalling the celebratory nature of the bill-signing, Crockett said she and Haveman “have the unlucky role of throwing cold water in the faces of people who are jumping up and down, patting each other on the back and having a party.”

“Our job,” she said, “is to walk in and say, ‘Well, nice start.’ “

We appreciate the efforts of the Center for Fiscal Excellence in making a compelling case for the work still to be done on public pensions, and the risks of failing to act.


The Free Press of Mankato, June 23

Immigration rhetoric: American values put to test

We hope President Donald Trump isn’t aware of the racial and cultural animosity he is fueling with his immigration rhetoric. But we doubt that’s the case. His rhetoric seems deliberate and mean.

Trump’s recent Duluth rally shows we have a leader who would tear at the very cultural underpinnings of modern American society. We are a nation of immigrants. Always have been. Other than Native Americans, every resident of this nation comes from immigrant families. So it’s ironic and frightening that we now have a leader who would strike at America’s longtime strength.

America is great, and has been since its beginning, because everyone was welcome. No one religion, creed or governing style could dominate because there were too many people who would not and were not required by the government to comply. Thus, the United States was set up with freedoms never before given to people who didn’t have to bow to government to get them.

To be sure, a country that is constantly inviting strangers who adhere to unfamiliar cultures creates tension and at times violent episodes. But never before have we had a president and leader who implicitly argues the way our country came into being is no longer accepted.

Trump seems comfortable continually baiting his followers with straw man arguments, such as his claim that because of violent immigrants (MS-13 gang), no immigrants can be trusted. That the foot soldiers at his rally in Minnesota were willing to repeat his hate-filled speech “Lock her up” and “Build the wall” is troubling. He has no compunction about lying, as in his assertion that his political opponents favor “extreme” wide open borders as a pathway to murderers and rapists.

Trump knows the under-educated of his followers will connect these statements not because they are even remotely true, but because they assuage fear. Many a dictator has used fear to change a country’s psyche.

One was expecting Trump’s rally in Duluth to be focused on economic issues, like tariffs that are supported by iron mining interests in northern Minnesota. Instead, he relied on his standbys: race baiting, immigrant bashing and fear mongering.

So it seems even when Trump can legitimately claim an economic issue, he chooses to go the route of dividing a diverse America rather than uniting it. He chooses to strike at what made us great, supposedly to support his “Make America Great Again” agenda.

The sooner his supporters realize this, the sooner we can dispense with this man who is dangerous to American principles, the American way of life and America’s strength in its diverse people.

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