THE DEATH OF KLINGHOFFER, THE OPERA, - AN ABOMINATION OR ART?

THE DEATH OF KLINGHOFFER, THE OPERA, -  AN ABOMINATION OR ART?

The prestigious Metropolitan Opera House has created somewhat of a furore with its latest operatic production,The Death of Klinghoffer. The criticism has been that the opera represents overt anti-Semitism and glorifies terrorism. There were protests against the production lead by many key New York politicians including the present Mayor De Blasio, Mayor Guilianni, Governor Cuomo, Governor Patterson and New York Congressmen. The staging of this drama once again raises the age old debate relating to politics and art. On the one end of the spectrum are those who believe as long it is art or purports to be art anything goes. Conversely there are those who maintain that art cannot be divorced either from the artist or from what the art claims to represent. 

ART AND POLITICS 

This discussion relates to the performing arts as the visual arts have unashamedly been used throughout the centuries to depict political and religious events and ideologies. It is also accepted that political connotations have been associated with the performing arts from time immemorial. As one is on the topic of anti-Semitism the most prescient example that springs to mind is the operatic genius Richard Wagner. During the World War 11 virtually every allied country took the decision to ban any production by that German composer. While it can be certainly argued that Wagner’s operatic content did not contain any overt anti semitism he was an avowed jew hater and even more significantly, Hitler was so obsessed with his music that it in effect became the anthem of Nazi fascism.  Hitler made no pretense as to the political significance of music. To hammer home his point the Nazis outlawed any non arian performer. Only three composers made the grade in the Third Reich - Beethoven, Bruckner and of course Wagner.

By and large there is an acceptance that the arts and politics are inextricably bound either by the behavior of the artists and composers or by the content of their musings. Even the Beatles were the subject of the church and certain governments’ wrath when they proclaimed that they were more popular than Jesus. All their music was “verboten” in certain countries such as South Africa following upon their provocative claim. 

THE CINEMA AS AN ART FORM AND POLITICS

Nowhere is the concept that art is value loaded than in the visual performing cinematic arts. Jay H. Ell has always believed that the USA’s greatest contribution to civilization and the arts in the twentieth Century will be its perfection of the movie as an art form. Here there has been no pretence that both the content of the art and the artist him or herself has a political persona. If one looks at the productions, and here examples are so many that personal bias comes into the selection, there are legion. Stanley Kramer’s Judgement at Nuremberg emphasized the abrogation of moral and legal responsibility of the German Judiciary in legitimizing and carrying out the racial laws of the Nazi regime. Spielberg’s Schindler’s List showed that the ordinary citizen had choice as to whether or not he collaborated with the Nazis and his heroic efforts to save Jewish lives.

It is interesting to note that Stanley Kramer as a producer and a director was responsible for some of the most politically and socially evocative movies of his time. In addition to Judgement at Nuremberg, there was Inherit the Wind, which examined the issues of evolution versus creationism, Guess Who Came to Dinner focussed on the topic of racial prejudice way ahead of its time and High Noon delved into the dilemma of doing what was right even at the risk of one’s own life. The latter was interpreted as Kauffman rebelling and standing up against the fascism of US Senator Joe McCarthy who in his crusade against communism conducted a vicious smear campaign ruining the lives of many by his guilt by association.

So there is little doubt that the performing arts, since time immemorial, has been considered to be value laden and could never escape criticism by claiming that it just represented art for art’s sake. Jay H.Ell will not look at the other many examples of the impact cinematography has on the values and mores of society, leaving that perhaps for another occasion, rather he will concentrate on the content and the values that The Death of Klingoffer evokes. 

THE NARRATIVE OF THE DEATH OF KLINGHOFFER

All this is by way of introduction in relation to the criticism that the Metropolitan Opera House has faced as a result of their decision to feature the opera,The Death of Klinghoffer, in prime time in the number one operatic venue in the world. Klinghoffer, written in 1991 would have slipped into oblivion, as that was where it was, had the New York Metropolitan Opera House not resuscitated it thirteen years after its unremarkable and forgotten debut.

Briefly, the story, as narrated in the Playbill of the Metropolitan production, is an account of the highjacking, by terrorists of the Palestinian Liberation Organization, of an American Holiday Cruise Ship the Achille Lauro. The narrative of the opera accepts that the hijackers do not want to make peace, are frustrated that their ransom demands are not being met and are antagonistic to Jews and Americans. It further details that the handicapped Klinghoffer, who is wheelchair bound, professes that he normally avoids trouble but he denounces the hijackers. The hijackers subsequently shoot him and throw his body overboard while the widow, Mrs. Klinghoffer, on learning of these events is inconsolable.

The consensus impression of the production is that it glorifies terrorism, is empathetic to the PLO cause and therefore this terrorism and murderous act. So at question here is not the artist per se but the content of his art.

THE METROPOLITAN INTERPRETATION OF KLINGHOFFER

The  Metropolitan and the Klinghoffer Director, Tom Morris, defended the production on a number of levels. Firstly, they maintained that one should see the production before judging it. By offering this explanation they were implicitly arguing the case of the art for art sake, that as has been contended above has not stood the test of time. To further support the art for art sake exchange the Metropolitan explained that they have championed the work of the composer John Adams as one of America’s greatest living composers. They continued along this line by maintaining that the Met is committed to presenting the finest works across the operatic repertory, as well as increasing the accessibility and relevance of the art form. The Metropolitan continue, “Since this opera dramatizes a horrific act of violence, the Met acknowledges that some members of its audience may disagree with the decision to present this work and the Met would like to assure its audiences that it is not endorsing any political views expressed in the libretto.” 

In the latter disclosure they are admitting that there are political views in the opera which they do not endorse.By way of justification they offer, again and again, the “art for arts sake” justification.

In addition in the above explanation the Met distorted the criticism they they were facing. They were being accused of glorifying terrorism and perpetuating anti semitism. They conceded that their accusers have validity in their gripe by conceding, “Please know that after an outpouring of concern that its, (The Metropolitan's), plans to transmit John Adams's opera The Death of Klinghoffer, might be used to fan global anti-Semitism, the Metropolitan Opera announced the decision to cancel its Live in HD transmission, scheduled for November 15, 2014.” Apparently it is acceptable to “fan” New York anti - Semitism but not in the rest of America and  the world.

Morrison in an interview further straddled the art for art sake mantra by stating, “It is fascinating that conversation ranges so quickly from detailed discussion of the production into the political context which is so fraught and which is still an ongoing global struggle.” Again the latter implied a justification of terrorism and murder as a solution to the “ongoing global struggle”.

It is fair to argue that the Metropolitan Opera House have not convincingly answered their enraged denouncers. One the one hand they offer the discredited “art for art sake” rationale and on the other they acknowledge that the opera has political views, that they do not endorse, and that the production could engender global anti - Semitism.

CONCLUSION

One wonders what the Metropolitan Opera establishment were really thinking. As the foremost proponent of the performing art of opera in the world they have to know what a politics 101 student is aware of - that art is not neutral. To give a platform for this blatant anti -Semitism and glorification of the murder of innocents in is at kindest naive and at worst tendentious and fascist. The highjacking of the Achille Lauro has significance in the terrorist world in that it marked one of their first indiscriminate acts of global terror on non combatants of other countries. Also to produce this in New York where there are still holocaust survivors and the greatest concentration of jews outside Israel is insensitive beyond belief. 

One has to come to the inescapable conclusion that those that gave the go ahead for this production, which incidentally several of the critics have not given the same high artistic bouquets that the Met have accorded to it, had to be aware of the outrage it would evoke and couldn’t have cared less. They were then supposedly taken aback by the response to it and withdrew from broadcasting it to the world lest it “fan global antisemitism”. Their response was to little to late. Whether they like it or not they have made a dangerous political statement. It is common cause that the lunatic fringe are recruited to Muslim fundamentalism by any propaganda that gives them reassurance that they have a cause. Being empathetic to those who, in cold blood, in “the ongoing global struggle”, murder a jewish cripple in a wheelchair who is on a holiday cruise is worse than irresponsible. 

One is also mindful, as the opera’s program indicates, that the Met receives a large amount of public money. Also there are those that donates literarily millions for the arts. If they support this will they support, for example, a future work by John Adams, who the Met “champion as one of the greatest living composers”, in an opera depicting an ISIS beheading where it reflects the “ongoing global struggle”. Or if Adams penned a work where animals were tortured would they then argue about the merits of the art and artist and claim that they do not agree with its content!

It might be a good idea, now that Adams has entered the political arena for him to follow up with a sequel to Klinghoffer entitled The Death of Reheynah Jibarri who was hanged in Iran this month. According to Amnesty International she killed her employer, a member of the Iran’s Intelligence and Security Department. She argued that she did this in self defense as he attempted to sexually assault her. Besides being tortured and held in solitary confinement, Amnesty  International reports that the investigation into the incident was flawed and the trial unfair. This is one of a spate of executions that have occurred since the so called moderate Rhohani has been elected President. 

Jay H. Ell will never ever be able to attend an opera in that iconic theater in New York with its breathtaking chandelier, its sweeping stair cases, its glass walls that makes it seem to spill out into the plaza outside thereby connecting the interior to the fountain resulting in a flowing panoramic vista and the incredible Chagall murals that bedeck its walls, without being reminded of the fact that as a new global antisemitic wave was sweeping across the world, the leading Art Center in America, by their own admission, fanned the flames. Shame on them. One can take  some solace at the almost unanimous condemnation of their action and hope that the matter does not rest there. 

Finally, what surprises Jay H. Ell most is the fact that the donors to opera are not up in arms or are they just worried that they won’t be invited to the company party? 

COME BACK NIXON ALL IS FORGIVEN

Watergate is considered the watershed event in modern American politics. It is the all time low that all scandals are measured against. The impact of the shame it engendered has resulted in every subsequent political calumny having the suffix “gate” attached to it. In its wake followed the only resignation of an American President and the subsequent election of a neophyte nonentity, Jimmy Carter, whose major credentials were that he was “squeaky clean”. The abuses inherent in the Watergate infamy resulted in major campaign finance reform in 1974, almost contemporaneously with Nixon’s ignominious exit, that limited the amount an individual could contribute to an election campaign. A loophole to that law allowed corporations to give any amount of money not directly to candidates but to political parties and Political Action Committees, (PACs). That escape clause was closed by legislation that expressly forbad that activity in 2002.

As a result of a series of sad, 5 - 4, Supreme Court decisions, to quote the Republican Senator John McCain, “We have come full circle back to Watergate”, thereby making every illegal campaign financial action Nixon perpetrated lawful under the current edicts of the Supreme Court. But the whole sordid saga needs retelling as it made for gripping drama that half a century ago and held a nation spellbound for years as they watched it all unfold on non stop television….

A BUNGLED BURGLARY STARTED IT ALL

What catapulted the whole saga into prime time, was what Nixon’s press secretary’s termed,  “A third rate burglary” . The latter set off a chase that unraveled into tens of individuals being sent to prison and endless court hearings that went to the very heart of a democracy. The “burglary” was on the Democratic headquarters in the Watergate Hotel in Washington and the main objective was to bug the Democratic headquarters. Five individuals were charged with the crime and initially all plead guilty, as it would turn out, under duress and for money. One of them was found linked to a check of $25,000 issued by a member of the fundraising Committee to reelect President Nixon, (CREEP). The donor was Ken Dahlberg a war time hero, who ironically was the only member of that committee not to face legal proceedings. All of the five burglars had direct or indirect connections with CREEP. It was subsequently learned that CREEP, in addition to its legitimate activities, garnered tens of millions of dollars illegally, and $500,000 of it was used to shut the burglars up. However, the burglary assumed a secondary place to the slush money as the Washington Post’s famed reporters took the advice of their anonymous inside informant, “Follow the money”.

One by one Nixon’s staff, several of his administration, including Cabinet Members and nearly all the members of CREEP were implicated and were sentenced to jail terms. His Chief of Staff, Haldeman. Chief Aide, Ehrlichman, and Counsel Dean were all involved. There were Court hearings presided over by Judge Sirica who suspected a major conspiracy. His instinct proved correct when one of the burglars, Jim McCord confessed that the burglars had committed perjury and that they were covering up the roots of the crime. John Dean, Nixon’s Council spilt the beans to the investigating Senate Committee chaired by the avuncular Sam Ervin, who had overnight became a TV folk hero. As the proceedings evolved Dean’s testimony was negated by what was left of the Nixon camp. In yet another dramatic moment Alexander Butterfield, a relatively lowly placed White House assistant, told Ervin’s committee that what had transpired could be verified one way or another by the “tapes” as everything that happened was recorded. This was political theater at its best.

Dean, who served a prison sentence, maintained he was coming clean to protect the integrity of the Presidency. He dramatically pronounced that, “There was a cancer in the Presidency”. He maintained that he was blinded by ambition and this allowed him to be party to all these excesses.

AMERICA’S FINEST HOUR

The behavior of President Ford, who had been unwittingly thrust into the Oval Office, Congress, the Supreme Court, governmental agencies and the media during this seedy affair is in total contradistinction to the self serving circus the American Public are being subjected to now. The media lead by the Washington Post’s owner Katherine Graham, Editor Ben Bradlee and the reporters Bob Woodward and Carl Bernstein relentlessly pursued the truth as did the three media television networks. Their news anchors, including the legendary Walter Cronkite, unflinchingly, told it as it was. Their universal mantra was democracy was being placed on the block and was being sold to the highest bidder. All the media were ad idem the American ideal of democracy was at stake.

Congress conducted itself in a highly professional manner to this assault on liberty. The Senate in a bipartisan vote, 77 - 0, established an investigative committee into Watergate. The House Judicial Committee in a bipartisan decision elected to send impeachment articles to the House of Representatives. Three Republicans, House Minority leader Rhodes, Senate Minority leader Scott and Republican Godfather, Barry Goldwater approached Nixon to persuade him to resign, rather than face a bipartisan vote of impeachment. There was a value higher than partisan politics. This whole episode sucked to kingdom come and the interests of Jeffersonian democracy were on the hook. Congress followed up the sordid episode by attempting to prevent a similar occurrence by enacting electoral reform in 1974.

The Supreme Court, much to Nixon’s chagrin ruled against him again and again. The Court ruled 8- 0, with Justice Rehnquist abstaining, that he produce the tapes that would ultimately sink him. Nixon wailed that it was a betrayal by the Judges that he had appointed. Chief Justice Burger, a Nixon appointee, thought otherwise.

The legal system vigorously pursued every avenue to right the democratic ship. In addition to the highest members of the Nixon administration, the latter’s most important staff members and the paid “plumbers”, who were employed to perform this and other illegal activities on Nixon’s behalf, were all prosecuted to the full extent of the law. The Corporate contributors such as the Dairy Board, Coca Cola and American Airlines, were convicted for their illegal donations to CREEP. American Airlines claimed that they were given the shake down and threatened lest they not contribute.

President Ford bravely pardoned Nixon to end this painful period in American history as he reckoned that perpetuation of this sleazy episode in America’s would further tear the country asunder. At the time it was a highly unpopular decision and Ford was alone in his judgement as he had deliberately not sought support of his resolution. It is common cause that Ford lost the 1976 election to Carter in consequence of that choice. History has judged that Ford made the correct decision. No focus groups or polls on the subject influenced him. He acted according to the dictates of his conscience and what he correctly believed were in the best interests of the country. Years later both Archibald Cox the Special Watergate Prosecutor that Nixon fired and Leon Jaworski, Cox’s successor, both reversed their initial judgements and agreed that Ford was correct. Nothing would be achieved by dragging Nixon through the courts and perpetuating this two year upheaval - the point had been made and in Ford’s historical words, “It was a time for healing”.

The Founding Fathers had been vindicated. The system had worked. All three branches of Government had put their responsibilities to democracy ahead of partisan politics. America could move forward. All this is in sad contradiction to the situation we face today.

WATERGATE’S CENTRAL ISSUE - MONEY AS THE DEFINING FACTOR IN POLITICS

The New York Times ran a retro report under the byline “The Cost of Campaigns” juxtaposing the current situation to the Nixon era. It is thus fair to say that the key issue in Watergate was not the burglary per se but the unlimited money that made these calumnies possible. This is certainly the way society interpreted the controversy at the time and Congress acted post haste. Congress introduced legislation, the Federal Campaigns Act of 1974, that limited the amount of money that individuals could contribute to a campaign and declared corporate donations illegal. Ford signed it into law in 1974. The belief had to be that money had been eliminated in the pursuance of a democratic society and the Founding Fathers had to have sounded a collective sigh of relief from their graves. All those deliberations, soul searching and endless papers had borne fruit.

NIXON IN RELATION TO TODAY’S CLIMATE.

When one reflects on the current response to the same challenges society faced under Nixon there has to be a sense of disappointment. There is a triple assault on the democratic process. Central to this threat is the introduction once again that money can rule supreme in the democratic process. As a supporting cast to this hypothesis is a Republican Congress caucus that unashamedly is just opposing an incumbent President rather than consider issues on their merit. Finally, the third leg of this trifecta is assailing the very basis of democracy, unashamedly impeding the right of those that probably oppose your philosophy, the ability to vote.

Remember the central issue of Watergate was what role should money play in politics. To capsulate the response of the three branches of Government’s to this question, was that it should be peripheral to the outcome of the political process. What is the interpretation of this dilemma of today’s government?

It is painfully obvious that the Republicans are only too happy, with their financial advantage, and believe that money should play a central role in the political process. They are supportive of unlimited money in the mix. The Democrats, in particular the President, has opposed this scenario.

The three issues with regard to campaign finance that the 1970 society, through all the branches of government, declared were inimical to the democratic process, were Corporate, Secret, and unlimited contributions . They criminally sanctioned those who were responsible for abrogating those tenets mercilessly. All these precepts have now been negated. Corporate and unlimited contributions, whether they or secret or not, are now the order of the day. Their legality has been sanctioned by the Supreme Court in a series of staggering judgements. Firstly they ordained that Corporations were individuals and had the rights of individuals. Then they maintained that free speech was equivalent to money. This paved their Citizen’s United edict where they gave corporations the green light to contribute unlimited sums to PAC’s and secretive 501(c) 4’s. This was followed up by the McCutheon ruling that allowed unlimited money to be given to candidates themselves by individuals. This all in the name of free speech.

The Supreme Court have gone further in the destruction of what have been perceived in the last century  as fundamental democratic principles. They have interpreted the Constitution to allow States to impede the right to vote. This is a hard sell of a provision that is mentioned far more  than any other in the Constitution and is regarded as a right and not a privilege. The two sets of decisions have had the effect of disadvantaging the poor and favoring the rich.

To Jay H. Ell’s limited constitutional knowledge this is all tautologous nonsense. The very underlying essence of the Constitution is equal rights for all and nowhere is this linked to property accumulation. How can a corporation assume the rights of an individual, for example? Can you put a corporation in jail for a felony? A rich owner of a corporation has in effect two sets of money he can use to impact on “fair and free” elections - his and his shareholders.

AMERICA  AT THE CROSSROADS

America democracy is at the crossroads and in the next few years the fight will be to maintain it or unceremoniously slip into a plutocracy. (Blogs: “Why The GOP 2014? - It’s The Plutocrats, Voter Suppression and Obamacare Stupid”, "2014: Dems and GOP ’s Conflicting Strategies”, “2014 Elections: Who Cares as the GOP are Dying Anyway?’” and “Election 2014: It Aint Over Till The Fat Lady Songs”. This election and the next will decide the fate of American civics.

Meanwhile poor paranoid Nixon must be cursing his luck at having been born fifty years to early. He wouldn’t have had to hide all that money today as all of it is perfectly legal. Nixon would have not have to wail at the present Supreme Court. As for the almost forgotten burglary - the technologies available and the Government’s powers make them unnecessary today.

So all that wringing of hands and soul-searching of the seventies has come to nought. There has been a regression to Nixon standards that is once again threatening the US Democracy, much as Watergate was universally perceived to have done then. 

ELECTIONS 2014: IT AINT OVER TILL THE FAT LADY SINGS

As Jay H. Ell has been blogging, the 2014 midterm elections are a crap shoot - nobody really has a clue as to how the cookie will crumble. (Blogs: “Why the GOP in 2014? - Its the Plutocrats, Obamacare and Voter Suppression Stupid”, “2014: Dems and GOP’s Conflicting Strategies” and “2014 Elections: Who Cares as the GOP are Dying Anyway”). 

Briefly, the burden of Jay H. Ell’s message has been:  On the face of it, the fragmented GOP, who have no policies to offer, should not have a ghost of a chance; However, the midterm elections and the demographics of them coupled with GOP money, voter suppression and the hatred of Obama had served to make the GOP outright favorites. Favorites to the extent that it was the consensus of the pundits that the it was all over bar the shouting and the GOP would take over the Senate;  Finally, as this all boils down to mobilizing the base of the respective parties, who really knows what will happen? In this fluctuating environment the pendulum now appears to be giving the Democrats a chance of holding the Senate but as Jay H. Ell’s life does not depend on it he would not bet a dime. 

The Senate elections are not the only feature on the card as there are, also of importance, the House of Representatives and the Governorships that are being contested. Of this trifecta the only one that isn’t raising any interest at all is the House. The 2014 midterms are a long yawn to the majority of the electorate, the latter having given up on Washington. Their disdain is juxtaposed with the frenetic activity of the two parties who are wrestling frantically to wake up their stuporous bases in an effort to drag them to the polls. Record amounts of money have been spent in attempt to motivate a tiny number of citizens to perform their patriotic duty by exercising their franchise. 

Jay H. Ell believes that the GOP is in the end stage of a terminal disease and win lose or draw they will be annihilated in the 2016 election. But as they have not reached Kubler Ross’s fifth phase of the emotions of a dying patient, namely acceptance, and are stuck in the first stage, denial, the charade continues. At best the Republicans can hope for is to live another two years. Having made that declaration, Jay H. Ell will proceed with his thesis that these elections can go anyway.

THE SENATE

Ostensibly the Republicans were going to win the Senate in a cakewalk. The pundits said it as did the polls. Not that too many are listening to those either, excepting the addicted like yours truly. Nate Silver, who is close as you can get to Nostradamus on these matters, rated the Republicans a sixty - eight percent chance of so doing for most of the run up to now. Fox News has never hesitated and is still running their competition as to which seats the GOP will pick up in their march to continue to do nothing. Because if they try to do anything substantive, like give an alternative health care plan, frame immigration reform, revise the tax code, for example, they will precipitate the long awaited split of the Party. So whatever the outcome they will carry on attacking the President and try and reverse Obamacare and leave it to the Supreme Court to enact the laws of the country.

The Race

To recap, there are 36 Senate seats up for grabs. The Republicans need to win six Democratically held constituencies if they are going to control the Senate. Conventional wisdom ordained that they had three in the bag - South Dakota, Montana and West Virginia with one almost certain, North Carolina. This meant they only needed two more and the prize of the mummified Senate would be theirs. (To this day no one has explained to Jay H. Ell what they were going to do, with fifty - one votes that the Democrats couldn’t do with fifty - five). Continuing with this argument the Republicans needed only two of Georgia, Louisiana, Alaska, Arkansas, Iowa, and Colorado to obtain seven Democratic seats. The champagne corks have been popping nightly in anticipation.

So what is going wrong?

The Fat Lady Has Still Got To Sing

Well to start with three of the GOP held "safe" constituencies have been taken out of the bank and are on the block. Both in South Dakota and Kansas the GOP candidates are facing a momentum that threatens to overtake them in the polls. In South Dakota there are three candidates that have more or less split the vote three ways. The other two are an independent Republican, who has voted for Obama on two occasions, and the Democrat. The Democrats will pour a million into that race attacking the complacent Republican, in the belief that whoever else wins it is a victory for them. In the Republican stronghold of Kansas the weak incumbent, backed by the not inconsiderable Republican war chest, is fighting to stave of a challenge by an Independent Republican, who is committed to back the winning side. (This gives the Dems the edge as if the Senate is 50 - 50 Biden becomes the casting vote). In addition to these two sudden “certainties” unravelling, Kentucky, a Republican held seat is literally a toss up, with a plucky assault by a highly capable charismatic but politically “unstable” candidate, Alison Grimes.

To get back to the other seats that are all technically deadlocked. In North Carolina the Democratic candidate still holds a slender lead. Then the Democrats maintain, more in hope than sincerity, that they are slightly ahead in Georgia, Louisiana, Kentucky and Arkansas in addition. 

The Math.

If the Republicans lose one of Kentucky, South Dakota or Kansas, the latter two had never even in contention till now, they have to win an additional five seats from the Democrats to be in control, (the GOP look certain to wrest Montana and West Virginia from the Dems ). With the current polls all over the place the Fox News laid back optimistic arrogance, where they wallow in the surety that it is a question of which seats the Republicans will win and how many, may be misplaced. The GOP would have to win these five seats from the following six, “too close to call”, states Georgia, Louisiana, Alaska, Arkansas, Colorado and Iowa - a really tall order. As the Democrats argue they only have to win one of the latter and Kentucky, which has been marginal all along, to retain the Senate. In this daily changing scenario the Democrats have abandoned their Kentucky candidate as a result of her continual attacks on President Obama. This is a very interesting development in that it shows the Democrats are thinking long term in so far that they would rather lose Senate control in 2014, as well as the opportunity of dethroning McConnell, than put up with the sustained abuse of the President from a member of their own party.

Whatever happens, it will be probably a couple of hundred thousand votes that will decide the control of the Senate. As Jay H. Ell has maintained from the get go, when the Republicans were fighting over which committees they were going to Chair in the Senate, that that election would hinge on the way the ball bounced. 

The Pundits.

Needless to say the pundits are singing a different song now. Nate Silver only rates the Republican chance of taking the Senate at twenty - four percent and has reflected that the Democrats might be clawing their way to victory . The Washington Post ran with a story that, “The Democrats are surprising”. The Rasmussen Report still favors the Republicans to win. A report on Meet The Press on Sunday argued that the outcome of the election could turn out to be to be the worst case scenario for the Republicans. ABC News, maintained, presumably on the basis of al the factors that favored the GOP going into the midterms, that if the Republicans fail to take the Senate by one seat it would rank as one of the most spectacular failures of all time. It is still fair comment to reflect that the majority of polls still give the Republicans the nod to win the Senate.

GUBERNATORIAL RACES

The races for Governor in several states are closer than were predicted. There are two Republican Governors that are particularly in trouble in Kansas and Wisconsin and there is one Democrat in Illinois. Generally speaking the Republican Governors, across the board are under a harder ride. Wendy Davis really fancies her chances to win the Texas Governor’s race and even if she doesn’t win she will come close enough to really jolt the Republicans out of their Southern State complacency. Just looking at these races - Kansas is in trouble for a very pertinent reason. The GOP Governor decided to put his money where the GOP’s mouth was. He would get rid of all State taxes and the economy would thrive with all that stimulus of disposable extra money in the one per centers’ pockets. Needless to say Kansas has gone to hell in a hand basket deeply in debt with very little payed for. Obviously this no tax mantra plays much better in the theory than it does in practice. Wisconsin is particularly important because its incumbent is considered one of the bright young stars of the GOP. His loss would be significant as he is considered a serious Establishment Presidential possibility. Illinois with its chronic corruption and massive debt has a very weak Democratic Governor, Quinn, who succeeded the imprisoned Rod Blagojevich. While Quinn’s Republican opponent suffers from the same disabilities as the venture capitalist Romney did he has to have a a more than even chance as Illinois is still in an unbelievable fiscal mess.

VOTER SUPPRESSION

Voter suppression which was to be the third leg in the GOP trifecta to win these elections, (Blog: “Why the GOP in 2014? - Its the Plutocrats, Obamacare and Voter Suppression Stupid”), is not going according to plan. The Supreme Court have not rubber stamped every State attempt to unashamedly to suppress voters. They have adopted an unpredictable approach to the various restrictive legislative Acts enacted by the various States. They upheld the North Carolina effort to stop voter registration on the day of the election and Ohio’s legislation to cut into early voting by a week . But they have halted the implementation of the Wisconsin Law that mandated the voters to produce identity documents which 600,000 voters did not have and that they logistically could not obtain to vote in the November election. Similarly a Federal Court opined that in Texas there was not enough evidence of voter fraud to introduce what was in effect a Poll Tax. As the Fifth Circuit of Appeals reversed that decision it is more than likely the Supreme Court will hear this case urgently.

In a devastating 30 page dissent to the rubber stamping of  the Wisconsin Voter Suppression Law, a Conservative Judge Gerald Posner of the Seventh Circuit of Appeals, blew the myth that these laws were enacted on the basis of eliminating voter fraud which the Judge says there was next to none. What makes this respected jurist's opinion especially significant is that he has changed his initial view point on the subject articulated seven years ago. He maintained that over that period there has been only a few  occurrences of voter fraud and at best the proponents of this argument were paranoid. His well reasoned legal argument will have to be addressed by the Supreme Court in their ultimate ruling on this subject. The Pennsylvania State Supreme Court also threw out the voter ID law in that State. So it would appear that some suppressive voter ID laws may well be under fire by the courts.

Even more significant than the legal thrusts to nullify the voter suppression laws is the massive voter registration drive by the Democrats in the affected States. This may not be enough for this election but surely it will have achieved the desired outcome by 2016. 

The Republicans, desperately clutching at the straws of survival, are even trying to sabotage  legitimate attempts to register voters. In Georgia, one of the key States in the fight for the Senate, 50,000 voter registration applications have “disappeared”. The Republican Secretary of State refuses to be interviewed as to what may have happened to these. Ironically, the GOP attempts to suppress minorities and youth, that favor the Democrats, seem to have had the opposite effect with tens of thousands being mobilized to get on the registers.

AT THE END OF THE DAY

*The outcome of these elections do not matter very much. Win, lose or draw gridlock will continue in Washington. To everyone’s surprise the Democrats are making a credible fight.
*If the Republicans eventually do not gain the Senate it will hasten their demise. 
* The see sawing of fortunes of the candidates is not surprising when one realizes that a few hundred thousand voters will decide the outcome of the race. Also the narrative keeps changing. At first it was Obamacare and jobs, then Benghazi and now it is Obama, Ebola and ISIS. The other variable is no-one knows whose base is going to be strongest and what the impact of voter suppression and the response to it  - voter registration, might have.
* Regardless of the eventual winners nothing is going to happen in this election that will impair the Dems winning the House, Senate and Presidency in 2016. 
*The Democrats are going to make inroads into the GOP Governorship roster.
*It hasn’t passed unnoticed that the Dems have several women candidates in these key fights. 

• If nothing else this election will illustrate that the South will become a key battleground in future elections and not just a pushover for the GOP.

*There are only two races that should impact on the political scene with immediate effect. These are the Wisconsin Governorship and the Kentucky Senate race. If Governor Walker loses in Wisconsin that will dash a very viable GOP Establishment Presidential Candidate’s hopes. More catastrophic would be Mitch McConnell’s defeat in Kentucky. He is the current GOP leader in the Senate and his exit would create a power vacuum and a Tea Party/Establishment fight that will expose, even more sharply, the GOP ideological split that is surfacing more and more in the public arena. 

*The Republican Establishment are still reeling from the shock defeat of Boehner’s understudy and obvious successor, Eric Cantor. This coup d’etat was executed at the hands of the Tea Party who obviously are adapting a “take no prisoners” approach. (Blog: “Cantor: Hype or Train Smash”).
*The electorate do not differentiate between the Republicans and the Democrats as to who is to blame for the gridlock. A recent survey revealed that only thirty - eight percent of those surveyed knew who controlled the House of Representatives.
*The election is showing up the glaring difficulties the Republicans have in maintaining a united front and that they cannot run forever with no policy other than to attack the agenda of the Democrats.

*Like all good forecasters, Jay H. Ell reserves his right to do a one hundred and eighty degree turn when the next polling figures are released.

NETANYAHU AND MAYBE OBAMA TOO - JUST DON’T GET IT

The much vaunted reconciliation between Obama and Netanyahu did not end in kumbayah but in chaos. The shambles created by Netanyahu’s dramatic breach of diplomatic faith, by allowing an East Jerusalem housing development to go forward, overshadowed the thousand pound gorilla in the room - where is Obama going on Iran, which is Israel’s burning priority. Like it or not, Obama’s approach to Iran is considered by many as a barometer as to his how much his administration supports Israel. Correspondingly, like it or not, Israel’s settlement behavior is regarded as the gauge of their sincerity in pursuing a two state solution. This has become such a deafening benchmark of Israel’s bona fides that is recognized by a coalition of liberal Israelis and liberals everywhere, concerned governments and the European Union and anti-semites. Ironically, the only nations not screaming the odds are most of the Arab Gulf States, Jordan and Egypt - perhaps they know something!

NETANYAHU

For all the Israeli Prime Minister’s apprenticeship, spending his formative years in America and its politics, he still does not get it. He does not get it on two levels. After all that has transpired he still cannot fathom that the bellwether of Israel’s good faith as to the creation of a two state solution, is not the fact that they are civilized island of democracy in a sea of insanity and brutality, but whether or not they construct settlements in areas that everyone perceives could become part of the Palestinian State, that he, Netanyahu purports to endorse. Maybe he believes that that marker is unfair, hypocritical and not realistic, but it is what it is.  

His second lapse from reality is his perpetuation of his childish feud with Obama. Literally, childish, because, regardless of Bibi’s ego, Obama is the adult in this relationship in so far as he has the control and power. Didn’t Netanyahu go to daddy Obama during the recent Gaza affair and ask for a replenishment of arms and ammunition? Didn’t Netanyahu request from daddy Obama close on three hundred million dollars to repair “The Dome” which daddy Obama had built him? Didn’t daddy Obama provide much needed diplomatic support during the ongoing war? 

It is time to call this infantile rebellion off! If Netanyahu wants to be treated like an adult he must behave like one. This conduct has been ongoing. It started ironically enough by the announcement of a Settler Housing Development during a State visit to Israel by Vice President Biden in Obama’s first term of office that embarrassed Biden and Obama no end. Then he addressed the US Congress over Obama’s head, “running” against him. He publicly humiliated Obama’s administration by belittling Kerry’s herculean efforts at brokering a peace in the recent contretemps in Gaza.  And on and on. Netanyahu needs to keep his eye on the main prize, namely an Israeli - Arab  - American coalition against Iran and show some leadership!  Not to mention that he should aggressively pursue what he maintains is his program - a two State solution to the Palestinian crisis.

Netanyahu needs Obama more than ever politically as Abbas takes his motion to the Security Council to get a Palestinian State approved by November 2016 that encompasses all the land they held prior to 1967. He needs the USA’s unqualified support not only to vote against it but to make it uncomfortable for other members to vote aye. 

 THE  EAST JERUSALEM HOUSING DEVELOPMENT.

The discord all started when an Israeli activist movement “Peace Now” broke the news, on September 26, that the plans to build two thousand six hundred and ten homes in East Jerusalem had been finalized. Obama was furious. He had taken great pains, as had Netanyahu, to have a show of normalcy about his meeting with the Israeli Premier. He felt blindsided and in briefings after the mandatory photo ops he let the world know in no uncertain terms. 

The reaction in Israel to Netanyahu’s housing lapse should open the eyes of those in the diaspora that there is an ongoing vigorous debate and criticism of the Israeli administration from the left and right in Israel and no-one is labelled as anti - Israeli for their vituperation.

Netanyahu’s response.

Netanyahu was furious and lashed out against “Peace Now” attacking them for deliberately kyboshing his talks with the USA leader. “Peace Now”, is a left wing organization that was founded in 1982 after the Lebanon invasion. It was then in its heyday and marshaled a demonstration of 400,000 which was ultimately responsible for bringing Sharon down.  Currently they have as their objective a two State solution and have a Settler Watch Committee because unlike Netanyahu they get it - this is the currency of Israel’s good intentions in this arena. So Bibi gave them hell for spilling the beans and one could almost feel for him under the circumstances - fight fair when I am oversea and parleying with Obama don’t embarrass me! Talk about hardball politics - this would be treason around here.

The Israeli PM did his best to explain away the situation - “This was not a settlement but a natural growth of a neighborhood”, “Seventy of the Houses were for Arabs”, “This was not East Jerusalem it was South Jerusalem” and “Israelis and Arabs can buy houses anywhere in Jerusalem”, were examples of his defensive response. The burden of his message was “That it was worth learning the situation before taking a position like that” and “I don’t understand this criticism. I don’t accept this position” he wailed.

All Jay H. Ell can do is just sigh and cry, with so much on a line and the stakes so high, the twenty - six hundred houses built inside of the green line was the height of irresponsibility. What was this guy thinking? One outcome is for certain as “Peace Now” can smugly confirm - Netanyahu will think twice before caving into his mindless right wing to pull another fast one like this. 

Obama’s response.

The USA  President’s comeback did not come in their post meeting platitudinous press conference. It came by the way of WhiteHouse and State Department Spokespersons, Josh Earnest and Jen Psaki. They both had the same direct mantra. They argued that the decision was contrary to Israel’s stated position and sends a troubling message;   “The action called into question Israel’s resolve for a peaceful solution while having the potential to draw condemnation from the international community thereby distancing Israel from the allies”, the “strong” Obama administration statement continued. The spokespersons further contended that Obama had conveyed this message to Netanyahu during their talks. Obama had chastised the Israeli Premier by charging that his peace statements were disingenuous in the light of his actions.

Israeli Press Response.

The Israeli press covered the Washington drama in detail providing a colorful spectrum of the political opinions in Israel. Netanyahu was hammered mercilessly from the left and the right as this sample from the daily newspapers reflect.

The Times of Israel lead with the headline, “US - Israeli Negotiations In Crisis” but the body of the report merely contained the “she said, he said” facts. Haaretz, a left wing daily, also chronicled the drama with its sordid details but the focus was on an op - ed piece by Ari Shavit that likened Obama to Roosevelt and Netanyahu to Churchill, supposedly the role models of each of them, respectively. He maintained that if Obama could exhibit some of the leadership that Kennedy exhibited and Netanyahu some of the wisdom of Levi Eshkol the two would save their legacies. ( Eshkol, an almost a forgotten figure in Israeli history, was a savvy operator who ensured American support, through Lyndon Johnson, in the celebrated Six Day War in 1967).

The Yedioth Ahronoth proclaimed that the whole episode played out like a bad Aaron Sorkin script. Sorkin being the American writer who has penned movies and TV series such as “West Wing”. 

Israel Hayom, which is recognized as Netanyahu’s mouthpiece, did not cover the disaster just the inane post meeting press conference. Giving Netanyahu’s line their commentator, Dan Margalit maintained; “Things are hunky dory between the two leaders. If only the gadfly Ministers on Netanyahu’s right would just shut their big yappers. In these circumstances there was no room for the statements of Uri Ariel and right after  Naftali Bennett. There is no democracy in the world where the leader makes a statement abroad and his ministers attack before he returns home. Even more so now, when Netanyahu reiterated a statement he has been making for five years. What was so urgent that they had to present his words as meaningless. This is a battle over the Jewish Home that is causing unneeded damage to the Jewish State.” 

 IRAN - DOES OBAMA GET IT?

There is a growing perception on the internet and now bursting into the legitimate media that Obama is “selling out” to Iran. Caroline Glick of the internationally recognized Jerusalem Post has very little doubt that he is. The Jerusalem Post also ascribed a statement to the Ayotollah Khomeini, who maintained that Iran was in a better negotiating position with Obama because of ISIS.

Iran has given no assurances on halting their nuclear enrichment program. Notwithstanding that fact the Obama administration has been making conciliatory noises towards the theocracy. Glick points out that Phillip Gordon, the WhiteHouse coordinator for the Middle East announced at the National Iranian American Council that a nuclear agreement would begin a multi-generational process that could lead to a new relationship between the USA and Iran. Gordon added that in order to further the nuclear agreement  the US would ignore Iran’s record on terrorism and other crimes”. This is all in tandem with Obama “in good faith” loosening the economic vice that is crippling Iran.

This is very heavy stuff. Obama would be flying in the teeth of International law as well as American law. It leads credence to Netanyahu’s belief that Obama is compromising on the deal with Iran. Thus Iran would, rather than eliminate their uranium enriching capabilities, just halt them. If this is so then it ignores the UN Resolution that calls for the elimination of the  enrichment process and oversight to effect Iranian compliance. Furthermore, as Glick is quick to point out, Obama initially stated that all that would happen in the event of a nuclear agreement is that the economic sanctions would be dropped and now “normalcy” is being promised. This was not only original Obama’s position it is the law of the land. Normal diplomatic relations can only be afforded with Iran when they drop their support of terrorism.

In addition, in case anyone has forgotten, Iran is a despicable brutal totalitarian theocracy. It is controlled by the Ayatollah not by the current smarmy Prime Minister Rouhani. Rouhani is as much under central control as was Ahmadinejad. It is common cause that Ahmadinejad lost his election and the results were rigged. The resultant “Green Revolution” was brutally put down in a fashion that would have made ISIS proud. Iran is a purveyor of terrorism and evil in the Middle East with its two terrorist organizations Hamas and Hezbollah in tow. Iran supports the medieval  Syrian dictator Assad whose crimes have been on show for all to see these past two years. There is absolutely nothing positive one can say about these mad mullahs other than that they are on their way to their objective to lead the Muslim world.

Eric Edelman, Dennis Ross and Ray Takeyh from the Center for Strategic and Budgetary Assessments of the Washington Institute and Council and Foreign Relations concur. They were quoted in the Washington Post warning, “The war on terrorism should not be allowed to conceal the fact that the theocratic Iranian regime and its attempt to upend regional order remains the United States’ most consequential long term challenge in the Middle East.”

If Obama goes ahead with a settlement he could have not foreseen the consequences on the international scene, the Middle East specifically and within the USA - that is he does not get it.

WHAT DOES THIS ALL MEAN?

• Netanyahu needs to get his act together so that he is not susceptible to the type of denunciation that confronted him in Washington. Even better if Israel could find a new leader that wasn’t so chained to the right wing Israeli crazies.
• A significant minority in Israel see the housing development in the same light as Obama and most of the rest of the world do.
• All this behavior is being accompanied by threats of sanctions to Israel if they do not settle. 
• Netanyahu's frustration is exacerbated by the chutzpah of Hamas who are insiting on a 4 billion aid package to rebuild Gaza that they were responsible for turning into a pile of rubble. As ridiculous as that may seem he has to focus on the fact that while he builds settlements it gives Hamas carte blanche to do what they please.
• Obama, should he go through with this alleged Iran deal, will lose total credibility on the international scene. But ostensibly it can’t really happen without Congress’s permission. Every other day there is talk of Congress impeaching him. The reason for his current predicament is naked prejudice. However this issue is big enough to set it all into motion. He would put the Democrats in a difficult position to try and defend him. As it is they are distancing themselves from him in the midterm elections.
• Obama in the event of a “sell out” would exacerbate the feeling, being openly stated and at present without real foundation, that he is abandoning Israel. Support of Israel is one of the few non partisan issues left in Congress. The “strong” statements following Netanyahu’s snafu will then be seen as an attack on Israel rather than a frustrated rejoinder to someone who has openly thumbed his disdain at him and his administration. Also the State Department’s Psaki’s failure to outright say that the US was opposed to Abbas’s move to gain a Palestine that included all the pre 1967 borders will be seen in a much more sinister light.
• The sentiment in Congress is so strongly in favor of Israel that even Rand Paul, the libertarian who is totally against foreign aid and adventures to the extent that he even opposed Obama’s ISIS policy, has stated that the exception to his philosophy is Israel who should continue to receive a billion a year in foreign aid. 
• Obama’s  strategy is clearly not to link Iranian and Israel policies. In fact Obama announced that the Palestinian crisis is not the cause for the Middle East problems leaving Israel more maneuver room.
• Obama if he strengthens Iran’s position would have crossed his Sunni Gulf State allies and secular allies Jordan and Egypt. He will have sided with the Shia against the Sunnis and destabilized the Middle East even further.
• Iran has a wobbly economically and an unpopular dictatorship and an overthrow is always possible. That could result in a nuclear arsenal being in control of even more radical Islamists.
• Also how could Obama, in the event of letting Iran of the hook, then deny the Saudis the right to build a nuclear reactor and thereby further destabilize the Middle East and the world.
• At the end of the day an Obama sell out is hard to imagine as it would be a disconnect between Obama’s stated policy and his cautious behavior to date. The US nuclear chief negotiator, Wendy Sherman, flatly denies the possibility.
• On November 24 the truth will out as that is the final date for a settlement of the Iranian issue or will it be postponed ad infinitum as Iran hopes.
• Jay H. Ell believes that should Iran not deliver on the nuclear negotiations Congress will step in and stiffen the sanctions against Iran.

So the Israeli and Iranian issues are inextricably bound, much to Obama’s irritation and the Israel’s Settlement policy is an embodiment of Israel’s bona fides to a two state solution much to Netanyahu’s anger and bewilderment. 

EBOLA ,THE ER, MEDICAL SCIENCE AND HEALTH CARE

Every other Emergency Room Doctor and every other Hospital in America has exhibited a combined audible sigh of relief at not being responsible for failing to diagnose the first Ebola patient in the United States. There is a common refrain - “There by the grace of G-d I and my hospital go”. There is sympathy and empathy for the Texas Health Presbyterian Hospital in Dallas and the ER staff. Nobody needs the whole nation second guessing your management. Nobody wants to feel that they have created a national crisis which has become the issue du jour in the media. There has been criticism of the care explicitly and implicitly and Jay H. Ell shudders to think of the pounding that all concerned have gone through both within and without the hospital. 

There are several questions being asked and the one most central to this discourse is, “How on earth did the USA’s much vaunted medical system, ostensibly the best in the world, miss the diagnosis thereby resulting in a moribund patient and the scare of an epidemic with fifty persons at immediate risk of which at least 10 are at serious risk?”  The Dallas Hospital was called to task and an article, in no lesser media mouthpiece than TIME, carried their explanation under the heading, “Dallas Hospital Scrambles to Explain Initial Release from Hospital”. Briefly, the hospital’s response was that it was a technical glitch that caused the disaster. 

CONTEXT OF DALLAS HOSPITAL'S "MISTAKE"

Let us try and put this all in some context before going into detail about the care and the hospital explanation. The hospital provides the following minimal details - a patient with a temperature of 100.5 Fahrenheit, with abdominal pain and a decreased urination presented to the ER. Without stating anything else or whether any laboratory work was done they state that after assessment the patient was subsequently discharged. The hospital maintains, correctly so, that at that visit the patient’s symptoms were not severe and could be associated with many other afflictions. The hospital argues that the fact that he had come from Liberia was recorded earlier in the notes, by the nurse, but due to software malfunction the note did not get through to the doctor. The hospital has informed other hospitals that might have that problem to adjust their software. 

Jay H. Ell believes the problem is far deeper than a software problem and, rather, is a manifestation of the paradigm of the current practice of medicine, medical education, the health care system itself and the values behind the endeavor of health or “sickness” care.

WHAT IS  MAKING TODAY’S ER SO STRESSFUL

It is fair to say that American ER physicians and the discipline of Emergency Medicine are of the highest standard in the world. While ER physicians, in general, are dedicated professionals who view their modern day mission with commitment, dedication and professionalism, there are several circumstances that make their job definition that much more difficult.

The Patients.

The Emergency Room is everyone’s fantasy of the drama of medicine - saving lives left, right and center. The fact that the most popular TV series feature ER doctors bears witness to this fact and that is where George Clooney met the world. The Emergency Room is a tough place to work in that one treats, under time pressure, patients in extremis, exhibiting sophisticated psychomotor skills in the process. (That is what the ER doctor originally signed on for). 

However, the ER is the one place in the USA where anyone has to be seen and evaluated, regardless of their ability to pay or regardless of whether they require emergent medical intervention or not. This brings a glut of non ER patients that place a strain on the doctor and the system. This includes drug addicts, chronic alcoholics and a host of social problems. It is extremely difficult to find institutions to accept these patients and they take up scarce ER space and time, sometimes lingering in the ER for days before being discharged or admitted to another facility. The other group of patients that are seen are patients, who don't qualify for the TV definition of ER patients, with minor complaints and or “undifferentiated Illness”. The latter is illness that has not as yet defined itself as a recognized disease process and is usually minor and is of the type that the Dallas Ebola patient presented with. More and more of those patients come to the ER facility as either they have insurance such as Public Aid where it is difficult to find one of the scarce Primary Care doctors or they still have no insurance, in spite of Obamacare, or they are just visitors as was the Ebola patient. Some just use the ER as their source of primary care not even bothering to establish themselves with Primary Care Physicians.

This all results in most ERs being overwhelmed and the wait to be seen can be several hours.

The Culture

Medicine is run in America on the business/industrial model. Thus the patient or what is now unashamedly called the “customer”, is always right.  “Customer satisfaction” is measured in most places by a process that is wholly unscientific, akin to a market survey, where only those that wish to reply do. To add insult to injury, no score is designated as to whether care is regarded as excellent, good, satisfactory for example, rather, every ER is compared to all the others. So if your score is 95% and all your competitors are 97% then you will be ranked on the lowest percentile. Conversely if your score is 47% and all your opposition are 45% your ER will be graded on the highest percentile! This bizarre system has become entrenched to the extent that Medicare is going to base remuneration on the basis of the outcome.

While emphasis on meeting a patient’s needs is most important giving in to unreasonable demands such as prescribing narcotic drugs and antibiotics inappropriately is not and ER physicians do not even at the risk of a complaint and a bad review score. One can give empathy and non judgmental acceptance to all but to be a professional one has to maintain one’s integrity.

This business/industrial culture adds pressure to the already stressed out doctor.

Malpractice Litigation

In spite of all arguments that malpractice is based on standards of care it is initiated in nearly every instance on a bad outcome. Now in a heavy duty morbidity situation like an ER there are plenty of bad outcomes. So the ER doctor is obsessed with creating a record, doing everything possible, to defend him or herself in the event that the patient does die or something untoward occurs. Any one who maintains that litigation is not an issue in patient care is not practicing medicine and/or has never practiced outside of this country. Patients are investigated ad nauseam and the whole exercise is costly, time consuming and anxiety producing. Again it is not argued that the “customers” should not be appropriately evaluated but “covering one’s butt” should not be a factor in health care. For example, the alcoholic who is there every night as he refuses treatment is given a multi thousand dollar work up each night as he is, sooner or later, going to drop dead and nobody, but nobody, wants to face a situation where he/she has not repeated the bloods the night before because they could have changed would argue a tort lawyer smugly.

Needles to say this all adds up to more unnecessary stress that is so inbuilt into the ER doctor behavior that he/she hardly knows that he/she is consciously taking it into account when he/she types his/her list of orders.

The Electronic Record.

The computerized medical record may be boon to administrators, business offices and the government but it is a royal pain in the neck to the ER doctor who spends more time on the medical record than ever before at the expense of patient - doctor time. You are either looking into the face of the computer rather than the face of the patient at the bedside or rushing from the patient to get to the computer.

MEDICAL EDUCATION ,THE PARADIGM OF MEDICINE AND EBOLA.

While everybody emphasizes patient - centered care, only lip service is paid to it in medical education. It is considered "soft", "unscientific" and not worthy of much attention. Doctor - patient relationship theory, personality and the like at best are taught in token classes. They are not going to be questions on the Boards so who cares? The paradigm of medicine is Newtonian Physics. The key variable is disease that it is measurable and treatable by laboratory or imaging. There is no taking into account the variables of doctor, patient and what happens between them. There is no acceptance of the fact that the observer and the observed can change the doctor patient "experiment" and are crucial to outcome. Everyone will accept that if a doctor despises alcoholics the latter are going to get poor care from him/her. Similarly, they accept if the patient decides to "give up" and not fight you can stand on your head, the patient will die. Both the latter examples illustrate that the doctor and patient variables impact outcome and not only disease process. Also Newtonian physics assumes total physician control. It doesn’t take into account the variable of the patient who needn’t tell you that he has chest pain and then drop dead within a month after his/her interaction with you.

Now certain branches of Medicine have defined disease where fixed protocols can be used to treat patients and the failure to address the other variables in illness is not so glaring. The ER plainly has defined disease and undifferentiated disease presenting to it as was the case of Thomas Eric Duncan from Liberia. While the Hospital claims, as exculpatory, the fact that his symptoms were minor, that is just the time that intervention is needed to give the patient the best chance of survival from this dreaded disease. It is no good just shrugging one’s shoulders and blaming it on software.

Let us look what was in potentially in place to prevent this from happening. The patient variable, what the patent feels, thinks and believes was not considered important enough for the doctor to address. He/she is far to busy filling in screens on his/her computer. The system delegates this important function to the nurse and the nurse only. The nurse records the patient responses and then sends these to the doctor. In this crucial instance the software failed and the doctor proceeded, as he was taught, to address disease but there was none obvious. He therefore does the best he can and is obviously uncertain as he prescribes antibiotics in what appears to be a viral syndrome. (He has in been criticized for that by some or other member of the CDC who obviously doesn’t practice medicine on a daily basis).

The only way he/she could have got to an Ebola diagnosis was via the patient. Now one can argue it was the patient’s responsibility to share his non medical history, namely, that he has just come from Liberia . But as far as the patient was concerned he had discharged his responsibility by telling the nurse. In addition the patient may well be in denial. He did not want to hear that he could have Ebola and was only too happy and relieved, having informed the system where he came from, that Ebola, that was looming massively in his mind and surely, he believed. in the doctors’ mind, was not being considered. 

The patient had a lot at stake, as he had come here to get married and that would have ensured his stay in this land so why would he change his reality. The American health care system has decided he needs antibiotics and Ebola is not in the picture.

So what could the doctor have done? While a provision is in place to avoid him getting involved in the so called “trivia” he is still ultimately responsible. But nothing in his training or even job definition that has defined and taught that he needs to vigorously pursue the patient variable. Certainly no check list in his endless computer record. He is rushed off his feet. There is the computer, the possible intubation, the cardiac whose oxygen stats are still low.. he better be nice to the patient because maybe he will be surveyed…..

There is something ringing a bell that this is not straight forward so he prescribes an antibiotic so what else could he do? Well he might have looked at the other variable, the patient, and see if he could have provided information that could have helped him/her in management. He/she needed to know the patient’s agenda, like why he came tonight with relatively mild symptoms and what were his fears? What he felt might be the cause of his not feeling well. He needed to have been trained to recognize if the patient is highly defended how to be able to facilitate these answers. 

For all as long as medicine regards all these psychosocial variables as trivia Ebolas will happen, cardiac patients will drop dead having just had a "check up", hypertensives will not be controlled and so forth and so on.

BACK TO THE EBOLA PATIENT

So to trivialize this as a software glitch is to invite further problems in the future. To blame the ER doctor with all that he/she has to contend with in the modern ER is simplistic and unfair. To start with she/he needs a scribe. He/she should not have to look at a computer - the job is to manage patients. More valid patient satisfaction tools should be devised that reflect the professionalism of the doctor in meeting his/her patients needs so that he can feel comfortable about behaving professionally. Medical education needs to be adjusted to best help the doctor manage patients with all the variables not just the disease process. 

In short one needs a paradigm shift in health care to prevent Ebolas as conventional knowledge and skill were not enough to prevent a disaster of unbelievable proportions and cost.