I find myself stifling a smirk when I hear a new term for a group. The homeless have become the “Unhoused”. I stifle the smirk because such a response is disrespectful. And the intent of the renaming is to offer respect and dignity to the renamed group. And the smirk may also be because I see such renaming as paltry effort, though, indeed well intentioned.

We cannot address the despair and dysfunction of the people living under tarps, near underpasses and in our metropolitan alleys with a softer new name. It may reflect our kind intent, but I’m sorry, there’s work to do. Creating a kinder, gentler name isn’t enough.

Other countries have addressed this complex problem. The solutions are complex and require significant investment. The price of housing, the availability of healthcare, the livability of cities are complex, swirling issues that some countries have addressed. And indeed, their solutions may not suit our problem. But we have the resources.  I suspect we don’t have the will.

And now I smirk at my own last comment regarding “the will,” because such a criticism would probably be leveled at the unhoused/homeless by those not willing to address a solution. Dismissing our shared responsibilities on this planet by pointing to others’ bootstraps is quite the style. Always has been.

I have come to realize my smirking reaction is not healthy. Not for me, or those I care for. I must do better. But it’s an old habit. It doesn’t dignify.

I found myself brought up short in mid smirk by a daughter a while back. I was bemoaning the low unemployment/ work force shortage we are experiencing. “People just don’t want to work anymore.” Was my smirking phrase.

She lit into me. She detailed the position our generation has saddled theirs with.

If they are a two-parent household, both making a bit above average income, and they pay for childcare, health insurance, taxes, and try to buy a home, they are just above water. Make that a single parent household and the drowning starts. Add a special needs child, or big student loan debt, or some other burden and it becomes evident the rising tide did not float all boats.

And we maintain the illusion of our 1960’s financial model for Social Security and Medicare. The demographics have inverted, yet we still cling to the Ponzi miracle of sustained economic and population growth that was true in 1960 but is no longer. These two great dignifying social programs that progressives point to as accomplishments need some major work if they are to live up to their founding ideals.

My generation has kicked this down the road. No wonder we witness disengagement. We have not been true to the founding principle that these dignifying programs deserved to be sustained. We have shirked; and maybe smirked, gesturing to their bootstraps. Like ours were what got us where we are.

And this is just the economic indignity which we have dropped on the sidewalk and pretended we did not leave. No baggie, we just walked away.

The environmental injustice of melting glaciers was not mentioned. But she could have.

I came away from my daughter’s admonishment knowing her response had more dignity than my whine. And I could see there was work still for our generation to do. It is not as simple as giving them bright shiny new bootstraps.

So, if you catch me stifling a smirk, raise a warning finger at me and smile. I will take the hint, I hope, with dignity.

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It’s going to be a hot drive down to our state capital tomorrow. But I’m excited to be making it. I got the AC in my old Volkswagen van charged up. It doesn’t blow cold, but it does blow cool.

Martha claims me driving the old VW around is a bit like the guys with the Trump, Let’s Go Brandon flags strapped in the beds of their pickups. She worries the VW pushes their buttons, like their flags push ours.

I shrugged at that, but she does have a point. Bumper stickers, yard signs, what is the purpose of such emblems? Is it to declare our position, thus provoke the opposition? Or is it just a weak attempt to persuade?

I know the flag guy with the pickup that U-turns to tailgate me in town doesn’t persuade me. He provokes my stubbornness. It’s irritating. Maybe that’s his intent.

The vanagon is not my tool for provocation. It just takes me down the road, and then I can sleep in it by the Salmon River on my way back home.

I don’t really like to provoke. I like to persuade.

These written words are my best effort to persuade, and I fear they are pretty weak too. Why read 600 words when there’s a Tik Tok video about cats to watch?

I’m thinking about provoking and persuading because of this upcoming trip to Boise. You see, I’ve been appointed to the Idaho Board of Health and Welfare by our governor. And the Idaho Senate confirmed my appointment. Whew. I thought that might be a hurdle.

We have a meeting in Boise on Thursday. The agenda is public. See if there’s anything there that interests you. Then give me a call. Or if there’s anything else bugging you about the direction or function of the Department of Health and Welfare, let me know.

Mainly I’ve gotten calls about specific services. I can’t really fix much, but it’s good to hear gripes. Sometimes there are trends.

The H&W Board is defined in law . There are seven members, one from each of the seven regions of the state. We are supposed to have political balance, with only four members from one political party.

One of our duties shall be to:

Advise the director and the governor on department fiscal, policy and administrative matters”.

For an appointed board to advise, there must be a clear understanding of the capabilities, and an even clearer vision for the responsibility. I’m working on those.

But if we as a board are to advise, we will need some consensus, some agreement. That’s where the provocation and persuasion come in. I can’t imagine wearing a “Let’s Go Brandon” T-shirt would persuade my fellow board members. It will take more effort than that.

Further, I hope my dented VW in the parking lot would not provoke. It will be a fun meeting.

I understand we have limited resources to deal with the Health and Welfare needs of our state. My bias is to find effective practices. We have had some significant shifts in how care is provided. It is our job to make sure that care is effective and cost efficient.

Before I head down the road let me leave you with some things to consider.

55,000 Idaho children have lost Medicaid health insurance this year. Approximately 53 of those children will have appendicitis next year. Who pays? Will their parents face bankruptcy? Will the hospital shift the uninsured costs to your bill? Is this how you want things run?

Idaho leads the nation in women incarcerated. The vast majority are in prison or jail for drug offenses. Is this the way we want to treat this problem?

I’ll be thinking of these things as I try to stay cool going to Boise. Wave if you see my blue beat-up van. Stay cool.

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We took a family vacation up toward the Cabinet Mountains in western Montana. This meant we got to go through the beautiful town of Libby on the Kootenai River.

Libby is famous for asbestos. And asbestos gives you more than 15 minutes of fame.

There was a vermiculite mine there, operated at a wonderful profit for the mine owners for some 70 years. The vermiculite contained asbestos. They declared bankruptcy when the cancer claims started rolling in. See, profit isn’t forever, but dead is.

The US government did what they could, I guess. In 2009 EPA declared a public health emergency. Haven’t such declarations always fixed things?

Max Baucus, a Democratic Senator from Montana thought he had a solution. He was in a pivotal position as ObamaCare got debated back in 2011. He had anyone testifying before his Senate committee who brought up the suggestion of “Medicare for All”, universal coverage, arrested. Though he found voicing such a solution to our health care problems criminal in testimony, he was not above slipping such a solution into some of those thousands of pages of the Affordable Care Act for Libby and Franklin County, Montana citizens.

His amendment offered free, never had to pay a dime into FICA, don’t have to be over 65, Medicare coverage to anybody living in Franklin County Montana exposed to asbestos. This might explain why Medicare has a payment code for “vaginal delivery”. Not everybody on Medicare is over 65.

This coverage follows qualifiers after they leave Franklin County. I’ll admit, I delivered a baby of a resident who moved to Moscow, Idaho from Libby. So, I am guilty of dipping my finger into this cookie jar.

I guess for Max Baucus an environmental/ public health emergency warrants universal health coverage, but public discussion of such a solution is criminal? Welcome to the American Healthcare Follies.

We like piecemeal, not universal solutions in this cowboy country.

Another such bite at the apple occurred back when the invention of kidney dialysis put the “God Committee” in charge of who lives or who dies. Swedish Hospital in Seattle had 17 machines, and there were thousands dying from kidney failure, so a committee chose the folks who got the treatment. In response to the uproar when Life Magazine did a cover story, our government offered universal Medicare coverage to anybody with the diagnosis of “end stage renal disease”. Not only would someone with this diagnosis get their dialysis covered by Medicare, but their erectile dysfunction is paid for too.

So, we offer universal government coverage based on county of residence, your exposure to a bad chemical, or if you have a qualifying diagnosis. We sure love piecemeal solutions, don’t we?

Some argue we should expand this piecemeal approach to medications. Say you need insulin. Then it should only cost you $XX a month. The Big Pharma CEOs and stockholders will expect their whittled down returns to be made up on the cost of blood pressure medications.

It’s a lot like me fixing the dripping faucet on a rundown house with a falling in roof and a settling foundation. Sometimes it’s just best to scrape the failing structure and start over.

Have we come to that point with American Healthcare? Max Baucus, no longer in the Senate, now says maybe we should be considering universal coverage and single payer.

Just how should healthcare be paid for and apportioned? Oops, will I get arrested for bringing this up? I’m not in front of a Senate Committee, so I’m probably OK. But I sure won’t get elected to public office anytime soon. No, to please the public you have to propose piecemeal solutions for poor, innocent victims.

If we keep this up, we’re all guilty.

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This isn’t my neighbor

Our neighborhood has been terrorized by a motorcycle rider for the last couple months. He has a Honda crotch rocket with a modified exhaust I can hear a mile and a half off.

I know you guys with the Trump flags in the back of your rigs think you are annoying me, but I can shrug at your silly efforts. This guy woke me up with his 120-decibel staccato. That is annoying.

We talked about it, me and Martha. Should I go knock on his door? He rents down the hill; I know the house. Absentee landlord who used to live here five years back but now just rents to whoever and doesn’t care about the neighborhood.

I thought about just calling the cops. Complain to the officials is the way, right? I even took the effort to look up the code. The Idaho legislature has had the foresight to put into Idaho law that modified exhaust on motor vehicles beyond factory and decibel allowances is illegal. I wonder, what does the Idaho Freedom Foundation think about the freedom to blast noise into my neighborhood? Maybe they will let me know about this freedom.

We kept listening to the BRAAAH as he came up the hill for the last couple months.

But last night after dinner I was out on my porch, and I could hear him coming more than a mile away. So, I did what any young person would do, I got my phone out, put it on video as I walked out to my driveway and stood there recording his climb up the hill.

He saw me as he rounded the curve and throttled down. He was only about 90 decibels as he went by, but he circled and stopped. He waved me over and flipped up his visor.

We were going to have a conversation.

That’s what needs to happen. Conversations about our differences might bring us together. Why should the annoyance we project have to be the substance? There are so many more important issues to consider.

The motorbike rider and I did not discuss school funding or gun rights. We did not argue about abortion or immigration. Maybe we should have. We all should. Instead, we are trying to annoy, poke the buttons on the sensitive spots of those we think we hate. How silly.

He and I talked about his noisy motorcycle and keeping the peace in our neighborhood.

It got difficult.

We too often avoid these difficult conversations. It is unwise to go into any negotiation thinking you have the same goal or even frame as the person you are talking to. But we need to listen and respond.

He apologized for the noise. I appreciated that.

I asked him when he would get it fixed. He demurred.

I pointed out to him his motorcycle was in violation of the law. He argued and I showed him the law.

But this is where our laws on paper meet the reality of how we live.

And it’s also why the laws we have on paper in our Idaho statutes are so valuable.

I told my neighbor, if he didn’t get his exhaust fixed, I was going to complain to the police: file a complaint.

We have all these laws on our books, but the cops can’t go around enforcing everything. So much is complaint driven.

I remember a cop car stopping in front of our house twenty years back and telling us we had to get rid of the red poppies along our lower retaining wall. We talked. I think he decided we weren’t harvesting heroin.

But I haven’t filed a complaint about my neighbor’s motorcycle yet.

This morning he went down the alley on idle as he went off to work. He didn’t disturb me. But maybe those alley folks got jarred out of sleep. Will they complain? Should I?

We should be good neighbors. Unless our goal is to annoy those around us. Then we need the law.

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Idaho’s grandstanding Attorney General, Raul Labrador, has decided he doesn’t like the process whereby the University of Idaho entered into a business deal with the University of Phoenix. He’s threatening the Idaho Board of Education with a lawsuit unless they “do over” an executive meeting where this forth coming deal was discussed. He’s insisting the deal be discussed in public.

I’m all for shining the light on public processes. But private companies might find this a chilling consideration, should any future businesses consider trading assets our way. Maybe that’s Labrador’s plan: throw cold water on state business deals. I am scratching my head about what he’s thinking unless it’s just my original assertion: he’s grabbing for the spotlight.

I can’t say I like the U of Idaho/ Phoenix deal, but the confidential business process is a long-standing Idaho tradition. Public institutions acquire, partner with, or somehow deal with private entities all the time. The Boards that ostensibly govern those state entities (appointed by the governor, approved by the State Senate) might hear some generalities about the process, or not. The discussions might be in public meetings, or they may not.

Take the 2016 affiliation of the private, for-profit medical school in Meridian with Idaho State University. Those deals were done in similar confidential ways. I don’t know if the Board of Education had discussions back then in executive session. But Labrador wasn’t AG then, he can rightly declare.

The announcement of the conclusion of that deal was heralded by most (but not all) as a wondrous accomplishment. Idaho College of Osteopathic Medicine is still a private, for-profit entity, paying Idaho State University an annual sum on their thirty-year lease for the buildings on ISU’s Meridian campus. The payments go right into ISU’s operating budget, with no legislative appropriation. I wonder how many thirty-year leases there are in state contracts. I’ll bet there are a lot. I just know about this one because I asked some questions.

Maybe Labrador is “just asking some questions”. If so, he’s being pretty public about his process.

What business would want to subject a major investment with the whimsical Idaho legislature?

Labrador’s point that there are public meeting laws is fair. And agreeing to support a long-term binding deal by the Board of Education in executive session is clearly not public.

But how is our state going to do business? And a lot of what our state does involves business deals.

I’m no lawyer. But I did spend some time on the easily read “Idaho Open Meeting Law” website that has AG Labrador’s picture quite prominently above the introduction. There, on page 17, in discussing when governmental entities can go into executive session, taken straight out of Idaho Code it says:

(e) To consider preliminary negotiations involving matters of trade or commerce in which the governing body is in competition with governing bodies in other states or nations;

It seems our state, indeed our governing bodies can have nonpublic sessions to consider preliminary business deals.

Since this seems OK under the law, and it’s something Idaho government has been doing for a long time, just what point is AG Labrador making?

Does he have the same sour taste I do about the University of Idaho, the “Flagship University of Idaho” getting in bed with a disreputable, private, for -profit University? If so, that’s a poor excuse to twist the plain words of the law into a bullying action by our states elected head lawyer.

This action, and quite a few others are making Idaho the state doctors are fleeing, and soon lawyers will flock to. Esto Perpetua.

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We citizens have decided it is best to let our legislature call itself into session whenever they can get enough to sign on. So be such folly. But while our august lawmaking body does their potato field, or insurance sales work and makes no laws, not in session, some small legislative groups labor on. For there is work to do. This is a wiser strategy.

The House and Senate Health and Welfare Committee chairs, during this last legislative session agreed to sponsor a resolution to call an interim committee together to consider whether it would be wise to move Idaho Medicaid toward managed care. They are thus meeting. I’ll bet you missed it. There were no headlines. But the meeting is available for your review if you have the hour to spare for the download.

I took that time.

They aren’t dummies, this group. That is deeply reassuring to this skeptic.

Just what the heck is “managed care”? Since in modern parlance, we can put a fancy name on anything we want to sell, the buyer should always beware. Make no mistake, we taxpayers are the buyer. Just what are they selling?

And I found the legislative group to share my skepticism. When someone goes into this sort of inquiry with a passionate bias, I expect somebody somewhere to make a lot of taxpayer profit. I did not see such bias as I watched the 4-hour download.

Managed care does not rile up folks like critical race theory does. Or indeed like “death panels” did. Health care policy puts people to sleep. It’s not like you are protecting your children from groomers or predators. The sad truth is, if you want to make some progress on public policy, saving the taxpayer a dime, you need to focus on some details. And that is boring, slogging, sit in the chair and pay-attention work. And that’s what this group seems ready to do. I was a bit thrilled. Are you?

Maybe instead you want to bring your semiauto to a pizza parlor to save the children. It seems that’s the prevalent mood out there. So, I want to speak up about the courage to pay attention to the details. Nobody brandished a weapon. But we are talking big money.

For contracting with a firm to “manage care” for Idaho Medicaid mean we, the Idaho taxpayers, are entering into a $3B dollar contract. Puleeze, notice the “B”. We might spend a million on a bridge, or a new school, but BILLIONS? Who is going to ride herd on such a contract?

It was telling that the spokesperson to the Department of Administration early on in the hearing admitted, meekly, that indeed it would require another full-time hire.

So, we’re going to hire one more person to make sure they don’t rob us blind?

Idaho has, since the Republicans have taken over, continually hummed the off-tune hymn “Business is Better than Government”.

Can I remind you of these mistakes? I know, all you guys with the Trump flags on your ¾ ton pickups will consider this a waste of time, but here I go.

Idaho tried privatizing our prisons. After lots of evidence for failures, a Republican governor who had advocated for this, abandoned his run.

Then there was the IEN fiasco, for broadband in schools.

Then the Luna Laws.

Wherever there is a lot of money in Idaho government, there are contractors out there willing to do our work for us. For a slim(?) share of the (?)profit.

Forty states have Medicaid managed care contracts. We have a lot to learn from them.

Heck, Idaho even has tried managed care with our Medicaid mental health contract. We contracted managed outpatient care back in 2014.

What did other states learn from these efforts? What have we learned?

Our poorly paid interim legislators have some hard work to do.

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This woke rant will probably mean as much to you as it would have to the Idaho Constitution drafters back in that hot summer of 1889. I specify Article X Section 1:

STATE TO ESTABLISH AND SUPPORT INSTITUTIONS. Educational, reformatory, and penal institutions, and those for the benefit of the insane, blind, deaf and dumb, and such other institutions as the public good may require, shall be established and supported by the state in such manner as may be prescribed by law.

Our state founders wrote constitutional sections delineating how mines could appropriate private property to dump their tailings, but the “insane, blind, deaf and dumb” got a cursory “shall be established”. And our legislature has continued this short shrift.

I must admit, the legislature has not totally ignored this edict. We have a Department of Corrections. We have a School for the Blind. Indeed, the largest state department, the most employees and the highest budget is for the Department of Health and Welfare.

So why this woke rant? It’s because we are doing this job so poorly. We can do better.

You only need to read this piece in the Idaho Capitol Sun about a mentally ill man in our prison because we have no other place to put him. He is not charged with crimes, no convictions. He’s just not safe to keep in our weak state mental facilities.

Everyone familiar with this sees the problem. But then, we’re probably just woke. Maybe you have some solution. Firing squad?

Our Governor saw this problem. Indeed, the previous director of Idaho Department of H&W told me of this need. We need a place to care for the dangerous, severely mental ill.

Brad’s budget request for this year proposed building a facility to care for these afflicted people. His budget request got ignored by the Joint Finance and Appropriations Committee. So, I guess our 21st century legislature has the same flippant attitude as our 19th century founders.

Go to the old penitentiary: sandstone blocks with guard towers in the desert east of Boise. Idaho has not welcomed woke.

Let me tell you why I rant. It’s because I see and care for many of these people in my practice. 

I see a patient released from State Hospital North. Two weeks after discharge, they are doing okay on the meds, and they have some group housing. But they don’t want to keep taking their medications. I prescribe the pills and tell them to come back in two weeks. They stop taking them. They miss their next appointment. I check the online county jail roster. My patient is now in custody.

Do we, citizens of Idaho, want the mental health care of our severely ill fellow citizens to be managed by jails?

I can tell you, the jailers, the sheriffs deputies don’t want this job. And I can tell you, they aren’t woke. They know, and you should too, that caring for severely mentally ill people takes a lot of work. But maybe it’s not something our legislature “shall” do, even though our State Constitution directs it.

I’m sorry if this woke rant burdens you. But I live in a town where severely mentally ill people have taken up arms and killed people.

I can’t say that Brad’s $24M facility would have prevented any of these deaths. But I can say that when Republicans respond to mass murders with calls for mental health considerations, not woke gun control appeals, then vote down a small effort, it’s a bit crazy.

But woke and crazy may actually be two sides of the same coin. Maybe we should talk about it.

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you can go here and complain about doctors. I haven’t found where you can go to complain about legislators.

I have only had one occasion to file a complaint against a colleague with the Idaho State Board of Medicine. They rebuffed me with a dismissive, “This is a local standard of care issue, handle it in your community.” My community colleagues had no backbone to address the poor care. I left the community.  A year later the person practicing medicine was finally sanctioned for another incident by the Board.

I offer this preface because you need to know, the Idaho BOM and I don’t always see eye to eye. Prior experience tells me this complaint will not be welcome either.

I hereby file a complaint with the Idaho BOM against the Idaho legislature, and our governor, while we’re at it, for the crime of practicing medicine without a license.

It takes quite a bit to get me riled up. I don’t always approve of choices my colleagues make when they provide care, but I can accept that what we do is a “practice”, and the variations within that practice, when studied, can guide us toward best practice.

Indeed, the Idaho Medical Practice Act defines the “practice” of Medicine:

The investigation, diagnosis, treatment, correction, or prevention of or prescription for any human disease, ailment, injury, infirmity, deformity or other condition, physical or mental, by any means or instrumentality that involves the application of principles or techniques of medical science…

Patients come to doctors for many reasons. I do my best to understand their complaints and provide care.

I remember a young woman who came to me with what I thought a trivial complaint. She was young, attractive, but had very coarse and prominent body hair. It darkly covered her forearms. She had a dark moustache she plucked. She said it afflicted all the women in her family, but she had researched an antiandrogenic treatment and asked me to prescribe it. I told her I would study it and get back to her. I did.

The drug blocked the effects of androgens, male sex hormones. It had been developed for the treatment of prostate cancer. But I found studies where it had been used for this young woman’s condition with significant benefit. After a week of study and contemplation, I called her to come back so we could consider this treatment.

I tell you this so you can consider what the Idaho legislature and our governor have just done. They have, by the heavy hand of the law, forbade me from considering a treatment for my patient.

No treatment, other than counseling, for a young person under the age of 18 who suffers from their gender may now be prescribed by a medical practitioner under the penalty of law.

The Idaho legislature and our governor have decided how medicine should be practiced in this state. The Idaho BOM should take heed.

I don’t know the best treatment for gender dysphoria. I have seen patients who struggle with this condition. I do my best to treat them with respect, knowledge, and wisdom. But now, I must also treat them with the consideration of prosecution. Is this the Idaho I love? Is this the community that cares for each other?

There are many issues the struggling youth must address. There are issues their communities must address. But passing laws about what treatments are available doesn’t seem a healthy way to proceed.

The Idaho legislature and our governor have proclaimed they know the best way to practice medicine. The Idaho Board of Medicine needs to assert their authority. Statutes clearly describe the penalties for practicing medicine without a license. Drop that complaint in the Attorney General’s lap. We all know where that would go.

Just because you know the enforcing authority won’t act doesn’t mean you shouldn’t voice your complaint.

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Our Attorney General is trying for a mulligan from his office in our House of The People down there in Boise. That’s what we get when we elect bullies. They shoot off their mouths, and then expect us to pay for it.

Let me catch you up. An AG’s opinion letter sent to Idaho Representative Brent Crane last month was made public. In it, our new AG, Raul Labrador, stated that a doctor who “referred” a patient across state lines to access abortion care would be guilty of a felony. Further, a doctor who prescribed medication for an abortion for an Idahoan to pick up across state lines would also be felonious.

This “AG analysis” as his signed letter heading indicates, hit the national news and in a few days our AG decides he didn’t really write it. It turns out he, or his staff figured out the analysis was requested by Crane for fundraising, rallying the troops, purposes, so he announced the analysis had never happened. It was “rescinded”.

Still, the alarm bells went off for some folks, mainly the ACLU, and now our AG is spending time defending this letter that he claims was never written in Federal Court. Isn’t that where we want our state’s lawyer spending time? Defending an analysis, he says now he didn’t even write in federal court? I’ll bet some of us do. I doubt AG Labrador serves in the Militia for the Unborn. But I know he wants their votes.

This militia is well organized. I remember getting called out of a room when I first started to practice long ago in Idaho by my nurse. “There’s somebody on line 4 that wants to talk to you.” It was the old days, and I could recognize a long-distance call by the static on the old land lines.

“Doctor Schmidt, will you be providing abortions?”

She waited for my answer.

This last week in the clinic where I work now there were two people scheduled to see me whom I did not know. The reason for the visit was in the computer as “discuss family planning”. I wondered, were they sent to entrap me? Did they want to get me to mention a clinic across state lines where they could access the care unavailable to them in this state? And then would they share this information with our state Attorney General? And would the state troopers roll up as I’m having a beer with dinner?

When asked to clarify his “analysis” by reporters, our Attorney General refused. He did not say this analysis was wrong, he just said it hadn’t happened.

I guess that’s how my fellow Idahoans want this to play out. Only legislatively approved care can be provided by doctors. Really?

It’s going that way with all the hot button issues. Abortion, transgender care, what is next? What kind of personal care will come under the scrutiny of our legislature and the analysis of our AG?

Could a twenty-year-old man request a vasectomy?

Can a 42-year-old woman request fertility treatment?

Can a 95-year-old man get Viagra?

I understand the passion of the Militia for the Unborn. They see the lives to be saved. And what’s a little arson, or a sniper round to save these fetuses?

And now, we have the full power of the government, the state, the marble-halled Capitol, the Peoples House, coming into this conversation.

I talked with the young women about their choices for family planning. I tried to understand their needs, their situation. I decided not to fear that I might be prosecuted. But I considered this going into the room.

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Coroner Story: Black Heelocopter

Sometimes how you get the call is an important part of the story. Sometimes, it’s who calls you, sometimes it why they thought you needed to be called, sometimes it why you weren’t called. All these little nuances to being a small town, rural county coroner fascinate me. So, when I picked up my phone on a warm fall afternoon and I got gruff old Ivan’s voice yelling into my ear, “Doc!?”, I didn’t expect this to be a coroner call.

“Yeah Ivan, what can I do for you?” He’s 85 years old, a crusty skin and bones old rancher in the east county. I see him maybe once a year as his doctor, less if he had his way. But the time I stuck him in the hospital with congestive failure and told him he wouldn’t make his 82nd birthday inspired him to come in annually after that, mainly to rub my nose in my errant prognosis.

I saw him more when his wife was dying. They cared for her at home right up to the end. She got demented and went fast, thank God. I’d met her three or four years earlier and while I was asking her about her family history, she looked me in the eye and told me a fractured but intelligible story of her brother, five years older, who’d gotten demented and died within a year.

“That old Alzheimer’s can really take you down,” she’d tsk’ed and shook her head. I nodded but silently disagreed. Alzheimer’s usually takes some one five years or more after the initial diagnosis. My mom had taken more than ten years. Usually, it’s plenty of time for families to flounder with personality changes, bed sores, diaper changes, nursing home costs and guilt. But Ivan’s Irene had just gotten pleasantly forgetful and died a year later. Her pattern, and her brothers made me fear I’d missed a diagnosis. None of this was on Ivan’s still sharp mind this fall Saturday afternoon.

“You still the coroner?” he yelled. His deafness made him yell. He was the deaf one, but he yelled to others out of politeness, I guess. “I know I voted for you once but maybe I missed something.”

“Yeah Ivan, I’m still the coroner. You fixing to die or something?”


“How can I help you? Yes, I’m still the coroner.” That last part as loud as I could yell into the phone.

“Oh no, I’m not dead. At least I don’t think so.” He laughs. “Say, I got a dead guy for you.”


“Yup. Out on American Ridge. I was out looking to bring in some cows and found him.”

“You call the sheriff?”

“No. Should I? I don’t think he needs arresting, he’s dead.”

“Where are you now?”

“I’m back at the house. But he’s up on the ridge like I said.”

“OK Ivan. I’m going to call the sheriff’s office then we’ll come out to your house, and you can show us this guy.”

“When’ll it be?”

“Maybe an hour. Why?”

“I was gonna get something to eat.”

“You go right ahead. See you soon.”

I hadn’t wanted to suss out details, yelling into the phone and his hard of hearing. I knew Ivan was a solid guy and wouldn’t be calling me about some pile of deer bones or an old flannel jacket on a log. So, I called the sheriff’s office. I think this was the first and only time I ever called them about a dead body. They usually called me. But it can go all sorts of ways. One time the funeral home called the local police about a coroner case. An old guy had driven his ’63 Chevy truck into the funeral home parking lot, taped a note to the driver side window and shot himself behind the wheel. He was trying to save us all the hassle. But we all got rousted out anyway and then had to call to get his bloody truck towed away.

I got to Ivan’s house after the deputy. They have radios. The deputy and Ivan were up on the front porch. Though sunny, there was a fall chill and a westerly breeze that suggested rain. Hunting season was full bore, so my hunch was this body was a lost hunter. But usually Search and Rescue hears about such a thing before the guy’s feet get cold. He doesn’t come back to camp and the word goes out. Still, some guys go out by themselves, break a leg, who knows.

I climb the porch steps. “Hello Ivan. Hello Brandon.”

Ivan smiles. Brandon grins. “Did you take a wrong turn doc?” He knows I’m famous for getting lost on the county roads.

“No, I just had to put the tools away. I’m mudding some sheet rock.”

“Oh yeah. Don’t want that shit to dry on the tools.” He’s being familiar but I doubt he’s ever remodeled or fixed up even his single wide.

“So, what have we got?”

“Ivan here says it’s a plane wreck.”

“Really?” I’m surprised. I felt bad for not asking more over the phone. But in person is best with this old guy. I made him come in once a year at least for his medicine refills, though he only took one or two pills, way below average. He took great glee showing me he had beat my prognosis. I had to go over him pretty good, since he minimized everything. The 2-centimeter skin cancer on his right shoulder I’d found under the Carhart jacket, wool shirt and long underwear.

“Oh, that.” He’d said when I asked him about it. Plane wreck? Small potatoes, I guess.

Ivan was retelling Brandon about how he’d noticed all the broken trees across the canyon. I could figure this was a retelling since Brandon rolled his eyes at me. Somebody had to cut him off; we’re losing daylight.

“So, Ivan, can you get us to this wreck? I wore my boots. How far is it?”

He puckered to an expression of thought. “Well, what rig we gonna take?”

“Which one did you take?” I yell at Ivan.

Brandon interrupted. “You get the twenty doc. I’m gonna tell dispatch about the plane wreck thing.” He went to his rig and the radio.

Ivan’s grinning at me about his answer. “Well, doc, I was on Sadie.” He looked at me intently and waited.

“Who’s Sadie?” You gotta let them tell the joke.

“She’s my old mare!” He slaps his thigh.

Old brittle 85-year-old on horseback with congestive failure rubbing my doctor nose in it.

“So how can I get there?”

“You driving that thing?” He nods at my rusty old Toyota two-wheel drive pickup.

“I drove it here. We need four-wheel?”

“It’s a bit muddy past the gate.”

“We’ll take the deputy’s rig. It’s got four-wheel.”

Brandon said no one knew of any plane wrecks but dispatch was going to check with the FAA. We all got into the deputy’s Ford Explorer. I got to sit in the back where the doors don’t open from the inside, so Ivan managed the gates. They were his anyway.

It was about three in the afternoon now and it would be getting dark by 5:30 or 6. At least it wasn’t raining yet or snowing. We passed three wire gates then we get into broken timber. Ivan was telling Brandon how he’d come at it a different way on horseback so he’s not sure we can see it here from the dirt track. “Hell, Sadie saw it first!” he yells. “I’m looking for cows and she keeps staring off at the far ridge, so’s I think she’s seeing some there, but that’s when I saw the broken trees and the plane.”

“Did you go up to it?” Brandon asks.

“Naw, but I could see something in the pilot’s seat with the glasses. He’s dead.”

After twenty minutes and maybe five miles Ivan suggests we stop. By the rig he offers, “Just climb up this ridge and head south a bit.” He’s gesturing with gnarled hands and stiff shoulders. “We was up on this ridge I think when we seen it.” He twists back. “I could show you but I’m not too good in this downfall.” Another gimped up gesture and I’m looking for a path.

“If you’re staying here, I’ll leave the keys with you if you need to warm up.” Brandon handed the old man the keys.

We clambered over logs and through brush. I didn’t sense any ridge nor even magnetic direction. After thirty minutes we agreed to go back and get Ivan. “I seen you were dropping down too soon” he grinned.

There were the usual jokes about if anybody got hurt at least we had a doctor. And if it really went to shit, we had the coroner. I’ve heard them too many times. Ivan was remarkably agile, though slow and I’m thinking of daylight. He followed game trails and stayed with the grade until we came to a clearing.

“You might be able to see some broken trees from here off that a way.” He gestured again. Both Brandon and I looked off. It was a quarter mile or so below us still. The thing that got my attention was the fine white dusting across a couple hundred yards before the broken trees and white fuselage shined at us.

“Think it was a crop duster?” Brandon asks.

“Nope,” I say. “They don’t spray white powder.”

“OK Ivan, we can see it. Do you think you can get back up to the rig?”

“I think I better stay with you guys. You got pretty fouled up last time I sent you off. It ain’t far.”

We dipped back down into the timber following the old man. There was a temptation, like when you shoot a deer, to head off full bore to where you think it’s down. But long ago I learned that temptation is to be avoided. Slow and steady got Ivan to 85. By the looks of it he’ll make 90 at this rate.

The white powder I saw contrasting the dark needles wasn’t visible on the ground, but I warned Brandon. “Don’t touch the ground and put your fingers in your mouth. You won’t be passing any drug screens the sheriff puts you through.”

“Is it OK to breathe?” He chuckles.

“Only through your nose.”

The wreckage was mostly intact though both wings had sheared, and the fuselage buckled. We could see it was a twin-engine prop, no numbers on it. Ivan had stopped and was looking back. “I think I spotted her from up over there.” He gestures back toward a clearing across the canyon a couple hundred yards up and over; always orienting. “I could see the guy in the pilot’s seat. He’s dead. That’s why I called you.” He reminds us.

Brandon was ahead of us downhill looking into the tilted cabin, past the bent and split open fuselage. There were lots of wrapped bricks and white powder back here. He hustled up the slope a little breathless. “I gotta call this in. They’re gonna want to know about this. I’ll head back to my radio in the rig. Hope I can raise them here. If I can’t I’ll drive out a ways. You guys gonna be OK? I’ll be right back.” He was panting.


“Take your time.” Ivan advised. “We’ll be fine.”

Brandon scoots up the sidehill back toward the Explorer. I walk down toward the cockpit. Ivan follows. It’s pretty quiet here in this canyon, no wind, but I can see it’s getting gray. We have another couple hours of light I figure.

The windows are all broken out and I can step into the tilted plane pretty easily with the left side torn open. Ivan was right, the pilot was very dead, not days, just pale and stiff. But it’s been cool, and this is a north slope, so maybe a couple days. No animals had gotten to him. There’s blood out both ears and the head is tilted at a funny angle.

I spook when “What do you think killed him doc?” is yelled in my ear. Ivan is all serious and frowning.

“Jesus, Ivan.” I want to tell him to soften his voice here in the presence of the dead, but I know it’s no use. “I think he died in a plane wreck.”

Ivan’s laughter is loud, and he laughs too long; my skin crawls a bit, I don’t know why. He gets serious and asks me intently, wanting to know. “No, I mean doc, did he bleed to death? I see some blood but not that much.”

“Oh, Ivan, it’s hard to tell. Here let me check.” I reach in and twist his head a bit and feel some grating bones. “Yeah, I think his neck is broken.” The yelling I have to do makes this almost obscene.

“But is that what killed him? People survive…” he trailed off as I turned my back to him. I wanted to get some identification. There were satchels that looked like luggage on the cabin floor and more stacked up where the copilot’s seat would have been. I zipped open a small one behind the pilot’s seat. There on top of rumpled clothes were three passports, one Columbian, one Mexican, one Peruvian. Miguel Sandoval was on the Mexican, Manuel Salinas was on the Peruvian and Miguel Santoro was on the Columbian. There were three other satchels jumbled next to him. I unzipped one. Bundles of US currency were neatly stacked and wrapped, some fifties, some twenties, some hundreds.

I jumped again when Ivan said, quieter this time, “Don’t know as I’d called you guys if I’d a known all that was there.”

Brandon got back in about a half hour. He looked troubled. “We’ll stay put ‘til they get here. Won’t be long.” For some reason I didn’t ask who. “Why don’t you take Ivan back up to the rig so he don’t have to scramble around if it gets dark.”

Ivan and I made the slow walk back to the Explorer, then I headed back down and across the slope, a little faster on my own.

When the big black helicopter came over just before dark and all the paramilitary dark suited guys came down the slope, I knew it wasn’t our sheriff’s department. A short man approached us with his combat weapon by his side as the others fanned out and disappeared in the gloom. He had night vision goggles up on his helmet, black clothes, black gloves and a smile. He didn’t offer his hand. He spoke to Brandon. “OK, we got it. You can take off.”

Brandon nodded and softly gestured to me as he turned up the slope. “Hey,” was my simple objection and the short man turned toward me.

“Who are you?” he shot at me.

“I’m the county coroner.”

His smirk didn’t feel so good. “You can go, sir. We got it.”

“And just who are you?”

Brandon was three or four steps up the slope. He stuck out a beckoning hand. “C’mon doc.” Like I’m a balky puppy. The short guy was getting ready to turn away again and I asserted all the authority a county coroner has. “What happens to the body?”

This time he wasn’t deferential. He snapped back toward me and up in the trees I could see a dark shape, maybe two, step into view. The short man looked me directly in the eyes. “You can go. We got this.”

Brandon was now stepping down the slope, impatient with me. “Come on doc. We’re going. These guys are taking over. They’ll take care of it. We gotta get back.” He put his hand on my shoulder, softly, not like he would have grabbed a puppy’s scruff, but like we were having beers. “C’mon.”

The trail back up was dark.  I only slipped a couple times.

“You guys see that big black heelocopter?” Ivan asked. Brandon wouldn’t tell us nothing. Maybe he didn’t know.

It was about three weeks later I got a call from the medical examiner’s office in Spokane. “Dr. Hawthorne?”

“Yes, how can I help you?” I hadn’t requested their services for years.

“We have a body here and we need your permission to release it to the family.”

I’m clueless. “Who is it?”

“Manuel Sandoval”

“Why are you calling me? I don’t know this guy. It’s not my case.”

“Our paperwork says you are the coroner on this case, and we just need your permission to release the body.”

“So, are you sending me a death certificate; an autopsy report?”

“Uh, no. Those were sent to Washington. We just need your authorization to release the body.”

“Call Washington. I don’t know anything about this.”

“Uh, we did. They said to call you.”

“Is my name going to be on any record of this?”

There was a pause. “No sir. We just need your permission to release the body.”

Deep sigh. I thought of Ivan’s smile and his slow steady gait. How he looked the graceful scarecrow under the dark pine canopy weaving through the brush and sticks. I thought how he would laugh at this silly joke. I wanted to be sitting on his porch in the afternoon sun, telling him this story, yelling him this story, repeating myself when he said “eh?” and finally getting tired of the whole tale, realizing it’s not a short joke but a long one with nothing really to laugh at. But then we’d just sit there and look at the sun on the hills from his old farmhouse.

“You have my permission to release the body.”

No death certificate filed.

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