Tag Archives: Philadelphia

Resident Perspective: My Biggest Fear

This is the continuation of a series of journal entries depicting what it’s like to be a part of the COVID pandemic from the medicine resident perspective.

Monday, April 6th

Aside from the very real concerns over lack of personal protective equipment (PPE), ICU beds, and ventilators, I believe that the biggest cause for anxiety among healthcare professionals is not having answers. Traditionally, the public has turned to physicians during public health scares as they purportedly know how to approach all ailments. This virus is demonstrating that given all of our progress in the medical field from state-of-the-art imaging modalities to treatments utilizing personal genetic properties, we still can’t answer many basic questions about this new disease.

Philadelphia has a geographic advantage over many other regions in relation to the viral spread. We have an up-close view of the damage that the virus has wrought in New York without having nearly the number of cases or hospital burden at this time. The delay it takes for the virus to move westward globally and down I-95 not only allows us to stock up on PPE, prepare the hospitals, and practice social distancing, it also gives us the opportunity to analyze the studies that have come out of places like China and Italy. Although hospital beds in Philadelphia are now filling up with COVID-19 patients, it’s the barrage of images in the media of trashbag-wearing nurses, overflooded hallways and pleas from staff urging more supplies or more assistance that make this even more terrifying. The answers to our questions will come, but during the quarantine when each day feels like a week, data collection isn’t necessarily the issue — interpreting the data is.

As the pandemic ramps up in our region, the ever-present fear of not knowing which patients entering the hospital with upper respiratory infection symptoms are positive is anxiety-producing, not only because these patients can become sick quickly, but because it’s easy to let your guard down. When you know your patient is infected you know to be extra cautious. Also, determining whom to test prior to admission, given the tests’ continued scarcity, remains an issue, even as our own institutions’ guidelines continuously evolve.

In an ideal world we’d screen everyone and it would be an accurate test. However, right now we cannot screen everyone and we know the test has a high rate of false-negatives. Let’s say we do identify a COVID-19 patient through testing but who doesn’t require hospitalization. Our guideline for duration of self-isolation is just a recommendation as we simply don’t know if they are still infectious post-isolation. We can’t even tell patients that tested positive whether or not they are susceptible to getting re-infected, and if it will return in autumn; we can only posit given what we know about other viruses in these situations. Lastly, we don’t even have a proven treatment plan, only what experts surmise is the best approach given the information we have. Hydroxychloroquine, among many other proposed treatments, is still in the nascent stages of evaluation but the public wants answers quickly. This is not typically how the peer-review process works in academia as it often takes months to years to evaluate therapies. In this case public expectations need to be grounded to a reality in which even when expedited, implementation of new practices moves at a seemingly-glacial pace.

Residents get daily updates regarding our own institutional policies as well as new relevant findings that could be practice-changing. It’s amazing seeing the sausage being made, but it’s also terrifying because the Attendings and veteran physicians that we as trainees look to for answers are now looking to each other for answers and opening the floor to all ideas.

The good news is that while we don’t have the answers yet (and we may never have all the answers), we can take comfort in knowing that we are in the golden age of data- and knowledge-sharing. Pooling the resources of physicians, epidemiologists, researchers, and statisticians internationally has allowed us to make great strides in our understanding of COVID-19 in a relatively short time, and work toward mitigating our greatest fear – the unknown.

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Filed under coronavirus, Pandemic, Residency

Feel the Bern and Vote for These Philly Judges on Tuesday, May 21

Last Sunday, Bernie Sanders published an op-ed decrying America’s system of criminal punishment for “effectively criminalizing communities of color.” Noting efforts already underway to end cash bail in Philadelphia under the leadership of community organizers and District Attorney Larry Krasner, Sanders urged “the citizens of Philadelphia [to continue this progress and] cast their votes for progressive judicial candidates in this month’s primary election.”

Voters can choose up to 6 of the 28 Democrats running to be a judge in the Philadelphia Court of Common Pleas. Knowing that Philly residents compelled by Bernie’s op-ed may be wondering who deserves their vote on May 21, I asked my sister Hannah, who closely follows criminal justice issues and is my moral role model, to provide specific recommendations. Hannah is currently getting her Master’s in Social Work from the University of Pennsylvania. She has extensive knowledge of the Philadelphia court system through both her past job in the public defender’s office and the activism she engages in with a variety of social justice organizations around the city.

Because Philadelphia’s Democratic judge pool leans conservative, there aren’t any candidates Hannah enthusiastically supports. There are, however, three judges she finds good enough to bullet vote for: Anthony Kyriakakis (#19 on the ballot), Tiffany Palmer (#23), and Kay Yu (#27). I have provided brief descriptions of those three candidates below.

Voting recommendations for Judge of the Court of Common Pleas in Philadelphia

#19, Anthony Kyriakakis (5th Ward): A lecturer at Temple Law and Penn Law, Kyriakakis is a private defense attorney and former prosecutor who says incarceration rates are too high, sentences are too long, and defendants are treated unequally along racial, gender, sexual orientation, gender identity, and class lines. He has been interested in representing low-income defendants since his time with the Harvard Defenders at Harvard Law and volunteers as a pro bono Child Advocate in family court. Campaign website: https://anthonyforjudge.com/

#23, Tiffany Palmer (9th Ward): A daughter of public school teachers, Palmer began her career in 1998 as a public interest lawyer at the Center for Lesbian and Gay Civil Rights and soon became the organization’s legal director. She co-founded the private family law firm she currently works at in 2003 and has won numerous awards, including being named one of the nation’s “40 Best LGBT Lawyers Under 40” in 2011. She says her “own experience with having her long-term partner treated as a legal stranger has shaped her commitment to fairness, inclusion, and equal treatment under the law.” Campaign website: https://palmerforjudge.com/

#27, Kay Yu (15th Ward): Yu’s own experience as an undocumented immigrant has informed her advocacy for increased ballot access and voting rights. While she is an employer-side lawyer in private practice, she has also chaired the Philadelphia Commission on Human Relations for four years and worked to update Philadelphia’s civil rights policy. She won several awards in 2018, including being named Attorney of the Year by the Asian Pacific American Bar Association. Campaign website: https://www.kayforjudge.com/

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Filed under 2020 Election, Poverty and the Justice System, Race and Religion, US Political System

Striking SEPTA Workers Deserve Public Support

On Friday, a judge denied an injunction request from Southeastern Pennsylvania Transportation Authority (SEPTA) management, who wanted striking SEPTA workers, represented by Transport Workers Union (TWU) Local 234, to be forced to go back to work.  The judge made the right decision.  At a follow-up hearing on Monday at 9:30 AM, the judge should stand firm, as TWU Local 234 has every right to strike and is justified in doing so.

The union, which represents a group of bus drivers, trolley operators, mechanics, and other transit workers whose base salaries seem to max out around $70,000 a year, has been trying to negotiate a new contract with SEPTA for months.  The union was unhappy with a potential increase in their health care premium contributions – from about $550 annually to a little less than $4,800 annually – that would have coincided with some increased co-pays.  They’ve also been bargaining to improve their pensions, which have long been less generous than both the typical public pension and the pensions SEPTA managers receive.

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Perhaps most importantly, the union has asked for scheduling changes that would improve safety for workers and customers alike.  Bus operators can currently be required to work 16 hours in a day or 30 hours in back-to-back days and may only get 15-minute lunch breaks.  They have inadequate opportunities to go to the bathroom and can’t sleep on-site in between their unpaid breaks, which creates a major problem for drivers with commutes.  SEPTA management has thus far insisted that their scheduling practices are necessary for “flexibility” purposes, despite the fact that research on sleep and crash statistics recommend against them.

So while SEPTA management may have reduced the magnitude of their proposed hike to health care premiums and offered some salary increases since the strike began, those who believe in worker rights, economic justice, and public safety should be firmly in the union’s camp when it comes to negotiations.

Some Democrats seem to have sided instead with SEPTA management, which has “argued the strike was keeping children from school, making travel around the city difficult for people with disabilities and those in need of medical treatment, and threatening to disenfranchise voters in Tuesday’s presidential election,” as reported by Philly.com.  Former Pennsylvania Governor Ed Rendell, who appears particularly worried that the strike will depress voter turnout on Tuesday and be “a real plus for Donald Trump,” has even argued that the state legislature should take away SEPTA workers’ right to strike in the future.

The problem with this formulation, however, is that it ignores both the power differential between labor and management and which of those two entities is more likely to be on the public’s side.  Union members risk a lot when they go on strike – their jobs and their pay are on the line.  They don’t decide to strike lightly, and TWU Local 234 made this decision because, as their president Willie Brown has said, “It’s the only tool [they] have available to [them].”  Binding arbitration (when both parties to a negotiation submit their offers to a neutral third party who makes a final decision on which offer to go with) can be an effective alternative to strikes for public sector employees, but while Brown “said he would be willing to go to binding arbitration to avoid a strike[,] SEPTA officials said…that wasn’t an option they were willing to consider.”

Note also that, for all the hand-wringing about union members supposedly not caring about the election, many of its members plan to volunteer to help get out the vote on election day (for the record, TWU Local 234 has also endorsed Hillary Clinton).  SEPTA Board chairman Pasquale Deon, on the other hand, has contributed thousands of dollars to Republican Senator Pat Toomey, whose record includes strong support of the Pennsylvania voter ID law that was struck down as unconstitutional in 2014.  Deon also donated to two Republican presidential candidates – Wisconsin Governor Scott Walker and New Jersey Governor Chris Christie – whose careers are characterized as much by defunding poor kids’ schools, denying people access to the medical care they need, and constructing obstacles to voting as they are by virulent anti-union crusades.

To summarize: Pasquale and the rest of SEPTA management chose not to engage in good-faith negotiations.  They chose not to go to binding arbitration.  And their rhetoric is belied by the other causes they support.  Yes, having public transportation up and running on election day would be ideal, but those worried about whether that will happen should be applying pressure to Pasquale and his friends, not complaining about bus drivers’ efforts to secure affordable health care, improvements in their retirement security, breaks long enough to catch some sleep in between shifts, and enough time to use the bathroom during the workday.

The outcome of Monday’s hearing is ultimately unlikely to matter much in Tuesday’s election.  Philadelphia policy “prioritizes spots [for polling places] within walking distance of people’s houses,” as The New Republic noted in 2008, and officials overseeing Philadelphia’s elections have pointed out that a 2009 strike did not depress turnout in that year’s local election.  Lyft and Uber are offering free rides to the polls that day, there are services connecting volunteer drivers to people who need rides, and the governor always has the option to extend voting hours if a lack of public transportation turns out to be a major voting obstacle.

What Monday’s hearing will impact, however, is TWU Local 234’s bargaining power.  More generally, people’s attitudes about the strike will impact the future of organized labor, an institution that raises wages for members and non-members alike, boosts opportunities for kids, and advocates broadly for the interests of low- and middle-income people.

The ethics are on the union’s side.  The public should be, too.

Update (11/7/16): SEPTA and TWU Local 234 reached a deal before the follow-up injunction hearing and the union will be back at work during the election.

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Filed under 2016 Election, Labor