Footnote

I got these publications as a State Senator and read them avidly. “Facts, Figures and Trends” published by the Idaho Department of Health and Welfare.

Now, on the Board of Health and Welfare, I get them again. You could read them online. I get great joy from turning the pages and folding over a corner. But they are printed at your, the taxpayers’ expense.

The trends, the facts are thrilling.

That’s a joke.

But if you are in charge of spending the public’s money, I believe you should pay attention to how it is spent. I watch our current batch of Idaho legislators and I don’t think they are paying much attention. You should be.

Let me draw your attention to the plot twist on page 57. This pertains to the Division of Family and Community Services, specifically Foster Care. The graphs clearly show that the number of children placed in foster care has gone down over the past four years. Yeah, the crowd roars, less children needing state intervention. But then it shows the cost of this to the taxpayers has tripled. If I was still on the Budget committee, I’d be looking at that pretty closely.

To be honest, you should know the IDHW, and the oversight committee has their eyes on this. But you, the voter, the taxpayer should too. Ask your legislator at the next town hall when he asks for your vote. I’ll bet you get a blank look.

We shouldn’t overlook the foreshadowing on page 31. This is a different chapter concerning the Division of Behavioral Health. The data here is deep, but on the forementioned page numbers struck me. Facts, don’t you love them?

The table shows the number of children served by this division over the last four years. In 2020 3,300. In 2023, 1715.

What? Are there suddenly half as many children needing mental services? Indeed, the number of court-ordered services dropped by 25% too. Are our youth suddenly more resilient? Are we doing something great that we should all know about?

Then I turn to page 35. The plot deepens.

Adults have also seen a decline in services. Over the four-year trend, 2000 less adults needed behavioral health services between 2020 and 2023. Only a quarter needed other services, housing, meds, employment.

Don’t skip over the footnotes.

Should footnotes be at the bottom of the page or in the back? Same type, or smaller? This one was on the same page, but small enough print I needed to squint.

Medicaid expansion happened in January 2020. Many adults needing behavioral health services became eligible for this health insurance and then moved to that care.

Do your legislators know such care is paid for with 75% federal dollars? Taxes pay for all of this. How do you want to pay?

Of course, maybe you just don’t think folks need this care. These are important questions. You might want to ask your representative.

I’ll skip over the bouncing numbers of communicable diseases on page 132.

At community town halls I have heard my representative say about Medicaid: “We can’t just keep paying for this, we have to get a handle on these expenses.”

I would encourage our representatives to get a handle on the expense by embracing the numbers. Only by paying attention to details can we manage a budget.

But then the question comes, should we embrace our fellow citizens with the comfort of health insurance?

Do you even understand where Medicaid money is spent?

You legislators are still whining about Medicaid Expansion. But the annual taxpayers’ cost for those coved by this health insurance is about $7500. While we taxpayers pay over $20,000 a year for the health insurance for our legislators.

Maybe you just think you deserve it, and others don’t.

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Coroner Story: Lessons

I don’t learn well about myself.  Do you?

Memorization.  Lists of things, formulas, I find I can commit lots of these things to memory if I can give them some meaning, some relationship to my life.  But my own mistakes and shortcomings, maybe they are forever hidden.  They just keep reemerging into my flawed consciousness like a hammer blow to a thumb.

 For instance, I write this story in the City Library at San Luis Obispo in California, far from my Idaho home and duties.  My daughter is in a soccer camp for four days.  I drove her down here the 1500 miles and now have these 4 days to kill while she sharpens her football skills. 

What to do?  No friends to stay with.  Do I rent a hotel room?  It’s expensive.  I have a sleeping bag…  Why not just sleep out on the ground tonight?  Save some money.  Besides it will be fun… 

Yeah.  Dirt, stiff joints…  Fun.  But I am by nature and by many years of upbringing a cheapskate. I don’t know if that will ever change.

We have our natures, our personal shortcomings. These shouldn’t afflict us in public service. But they can.

But this story should not be about me. 

It’s about a dead old man in his basement.  It was one of the early years I had doing this coroner job.  It was still very perplexing, and I felt very alone.  No one to call for advice.  Further, I was working with a sheriff that hated me and wanted me to look bad so he could get his friend elected coroner. This may all sound like excuses to you, but it helps me to make sense of my thinking at the time, since, looking back now, the decisions seem so wrong. And then, there was the dead guy.

The call came on a late fall evening at a reasonable hour, maybe seven o’clock.  The dispatcher told me of a dead body found in a home in Potlatch. The deputy was requesting me to come to the scene.  I called the deputy at the deceased’s home phone.  It’s always interesting how they will answer.  “Mr. so-and-so’s residence,” is often it since they don’t want to give away his death to a casual or mistaken caller.  They are standing there with a dead body in a delicate situation, etiquette– wise.  If they pick up a ringing phone and answer with their own name or rank, “Deputy Jack M. Hoff” the caller may wonder what the sheriff’s deputy is doing there.  No, they will wonder. They may just be polite enough not to ask. 

The deputy doesn’t want to go telling who ever might happen to call about the death, you know, all those messy questions.  Best to let that come out in an official manner. 

But they want me to call them at the residence over a land- line since the sheriff radios get picked up on scanners and they know people are listening in. The nice dispatch lady gave me the home landline number.

The deputy I’m calling answered this time, “Uh, hello” after the fourth ring.  He sounded a bit nervous.  I asked if this is the residence of Mr. Thompson.  I’m letting him know he could’ve answered the phone this way. But this question seems to puzzle him a bit, no answer right away. I figure he’s confused about the tense.  Is versus was.  I can hear his confusion. Kind of a stammer-pause, awkward sort of thing, like you hear in class when the kid doesn’t know how to get past the teacher.  So, I interrupt,” Is this deputy Smith?  This is the coroner.”

“Oh, Hi,” he says.  So, I’m getting the picture of a low-watt appliance here.  I ask the setting, where the body is, any sign of a struggle.  Can’t we just call it natural and save me the drive to the small town?  But he says, “Doc, I think you better come out here.”

“So, you think there might have been a crime?”

“Well, I don’t think so,” he offers.

I still don’t want to make the drive.  “So why don’t we say he died of a heart attack and have the funeral home pick him up?”

“I really think you ought to come out here.”

“Has the Sheriff assigned any detectives?”

“No.”

I give him a big sigh, “Oh, all right.  I’ll be 30 minutes or so to get there.  Give me the directions…”

No traffic, no snow, but I still drive by it two times before I find the house.  No real house

numbers or mailboxes in his little old mill town. 

The sheriff’s deputy car is down in the lower part of the driveway, and this is my clue on

the second pass. It wasn’t easy to see from the road and I missed it the first time around. 

I knock on the front door and a younger man opens it.  The deputy is standing in the living

room behind him. 

They want me to go right down to the basement and look at the body. 

I get them to slow down a bit and set the scene for me. 

The young man is the neighbor.  He checks on the elderly Mr. Thompson every day or so. 

The neighbor saw him Saturday but didn’t check on him Sunday.  Weekend and all and he

took his kids hunting, a family activity in this part of the state.

After work tonight he came over to check on him. Today’s paper was still on the front

porch from this morning but not the Sunday one.  The door was locked like usual, but he

had a key and let himself in as usual. 

It was common for the front door to be locked. 

The neighbor also picked up the mail and the paper and brought them in dropping them all

in an easy chair in the living room on the way into the kitchen. 

As he tells this he’s a little agitated and wants me to go look at the body right away.  I need

to get him to concentrate so he tells me all the details in order, carefully. 

I ask about the old man’s habits. 

The neighbor, a short, lumberjack- dressed guy in a clean flannel shirt and clean work

pants and Romeo slippers obviously showered after work before coming over. He seems

bright and observant but sort of pressured. He obviously thinks the answer is in the

basement, what’s with all these questions?

However, he answers the best he could.

 “Oh, he was real regular, nothing special.”  It sounds like there’s no family nearby, he had a wife, but she died quite a while ago. 

Had he seemed despondent, sad?  Was he in poor health?  Any changes in his usual ways? 

Did he drink?

 The neighbor, frowning, shakes his head.  He’s paying good attention.  But he has no clues

for me.  And I can tell he’s feeling bad about not being able to help me.

So, I look at the little table in the kitchen.  The whole kitchen is just neat as a pin.  Coffee cup rinsed and tipped up in the strainer.  Oatmeal bowl rinsed and tipped next to cup and saucer.  Spoon standing up.  At his place was a lined stationery pad with four lines of pencil verse, oddly sad with the general melancholy of the Scots.

            A time to remember is now past

            my heart once younger now breaks

            the love of mine heart did not last

            my soul wanders wherever the Lord takes.

I offer a wry smile.  “Look at this”, I note to the neighbor.  “It looks almost like a suicide note.”  The neighbor stands over it.   He’s frowning at the verse.  I figure he finds it too dense, but he says, “Nah Doc, he was always writing stuff like that.  Look.” 

And he points to the wall above the little table. Sure enough, similar four-, six- or eight-line verses are torn from the same lined pad and scotch taped to the wall.  They all seem as melancholy and vague.  And the yellow of the tape lets you know some of them are not recent.  Some more are on the kitchen cabinets. Regular Robbie Burns fan, I guess.

Dead end, so to speak, the suicide note idea.

They want to rush me down the stairs, but I go to the old man’s bathroom first.  Regular stuff, some high blood pressure medications, no antidepressants. No pain medications.  Nothing exciting.  I did get the name of his doctor. I’ll give him a call in the morning and review the medical record.

Now it’s time to go down the stairs.

The basement is well lit and neat like the rest of the house.  Laundry in one section with a washer and dryer.  There was a load in the washer, clean but wet.  Nothing in the dryer.  There was a plastic clothes basket overturned at the bottom of the stairs and there were dry, clean clothes, some folded, strewn down the steps and onto the cement floor.  The deceased was lying on his side near the center of the room.  In the center of the basement was a small wood stove backed to a brick flue. It was cool.

The dead man was cool and stiff, probably dead now at least a day, maybe a day and a half.  The cement floor was cool.  He had fixed, full body rigor, but the fingers were loosening.  The lividity was fixed.  It showed no movement of the body since death. This put his death about Sunday morning, after breakfast but before afternoon. 

The clean, worn Levi’s he wore were unbuckled and unzipped and pulled down to mid-thigh.  He was lying on his left side with his left arm underneath him.  The right arm was out, extended.  His underwear were still up and urine-soaked.  But his forehead was injured.  There was a significant pre-morbid contusion, laceration with dried blood going down the nose and dried blood on the forehead.  Some was on his lips and on the teeth.  There were no injuries to his mouth.

Geez

I looked up at the neighbor.  He was pretty nervous.  “You got anything further here?”  I asked him.  He shakes his head and I look at the deputy.  I ask him if he needs anything from him.  Then I send him off home.  I turned to the deputy. 

“Has a detective been called?”

“Um, no sir.”

“Can you call one?”

He shook his head. “I suggested that earlier to dispatch and the sheriff said to call you.”

I looked down at the cement floor next to the dead body and shook my head. So, this is how it is going to play, no cooperation.

I try to work with what I’ve got. “What do you think happened?” I ask the deputy. I do this, trying to get folks to rise to the situation.

“I’m not sure.”

So, I go on. “If you look at these clothes all over the floor here it looks like he dragged himself around some.  These clothes kinda hooked on him and got pulled this direction.  You take any pictures of this?”  The deputy shakes his head.  “Nope Doc.  I’m no detective.”

Usually, the sheriff’s office does these investigations since their budget is a thousand times mine. Plus, they have all the camera equipment and record keeping.

But this guy and me aren’t getting along. I’m pondering what to do as I’m looking down at the smooth cement floor and I notice a blood spatter. 

There are regular spatters, about 3 inches in diameter in the line I think he drug himself around.  The blood marks are like he’s hitting his forehead against the floor as he tries to drag himself forward.  There are splatters outward from the circular smear, like he hit his head downward with pretty good force.  Hard enough to split the skin and splatter droplets of blood a foot or two outwards. 

He’s kinda made a circle in the floor starting near the base of the stairs and coming clockwise around the central wood stove.  He’s now lying facing the washer and dryer across from the foot of the steps.  He’s perpendicular to the steps, a bit to the right of them and a little behind where they came into the room. 

At the landing on the stairs a 2×4 railing had pulled loose. We’d missed this on the first trip down the stairs.  Then the clothes are scattered down the steps from the landing to the floor.  There is no blood at the bottom of the stairs. It’s just in the last three to 4 ft. of what I presume was his path dragging himself across the floor.

Foul play?  Did somebody shove him down the stairs in a struggle, then pound his head on the floor?  Why the pants down?  No evidence of sexual assault.

I stood looking at this for a long time with the deputy watching me.  I wasn’t sure whether to ask him for help or tell him to go away.  Finally, the way I put it together was that the old man had a stroke, or broken hip, or some sudden injury on the landing.  He’d stumbled and fell to the basement floor, letting the clean folded clothes in the basket go flying.  As he falls to the basement floor, he can’t get himself up.  He can’t arise because of either the hip fracture or paralyzing stroke, which I am favoring because of the difficulty pulling down the pants.  As the bleeding in his brain worsens and he realizes he will not be getting up the stairs to call for help he tries to end himself, do himself in with the only tool at hand, a hard concrete floor.  He also realizes he needs to urinate but cannot do this with one hand.  He cannot fully get his pants down.  Imagine the shame and indignity for this neat, tidy, poetic man.

 Or at least so I put it together.  I ran the scenario by the deputy.  He nodded about wasn’t enthusiastic.

“You going to get an autopsy?”  He asks.  They always want an autopsy.

“I’ll tell you what….”  I’m now arguing with my cheapskate self and the Sheriff who is not in the room. 

The deputy just wants an answer to a very interesting question.  Kind of like the folks who say, “What does this pain in my stomach mean, Doc?”  A pain they know well but haven’t the context in which to place it. No meaning to a memorized fact. I struggle with the range of diagnostic tests available.  The tests have a quite fallible ability to answer the question of the pain. Expensive, uncomfortable, imperfect tests.  And I also ponder the likelihood of this pain making any difference in the long run to this poor suffering student’s mortality or morbidity.  In other words, I think of it in terms of how to best spend their resources to answer this question.  I usually frame my answer in these cases based on my impression of whether this pain is minor, self-limiting, like most pains we suffer are, or if it is related to a bigger more problematic situation needing intervention.  This is also how I am thinking about the expensive autopsy test we are considering, me and Mr. Deputy on the cement floor next to Mr. Thompson now a day and a half dead.

Plus, I consider I am over budget for autopsies this year.

I decide I would try to take a shortcut and do an x-ray of the hip in the morning. Maybe I could save the taxpayers a couple thousand dollars.  If the x-ray is positive, then a broken hip led to his death.  I’m trying to pinch the taxpayers’ pennies.  Nothing is missing from the house, no money, no goods, and there was no forced entry.  It does not look like there was a struggle, at least I don’t think so.  So, the manner of death is most likely “natural” or at the worst accidental.  Why all the expense?

But the x-ray was negative: no broken hip.

His doc had nothing to help me. Just a little high blood pressure in a guy in his late seventies who hated doctors. My kind of patient.

By morning, even with the negative x-ray I managed to convince myself I could call it a stroke. I signed off the manner of death as natural, cause of death stroke.

Then, a year later, in the same little community, an elderly woman disappears.  There is a new sheriff now.  The careful detective’s investigation finds blood on the walls of her bedroom (only traces) and her skull is found two years later.  Her cause of death was a homicide. No forced entry. Nothing missing from her home except her body. And this has not been solved to this day. So now, at this advanced stage of my career, after years of pondering and reflection, I order more autopsies. I have learned a little bit about my skin flint self, and I have made some adjustments.

But writing this story has taken a long time, and I need to get going.  I’ve decided to get a campground spot.  I’ll sleep in the chill and the fog on the hard ground in my inadequate sleeping bag.  Stiff bones in the morning.

Cause of death: Stroke

Manner of death: Natural

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Coroner Story: July 4th

For some reason I passed up the family invitation to the fireworks.  I usually love fireworks, but my hip was real sore, and I didn’t want the pain of sitting on a grassy hill despite the pleasure of explosions and showers of color.  So, I stayed home, and they were all gone.  The house was empty except for me and computer solitaire when this coroner call came.  Dispatch gave me the address and name and requested me to come to the scene.  The dispatcher wouldn’t elaborate but it sounded like there may be some question about the manner of death.

I recognized the guy’s name and checked the medical record.  I had admitted him to the hospital just a month earlier for a partner of mine. He had painless jaundice and unexplained weight loss.  Both my partner and I, when discussing it were sure he had pancreatic cancer. These are the hallmark symptoms taught in medical school. The abdominal CT had supported this with their usual vague description of a mass in the head of the pancreas. It looked like they had tried to obtain a biopsy, tissue diagnosis.  You cannot treat without a tissue diagnosis. 

This is one of the basic rules of medicine.  We cannot treat until we know exactly what we are treating. 

I recall an incident when that was almost accidental, but quite fortuitous.  I’m now wandering off the coroner work into the doctor work. But you should have figured out by now, that’s just how it was.

One pre-Christmas December I was called to see a man who came to the emergency room with a first-time seizure.  His CT scan was up on the reading room boxes in the radiology department when I got to the hospital. The radiologist in his darkened room gloomily pointed to the mass in the brain and said, “Most likely glioblastoma, could be an astrocytoma,” both brain cancers.  Then he looked at me and said, “Looks like a young man.  Not good news you’ll be giving him this Christmas.”  As he was packing up the films in their large manila envelope he added as an aside “It could be an abscess I suppose but I doubt it.”  Then he headed out to his $45,000 car.  He had just earned more in 10 minutes of reading that film than I would in the next two hours with this family. 

I’ve never given this news to a man of his age.  I didn’t know him. I’d met his wife and young children in the office for sports physicals or their colds and sprains.  They were a friendly and loving family, not unlike my own.  As I climbed the stairs to the third floor of our small hospital I practiced the words, the speech that I would need to give. 

But you really can’t practice. You just still your heart and empty your mind.  You try for stillness and calm in the face of the unknown.  The immense and deep unknown of death we all will face if we only pause to realize.

I entered the room where the wife sat quietly in a chair next to his bed.  He was groggy from the seizure medication he’d been given in the ER.  He looked not much older than me.  I introduced myself and then asked them to tell the story of the seizure.  The family was getting ready to go to a Christmas party when he felt the seizure start.  His right arm jerked and stiffened uncontrollably then it marched to his leg and then generalized to his whole body.  He remembered only a little of this, so his wife told most of the story softly and calmly. 

It was a classic description of what I had learned in medical school as a Jacksonian seizure.  This is usually indicative of a brain lesion, something that didn’t belong, a brain lesion like we had seen on his CT scan, the horrible growth that had been glowing in the radiologist’s darkened room.  I did a cursory physical examination and then softly closed the door to the hall.

“I’ve spoken with the radiologist about your CT scan.”  I remembered looking at his face.  He was calm, open and waiting, listening.  I also looked at his wife’s darkened face in the corner.  “There is a mass in your brain.  This is what has caused her seizure.  The radiologist feels it is most likely a brain tumor.”

At this point I paused.  He was looking at me with his head on the pillow.  “Well, I guess that’s it then, isn’t it?”  He said.  I looked to his wife.  I don’t know what my face said, but hers was melting into shock, grief, despair, anguish.  Tears rolled.  Sobs shook.  His face was stolid and still.  She got up and walked over to him to hold his head. She buried her tears in his shoulder and sobbed.  He looked up at me.  “I guess that’s it, huh?”  He repeated.

I spoke to him of a tissue diagnosis.  One always wants to know for certain I said. We would arrange for consultation, a neurosurgical evaluation for their recommendations. I expected they would recommend surgery, at least a biopsy. “But that’s pretty messy isn’t it?  I don’t know as I’d want all that.”  He said.

I cautioned against fatalism.  “There is the possibility of an abscess, a lingering small area of infection.  Or some other cause possibly.  But yes, it does look like a malignancy, cancer, at this point.”

We arranged for the consultation.  The family dealt with the news.  And two weeks later, in our regional hospital the surgeons prepared to cut out his brain cancer, saving as much of the important tissue as they could for this active vital husband, father and professor. 

But they found that it was an abscess.  It was a pocket of infection that was drained and after weeks and months of IV antibiotics he recovered fully.  So, we always, whenever possible, press for a tissue diagnosis.

Why am I digressing into these doctor stories? Why can’t I just stick to the coroner story line? My mind just blends them. It was the work I did.

I remembered another case that didn’t go so smoothly. An elderly woman with a hysterectomy years before came to me with episodes of vaginal bleeding. She was overweight. On pelvic examination I could feel no mass or see a source for the bleeding, but imaging studies showed a growth in her pelvis suggestive of a malignancy. The surgeon and I suspected an ovarian cancer that had infiltrated the vagina as the cause for intermittent vaginal bleeding. He opened her abdomen to prove the diagnosis. As he looked around, he saw abnormal tissue growths everywhere. He assumed it was cancer and did extensive dissection. Specimens were sent to pathology. The extensive surgery required a week in the ICU and months of healing for recovery. The pathology report four days after the surgery described the tissue as endometriosis.

This is uterine tissue that has migrated out of the uterus and is growing in other parts of the abdomen. She had been on post menopausal estrogen replacement. All we had to do was stop her hormones and the endometrial tissue would dissolve. It did. But a timely tissue diagnosis during the surgery would have saved her from the four-hour operation and prolonged recovery. We don’t always get it right.

But this elderly dead man that is not the fireworks had gone to a specialist and the procedure for the diagnosis had been difficult and fruitless.  He had suffered two endoscopies and an attempted needle biopsy through his abdomen.  Neither could obtain tissue to prove the diagnosis.

The pancreas can be hard to reach.

However, given his condition and presumed diagnosis treatment had been started.  Chemotherapy poisons had begun, and their chemical insults were affecting him even more than the undiagnosed illness. 

He was an elderly bachelor and had lived at home, alone by himself outside of town. But now the effects of the chemotherapy had required him to be in a nursing home for a few days stretching into weeks because of his nausea and weakness. 

But he was still his own man.  He walked the halls and with permission of his physician went out of the care center on passes in his old pickup.  And now he was dead at his home 10 miles out of town. And I was going to look at him.

When I drove out there the sky was darkening. You could see the occasional skyrocket from the private backyard, illegal celebrations of this holiday. Impatient children cannot wait for the late darkness in these northern latitudes at this time of year.

There were two sheriffs’ cars in the driveway. The sheriff himself came up to me in the gravel. I didn’t usually run into him on these calls. He must have taken the holiday shift this year. “He’s out here in the back,” he said leading the way.  I followed and told him I knew the man and some of his medical history.

“Is it a suicide?”  I asked.

“Well, it looks like it, gunshot wound to the head, but we haven’t found the weapon.”

“Did he leave a note?”

“Well, maybe.  They say he was a man of few words and there’s a note by the front door that says Jimmy, that’s his nephew, is to get his .44 caliber pistol.  He has a lot of guns and I guess he wanted to make sure that this kid got that specific one.  I guess it was the kid’s favorite or something.”  He was standing over the crumpled body of the old man.  It lay parallel to the back concrete porch.  There was a sliding glass basement door behind us. The hills and timber rose to the north.  A barn stood 100 yards off to the east.  There was still some glow, but the sky was darkening by the minute; near time for the fireworks show to start.

“No weapon huh?”  I asked.  There was tall grass from the concrete porch down to a seasonal creek behind the house.  I assumed they’d looked hard before calling me.

“Not that we could find, but we haven’t moved his body yet.  We were waiting for you.” 

I stood over the head.  Entrance wound above the right temple; exit wound must be down below. He was lying on his left side facing north, his back to the house.  His cap and glasses were off in the tall grass a couple yards to the east.  I picked up the hat. There was a bullet hole on the left side of the crown.  “There’s your exit wound.”

“Yeah.”

“Well, let’s roll him over.”  I checked and he was cool with a little rigor.  “Who last saw him?”

“A neighbor drove by and saw him in the yard around one o’clock. He checked out of the care center this morning on a pass. His son came out and found him here about five o’clock.  That’s when we got the call.”

I bent to pull on his downside arm and roll him onto his back. He was a small, withered old man. My eyes moved over him, and I saw the revolver. It lay down by his ankles in the darkening wet grass.  The deputy and sheriff photographed and inspected the weapon.  38 caliber Smith & Wesson.  Two shells, both spent.

“That’s typical, one test shot then the real one.”

With him on his back we could see the exit wound.  It was large and gaping on the left side of his skull.  Instant. 

We three, the sheriff, the deputy and I, stood over the body and tried to make the scene come back together.  His cap and glasses had flown off to the east, but his right hand had been to his temple.  Was he facing the house?  How had he stood as he shot himself?  These sorts of questions were going through our heads.  We were trying to get an answer to the last minute of this man’s life, looking for the final diagnosis.  It made no sense that this man would die looking into his basement windows with those beautiful rolling hills calling for his last attention.

“Look, if he stood here and was looking out at the barn and the trees, maybe a little to the east and shot with his right hand, the hat would come off over there where it landed. Then he must have spun almost all the way around before he fell down.”

“Yeah,” the sheriff said.  “That must have been it.  I don’t think he was looking at the house.  He must have been facing northeast, up that way; looking at the hills, the trees, and the barn.  And then the gun fell right to his feet.  And he spun around as he fell.”  We were trying to come up with an understanding, even though we knew it didn’t really matter; making out all the details, so that it would make sense. There was nothing here we could treat, maybe, except ourselves.

“Can’t blame him really, what he’s gone through.  What he’s facing.”

“No.”  The sheriff, the deputy, and I looked at the ground.  It seemed we understood the cause.  We were just doing our little study of the details to make our jobs more meaningful.  Put some order or sense to what we knew.

I drove home wondering if we made any difference. There were more skyrockets in the blackened sky.

Cause of death: gunshot wound to the head

Manner of death: suicide

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Idaho Mother’s Day

Idaho laws are clear about being a mother in this state. So, on this Mother’s Day, let us be clear how we celebrate you.

It is simple.

We love you and cherish you. That is not in the laws, but maybe I am going out on a limb to state it is understood. Maybe we can all agree on that.

But any pregnancy you carry is clearly written in our laws. And such is the process of motherhood, isn’t it? There are women, and then there are mothers. Since we celebrate Mother’s Day in Idaho, any woman considering motherhood should know just what Idaho laws say to you.

The laws are multiple, confusing, contradictory, but ultimately clear if you believe our Idaho Supreme Court and Attorney General.

Let me summarize.

If you have a growing fetus in your womb, we Idahoans, by the laws we write, express our care for that fetus at your expense. The life you grow in your body is more valuable to this state than your health.

Maybe, if it comes down to the ultimate question, that your life will be lost for you to maintain your pregnancy, the state will allow you to save your life at the expense of the life growing inside you.

But if the condition of your pregnancy is a risk, or harm to your health, you are forbidden to terminate the condition of pregnancy, no matter the stage, no matter the circumstances.

I believe this strong prohibition has been written into Idaho law because so many conservative Republican legislators believe women kill their babies growing inside them for convenience, at their whim.

No legislator has considered or proposed a law to allow a woman carrying a malformed, doomed fetus to be terminated. If you, an Idaho woman find yourself in such a situation, Happy Idaho Mother’s Day.

You will be required to carry this fetus, this child to term and deliver it to die, maybe in your arms.

If your growing fetus was the result of a rape or incest, you may be allowed to terminate this process toward motherhood. But only if you have a police report on record that confirms these suspect allegations. Our legislators are sure women are always crying “rape” or “incest” for their convenience.

Such generous wiggle room in this motherhood process has been contested by my own State Senator. He’ll get reelected.

Happy Mother’s Day, Idaho women.

Senator Foreman didn’t send flowers or candy. He is just reminding you of your God given obligation. Women must bear fruit.

Men demand it. They claim God demands it.

Maybe He does.

But men, and a few women write the laws that rule over all of us in this representative democracy our founders designed as such a noble, flawed experiment.

It really comes down to if we believe in the rule of laws, written by men, whom we the people elect.

Such folly may fade, as the rule of Our Lord comes to bear.

Happy Mother’s Day, Idaho mothers.

Idaho mothers might have faith in the rule of law. Or they might have some religious or spiritual direction. And they may instill such in their children they have borne. I guess we can only have such faith on this Mother’s Day.

I do not know the burden or the gift of motherhood. I have watched it closely in my years.

I have seen and been close to good mothers.

I have witnessed and investigated bad mothers.

But that is just my judgement, good and bad. It is no better than yours.

But here on Mother’s Day it should be clear what we Idahoans think of mothers, and motherhood.

I have my perspective.

I hang my head in shame to think of what we, through our elected leaders are saying to our mothers.

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Wrongness

I have made a few mistakes in my life. God willing, I will live a few years to make more. When we make a mistake, it means we did something wrong. Admitting the mistake, accepting our wrong behavior, choice, maybe even thought, allows for us to learn to not make that mistake again. There will be so many others we can learn from.

Isn’t this life wonderful?

Idaho was and is becoming again a bastion for wrongness. We are a place where people can live free in their wrongness. We have the space; we have the tolerance to accept our neighbors’ crazy ideas.

I am OK with that. I love space, I love tolerance.

Except when it crosses a line.

This week a prosecutor in North Idaho decided it wasn’t crossing a line to yell racial slurs and profanities in a threatening way at guests in our fair state.

I’m not saying he was wrong to make that decision. Our legislators write laws carefully, thoughtfully to draw these lines that we can go right up to and not cross. The prosecutor must read these laws carefully and act on them.

I am saying the behavior in that beloved North Idaho city was wrong. But with no criminal charges, I guess those folks are left to figuring out their wrongness on their own.

The Idaho Senate responded quickly to this story. Within a week of this hitting the national press a resolution was introduced that: “denounces acts of racism and commits to eradicating the conditions that allow racial animus and undue prejudice to persist in Idaho.”

One Idaho Senator voted “NO” on this resolution. Senator Phil Hart, who represents Coeur D Alene, voted against the resolution, both in his debate, and on the floor of the Idaho Senate. But only when he was forced to.

He tried to skate out of the vote by leaving the chambers before the roll call. The Senate Pro Tem, Chuck Winder did a “call of the Senate” which requires all Senator to return to their seats.

How you vote should be of note to your constituents. Phil came back and voted “no”. He’ll probably get reelected up there in that North Idaho district where it doesn’t cross a legal line to shout racial slurs and sexual threats to visitors of dark skin.

My Senator, Dan Foreman (Viola) voted for the resolution. I must give him that credit. You need to know; he did beat me in a remote election. Then he got beat, and then he won again. It’s fun to be in an Idaho legislative district where a Democrat has more than a snowball’s chance.

His debate on the floor argued against the Senate passing the resolution. He argued that the state, the Senate should not apologize. The perpetrator, the person who committed the act should.

Boy, can I agree with that. More people need to apologize. This world would be a lot better if there were more apologies and less growling.

Wag more, bark less.

Senator Herndon (Way North Idaho) did cast doubt on the veracity of the claims. “We don’t know if this really happened.”

Well, we now do.

We know it happened. We know there were multiple vehicles, and one perpetrator admitted to his behavior.

But, according to the laws of the state of Idaho, he didn’t cross a line.

So, in the realm of the laws that our legislators write, maybe it didn’t happen.

No line our legislature has seen fit to craft was crossed.

I respect this freedom they have given us.

But if my fellow citizens think such freedom is any sort of sanction for their wrong behavior, then our representatives need to be looking at the lines drawn, not toothless resolutions.

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Consent

Blanche took Dennis to the doctor’s office for his sports physical.

She had mixed feelings about him playing football. She knew he really wanted to join the other guys in the effort. It is a little school, and they need all the bodies on the field they can get.

But he hasn’t got his full growth yet. She knew they’d put him in with the seniors, bigger, stronger boys. She worried he could get hurt.

But she wasn’t going to say no to him, though she’d shared her worries. He seemed pretty confident about it.

Blanche looked around the waiting room. Dennis sat next to her, worried, she was sure about the “turn your head and cough” thing he’d heard from all the other boys at school. She smiled a little to herself about boys and privacy. She didn’t say it, but she wished they had all experienced childbirth.

As she was smiling to herself, she looked across the waiting room at a young girl by over by herself. Couldn’t be much older than Dennis, maybe a sophomore She had makeup on and looking at her cell phone. Blanche didn’t like the torn jeans, though she knew it was the new thing.

A lady came out to talk to the young girl with a clipboard in her hand. The lady knelt down in front and explained something in hushed tones as the girl listened. Blanche saw the expression on her face change. First the girl had interest, trying to understand, then she started frowning. Then she tucked her chin in and started shaking her head. Then she just got up in a huff and strutted out.

Blanche could tell she was mad or hurt. Probably both.

“Something got her shorts twisted up.” She mutters to Dennis, who doesn’t miss much.

“Mind your own business Grandma.” He muttered back to her. She appreciated the good advice from this growing boy, soon to be a man.

The clip board lady retreated, and peace and boredom settled on the bland room again.

Not much else to study. An old guy with the oxygen tubes in his nose, a younger woman with him.

Blanche turned to Dennis. “You want me to go in with you?”

Dennis kinda snorted. “No Gramma, I’ll be OK.”

Blanche knew he would.

It was fifteen minutes after the appointment time, so Blanche was getting antsy. Doc Hawthorne never ran late. But he had retired, and they’d scheduled this with some new one, a nurse practitioner.

But the next thing you know the clip board lady comes out again and comes up to them. “Dennis?” She says to the both of them, kinda in general.

Dennis answers, “Yeah, that’s me.”

She does the kneel thing again in front of Dennis. Blanche wished she could still kneel like that. “I need to get your parent’s or legal guardian’s permission to treat you for your visit today.”

Dennis nodded at Blanche. “She’s my gramma.”

Clip board lady looks at Blanche. “So, are you his legal guardian? Then just sign here.” She holds out the clipboard.

Blanche knows something about this, having struggled with Dennis’ mom’s legal issues in the past. “No ma’am, I don’t actually have guardianship over Dennis. His mother, my daughter is currently incarcerated. She has agreed to let me take care of him, but she wouldn’t sign no papers about it. She hates my guts since I turned her in.”

The clipboard lady seemed a little bored about the whole story. “Well, it’s Idaho law now that an unemancipated minor cannot receive care without the parent’s consent. We need consent to treat Dennis.”

“You have my consent.” Blanche offered.

“But you said you aren’t his guardian or have legal custody.”

Blanche looked back at the clipboard lady.

She rose. “Come on Dennis. I guess we gotta go to the courthouse. You might not be playing football this fall.”

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Coroner Story: Cooperation

No dead bodies in this story. Though I felt like one at times. But I’m not dead yet.

I got a call, a message to the clinic where I was a daily, struggling family doctor in our small town. The prosecuting attorney wants me to come visit him.

I quickly racked my brain about my recent coroner cases. None I thought might be under consideration for prosecution. Had I missed something? Big gulp. Maybe a big oops here. I let his office know I’d be up to visit this late afternoon, after my last patient.

The courthouse is up on a tall hill overlooking our town. It has 1970’s architecture, so it is low, not tall and imposing. But there is the hill.

Close to the end of the day for county workers, so there was a spot in the parking lot. I slid the rusty Hilux in between a couple 4WD pickups.

The Prosecuting Attorney’s office is on the main floor. The secretary asked me to wait so I sat down. It was past five, so she must be getting overtime, I thought. Or maybe she did four tens. Maybe they didn’t come in until 9AM so they weren’t due to be off the clock. My mind jumps around like this when I’m nervous.

There was a picture of a barn on the wall.

James came out to get me. Big smile and handshake. He was in his second term in this elected position. I had just been appointed three years back. Both he and I would be on the ballot this coming fall. We all need to know our places. He brought me into his office, and I sat down. So did he. Behind the big desk.

There was some chit chat, then he got down to it. “I’m your attorney. As a county elected official, I represent your interests. So, I need to speak with you about your job as coroner and its obligations, your duties.”

“Yes?” Finally. Somebody is going to explain just what the heck I should be doing. I felt some relief.

He adopted a lecturing tone that seemed pretty natural for him. “Idaho code requires that you cooperate with other investigating agencies as part of your duties.”

Maybe I rolled my eyes. I hope I didn’t. I could see where this was headed. “I haven’t been cooperative?”

James looked down and shifted his elbows onto the desk. His voice was now softer. “I have heard from our sheriff that you aren’t always eager to investigate deaths that are brought to your attention.” Here he paused.

“If this is about his idiotic call to me about the landslide down in Juliaetta, yeah, that was bullshit. He calls me out with no information, no instructions to bypass roadblocks, and then when I get down there, there are no dead bodies, nothing to investigate. He called me out on a late Sunday evening on a wild goose chase. What part of me going to that bullshit scene does he call noncooperative?”

James shifted a bit.

“Or is there some other dereliction I have committed? If you ask me, he’s the one not cooperating. He isn’t sending detectives to scenes of unexplained deaths. Did he mention the one out past Bovill? Look, he’s got the budget. He’s got the personnel and the resources to investigate and document, keep evidence. He’s the one should be leading on these, not me. I got squat.”

James looked me in the eye. “This is all news to me. He said you weren’t cooperating, so I said I’d speak with you.”

I just shook my head. Not cooperating.

James did the big sigh and spread his hands wide. “I know you are busy. You run your practice and all. But maybe this would be better if you and him had a talk. Make some time and you sit down with him. It is indeed in the Idaho law that you should cooperate in your investigations. But relationships take time.” He beamed, the peacemaker.

I reflected. My spat with our sheriff down on the Potlatch River blow-out was the only time I had any direct contact with our fellow elected officer. The people put us here. “You’re probably right. I’ll meet with him.”

James beamed. “It would be best that way, since you outrank him and all.”

“What do you mean?”

James chuckled. “I guess you don’t read all the statutes about your duties. You are the only one who can arrest the sheriff. And if for some reason he is incapacitated, absconds, or is arrested, you become the acting sheriff.” He was goddam grinning at me.

“No way.”

“Yes way. It’s the law.”

He chatted me out. With his hand on my shoulder he offered, “I’ll have my clerk look up the sections of Idaho Code that pertain to your office and duties. You should be familiar with these statutes. We’ll get those to you. This will save you all the searching around.” He almost winked.

Did he know there was some ambiguity here? Did he know the depth of my ignorance? Probably both. I chatted on out. I had met the prosecuting attorney and left feeling a fool. But that is my nature. The Hilux awaited.

The folder of photocopied Idaho Code came to me in a couple days. I read the Articles and Sections and Chapters. Could they possibly make it more confusing? From my reading it seems nobody in an elected position wants me, the county coroner, to know how I’m supposed to do my job, at least in the twisted, arcane laws they write.

Maybe they think I should know my responsibilities since the people elected me. If so, I’m beginning to lose some faith in our democratic institutions, from the perspective of an appointed county coroner who has now learned I can arrest the sheriff. But the voters will decide soon. Maybe I am unfit. Would they know?

In the meantime, I asked to meet with our sheriff. I had said I would, so I did. It took some back and forth and I had to cancel a couple patient appointments, money out of my pocket. He’s on the taxpayer’s dime. But I guess he was pretty busy. He fit me in.

The sheriff’s office is in same the county courthouse as the prosecutors. I knew the place well, since I was also the doctor for the jail, which was in the basement below the courtrooms and the sheriff’s office. I had been there many times. Getting that job is another story. I’m sure our sheriff knew this since the county sent me a meager monthly check for my oversight. I was cheap. Maybe he saw that as a weakness. I’m jumping around in my mind as I nervously wait.

 I sat in the reception area as requested by the uniformed female deputy. She was attractive. My thoughts again bounced around to too many places as I took my seat. No magazines, some wanted posters on the far wall, it was before smart phones, so I just sat there and looked around. A few desks with just the pretty deputy right here in front of me. And then the door to the sheriff’s office behind. Walls covered with metal file drawers on all sides. Back in the far southern corner was a door to the detective’s room. I had been there once to talk with Earl. I didn’t see him, nor many coming and going. It was pretty quiet.

The sheriff came out to get me. He greeted me warmly with a handshake, but I could see a tall deputy in his office. I was invited to enter. The tall guy was the same asshole from the Juliaetta mudslide. He stood with his broad shoulders and erect posture at the east window. I went to introduce myself and shake his hand, but he dropped both hands to assume the position of attention and looked off into the not real distance. Like he wasn’t to be acknowledged.

“I just asked Deputy Dobbin to join us as an observer.” The sheriff offered. Observer?

“So, Coroner Hawthorne, what brings you to our humble office?”

Lob. “I thought it would be best if we met in person, not at a scene, to improve our sense of cooperation.” Lob with spin.

“Yes.” He folded his hands and looked down at his very big desk between us. “And how could we cooperate better?” Deputy Dobbin rested his attention pose a bit, though he didn’t assume parade rest.

No point further dancing. “Sheriff, you have all the resources, detectives and equipment and evidence security to investigate suspicious deaths. I got nothing. So, when a death is suspicious you should be assigning your resources. If you want just the coroner to be investigating suspicious deaths in this county, I’m afraid we could miss something. We are required to cooperate in Idaho Code. I am here to ask for your cooperation in death investigations.”

He smiled and shook his head. “You are suggesting I spend taxpayer money on cases that you should be investigating. How does that serve the public?”

I hope I didn’t roll my eyes, but I might have. “Deaths sometimes need investigation. I’m very comfortable with my role. But sometimes, having a sheriff’s detective involved really helps. Can’t you see that?”

He shook his small balding head again and smiled down at his huge desk. “I’m hearing here that you just don’t want to do your job.” Here he looked at me directly. Deputy Dobbin came to his full height off to the east.

So, cooperation might just be off the table I assumed at this point. “I’ll do my job, if you’ll just do yours.”

Deputy Dobbin interjected his commanding tone I had heard down in the canyon. “The Sheriff is clearly doing an excellent job.”

But I was looking at the small balding man behind the big desk. He was moving his fingers around in a circle on the clean desktop. “I serve the county taxpayers. If we spend their tax dollars on death investigations that are your responsibility, then we have less money to protect them from the bad guys. If you’d do your job, we’d all be better served.”

“Can you give me an example of when I should have investigated a death that I didn’t?”

Here he smiled and looked at me directly. “I’m not here to criticize your performance. And I don’t believe you are here to criticize mine either. You said cooperation was the goal. So, let’s cooperate. You do your job and I’ll do mine.”

He wasn’t dismissing me, but almost. So, I took what I expected was my last shot. “Sheriff, you have the resources for good investigations. I don’t. If a death needs that level of investigation, I would appreciate you authorizing those resources. I don’t want to be left out on my own. I’m afraid we could be doing the citizens a disservice.”

He was standing and coming around the big desk. Again, I was shocked that he was shorter than me. He was smiling, like he had won this duel. “I’m sure you will do your job, just as I have sworn to do mine.”

I left the office knowing this was not going to work out. I felt like a weak pissant to his authority. Welcome to this democratic institution. I knew I had failed to persuade.

Our cooperation was dead.

Manner of Death: ineptitude

Cause of Death: weakness

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EMTALA

The Emergency Medical Treatment and Active Labor Act (EMTALA) has been in the news recently. The Biden Administration has sued Idaho over our restrictive antiabortion laws, claiming the Federal Act trumps the states restrictions. Oral arguments were heard before the US Supreme Court this week.

So, let’s step back a bit and try to understand just what EMTALA says.

The law was passed by Congress and signed by President Reagan back in 1986. There were many stories at the time in the press and professional testimony telling stories of patient “dumping” between hospitals.

A patient with no health insurance might show up at an emergency room. Let’s say the ER is in a private hospital.

If the city had a public hospital, like LA County Hospital or Cook County Hospital in Chicago, the private ER would just send the patient down the road to the public hospital without offering any treatment. That is, they performed a “wallet biopsy” and determined they wouldn’t get paid, so sent the patient off to a publicly supported facility.

There were also cases of pregnant women in active labor being shunted off. Tragic outcomes were reported.

Congress acted. Not to fix our messy health care system, just to make such dumping cases sanctionable.

Congress put the Centers for Medicare and Medicaid in charge of enforcing these rules.

EMTALA violations are investigated, and fines are levied. Every year 3-4% of US hospitals are fined. Private, for-profit hospitals have twice the incidence of violations as do nonprofit hospitals. Fines average about $34K per incident.

So, dumping still occurs, I guess, but it just doesn’t stir the outrage it used to.

EMTALA prohibits the transfer of patients based on their ability to pay. It also required patients receive stabilizing treatment before transfer. Indeed, the emphasis on “stabilizing treatment” in the law is at the crux of the Biden Administration lawsuit against Idaho’s antiabortion laws.

I am not a great fan of the Federal EMTALA law. I think it responded to outrageous behavior with bureaucratic hand slaps. Indeed, the cost of healthcare went up after EMTALA. More cost shifting onto insured patients occurred when hospitals were required to provide uncompensated care.

 But it was enacted to put a band aid on our bleeding health care system. Uninsured patients were being treated inhumanely. So, dumping them gets a fine.

Instead, we should have made sure all had health insurance.

Back when EMTALA was passed about 17.6% of the population was uninsured. In 2022, we have gotten down to 7.9%. EMTALA didn’t give anybody health insurance. It just brought civil penalties, fines to violators.

The public and Congressional moral outrage at hospitals denying care based on the patient’s inability to pay lead to EMTALA. But we still have uninsured. We still have the most complicated, mind boggling health care system in the world. Maybe you think it’s what makes America great. I don’t.

Whether the US Supreme Court will decide Idaho’s antiabortion laws violate EMTALA has almost stood the purpose of the law on its head.

Idaho is arguing our laws, to DENY CARE take precedence over the Federal requirement to provide care.

Specifically, in Idaho, if a pregnant woman comes to an emergency room and is unstable due to conditions of pregnancy, she cannot be treated with an abortion, that is, delivery of the fetus that likely will not survive, unless it is to save her life. If she is bleeding, infected, unstable, and the recommended treatment to save organs, her reproductive future, she cannot receive this treatment in Idaho. She must be transferred to a state where such treatment is legal. Six such transfers have occurred since our laws went into effect.  Idaho is dumping our unstable pregnant women on other states.

Little wonder that doctors who treat pregnant patients look at Idaho with trepidation. Such a determination puts them very close to, if not over the line of “do no harm”.

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Pit Toilet

My wife and I just finished a 5000-mile trip across this country in our 1985 Volkswagen Adventurewagen. We saw a lot of farm country and small towns, since we avoided most interstates. We camped in a lot of nice little parks that most people fly over.

We always commented about the toilets.

It was a bit early for most parks to turn the water on. We had 2” of snow in Mobridge, South Dakota. It was freezing in Rosebud, Montana.

But the pit toilets were open for use. We had a shovel but didn’t have to resort to that.

The pit toilet at Far West, where Custer left the steamboat for the Little Big Horn was inspirational. It was very clean and had a poster on the wall. “Let gratitude wash over your experience.”

In Ohio, a sign above the toilet forbade trash disposal, as many do. “It is extremely difficult to remove.” The half dozen plastic bottles below told me something.

Pit toilet ethics are worth consideration.

Pit toilets have a specific construction that is best enabled when the door is closed and the seat on the throne is closed. Most toilets have such a sign inside. It seems only respectful to follow such advice. Most people do.

Pit toilets are the alternative to flush when water or septic doesn’t suit.

 I remember when my favorite road stop on the Salmon River switched out their flush toilets for pit ones a few years back.

Flushing is what we are used to. We all love it. But this site was just above a treasured river. Septic drains downhill. Pit toilets get pumped. I came to appreciate this choice.

How we treat each other is reflected in these ethics.

I remember reading about the Mormon Trail. These westward travelers left firewood for the next party and had their latrines downstream from their camp. It was in their ethics, their values. They got less typhoid. I appreciate such values.

It might seem a frivolous writer’s obscure segue to come around to the Idaho legislature about now, discussing pit toilets and septic systems. But permit me.

We elect these folks to do the duty of taking care of issues for all of us.

I am here arguing that the Idaho Legislature has left the seat up on a mess they have made. The smell is evident.

Idaho Republican legislators have acknowledged that their abortion statutes are a mess. Idaho House Health and Welfare Committee Chairman Vander Woude said, “OK, now we have to take a really close look at the definitions.”

But they didn’t.

Vander Woude cancelled the public hearing of the joint Senate and House Health and Welfare committees to hear from medical providers about how their mess was affecting health care for Idaho citizens.

The Idaho legislature left the seat up as they walked out of our pit toilet. What does that say to you? I find myself disgusted by such behavior.

When you walk into the pit toilet and the lid is left up, you might find yourself muttering curses against the last guy before you.

But in this case, the last guy has an excuse. He was told to leave the lid up.

It turns out our Idaho State Attorney General directed his fellow Idaho Republican colleagues to walk away from solving this stinky problem. He wants to make a name for himself as he argues his case before the US Supreme Court.

This has indeed become very stinky.

It should not be so.

If folks, our Idaho Attorney General and our elected legislators would have just lowered the lid on their mess, this pit toilet we share might be less unpleasant.

But they chose not to. They left the lid up.

Think about the pit toilet of Idaho politics. And let gratitude help you vote.

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Medical School

I attended a town hall meeting with two of my elected legislative representatives a while back. Only two of the three who represent me were in attendance. The absent was my State Senator, Dan Foreman.

He beat me in 2016 (Trump-Hillary), then lost in 2018, probably because he couldn’t control his temper. But he bounced back. Maybe he’s figured out public interactions don’t suit him. That’s just Idaho Republican politics.

Instead, I want to talk about another of my representatives.

Representative Brandon Mitchell voiced an interesting idea. It’s an old, tired, worn idea that might have some credibility, given Idaho’s recent explosive growth. But I doubt he has much understanding of the history of this idea.

He suggested it might be time for Idaho to be considering establishing its own medical school. This is a guy who represents a district where there are currently 80 medical students residing. All are tax-paying voters, I presume.

Idaho shares in a consortium with the University of Washington School of Medicine. That consortium is called WWAMI, which stands for the participating states: Washington, Wyoming, Alaska, Montana, and Idaho. The states shell out cash to UWSOM to make medical school seats available for their residents. Applicants must prove their Idaho residency, then get charged in state tuition for their four years of training. Idaho taxpayers shell out the difference between tuition and the full cost of the education.

This program started back in the 1970’s. Full disclosure, I am a graduate of this program, back in the stone age. We puked and bled our patients.

But Representative Mitchell’s idea might possibly serve Idaho if we had any kind of sticking power.

But it would definitely not serve his district. Maybe he’s seeing the bigger picture. I don’t really know. He doesn’t respond to my emails.

I just drove across South Dakota. It has less population than Idaho and its own very decentralized medical school. It proudly claims to produce doctors for their rural needs. I googled the heck out of their budget documents but could not find what South Dakota taxpayers fork over to fund this program.

They must be happy with it.

Wyoming wasn’t. They had a medical school for a while but dropped it to become the second “W” in the WWAMI program. It was too expensive, and they weren’t getting the product they needed. States should be critical about how they spend their money and pay attention to what they get for the dollar. Wyoming was and joined WWAMI.

Idaho should be critical too. But what do you count?

Idaho’s current yearly funding for WWAMI is about $7.5M. That supports 40 Idaho medical students a year. These students also pay their share of their tuition coming to $55K a year per.

For South Dakota medical students it’s only $32K a year.

You can see that the numbers are piling up here. And we haven’t even discussed the cost of a cadaver lab.

Facilities are the capital costs. But, if you build them, maybe they will come.

Remember, Idaho already has a private, for-profit medical school subsidized by Idaho taxpayers because of a cheap, 60-year lease agreement made by our previous governor.

Idaho College of Medicine is down in Meridian, churning out Doctors of Osteopathy. Their tuition is significantly less than UWSOM. They seem to be doing great. Why isn’t this the model we should be following? Capitalism solves all public needs through the invisible hand, right?

Only WWAMI graduates are required to come back to Idaho, under current law. Doesn’t that solve our shortage? Unless we keep driving them away, maybe.

Will Idaho doctors be from UWSOM taxpayer supported, or ICOM, the free market variety?

These are twisted concepts that require vision.

Representative Mitchell’s idea to build an Idaho medical school will send 80 of his voters to Boise. And all the funding that goes along with them.

Who is he working for? Not his district.

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