Tuesday, September 1, 2009

"Warts and All" - Cryonics Case Reports

This post is dedicated to Saul Kent.

"As to your question of whether Saul Kent wants case reports on cryonics standby cases done, if you have to ask, you don't know the man. For a time, several years ago during the Waynick Alcor administration, Kent actually offered cash bounties out of his own pocket for full Alcor case reports to be done and published. This resulted in some getting done, but others are still hanging fire even now, and quite a lot of this bounty money still remains collectable but uncollected-- a matter of some thousands of dollars. If you want to know the details of why not, you can ask Alcor; that story is not mine to tell. However, suffice to say that SA case reports will certainly be done, warts and all. Everyone at SA understands how critical such things are, for quality control reasons. That includes, perhaps more than anyone else, Saul Kent."

Steve Harris

(A special thanks, to "Phil," for reminding me of this Harris post.)

Today is September 3, 2009, and Suspended Animation, Inc., (a company funded by LEF/Kent), has yet to publish a case report for Curtis Henderson (CI-95), for the procedures an SA team performed on Mr. Henderson, June 25th, more than two months ago. Where are your "warts," Mr. Kent???

Since Phil reminded me of the Harris remarks, others have verified that Kent has often criticized Alcor for not producing timely case reports. One person maintains that some of the reports were produced, but didn't live up to Kent's standards. They seem to think he would prefer something like one of Platt's monstrosities, filled with irrelevant subjective material, to an objective reporting of the facts.

Thus far, most cryonics case reports have been subjective, rambling narratives, of little merit. Subjective reporting is "sometimes completely false, and "destructive in decision making," while objective information is "as close to the truth as we can get," and "helpful in decision making. http://www.asdatoz.com/Documents/Website-%20Objective%20vs%20subjective%20ltr.pdf

We didn't need to know most of the information in SA's CI-81 case report. We didn't need to know one of the people who didn't show up had a job at a local supermarket, or that a former employee wasn't there because she "refused to make herself available to assist in future cases even as an independent contractor," (especially since that last part was untrue...I am the "former employee" being referred to, and as I recall, no one ever asked me to take call as an independent contractor).

We didn't need speculations like: "The batteries in one of the voice recorders may have lost their charge as a result of someone failing to switch off the recorder after a practice session." That wasn't a fact, it was nothing more than a lame excuse for showing up with dead batteries. Cryonics case reports are rife with lame excuses, like this.

Case reports shouldn't include discussions about equipment that isn't even brought to the case, or remarks about the team members being best buddies. You won't read, "Though rewarming from 18-degrees C, took a long time, the heart team all got along well, with the perfusionist and surgeon amusing the other team members with off-color jokes," in a heart surgery case report, though something like that probably happens, a lot, near the end of profound hypothermia cases.

You will see the "warts." You'll read about the time a scrub nurse accidentally threw a vessel intended for a graft off the table and the patient's leg had to be reopened. You'll read about the anesthesia nurse who inappropriately applied pressure to a transfusion bag and filled the patient's heart with air, causing him to "crash and burn" and requiring him to be placed back on the heart-lung machine. (The patient lived to tell about it, because the anesthesia nurse admitted to what he had done, the second he saw the patient's pressure drop and realized what had happened.)

Medical case reports are not intended to be "stories," they are meant to convey a factual representation of the case. They serve several purposes, one of which is to facilitat comparing cases. It should be obvious that the only way to do this is to have uniform reports. It's not as easy to compare the apples in Chef A's Cajun Apple Cobbler, to the apples in Chef B's Apple Walnut Celebration Pie, as it is to compare apples used in identical recipes.

There should be standardized forms, for cryonics case reporting. Aschwin de Wolf and I tried to establish this, at SA, and we caught no small amount of hell, for doing so, from a man who has probably billed cryonics organizations for quite a number of his hours for writing rambling, subjective case reports that contain more "padding" than any professor teaching freshman "Comp and Rhetoric" courses probably sees, in an entire year.

In heart surgery, (something much more complex than a cryonics washout procedure), the reports are in a standard form, and produced immediately after the procedure, by the medical personnel involved in the case, (not three months later, by a science fiction writer who wasn't even present for the case).

I can look at any heart surgery case report and tell a lot about the case, immediately. I can tell you who the personnel were, when the first incision was made, when they went "on pump," when the cross-clamp was applied to the aorta, when they started cooling, how many grafts were done, where each graft came from and where it was placed, when they started warming and how long it took, exactly what medications were administered (including the amounts and time of administration), and a lot of other information about the case, the most important being variations from the norm.

From the perfusion record, I can tell you the perfusion flow rates, a number of temperatures, patient pressures, perfusion circuit pressures, arterial and venous blood gases, how much oxygen was being applied, ACT's, HCT's, (all of these, at approximately ten-minute intervals, throughout the pump (perfusion) run), and more, including how long the patient was "on pump," how much fluid was added, (or removed), etc.

From the anesthesia record, I can tell you everything you want to know about the medications that were administered by the anesthesia team, and a vast amount of information regarding the patient's condition, throughout the case.

A lot of the information will be duplicated on all the records. For instance, the "on pump," "cross-clamp," and "off-pump" times will be called out, and documented by anesthesia, the perfusionist, and the circulating nurse. (The surgeon will ask for those times, (and other information), before he does his dictation.
And, one more thing...there should not be any photos. I believe publishing images of themselves in scrubs, attempting to perform medical procedures they don't really know how to do, probably helps some of the people working in cryonics to maintain the illusion, (or self-delusion), that they really are medical professionals, when most of them are incompetent to the point of inflicting a tremendous amount of harm on their patients.

So, Mr. Kent, if you want timely and productive case reports, you should hire some medical professionals who actually know how to perform the procedures you are selling, at SA. Then, your personnel would be capable of properly documenting the procedures, and producing timely reports that could be used to compare cases. On the other hand, if you want to be entertained by a rambling, inaccurate narrative, with a lot of extraneous information, hire a fiction writer who will make up a story based on information he receives from care providers who don't really know what they are doing. OH...wait...you already made that decision.

I think LEF/Saul Kent are excellent proof that people don't always get what they pay for. LEF could fund competent medical care, for a lot less than what is being spent at SA.

Sunday, August 30, 2009

Embalming and Cryonics

1 : to treat (a dead body) so as to protect from decay
2 : to fill with sweet odors : perfume
3 : to protect from decay or oblivion : preserve
4 : to fix in a static condition


Are Alcor and Suspended Animation illegally "embalming"? (Cryonics Institute is licensed as a cemetery. Their procedures are conducted at a licensed funeral establishment, under the supervision of a licensed funeral director/embalmer, and monitored by the State of Michigan.)

Alcor and Suspended Animation may attempt to defend their activities by calling their procedures "medical research," but I believe any state board familiar with what they are doing, and the qualifications, (or lack thereof), of their care providers, will agree with me that their activities cannot be qualified as "medical research." I say they are (possibly illegally) preserving dead bodies, (embalming).

After a little research, I have ascertained that embalmers must be licensed in all 50 states. I am not going to research the regulations of all 50 states, but the states I have researched all require a formal education, (some from 2 - 4 years), an internship, (most of at least one year), and passing a local and/or national certification exam. Violation of embalming regulations result in possible jail time and/or fines, for each incident, in all of the states I have researched.

After the Dora Kent case, Alcor was accused of murder, illegally practicing medicine, and the theft of equipment from UCLA. None of these accusations held up, but as far as I know, they have never been accused of illegally embalming, a charge I believe would hold up.

As for SA, not only might they be illegally embalming, but in recent years, they have had laymen, (people who would not be allowed to legally administer drugs to patients, or embalm), traveling across state lines, carrying regulated medications, in order to do so.

From Florida Statute 497.368, (with emphasis added):

497.368 Embalmers; licensure as an embalmer by examination; provisional license.--

(1) Any person desiring to be licensed as an embalmer shall apply to the licensing authority to take the licensure examination. The licensing authority shall examine each applicant who has remitted an examination fee set by rule of the licensing authority not to exceed $200 plus the actual per applicant cost to the licensing authority for portions of the examination and who has:

(a) Completed the application form and remitted a nonrefundable application fee set by the licensing authority not to exceed $200.

(b) Submitted proof satisfactory to the licensing authority that the applicant is at least 18 years of age and is a recipient of a high school degree or equivalent.

(c) Made disclosure of the applicant's criminal records, if any, as required by s. 497.142. The applicant shall submit fingerprints in accordance with s. 497.142. The applicant may not be licensed under this section unless the licensing authority determines the applicant is of good character and has no demonstrated history of lack of trustworthiness or integrity in business or professional matters.

(d) Completed a course in mortuary science approved by the licensing authority, which course embraces, at least, the following subjects: theory and practice of embalming, restorative art, pathology, anatomy, microbiology, chemistry, hygiene, and public health and sanitation.

(e) Submitted proof of completion of a course on communicable diseases approved by the licensing authority.

(2) The licensing authority shall license the applicant as an embalmer if the applicant:

(a) Passes an examination on the subjects of the theory and practice of embalming, restorative art, pathology, anatomy, microbiology, chemistry, hygiene, public health and sanitation, and local, state, and federal laws and rules relating to the disposition of dead human bodies; however, there may by rule be approved by the licensing authority the use of a national examination, such as the embalming examination prepared by the Conference of Funeral Service Examining Boards, in lieu of part of this examination requirement; and

(b) Completes a 1-year internship under a licensed embalmer.

(3) Any applicant who has completed the required 1-year internship and has been approved for examination as an embalmer may qualify for a provisional license to work in a licensed funeral establishment, under the direct supervision of a licensed embalmer for a limited period of 6 months as provided by rule of the licensing authority. The fee for provisional licensure shall be set by rule of the licensing authority, but may not exceed $200, and shall be nonrefundable and in addition to the fee required in subsection (1). This provisional license may be renewed no more than one time.

From Arizona Statute 32-1322 B, (with emphasis added):

B. An applicant for licensure as an embalmer shall:

1. Pass the funeral service science section of the national board examination or the state equivalent examination.

2. Pass the embalmer state laws and rules examination.

3. Be of good moral character.

4. Have been licensed as an intern for at least one year.

5. Have successfully completed an internship program that included assisting in the embalming of at least twenty-five dead human bodies.

These are just the regulations in Alcor and SA's home states. Both organizations have traveled outside their states, to perform procedures. Call me "overly cautious," but if I were managing a cryonics facility, I would do anything, and everything, to comply with state and federal regulations, for fear of negligence, or illegal activities, shutting down the entire cryonics industry. People working in cryonics aren't going to be able to put on their scrubs, or white lab coats, and believe this transforms them into professionals capable of performing advanced medical procedures, or gives them the authority to do things like declare people dead and commence preservation procedures, forever. Eventually, someone will stop these behaviors, and it won't be pretty, for the cryonics industry, as a whole.

If I were Bill Faloon, or Saul Kent, I would take part of the ~$2M a year I was spending for a lot of unqualified personnel and questionable "research," at SA and CCR, and spend it on establishing relationships with licensed embalmers in all the states in which I had clients. Better yet, I would investigate whether it was possible to acquire embalmers who are licensed in multiple states. While I was doing this, I would have a team investigating how to move the procedures into mainstream medicine, where they could be carried out by vascular surgeons, perfusionists, and other competent, qualified, medical personnel.

I believe LEF is supporting ten employees at SA and CCR, combined. When I resigned from SA, there were seven of us, all putting in 40-hour weeks, plus at least one consultant who told me he was allowed to log 160 hours per month. Taking into consideration that the SA employees are allowed four weeks of vacation, per year, that was approximately 15,360 man hours, per year. I've been there, and I feel an EXTREMELY large percentage, (the vast majority, in my opinion), of those hours were absolutely wasted. I felt some people were being paid to do absolutely nothing, with most of their time, and half the man-hours were being used on questionable "design and fabrication" projects.

SA has the time, and the money, to provide the services they offer in a professional and ethical manner. Yet they continue wasting all their valuable time and money attempting to train layman to perform medical procedures they will not be able to master without extensive, properly-supervised clinical experience, and designing and fabricating equipment of questionable merit. Bill and Saul, (or their extremely well-paid management), should really focus on researching ways to provide their services, competently, and in a manner that won't result in more trouble for the cryonics industry.

As "FD" recently suggested on the Cold Filter forum, and as I have suggested, many times, in the past, if the cryonics organizations don't regulate themselves, someone is going to do it for them.