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Show DAILY HERALD Sunday. September 1. 2003 Forests may not get thin, but bureaucrats will get fat Hospital Continued from E8 safely rounded down to zero. Her secretary put me through. I introduced myself and told her there was a blood pressure cuff in the screening clinic that I'd like her to fix. Flustered, she said she'd look into it. t. I went to the next room to find the portable one. It wasn't there, but I noticed that the cuff on the wall was broken, too. I called the secretary back, and that evening made three more calls, resulting in a request for disciplinary action against me. But times are changing. To-day, there's an organization that would like to hear my complaints: The Accreditation Council for Graduate Medical Education (ACGME). It's difficult to overstate the shock in the medical world last week when the news broke that ACGME had threatened to decertify the internal medicine residency program at Johns Hopkins Hospital It would be as if the American League told the New York Yankees they couldnt play baseball. It's inconceiv- Douglas Gantenbein SPECIAl TO THE LOS ANGEIES TIMES eorge W. Bush can surely pick a when he n backdrop. A year ago,Forests InitiaWl unveiled his U , Healthy tive, aimed at curtailing Western forest fires, his handlers arranged behind him a phalanx of Nomex-cla- d firefighters, not to mention a smoke plume from the 485,000-acr- e Biscuit Fire, the biggest blaze in Oregon history. Last month, in Oregon again to stump for his plan, he topped even that: The original site for his planned speech on fires was . on fire! That allowed him to do a flyover instead - it was quicker, and more ruggedly presidential. Upon landing in Oregon, he described the two fairly small forest fires as "a holocaust'' and called them "devastating." And he again outlined his solution: Cut down trees. OK, he calls it "thinning," which sounds pretty benign, and he also wants to whack some of the brush and smaller "fine fuels" that have stacked up in forests after years of fire suppression. But Bush is basically bor- rowing a riff from Ronald Reagan, who once blamed trees for causing pollution. In this case, Bush is blaming them for ' causing fires. rr . I have met a number of people in the fires are a natural event, not necessarily Forest Service, and I believe many of good or bad, but simply part of any forthem are knowledgeable about fire and est's life. And though people do cause want to do the right thing. But in Bush's fires, lightning is the main culprit, in the circle of Forest Service types - hunWest, at least. But no matter. Bush is building on an kered in their brick building just across the Mall from the White House -- the existing foundation, trumpeting the idea that we can do something about fires Healthy Forests Initiative probably has and insisting they're terrible, unnatural another name: the Forest Service Bureaucrat Lifetime Employment Act. things, y Bush's plan would be budgetary magic It's true that in some forests, such as for the Forest Service. In addition to those dominated by Ponderosa pine, it each summer's orgy of may well be possible to thin out enough excess trees and brush to allow fires to firefighting (many forest fires cost $1 million a day to fight, with no limits on resume their natural pattern of burning the checkbook), the agency would be through every 10 years or so, cleaning back in the timber business: planning . up dying trees and brush or saplings that thinning projects, managing same, probcompete for scarce water. But that's only one of many forest types in the ably building or rebuilding roads to ac' cess them. West. The reality is that the Forest Service Lodgepole pine trees, which burned so "experts" did much to create the present-da- y spectacularly in Yellowstone National Park in 1988, aren't designed to survive problem, first by stamping out fire. They're designed to burn to the many fires that would have naturally thinned out forests and by creating the ground every hundred years or so, to the extent that their cones often wont impression that fires are a problem that can be "solved." As icing, the agency release seeds unless they feel a hot blast gave fires a moral dimension through its of flame. famous Smokey Bear campaign. Its mesAlso, there are two points Bush ne--' sage: Fires are bad. And a corollary: Peo- gleets to mention. First, thinning is not conducted by forest rangers with hedge ple cause fires. The former notion is highly debatable; trimmers. It's done by loggers with damn-the-co- . .WIi.i.,,..i.wiM.i,WiM ot st I. inn. n.,,!....,. .,,.,,,.,.,,!. m.,,,,.,,,,.., chainsaws, and if not performed properly can damage soil and streams as well as leave behind a carpet of flammable debris. Some studies show that in certain forest types thinning may make fires worse. Second, thinning is not a one-shdeaL That's because the very trees and brush that are thinned immediately begin growing back, necessitating a repeat treatment every five years or so. Now, given the Forest Service's estimates -- 190 million acres that need thinning, maybe 2.8 million a year now getting thinned -- it will take more than 50 years to get the job done. And by then, four-fifth- s of what has been thinned will need thinning again. Meanwhile, fires will not have stopped. Drought, Kght-ninthe natural state of forests - all of that will ensure that plenty of fires still will burn. There's much to discuss in the realm of fire, forestry and humans. But it needs to be an honest discussion, one that takes into account the complexity of bc4h forests and fire's role on the landscape. Apparently, Bush just isn't interested in having that sort of discussion, g, : I Douglas Gantenbein is author of "A Season of Fire: Four Months on the Firehnes of America's Forests. Mitww,.ww,lw,,iwWWw,ww, .....,...,,., able. And yet it's happening because the American public (in the form of ACGME) is finally getting serious about the relationship between the working conditions of residents and the quality of medical care. Hopkins's infractions include having residents assigned to the medical intensive care unit be on call every other night for at least part of their month of duty. A resident on call especially in the ICU is likely to spend most of the night awake, wor-- v ried and working. Such a schedule is thought to wear down residents physically and emotionally. Significantly, ACGME cited some seemingly trivial problems it also wanted Hopkins to correct trivial, that is, unless you're on the inside. Specifically, it said the hospital should ensure that residents on call don't spend a lot of time in the middle of the right drawing blood and retrieving Hopkins has already changed its ICU scheduling, and is on its way to addressing the other issues. There is no way it will allow its accreditation to be revoked. The Yankees will stay on the field bet on it. Scientific evidence suggests that the status quo might be affecting patient safety. One study snowed that surgical complication rates were 45 percent higher when surgical residents doing the operation had been on call the night before. Another study snowed that staying awake 24 hours impaired psychomotor skills to the same degree as a bipod alcohol level of 0.1 percent, which is an illegal amount for driving in all 50 states. This got a further boost from a report in 2000 by the National Academy of Science's Institute of Medicine, which estimated that between 44,000 and 98,000 Americans die of medical errors each year. While it turns out those numbers are very hard to defend, few experts deny that many people die of mistakes that are actually not just theoretically preventable. Some arise from the actions or oversights of harried, tired or less than adequately supervised residents. Will it be possible to produce confident and assertive d physicians who have the sense of personal responsibility needed for the job if you don't make them do a dozen things in the middle of the night along with taking care of sick strangers? Will people push themselves when they have to if they don't have to very often? The answer possibly is no, although personally I think it is yes. But in one sense the question is moot. There's no going back to the old system. 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