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'The scene belonged to a disaster movie, not a family holiday': the day my partner drowned
When Decca Aitkenhead's partner, Tony, died rescuing their son from a riptide, she believed she had survived the worst time of her life. But there was more to come
Decca Aitkenhead
Sat 26 Mar 2016 05.00 EDT Last modified on Mon 25 Nov 2019 07.22 EST
Decca and Tony at a festival in London in 2007. Photograph: courtesy of Decca Aitkenhead
Jamaicans have a word that can mean hello, goodbye or thank you. "Bless-ed," they say. Our two sons picked it up within days of arriving on the island. In their English toddler accents, the patois sounded comical – but also unexpectedly true.
It was May 2014, and my partner Tony and I were approaching our 10th anniversary together. Our boys, Joe and Jake, were two and four. A year earlier we had moved out of London to a new life, in a 16th-century farmhouse nestled between tumbledown barns and bluebells in rural Kent. And now here we were on holiday in Treasure Beach, a sleepy Jamaican fishing village we loved more than anywhere on Earth. As we sat on the sand, laughing at our boys yelling, "Yo, bless-ed!" I thought we were the luckiest family alive.
Day 10 of the holiday started as peacefully as any other. Waking early on a cloudless Caribbean morning, Tony took a mug of coffee down to a sunlounger on the curl of deserted beach at the bottom of our garden. Jake paddled at the water's edge a few feet away. Joe was playing in his bedroom, while I began yoga stretches on the deck of our beach cottage.
When I spotted a child's head bobbing in the ocean, it didn't occur to me that it might be Jake's. How could it be? He hadn't yet learned to swim. I scanned the empty beach idly, wondering where the child's parents could be. By the time I had realised it was Jake, and begun sprinting to the sea, Tony was already in the water and had our spluttering son in his arms. The momentary panic over, I sank on to the sand with relief, and waited for Tony to swim them back to shore.
Tony at Treasure Beach, Jamaica, in 2009. Photograph: courtesy of Decca Aitkenhead
But why was Tony calling for help? Why were they drifting farther out to sea? Although choppy, the water wasn't rough. Confused, I plunged in and was quickly beside them. Taking Jake from Tony, I flipped him on to his back beneath me, cupped his chin with one hand and began swimming for the shore.
Only then did I register the power of the riptide that had swept Jake off his feet. Beneath an apparently benign surface, an undertow had gathered, like a gigantic magnet on the horizon sucking us out to sea. The force of the current took my breath away. But I am a strong swimmer, and sensed no cause for great alarm as we inched our way to safety. On my back, in the soundless calm, all I could see was blue sky. It didn't even cross my mind to panic.
Wading ashore with Jake in my arms, I turned, expecting to see Tony behind us. But Tony was nowhere near us, not even where I'd left him. He was farther out to sea, much, much farther – maybe 50 feet off shore – floundering in the waves. Three local fishermen were swimming hard towards him, and from houses on either side of our cottage people were streaming on to the beach, shouting for help, hurling life rings and floats towards the swimmers.
It had taken 10 minutes for a fit man to become a corpse. It would take months for me to accept he was never coming back
How had this tranquil little beach assumed the sudden frenzy of emergency? It seemed surreal, almost ridiculous; the scene belonged to a disaster movie, not a family holiday. Even as I paced helplessly, I couldn't quite take my own fright seriously. Emergencies in real life always turned out to be false alarms, didn't they? And sure enough, a float reached the fishermen, and soon they had Tony in their arms. A neighbour and I stood in the surf holding the float's rope, and together we hauled the exhausted tangle of swimmers ashore. The drama was over. In a minute or two Tony would sit up, complain about sand in his ears and ask for a Red Stripe. As the crowd gathered around him, I turned my attention to Jake, who'd not moved from the spot where I had left him. Pale and still, he was staring past my ankles at his father.
"What's that white stuff coming out of his nose?"
And then I saw it. Two thin streams of foam, like whipped egg white, trickled from Tony's nostrils. Cold dread wrapped itself around me. The commotion around Tony became frantic; men were pumping his stomach, someone screamed for a doctor, people were pouring on to the beach from every direction. But it was too late. He didn't move; his eyes remained closed. Seawater had filled his lungs while he was gasping for air in the water. As we were pulling him ashore, he had died.
Sudden death defies the laws of physics; the human mind cannot reconcile the velocity of the first word with the enormity of the second. It is literally incredible. It had taken less than 10 minutes for a fit 49-year-old man to become a corpse, but it would take months for me to accept that he was never coming back. For more than a year, Joe asked me every day to tell him the story again "about how Tony died-ed"; even when he knew the words off by heart, it still sounded as fantastical as Little Red Riding Hood. Even now, I sometimes wonder if I really believe he is dead. But within 24 hours, amid the chaos of shock and confusion, one fact had become incontrovertibly clear in my mind. I knew whose fault it was.
Survivors' guilt always used to baffle me. Why did people think someone else's death was their fault; that if only they'd acted differently, they could have prevented it? The illogic seemed so self-evident, and the implicit self-importance rather alienating. But by the time my three brothers and two family friends flew in the following evening, I was convinced they were furious with me.
We sat up late that first night, on the terrace of a friend's beach house. I tried to explain how Tony had drowned, but kept breaking down, semi-hysterical with self-blame, deaf to all reason or reassurance. Why hadn't I tried to swim Tony back to shore along with Jake? Why didn't I swim back to him after saving Jake? How could I not have panicked, even when he was drowning before my eyes? The others' astonishment at my outburst only made me angry. Why wouldn't they see – I could have saved him? Come to think of it, if I hadn't booked this holiday in the first place, he would still be alive. For that matter, he would still be alive if I had never met him. Whichever way you looked at it, if it weren't for me, Tony would not be dead.
I knew I was becoming increasingly irrational, but could not control the rampaging narrative of guilt – until one brother took my hand and said slowly, gently, as if addressing a small child: "Dec, there was literally nothing you or anyone else could have done to save Tony's life." And suddenly I saw that it was true. But instead of relief, what I felt was despair.
Decca, Tony, Jake and Joe at home in Hackney in April 2011, a few days after Joe was born. Photograph: courtesy of Decca Aitkenhead
I wasn't, I realised, feeling guilty at all, but creating a parallel universe in which Tony did not have to die, for which taking the blame was a small price to pay. One cannot be a victim if one casts oneself as the culprit, and I suspect this psychological device may explain why Jake exploded three days later, screaming, "I made him dead! I walked into the sea, that's why he's dead. It's all my fault." To this day, he remains implacably wedded to this self-indictment. He says he likes believing it was his fault, because he would rather face the truth than fall for "a lie made up to make me feel better". But I suspect it might be less frightening for a six-year-old to tell himself he killed his father than to live in fear of the caprice of bad luck.
I recognised Jake's choice, because I had made a similar one when I was only three years older than he is now. My mother died of breast cancer when I was nine, and in my mind I reframed her death as a stroke of extraordinary good fortune. I studied other people's mothers, and pitied their children for being lumbered with such an insufferable intrusion, forever driving them about, cooking their food, helping them with homework, choosing their clothes. I couldn't think how they could stand it, or believe my luck to be spared this interfering busybody. My own mother's intense devotion to her four children had been legendary, and was posthumously much praised. To me it sounded intolerably meddlesome, and I thanked my lucky stars to be shot of it.
There must be some truth in the old saying that you make your own luck, for having decided at nine to be lucky, it seemed surprisingly easy to make it true. Exam results were always As, university was a ball, and on graduation I moved into a career on a national newspaper. At 26, I fell in love with a wonderful man. Our wedding was magical, and everyone agreed we made a perfect couple. Even when our marriage went heartbreakingly wrong, I must still have believed I was lucky. If not, I could surely never have left my husband for an ex-con who wholesaled cocaine for a living.
We made an unlikely couple. My world was media London; he had been sentenced to 14 years' jail in his teens
Tony was our neighbour, and a lifelong criminal who had spent much of his childhood behind bars; in his teens, he was sentenced at the Old Bailey to 14 years for gun crime. Loud, charismatic and good-looking, he was the kind of character anyone would want to have at their party. But to make a life with him? When I walked out of my marriage and we set up home together, everyone thought I must have lost my mind.
In the early years of our relationship, I often thought they might be right. We made an absurdly unlikely couple. My world was media London, his a nocturnal demi-world of shady assignations in pub car parks. A difficult day in my line of work would involve an email argument with a publicist about a tricky interviewee. In his, a violent dispute about the purity of a consignment could wind up with someone in a car boot. Although I loved him with a fierce abandon, any future together looked a very bad bet.
But according to Tony, he was the luckiest man he knew. The mixed-race son of a white 15-year-old girl in non-multicultural 1960s Yorkshire, he could easily have been aborted. The white suburban family who adopted him would have been well within their rights to reject him, after he began burgling houses aged just four (or so he claimed). But since his release from prison, he had not once been reconvicted. Didn't that prove the gods would always smile on him? "You should write a book about me," he used to say. "My life would make a wicked book. Come on, you know you're going to write it one day." He told me he would change his life for me and, believing himself uniquely blessed by serendipity, he did.
With the haziest notion of what an essay or even a paragraph might look like, Tony enrolled in college, won a scholarship to university, graduated with a first and got a job with Kids Company, mentoring youngsters who reminded him of his old self. By the time he died, Tony and I made a perfectly plausible couple. But in the beginning, reckless faith in our good fortune was probably the one bond we shared.
Eight days after Tony died, we flew home with his body in a coffin, to find a mountain of condolence cards and letters. Moved to tears by words from school friends I'd not seen for decades and from neighbours I barely knew, I wondered why so many people had felt compelled to write. A sudden death galvanises the emotions, but it is the horror of tragedy's proximity to innocent pleasure we must find so haunting – because all of us can picture ourselves on holiday with our family. The possibility that one of us might not come home seems to evoke the primitive terror of a fairytale.
In the absence of a reason, it can be tempting to form an impression that misfortune was in some obscure way deserved
Tony's death had been widely reported, and was announced on billboards down our village high street: "Local Man Drowns Saving Son." This spared me the need to keep breaking the news, but made me cripplingly self-conscious. When I realised I looked like a fright, I wanted to get my eyebrows waxed and do something about my hair. But if I went to the salon in the village, would I look unseemly? I pictured the beautician in the pub, gossiping with disapproving friends about my shocking sense of priorities. I was touched by the postman's condolences when he delivered the mail, and grateful for his kind words. But then each time he knocked, I couldn't tell how sad I was supposed to look. If I was always in tears, would my grief begin to look slovenly and unedifying? Perhaps I was expected to pull myself together – but then I fretted he would think me cold and indifferent. Able neither to bear nor escape my new role as the Dramatic Widow, I worried about getting it right.
I thought I was being paranoid, but there were early clues that my self-consciousness was not totally irrational. In Treasure Beach, before the autopsy report confirmed death by drowning, a consensus had quickly formed that Tony had died from a heart attack; a tragedy, still, but reassuringly downgraded from freakish to inevitable. In England, people kept asking if Tony had been drunk when he drowned. The desire for a reason must be a universal longing. In its absence, it can be tempting to form an impression that misfortune was in some obscure way deserved.
No one wants to feel sorry for someone who turns out to disappoint their expectations of widowhood, and by simply being myself I was afraid I might incur disapproval. I felt too vulnerable to risk it. The situation therefore required me to appear blandly virtuous and unobjectionable at all times. What people really wanted I discovered quite by accident, when one of my more Pollyanna-ish friends came to stay.
Telling the truth about how broken I felt was, I soon saw, a mistake; her expression grew increasingly aghast and panic gathered in her eyes. "But of course," I diverted hastily, "it could be worse. Jake could have drowned, too." The panic faded a fraction. "And it was amazing that my brothers and friends could fly out." Yes, this was definitely working. What else? "Um, and Tony would be so proud of how the boys are coping. When I think about it, this whole situation could be so much worse. We're really very lucky."
Tony at Treasure Beach in 2006, just yards from the place where he drowned. Photograph: courtesy of Decca Aitkenhead
She relaxed into a beam of approval, and I basked in its warmth. Already I could picture her reporting this conversation to others – "Isn't she brave?" – and anticipated their awed admiration. I learned to reel my blessings off by rote, even if the idea that I felt fortunate was demonstrably farcical.
It did, however, feel like a helpful pretence for two small, bewildered boys too young to know that parents do not routinely die at random. The only way I could see to help them make sense of their inexplicable loss was to impress upon them its rarity. Over and over, I assured Jake and Joe that the world was not normally like this. Nothing like this would ever happen to them again. I did not tell them that Tony's death had plunged us into insolvency; that he had neglected to update the will he made in the 90s, which left everything he owned to his first wife. They had nothing to fear from the future, I told them; we were still a lucky family. When we reached the first anniversary of Tony's death, everyone told me the same thing. There was no doubt in anyone's mind. We had survived the worst year of our lives; whatever the future brought, nothing would ever be this bad again.
Looking back now, my trust in some sort of mythical cosmic calculation seems almost childlike in its naivety. Luck, by definition, does not come with a quota. Yet I still believed in the inevitability of normality when I woke one morning late last June. A friend was throwing a summer party that evening, five days after the first anniversary of Tony's burial, and the timing seemed serendipitous. After a year of mourning, there would be party dresses, and cocktails, canapes and laughter. I stepped into the shower and my hand brushed across my right breast. The lump was unambiguous. I froze. This wasn't the day when the darkness would lift, but the day I discovered I had breast cancer.
Dismantled by the diagnosis, lost in the unfamiliar vocabulary of oncology, I stumbled through weeks of test after test in a daze of disbelief. At first, there was talk of a lumpectomy, for the tumour was still small. But it proved to be grade three, the most aggressive kind, and closer scrutiny of my family history revealed a genetic inheritance that made a lumpectomy look like an enviable solution. If my mother had died young of breast cancer, and her only sister of ovarian cancer, the geneticists were unequivocal: the only prudent course of action was a double mastectomy. Still I clung to the desperate hope that I might yet be spared chemotherapy, until further tests extinguished this glimmer, too.
Even a negative result for the BRCA gene transpired to be meaningless. Only a quarter of women whose breast cancer is hereditary carry the genetic mutation made famous by Angelina Jolie. My negative result meant only that I had inherited a faulty gene for which no test yet exists.
The revelation that I had, quite literally, been born unlucky came as a curious kind of relief. I hadn't eaten too much bacon, or too little kale, or drunk too much vodka. It wasn't my fault. And yet, so irresistible is the allure of agency, I was still willing to blame myself for getting cancer if it meant the cure could also lie within my gift. What I could not have predicted was how many people would assure me this was absolutely true.
Jake listed things making him angry. 1 Joe calling me names. 2 Tony dying. 3 Having to tidy up. 4 Decca getting cancer
When Tony died, no one knew what to say. When I told people I had cancer, everyone knew what I should do. Cannabis oil, I was assured, would magic it away. Failing that, green coffee enemas. Colonic irrigation was a popular suggestion. And had I heard about lemon juice? Someone offered me a rock from an Austrian spa. Just pop it under the warming plate on the Aga, he said, hold it to my skin, and I'd be cancer-free the very next day. Above all – and under the circumstances, this one felt like a tall order – it was imperative to Think Positive. We all want to believe there is a cure for bad luck.
I resolved to try the lot. Then chemotherapy began, and simply getting dressed became laughably ambitious. I spent the large part of six months in bed eating KitKats, watching terrible TV, helpless while my children unravelled around me. Jake's rage became ungovernable, Joe's confusion unreachable. I think they used to enjoy a sense of mild difference from their friends; they were from London, they called their parents by their first names instead of Mum and Dad, their father was black. But they now felt exiled from the playground fraternity of shared experience: "I hate it when everyone else is laughing and playing," Jake explained, "because how can I join in when they're not thinking about any of the things I'm thinking about?" Jake's teacher gave him a diary in which to write down all the things that were making him angry. His lists seemed to soothe him, but their poignancy undid me. "1 Joe calling me names. 2 Tony dying. 3 Having to tidy up. 4 Decca getting cancer."
The boys wanted to understand this mysterious thing called chemotherapy which was making a dead-eyed stranger of their mother, so I brought them with me to hospital for a session. The oncologist looked a little taken aback when Jake unfolded his list of questions and asked: "Where does cancer come from? Why does chemotherapy make my mum tired? Why did it make her hair fall out?" With heartbreaking care, she tried to answer each question, but the explanation the boys sought lay beyond the boundaries of medicine. They wanted to know why this had happened to their family. All I could say was that we were bitterly, unfathomably unlucky. "No one can believe how unlucky we are," I told them.
But when I overheard Joe tell a friend, "The thing about us is, we're really unlucky", I willed my words unsaid, and wept. What I had loved about their father, more than anything, was his dauntless optimism. I would rather die than raise his boys on self-pity, and I worry that a sense of relentless victimhood will become a self-fulfilling prophecy.
I also worry that it will make us toxic. Having moved to Kent just 12 months before Tony drowned, there had been no time to establish an identity before becoming the Dramatic Widow With Cancer – and who would want to make friends with her? How to navigate social introductions has become a perennial problem. At Christmas, I ventured to a local pub with the boys for a Secret Santa gathering, and got talking to an appealing family who had recently moved to the village, too. The conversation seemed to be going quite well, until the inevitable question: "So how have you been finding life here, then?"
If there is an appropriate tone to strike when answering this, I am yet to find it. I cannot bear to present myself as an object of pity before phone numbers have even been exchanged, and the instant imbalance of full disclosure compromises any prospect of a normal friendship evolving. I have tried trotting off a brisk synopsis, but synthetic breeziness makes it sound too far-fetched to be true. An affectation of wry gallows humour – "Well, you'll never believe this, but guess what…" – might work for a comedy of errors featuring cowboy builders and nightmare new neighbours, but makes me look like a lunatic. An emotionally truthful account is therefore both imperative and impossibly elusive: even if I could work out how to word one, it would feel like bad manners. Casual chat at the school gate cannot be expected to bear its weight, and I don't want to embarrass people away when I'm trying to make friends.
Decca with Joe and Jake at Treasure Beach this month. Photograph: William Richards for the Guardian
I doubt I could have predicted a single one of these dimensions of misfortune before it struck. I would certainly never have guessed the greatest revelation the last two years have brought. Until everything goes wrong, one cannot possibly know the astonishing kindness of the universe. I have spent most of my life aspiring to perfect autonomy, but helplessness cast us on the mercy of others, without which we would not have survived. If my children have learned anything, it is that their world is full of people who love them, and perhaps this is a more precious lesson than any promise of good luck. Every day we have been the beneficiaries of generosity I never dreamed could exist.
I always wanted to give my children a perfect childhood. Now I find myself asking why. If one common theme unites the most captivating people I know, it is a childhood conspicuous for its absence of mundane serenity. Tony was living proof of it. On the night of his funeral, I sat up late with an old friend. Her father, a West Indian musician and decidedly colourful character, had died recently, and as we swapped stories about the unexpected comedies of bereavement – the complicated caravan of multiple girlfriends at her father's deathbed, the small cannabis factory I discovered in one of our barns after Tony died, the necessity of booking a discreet bouncer for his funeral in case a fight broke out – we fell about laughing.
"But you know," she reflected wistfully, "my children have a really lovely life. And sometimes I wonder if the spice of my own childhood isn't something I'll be sorry they never get to taste." Perhaps there is a price to pay for vanilla perfection. Perhaps my family has been blessed, after all.
Chemotherapy came to an end in November. In December I underwent a double mastectomy. The treatment is now complete, and the doctors tell me my prospects are good. Unless I am very unlucky, I will live. I hope, of course, to be lucky. But I'm not sure I would conjure my old assumption of good fortune back, even if I could, for it looks like hubris to me now.
• All At Sea by Decca Aitkenhead is published by Fourth Estate at £16.99. To order a copy for £12.99, go to bookshop.theguardian.com or call 0330 333 6846.
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Mayers brothers ready for King Of The Hill, Sol Rally
MIKE KING, [email protected]
The Mayers brothers, Roger and Barry, say they are ready to make their mark on the forthcoming King Of The Hill and Sol Rally Barbados.
The season has already kicked off with the Carters Warm Up Stages Rally, by which Barry was able to secure a win in his class SM2, but it was not easy going with mixed weather conditions all day.
Roger unfortunately missed this rally as he was waiting on his new engine.
Both cars are now fully prepared and ready for King Of The Hill and Rally Barbados.
Barry has to defend the two-wheel drive title which he won last year, but he is now up against some stiff competition, with Roger among his biggest rivals.
Apart from Roger, there are also some very quick guys such as Rhett Watson, Daryl Clarke and Dane Skeete – which will make the fight very interesting.
"I am ready and I am quietly confident I will do well. Roger is also feeling very confident.
"He got some gearbox problems sorted which plagued him in 2017, and is ready to give maximum attack," Barry said.
Both cars will be on display at Chefette Warrens next week (May 25) for the Chefette Lime.
"A lot of hard work has been put in and much thanks has to go to our sponsors for constantly sticking with us – Chefette, Rubis, Digicel, Hankook, DHL, Illusion Graphics," Barry added.
Ninety-three crews are expected for the 29th running of the Sol Rally Barbados slated for June 1 to 3. Flow King Of The Hill which is set for May 27 returns to Hangman's Hill, St Thomas, with four official timed runs. (MK)

redpajama_set_name: RedPajamaCommonCrawl


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Misinform Quotes
Nothing can now be believed which is seen in a newspaper. Truth itself becomes suspicious by being put into that polluted vehicle. The real extent of this state of misinformation is known only to those who are in situations to confront facts within their knowledge with the lies of the day.
Most Powerful Misinform quotations
We need an extreme movement because what is happening to animals is so extreme.
Some misinformed people claim that animal rights activists are terrorists, but these people are simply ignorant of who the real terrorists are - the companies and industries that torture literally billions of animals each year.
— River Phoenix
Often the surest way to convey misinformation is to tell the strict truth.
Beauty is in the eye of the beholder and it may be necessary from time to time to give a stupid or misinformed beholder a black eye.
— Jim Henson
Economists who adhere to rational-expectations models of the world will never admit it, but a lot of what happens in markets is driven by pure stupidity - or, rather, inattention, misinformation about fundamentals, and an exaggerated focus on currently circulating stories.
— Robert J. Shiller
I could not believe that anyone who has read this book would be so foolish as to proclaim that the Bible in every literal word was the divinely inspired, inerrant word of God. Have these people simply not read the text? Are they hopelessly misinformed? Is there a different Bible? Are they blinded by a combination of ego needs and naïveté?
— John Shelby Spong
Democracies die behind closed doors. . . . When government begins closing doors, it selectively controls information rightfully belonging to the people. Selective information is misinformation.
— Damon Keith
There is an abundance of misinformation, exaggeration, and blatant lies being spread by interest groups regarding the prospects for embryonic stem cell research.
— Virginia Foxx
There is still a lot of misinformation being spread about higher education funding arrangements under the new Act. The students page on my website sets out the main points in the Act.
— Anne Campbell
At any given moment, public opinion is a chaos of superstition, misinformation, and prejudice.
— Gore Vidal
If you repeat a lie often enough, people will believe it.
It really is public brainwashing and misinformation.
— Robert Kane Pappas
Until we have a better relationship between private performance and the public truth, as was demonstrated with Watergate, we as the public are absolutely right to remain suspicious, contemptuous even, of the secrecy and the misinformation which is the digest of our news.
— John Le Carre
Beware of ignorance when in motion; look out for inexperience when in action, and beware of the majority when mentally poisoned with misinformation, for collective ignorance does not become wisdom.
— William J. H. Boetcker
Much as I would have liked to respond factually and truthfully to each and every piece of misinformation spread by the Brexit campaign, it was important that I stayed out of the domestic political debate. It was David Cameron's task to win the UK referendum, not ours.
— Jean-Claude Juncker
You can't be distracted by the noise of misinformation.
— James Daly
We all get misinformation growing up about people who are different from ourselves.
— Beverly Daniel Tatum
Prostitution myths justify the existence of prostitution, promote misinformation about prostitution, and contribute to a social climate that exploits and harms not only prostituted women but all women.
— Melissa Farley
Among all the world's races, some obscure Bedouin tribes possibly apart, Americans are the most prone to misinformation. This is not the consequence of any special preference for mendacity, although at the higher levels of their public administration that tendency is impressive. It is rather that so much of what they themselves believe is wrong.
— John Kenneth Galbraith
Like it or not, we're still a primitive tribe ruled by fears, superstition and misinformation.
— Bill Maher
Unless I have been sorely misinformed, supermodels are powerless to resist a man with illuminated doorsills.
— Richard Hammond
The propaganda machine is endless. Religion, media and schools spew intentional lies and misinformation about proper human-to-animal relationships.
— Gary Yourofsky
I deserve a fair trial, like every other American citizen.
A large amount of ugly, malicious misinformation has been released to the media about me.
— Michael Jackson
The priceless galaxy of misinformation called the mind.
— Djuna Barnes
I think that part of the problem that arose with that legislation, is that there probably wasn't sufficient information - probably there was misinformation. I am not sure that they have looked at the legislation.
— Thabo Mbeki
Those who do not read the news are uninformed. Those who do are misinformed.
Personal branding is about managing your name - even if you don't own a business - in a world of misinformation, disinformation, and semi-permanent Google records. Going on a date? Chances are that your "blind" date has Googled your name. Going to a job interview? Ditto.
— Tim Ferriss
My main worry about referendums is that you are taking a very complicated political question that requires knowledge of a bunch of background facts in the social sciences and you're handing that question to people who don't know those facts and in fact, are systematically misinformed about them.
— Jason Brennan
The writer's first job is not to have opinions but to tell the truth.
.. and refuse to be an accomplice of lies and misinformation. Literature is the house of nuance and contrariness against the voices of simplification.
— Susan Sontag
Don't misinform your Doctor nor your Lawyer.
One of the greatest sources of problems in our society arises from people having loads of wrong theories in their heads - often theories that are critical of others - that they won't test by speaking to the relevant people about them. Instead, they talk behind people's backs, which leads to pervasive misinformation.
— Ray Dalio
Americans are not only a less homogenous population than we were when we were 3 million ex-colonists, but we're less educated. On top of that, we have constant misinformation and manipulation by media.
Today, ordinary Americans are being stuffed with garbage.
— Carl Bernstein
I do know that if you can name certain things and understand them, it allows you to make better choices. Unfortunately, there's so much misinformation that towers over a person's head, it's really difficult to make the right decisions. Consequently, we just go along because it's way too hard to sift through the information.
— Jimmy Santiago Baca
The best society, the best human existence, arrives when humans most closely determine the truth, and act on the truth, and separate it from superstition, falsity, or misinformation. And there is no better system for determining the truth than free speech: Testing the validity of an idea in the waters of public discussion and debate.
— Dave Rodgers
We have to uphold a free press and freedom of speech - because, in the end, lies and misinformation are no match for the truth.
animal rights quotes
word of god quotes
would be quotes
behind closed doors quotes
closed doors quotes
closing doors
political debates
american citizens
fair trial
common culture
right decision
make the right decision
human existence


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Baptist Hospital Case
jsh0316
Auditing Case
simpanSimpan Baptist Hospital Case Untuk Nanti
Fiduciary Imprudence €" Washington's Failure to Protect the Nation's Retirement Resources (Don Trone)
Paraphrasing Summarising Lecture Exercises (1) (1)
Law on Trust Reviewer
Simon E. Gluck, John R. Clarke, Harry G. Ganderton, Robert K. Williams, George E. Lund, Jack Richards, Richard Jackson, Charles S. Derenzi, John Lapic, Angelo Deluca, Gwen Smolnik, John Maloney, Lee N. Caplan, William E. Howe, Jr., Joseph G. Barney, Lawrence G. Wagner, Harold D. Atkins, John E. Legory, and Mark Wright, on Behalf of Themselves and All Others Similarly Situated v. Unisys Corporation, Unisys Pension Plan, Administrative Committee of the Unisys Pension Plan and All Members Thereof and Retirement Committee of the Burroughs Employees' Retirement Income Plan and All Members Thereof, Kenneth L. Miller, Jack A. Blaine, Michael R. Losey, John J. Loughlin, Stefan C. Riesenfeld, Michael R. Capo, Stanley Jones, Walter J. Williams, Richard H. Bierly, Bobette Jones, Raymond v. Thomas, Thomas E. McKinnon Michael N. Johnson, Ronald C. Anderson, Leon J. Level and William N. Geary, Simon E. Gluck, Lee N. Caplan, John R. Clarke, Harry G. Ganderton, Robert K. Williams, William E. Howe, Jr.
22 Employee Benefits Cas. 2688, 12 Fla. L. Weekly Fed. C 466 Herbert A. Slamen v. Paul Revere Life Insurance Company, a Corporation, 166 F.3d 1102, 11th Cir. (1999)
Understanding business culture
DOL Seeks Comment on President's Proposal to Postpone Fiduciary Rule
Bollman Hat Company v. Kevin T. Root Dale E. Anstine, P.C. Bollman Hat Company, as Sponsor of the Bollman Hat Company Health and Welfare Benefits Plan, 112 F.3d 113, 3rd Cir. (1997)
Shirley M. Critchlow v. First Unum Life Insurance Company of America, 378 F.3d 246, 1st Cir. (2004)
Q.E.R., Inc., a Delaware Corporation v. Alva J. Hickerson, 880 F.2d 1178, 10th Cir. (1989)
Norman Hobbs, Individually, and on Behalf of a Class of Similarly Situated Persons, Samuel Irvine, Individually, and on Behalf of a Class of Similarly Situated Persons v. Blue Cross Blue Shield of Alabama, 276 F.3d 1236, 11th Cir. (2001)
International Union of Electronic, Electric, Salaried, MacHine and Furniture Workers, Afl-Cio James R. Baldwin Harry J. Layne Rodney J. Pettinato Pauline Rothermel Marlyn Thompson v. Murata Erie North America, Inc., a Georgia Corporation, 980 F.2d 889, 3rd Cir. (1992)
Attorney Statement
Anker Energy Corporation, and King Knob Coal Company, Inc. v. Consolidation Coal Company United Mine Workers of America Combined Benefit Fund Marty D. Hudson, Trustee Michael H. Holland, Trustee Thomas O.S. Rand, Trustee Elliott A. Segal, Trustee Carlton R. Sickles, Trustee Gail R. Wilensky, Trustee William P. Hobgood, Trustee Kenneth S. Apfel, Commissioner of the Social Security Administration, 177 F.3d 161, 3rd Cir. (1999)
OCA vs. Borromeo Digest
Chemung Canal Trust Company, as Trustee of the Fairway Spring Company, Inc. Restated Pension Plan William H. Brown Joseph R. Peters, Chemung Canal Trust Company, as Trustee of the Fairway Spring Company, Inc. Restated Pension Plan v. Sovran Bank/maryland, Sovran Bank/maryland, Third-Party v. Fairway Spring Co., Inc., Theodore Peterson, as President and Director of Fairway Spring Co., Inc. Donald R. Peterson, as Vice President and Director of Fairway Spring Co., Inc. Dorothy Tarby, as Secretary-Treasurer and Director of Fairway Spring Co., Inc. John Doe Jane Doe, as Members of the Investment Committee of the Fairway Spring Co., Inc. Restated Retirement Income Plan Lynn G. Keyser, Third-Party Fairway Spring Co., Inc. Theodore Peterson, as Director of Fairway Spring Co., Inc. Donald R. Peterson, as Vice President and Director of Fairway Spring Co., Inc. Dorothy Tarby, as Secretary-Treasurer and Director of Fairway Spring Co., Inc. And Lynn G. Keyser, Third-Party, 939 F.2d 12, 2d Cir. (199
BEG Lecture 4 Ethical Leadership and Corporate Culture.pptx
Louis J. Bornstein v. Richard E. Poulos, Trustee in Bankruptcy of Blier Cedar Company, Inc., 793 F.2d 444, 1st Cir. (1986)
135 Strong vs Repide
Retiree Health Care Benefits Continue to Decline
Baptist Hospital and the State of North Carolina: Employee, Citizen, or Self?
ABSTRACT Do you know what choices you would make if faced with an ethical dilemma? This fact-based case includes situations and issues a real citizen considered when faced with the knowledge that his employer may have been overbilling the state of North Carolina for health care. Professionals, especially those in accounting and finance positions, are likely to face serious dilemmas in the course of their careers. These situations may require them to choose between honoring a confidentiality clause in an employment contract and acting according to ethical and professional values. This case provides real facts gathered from a real case, in which an individual faced this particular challenge. By working through the case, you should develop an appreciation of the pressures and personal ethical challenges you are likely to face in the workplace. By engaging in discussion and role-play, you will be more likely to recognize these issues when they occur, and will have already developed critical thinking skills to help you develop a plan of action. BACKGROUND The State Health Plan (SHP) of North Carolina provides health care benefits for 667,000 state employees including teachers, university faculty, and retired lawmakers. The state selfinsures, meaning that it pays providers for the actual health care costs, but contracts with Blue Cross Blue Shield of North Carolina (BCBSNC) to process the claims for a fee, which at the time of this case, was calculated as a percentage of the cost. In July 2003, the SHP signed a five year contract with Wake Forest University Baptist Medical Center (Baptist Hospital), located in Winston Salem, NC, to provide negotiated discounts on medical services. The contract allowed the state to pay a discounted amount, such that any increases in the billing above the rate of
inflation would be nullified by the discount. However, there was no provision in the contract that required the hospital to notify the state when the increase was greater than inflation. Because the SHP did not monitor the rate increases, over the course of the contract, Baptist Hospital was able to charge and collect between $770,000 and $1,340,000 more than they would have had the SHP requested the discount (Woods 2011). BCBSNC had contracts with both the SHP and with Baptist Hospital. Their contract with the hospital required the hospital to notify them of rate increases, however it forbid BCBSNC from disclosing any information, including rate increases, to the SHP. BCBSNCs contract with the SHP did not require them to monitor the contracts for increases in excess of inflation. (See Figure 1 for a diagram depicting these relationships). In 2007, toward the end of the contract, a Baptist Hospital employee brought the overcharges to the attention of the CFO and was told to let sleeping dogs lie. After his employment was terminated by the hospital, he signed a confidentiality agreement and was a paid $10,000. The employee then notified the state about the charges, which led to investigations by the SHP, Attorney General, and State Auditor. All found that since the contract did not require the hospital to notify the state about available discounts, the hospital did not have a legal obligation to honor the discounts. Furthermore, the contract had expired before the investigations began. The hospital eventually sued the employee (whistleblower) for breach of contract (violating a confidentiality clause), although the suit was later dropped. Aftermath In April 2011, NC State legislators voted to make changes to the SHP to deal with a projected $515 million shortfall (Robertson 2011). These changes included, for the first time, charging a premium to employees for the highest levels of health insurance, and raising premiums and deductibles for all plan participants. A competitive bid process was put in place
for SHP contracts, and cost- plus contracts, like the one with BCBSNC, were outlawed and replaced with flat fee plans. The reason given was that cost-plus contracts provided an incentive for BCBSNC to approve higher charges.
Bill plus fee (3)
State Health Plan (SHP)
BlueCross Blue Shield (BCBSNC) Process Claims Retain Fee
Bill for service (2) Payment for service: minus fee (5)
Payment of bill (4)
FIGURE 1 Relationship among Parties
The SHP and BCBSNC contract provides that BCBSNC will process claims and payments for a fee. The BCBSNC and Baptist Hospital contract specifies amounts that Baptist Hospital can bill for services for patients covered under plans administered by BCBSNC (including SHP participants).
THE CASE The October 28, 2011 headline, N.C. Baptist Hospital dismisses lawsuit against whistle blower (Winston-Salem Journal 2011b) marked the end of Joseph Vincolis campaign to do what he felt was the right thing. It all began back in July 2006, when Vincoli was hired as Managed Care Director for Baptist Hospital. Soon after beginning work, sometime in the spring of 2007, he discovered that his employer may have been overcharging the SHP for health care. Based on his review of billings, he noted that Baptist Hospital increased the charges for medical services at a rate higher than the inflation rate. The SHP paid the bills and did not request the discount to which they were entitled. It appeared that the SHP was not monitoring the contract and was unaware that the rate increase exceeded the inflation rate. As an employee of the hospital, Vincoli first took his concerns to both the hospitals general counsel, McLain Wallace, and to the CFO, Gina Ramsey. According to Vincoli, they advised him to let sleeping dogs lie and not to report his findings to the state. In addition, Baptist Hospital said that they informed BCBSNC about the increases, as required by their contract. BCBSNC benefitted from the higher charges, as their contract with the SHP paid them a percentage of each charge. In October 2007, Baptist Hospital fired Vincoli, who then became a self-employed consultant providing managed care and ERISA consulting services to area benefits consulting firms and law firms, a position he held until 2009. The facts are unclear about the reason for his termination; however, Vincoli sued Baptist Hospital and reached a confidential settlement with them in May 2008. As part of the settlement, Baptist Hospital denied any liability in terminating Vincoli and paid him $10,000. In return, Vincoli signed a confidentiality agreement promising 1) not to speak in a disparaging manner concerning the Hospital to any outside party and 2) not to
disclose any proprietary or damaging information without the hospitals prior written consent, except as required by court order, statute, law, or regulation (GCJSCD 2011). In January 2009 Vincoli contacted state officials and emailed state lawmakers to report the past overpayments. He took these actions even though the contract related to the overpayments expired July 2008 and despite his agreement to maintain confidentiality about the hospitals inside information. Based on Vincolis allegation, in March 2009, the SHP conducted an audit of its contracts with Baptist and other hospitals, and made a high-profile request for $4.43 million in refunds from 30 hospitals. The SHP requested $638,485 from Baptist, which it later reduced to $388,895 based on a three-year statute of limitations. Although the SHP subsequently collected $837,000 from other hospitals, Baptist Hospital denied that it breached the contract, and in August 2009 offered the state $20,000 to avoid unfavorable publicity and the expense of litigation. In November 2009, before the SHP accepted the offer from Baptist Hospital, Vincoli submitted an online complaint to the NC Department of Justice alleging that the hospital was committing fraud against taxpayers. The ensuing investigation was closed when the Attorney Generals Office informed the investigator that the issue was one of contract interpretation and not fraud. A year later, the State Auditor notified Baptist Hospital that it was reopening the SHP contract issue. Baptist Hospital alleged that Vincolis sharing of disparaging and/or confidential information with the State Auditors office precipitated the audit. Either Baptist Hospital rescinded the $20,000 offer or the SHP refused to accept it, in light of the ensuing audit. Shortly thereafter, on January 25, 2011, Baptist Hospital sued Vincoli, alleging breach of the May 2008 confidentiality settlement. The suit alleged that Vincolis unjustified, vindictive, malicious and
gratuitous actions have caused NCBH1 to suffer embarrassment, negative false publicity, loss of good will with the State of North Carolina and the communities that NCBH serves, and financial loss including but not limited to legal fees (Winston-Salem Journal 2011a). In September 2011, Beth A. Woods, the State Auditor, issued a report summarizing her investigation (Appendix A). The report confirms that the contract did not specifically require Baptist Hospital to notify SHP of outpatient fee increases. SHP did not have a plan for monitoring fee increases and it did not receive, seek, or obtain annual outpatient fee information from Baptist Hospital. Many of the contract terms were not clearly defined, resulting in at least 96 possible combinations of calculations for the overpayment. SHP estimated the overpayment at $638,485; however, Ms. Wood estimates it to be $1.34 million. Ms. Woods opines that a major element in estimating the over payment is the appropriate discount rate. Given the lack of clarity in contract terms, it is not likely that SHP and Baptist Hospital would agree on the overpayment amount, even if the contract allowed for a rate adjustment after the contract terminated. Ms. Woods estimates that the range between the lowest and highest overpayment is $1.8 million.
NCBH is Baptist Hospital
Epilogue SHP officials confirmed that at least one employee had already reported the issue that Vincoli reported in January 2009 as early as 2006/2007. SHPs Executive Director told the employee not to pursue the matter. Per SHP accounts, the same employee then alerted the NC Attorney General who decided not to pursue the matter. Based on the audit report, the SHP did not pursue Baptist Hospital for the overcharges, nor did they collect the $20,000 offer. On October 18, 2011, Baptist Hospital dropped its suit against Joseph Vincoli without prejudice, meaning that it can re-file against him later. Each party paid their own costs and attorney fees. While Vincoli remained silent, his attorney, Phil Michael stated, This is an appropriate disposition. Mr. Vincoli had acted honorably (Winston-Salem Journal 2011c). REQUIREMENTS Questions 1. Vincoli signed the confidentiality agreement and took the $10,000 in May 2008, after he knew about the alleged overpayments and before he reported them to SHP, lawmakers, and the NC Department of Justice. a. Why do you think took a payment and then reported anyway? b. Did Vincoli act ethically in blowing the whistle? c. Imagine that you are Vincoli make a pro/con list for: i. Signing the May 2008 agreement and taking the money ii. Reporting the overpayments to the state 2. Some people portray whistleblowers as angry ex-employees trying to exact revenge while others hail whistleblowers as heroes performing heroic acts what facts support these opposite portrayals?
3. Navigate to http://www.sec.gov/about/offices/owb/owb-faq.shtml. This SEC site includes answers to FAQ about the Dodd-Frank Whistleblower Program which took effect July 21, 2010. a. In your own words, explain the purpose of the SEC Whistleblower Program. b. How does this legislation protect employees from employer retaliation? c. Is an employee protected if he or she reports wrongdoing to a regulatory body other than the SEC? (Hint, follow the link to the OSHA website). d. Is Baptist Hospital as an employer covered under either Dodd-Frank or SOX? Why or why not? 4. Based on the legal definition of fraud (see criteria below), was Baptist Hospital guilty of fraud? a. False statement b. Material fact c. Intent to deceive d. Justifiable reliance e. Damages 5. List the stakeholders and discuss the harm and benefit each incurred/received. 6. The state could rescind the hospitals state-level status as a non-profit corporation (which could possibly lead to issues with its federal non-profit status) and/or refuse to contract with the hospital in the future. What stakeholders would these actions affect and what could the possible effects be? 7. What level of responsibility does the SHP carry for the overpayments and why? 8. What actions should/could the SHP take to prevent, detect, and correct overpayments in the future? 9. Most large employers must comply with ERISA (Appendix B), a law that regulates selffunded health plans; however, ERISA does not cover government plans. ERISA holds fiduciaries to the highest standard and requires that they make decisions with a single eye toward plan members best interests. It appears that SHPs failure to pursue the matter directly cost taxpayers millions of dollars and affected State employees out of pocket costs as well. If SHP had been subject to ERISA (see Appendix B), do you think plan administrators would have been guilty of non-compliance? Why or why not?
REFERENCES Browner, J. T. 2010. Are you ready for the North Carolina False Claims Act? North Carolina Bar Association Education Law Section Online Newsletter (November). Available at: http://educationlaw.ncbar.org/media/9242976/ednov10.pdf. General Court of Justice Superior Court Division, Forsyth County (GCJSCD). 2011. Complaint 11CvS 548. January 25. Robertson, G. D. 2011. NC State Worker Health Plan changes get final OK. Associated Press (April 5). Winston-Salem Journal. 2011a. Baptist Hospital sues fired worker and whistle-blower. (September 12). Winston-Salem Journal. 2011b. N.C. Baptist Hospital dismissed lawsuit against whistle blower. (October 28). Winston-Salem Journal. 2011c. Editorial: Baptist Hospital right to drop lawsuit against whistleblower. (November 3). Woods, B. A. 2011. State of North Carolina Performance Audit, North Carolina State Health Plan for Teachers and State Employees, Baptist Hospital Overpayments. (September).
APPENDIX A State Auditors Report (Summary only) Complete report available at: http://www.ncauditor.net/EPSWeb/Reports/performance/per-2011-7266.pdf Purpose This audit report evaluates the circumstances surrounding the overpayment2 of outpatient medical claims provided by Wake Forest University Baptist Hospital (Baptist Hospital) and makes recommendations so the North Carolina State Health Plan for Teachers and State Employee (State Health Plan or Plan) management can take appropriate corrective action. Results The State Health Plan did not increase the outpatient discount rate as allowed in the contract because it did not have a contract monitoring plan and did not seek or obtain annual outpatient fee increase information from Baptist Hospital. Because there was no contract monitoring, the Plan did not know outpatient fees increased, therefore it could not determine if an increase in the negotiated discount rate was allowed per the contracts inflation adjustment provision. The State Health Plan was unsuccessful in recovering the approximately $638,600 it later estimated was overpaid after March 1, 2006, because Baptist Hospital denied its attempts to recover the overpayment. Baptist Hospital claimed it complied with the terms of the contract and further stated that only in circumstances of noncompliance on its part can the Plan seek an adjustment to the rate after expiration of the contract. The Plan did not attempt to increase the
Overpayment is the term used to describe the amount paid in excess of what would have been paid if the Plan had exercised its right to receive additional discounts from Baptist Hospital.
outpatient discount rate until after the contract concluded. The contract did not specifically require Baptist Hospital to notify the Plan of outpatient fee increases, a deviation from the terms the Plan commonly used to contract with other North Carolina hospitals. Many of the contract terms were not clearly defined, resulting in at least 96 possible combinations for calculating the over paid amount. Using the same method the Plan used for calculating the overpayment, the Plan paid approximately $770,000 more to Baptist Hospital for outpatient services during the contract (July 1, 2003 to June 30, 2008) than it would have if the discount rate was adjusted for inflation. Using the combination of variables most closely aligned with the cost containment intent of the contracts inflation adjustment provision, the estimated overpayment to Baptist Hospital for outpatient services is approximately $1.34 million, or 75% higher than the Plans calculation method. Agencys Response The Agencys response is included in the appendix of the complete report.
APPENDIX B ERISA Notes The Employee Retirement Income Security Act of 1974 (ERISA) is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. ERISA requires plans to provide participants with plan information including important information about plan features and funding; provides fiduciary responsibilities for those who manage and control plan assets; requires plans to establish a grievance and appeals process for participants to get benefits from their plans; and gives participants the right to sue for benefits and breaches of fiduciary duty. In general, ERISA does not cover group health plans established or maintained by governmental entities, churches for their employees, or plans which are maintained solely to comply with applicable workers compensation, unemployment, or disability laws. ERISA also does not cover plans maintained outside the United States primarily for the benefit of nonresident aliens or unfunded excess benefit plans. The primary responsibility of fiduciaries is to run the plan solely in the interest of participants and beneficiaries and for the exclusive purpose of providing benefits and paying plan expenses. (emphasis added). Fiduciaries must act prudently and must diversify the plan's investments in order to minimize the risk of large losses. In addition, they must follow the terms of plan documents to the extent that the plan terms are consistent with ERISA. They also must avoid conflicts of interest. In other words, they may not engage in transactions on behalf of the plan that benefit parties related to the plan, such as other fiduciaries, services providers, or the plan sponsor.
Fiduciaries who do not follow these principles of conduct may be personally liable to restore any losses to the plan, or to restore any profits made through improper use of plan assets. Courts may take whatever action is appropriate against fiduciaries who breach their duties under ERISA including their removal.
http://www.dol.gov/dol/topic/health-plans/erisa.htm Accessed 12/7/2011
APPENDIX C Excerpts from the Code of Conduct What is a Code of Conduct? A Code of Conduct is a description of values and actions that are important to a culture or organization. It describes what is expected from people who live or work in that culture.
This Code of Conductis a practical guide to handling important issues and deterring wrongdoing for all representatives of North Carolina Baptist Hospital and Subsidiaries (NCHB), including board members, employees, and volunteers. Built on the foundation of our Mission, Vision, Values, and Policies, it promotes:
Compassionate and excellent care for our patients and their families Respectful, collegial, and compassionate relationships with our co-workers Honest and ethical conduct, including adherence to the Policy of Ethical Behavior Compliance with applicable governmental laws, rules and regulations Prompt internal reporting of compliance issues
Management and staff at NCBH are individually and collectively responsible for compliance with laws, regulations, and sound business practices that govern our services. Education and policies contribute to assuring that we provide and bill for our services accurately and in
compliance with all guidelines. However, we must act on our knowledge and the Code of Conduct was created to help us understand what actions support compliance.
The Code of Conduct cannot address every ethical issue that might happen and employees are encouraged to clarify questions through their supervisors, Human Resources, or the Compliance Office. Employees are asked to take issues or concerns that might affect our compliance with laws, regulations, or appropriate business practices to their supervisors for clarification or resolution. If this is not an acceptable alternative, other appropriate support services may be contacted (e.g. Human Resources, Risk Management, etc.). If these avenues for resolution are not successful, the Compliance Office may be contacted directly 336-713-4949, through the WFBMC Hotline (877-880-7888), or by e-mail to ncbhcompliance@wakehealth.edu.http://www.wakehealth.edu/NCBH-Compliance/Code-ofConduct.htm accessed 12/19/11
Key Values and Standards of Behavior Key Values The NCBH Five Key Values are the characteristics which will move us towards our future state and help us achieve our Vision. In the spring of 2004, both NCBH and WFUHS, with support from the Board, made the decision to add Collegiality to our Key Values. The following defines what the Values mean to us:
Excellence means being committed to consistently provide superior education, patient care and research.
Compassion means being aware of and responsive to the physical, emotional, spiritual, and intellectual needs of others.
Innovation means discovering and developing new ideas for enhancing quality, efficiency and effectiveness.
Integrity means demonstrating fairness, honesty, sincerity and a commitment to our Mission, Vision and Values.
Collegiality means promoting an environment that fosters mutual respect and teamwork while rewarding collaboration.
Standards of Behavior Standards of Behavior are specific actions that support each of the Key Values. They guide our ethical behavior at all times and are woven through the Code of Conduct. Excellence Compassion Innovation Integrity
I will be honest and reliable in everything I do. I will set a good example. I will be sensitive to cultural and language difference. I will speak positively about The Medical Center and my co-workers.
Collegiality (The components of Excellence, Compassion, Innovation, and Collegiality are available on the web site.) http://www.wakehealth.edu/NCBH-Compliance/Key-Values.htm accessed 12/19/11 Interacting Ethically and Responsibly The organizational culture of NCBH & Subsidiaries is created through our actions and attitudes guided by our key values: Excellence; Compassion; Innovation; Integrity; and Collegiality. Part of our culture is a dedication to behaving ethically and responsibly and to complying with applicable laws, regulations, and policies.
Each one of us has a vital role in making sure that NCBH & Subsidiaries are in compliance with all laws, regulations, and policies that affect how we do business and deliver health care services. The degree to which we achieve compliance for NCBH & Subsidiaries is the total of each of our individual actions added together. Therefore, we commit to doing the right thing for the right reason even when no one is watching and to encouraging others to do the same. (The additional twelve elements are available on the web site.)
We discuss legal and ethical concerns with the appropriate party and report any suspected violations according to the NCBH & Subsidiaries Code of Conduct.
http://www.wakehealth.edu/NCBH-Compliance/Interacting-Ethically.htm accessed 12/19/11 No Retaliation Against Employees Who Report Ethical or Compliance Concerns in Good Faith NCBH & Subsidiaries value employees and want them to feel comfortable expressing concerns regarding ethics and business practices. It is against the Policy of Ethical Behavior to retaliate against any employee who, in good faith, notifies members of management, Human Resources, administrative support functions, the Compliance Office, and/or the WFBMC Hotline of a perceived, actual, or potential compliance concern or question for clarification.
We strive to create an environment where employees feel comfortable expressing their concerns about compliance issues.
We evaluate and resolve compliance concerns and/or questions in a timely manner. We provide, upon request, strict confidentiality to the extent allowed by law for employees who contact the Compliance Office or WFBMC Hotline.
We encourage employees to immediately report any suspicion or question of harassment or retaliation in response to raising a compliance concern.
We do not tolerate personnel who harass or retaliate against employees who seek advice, raise a concern, or report non-compliance with laws, regulations, or hospital policies.
We expect employees to use the Compliance reporting system as a way to communicate legitimate compliance concerns or questions about a compliance issue.
http://www.wakehealth.edu/NCBH-Compliance/No-Retaliation.htm accessed 12/19/11
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If you grow up near the water your desire is always close by to the water or bring some water breeze to your house. If you have a bond to the water,your kid will follow your footprints. This bond passes from one generation to another. In this article, you will find out some good pictures about Nautical Boy Bedroom Ideas with some explanations.
Usually the stripe fabrics are used to decorate the nautical boy bedroom. The main nautical colors are, white, red, navy blue and blue. To remind the nautical term, some hanging signal flags or flags on bedding. You cannot think a Nautical Boy Bedroom Idea without sailing boat. I think the cabin style windows, cabin, compass, navigation map, lighthouse, steering wheel, captain's bridge ,buoy and rakes can take place in the theme. The good things on the theme are using any elements you long for it.
Hopefully the pictures will find you well by having some Nautical Boy Bedroom Ideas.
Picture Credit: Studio M Interior Design. The white panel bed , blue nightstand and white bookshelf is such a good selection for this room. Striped quilt cover and plain and small printed pillows are used for cute bedding . Buoy, accent pillow and sign flags are very neat. But the naming letters over the book shelf is the cutest. Very admired design.
Picture Credit: Ourtownplans. I really like the idea of the sliding bedroom door. It saves to much space. Two Captains Bed in a row is an excellent design. Light blue and white striped area rug, buoy and rake wall decorations, monogrammed pillows, red and white bedding bring me the ocean scent. Adorable.
Picture Credit: Gloss NY. Off white boy bedroom furniture, contemporary style matches perfectly with sign flags theme area rug and bedding and nightstand lamp. The wall paper amazingly shows the navigation map and red toy shelf is a plus. Hats off design for Nautical Boy Bedroom Ideas.
Picture Credit: Mary Cook. Full size bunk bed with nautical theme. My first priority in this room is the rake rack ,ottoman,striped wall borders and curtains . Nautical bedding is very unique, The Headboard is catchy.
Picture Credit: The Baby Cot Shop. Such a cute loft bed for a little sailor! Sleep in the top, play in the bottom of the sailing boat. Striped wall colors with striped port hole curtains and striped loft bed cabin curtains , steering wheel and captains bridge this design takes its place in my heart . I like the blue furniture color.
Stay tuned; my next article is Pirate Boy Bedroom Design. Please drop your comments and please take look for the coming idea.


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MODEL:BIG BERTHA. SHAFT:BIG BERTHA. GRIP: CALLAWAY. IRON: #6 IRON. MATERIAL: STEEL.
Left Handed Callaway X-HOT. Lincs Golf.
Left Handed Callaway Big Bertha 5 Iron.
Pitching Wedge. Left Handed Callaway X Series 416. Lincs Golf.
Left Handed Callaway X Tour Forged 9 Iron. Lincs Golf.
Left Handed Callaway Steelhead X14. Sand Wedge. Lincs Golf.
LEFT HANDED CALLAWAY GOLF DIABLO EDGE No.5 IRON ONLY. LENGTH: 99.
USED CALLAWAY TOUR X WEDGE. LEFT HANDED. GOLF PRIDE TOUR VELVET GRIP. 52' / 11' BOUNCE. PART OF OUR TRADE CLEAROUT.
Left-Handed Callaway X2 Hot 8 Iron.
Callaway Golf X Hot N14 Pitching wedge in good overall used condition. Callaway Golf X Hot uniflex steel shaft, minor pitting as shown. Callaway Golf grip in good condition. All pictures are of the actual club for sale.
Left Handed Callaway X Series 416. Lincs Golf.
Left Handed Callaway X Hot 5 Iron.
Callaway Razr XF Black #6 Iron. LEFT HANDED. Grip: Golf Pride Patriot. (All photos are of the actual club being sold). Get in Touch. 'Pured' Shaft. Length: Standard. Club Length: 37.5".
Left Handed Callaway Diablo Edge 6 Iron.
Left Handed Callaway Steelhead x14 4 Iron.
Left Hand Callaway X12. #5 Iron.
Left Hand Callaway X12. #5 Iron. Fitted with Memphis 10 regular steel shaft. Original grip. Great club in very good condition.
FITTED WITH A CALLAWAY UNIFLEX STEEL SHAFT .
Left Handed Callaway Big Bertha. Sand Wedge. Lincs Golf.


This systematic review is an update to a previous systematic review on the effectiveness of manual therapy for several different conditions. 178 studies are included in the review. The review includes systematic reviews, randomized controlled trials, and non-randomized controlled trials. Conditions that are evaluated in the review include: neck pain, non-specific mid-back pain, ankle and foot conditions, carpal tunnel syndrome, lateral epicondylitis, shoulder conditions, temporomandibular disorders, cervicogenic headache, tension-type headache, miscellaneous headaches, fibromyalgia, asthma, ADD/ADHD, cancer care, cerebral palsy in children, cervicogenic dizziness/balance, chronic fatigue syndrome, cystic fibrosis, paediatric disfunctional voiding, gastrointestinal disorders, hypertension, infantile colic, insomnia, menopausal symptoms, myofascial pain syndrome, otitis media, parkinson's disease, paediatric nocturnal enuresis, peripheral arterial disease, pneumonia and COPD, pregnancy/obstetric care/neonatal care, rehabilitation, and systemic sclerosis. Each condition includes a rating of inconclusive, moderate, or high level of evidence and a rating of favourable, non-favourable, positive, or unclear results. Review ends with recommendations that further high quality studies should be conducted.
This systematic review and meta analysis evaluates the effect of non-surgical treatment for lateral epicondylitis. Evaluated non-surgical treatments include: injections, physiotherapy, shock wave therapy, laser, ultrasound, corticosteroid iontophoresis, topical glyceryl trinitrate, or oral naproxen. 22 randomized controlled trials, encompassing 2280 patients, are included in the review. Findings indicate that there was no benefit to non-surgical treatment verses no treatment for overall improvement, escape treatment, outcome scores, or grip strength. The authors recommend watchful waiting for management of short-term symptoms.
This systematic review evaluates the effectiveness of manual therapy for musculoskeletal disorders of the upper and lower extremities. 3 randomized controlled trials are included in the review. Findings indicate that manual therapy may be effective for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome. These conclusions are based on low quality evidence due to the small number of studies. There was not enough evidence to evaluate other musculoskeletal conditions of the extremities.
This systematic review evaluates the effectiveness of soft-tissue therapy for musculoskeletal disorders and injuries of the upper and lower extremities. 6 articles are included in the review. Disorders that are evaluated in the review include: shoulder impingement syndrome, carpal tunnel syndrome, and plantar fasciitis. Findings indicate that: 1) myofascial release is effective for plantar heel pain and lateral epicondylitis but not for subacromial impingement syndrome, and 2) trigger point therapy provides very little benefit for plantar heel pain. However, more high quality studies are needed to make further conclusions and recommendations.
Thompson, W. R., Scott, A., Loghmani, M. T., Ward, S. R., & Warden, S. J. (2016). Understanding Mechanobiology: Physical Therapists as a Force in Mechanotherapy and Musculoskeletal Regenerative Rehabilitation. Physical Therapy, 96(4), 560–569.
This review paper discusses the regenerative effects of physical therapy at the cellular level. The paper is divided into sections that discuss mechanotransduction at the cellular and molecular levels, and regenerative rehabilitation at the cellular and molecular levels. No specific conclusions or recommendations are presented, only a review of the evidence.


I did the Gastric Bypass. I am off all medication except the pill that slows my heart down for Afib.
Today, a year and 1 month later, I am down to my goal weight which flucuates between 135-140. My BMI is 22.6 and I am so much healthier than I have been in many, many years.
I look and feel fantastic, and have to thank everyone, from the folks at BeLiteWeight to the surgeon's office for helping me to achieve this goal."
Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.
The most common gastric bypass surgery is a Roux-en-Y gastric bypass.
In normal digestion, food passes through the stomach and enters the small intestine, where most of the nutrients and calories are absorbed. It then passes into the large intestine (colon), and the remaining waste is eventually excreted.
In a Roux-en-Y gastric bypass, the stomach is made smaller by creating a small pouch at the top of the stomach using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum). This procedure can be done by making a large incision in the abdomen (an open procedure) or by making a small incision and using small instruments and a camera to guide the surgery (laparoscopic approach).


While my goal is to get posts out early in the morning or ideally, the night before, but occasionally life happens. I am a real mom, with a real husband and real kids who demand much of my time. The day started out well and we finished homeschooling before 10 am, but it quickly went downhill after that. So alas, work gets put on hold until life is under control again. So, I hope you will enjoy this week's printable theme – Election Day.
Even though we don't have a Presidential Election this year, there are plenty of other elections coming up in October. So I decided this year my 4th grader would learn about elections and voting. While we've never been shy talking with our kids about who we vote for and why, Mister Bull (9) is now old enough to understand how voting works. So this week's theme – Election Day – is a great way to introduce your kids to elections.
To download this set click the link below and you will be redirected to the Election Day Printables Page. Scroll down to find the correct button and click it to download instantly. Please feel free to share this freebie with others, but I ask that you share this post and not the direct link. Thank you.


Honourable Silvio Parnis has been successfully elected in general elections since 1998. He served as mayor of Paola from 1994 until 1998. During the 2003-2008 Legislature, he was the Labour Party Spokesperson for the Senior Citizens and together with a team of experts prepared the position paper of the same Party for this sector.
In 2008, he was appointed Opposition Spokesman of the Labour Party for Consumer Protection. Later during that legislature, Silvio Parnis served as the Opposition Spokesman of the Labour Party for Sustainable Development for the South of Malta.
In March 2013, he was re-elected in the Maltese Parliament from the fourth district, and was appointed by the Prime Minister as Chairman for the Consultative Council for the South of Malta. During this term he chaired several projects including the Paola Square Project, the study on Wied Blandun and the new concept about the "Ġonna tal-Qari". Parnis also gave an important contribution on other projects such as the University Premises in Cospicua and Marsascala and the Inwadar Park. From 2013 until 2017, he also occupied the role of Chairman of Bills Committee.
In 2017, Prime Minister Joseph Muscat appointed Silvio Parnis Parliamentary Secretary of Local Government and Communities. Upon taking office, he immediately began working on what would lead to a reform in both the Local Government and the Local Enforcement.


text:
The First Part of Captn. Pike's Chart of the...
Zebulon Montgomery Pike
The First Part of Captn. Pike's Chart of the Internal Part of Louisiana . . .
Philadelphia / 1810
Uncolored
A Foundational American Map
An exceptional Trans-Mississippi West map, showing the first portion of Zebulon Pike's exploration of the American Southwest.
The map shows Pike's route through the region from the west of the Mississippi, from the Missouri River to the Red River, and extending west to the Pawnee Villages (including Missouri, Eastern Kansas, Eastern Nebraska, Eastern Oklahoma and North Texas), on his way to the Rocky Mountains and through Texas.
The detail between the Missouri River, Kansas River and the Red River is truly extraordinary, and includes many original notes and observations which make it a source map for all maps which came after.
The map was prepared to illustrate the first edition of An Account of Expeditions to the Sources of the Mississippi, and Through the Western Parts of Louisiana, to the Sources of the Arkansaw, Kans, La Platte, and Pierre Jaun, Rivers; ... During the Years 1805, 1806, and 1807. And a Tour Through the Interior Parts of New Spain, When Conducted Through These Provinces, by order of The Captain-General, in the year 1807. By Major Z.M. Pike.
Pike's maps were the first to describe the terrain of the Southwest based on first-hand accounts and are considered "milestones in the mapping of the American West" (Wheat). Setting out from St. Louis in 1806, Pike and his party proceeded overland to Arkansas, Kansas, and Colorado (failing to reach the summit of the Peak that now carries his name), before falling into the hands of the Spanish authorities and being escorted to Santa Fe, and then to Louisiana. He provides the first account in English of Texas as a whole and his very detailed information on the local Spanish government proved influential for federal territorial ambition. Pike's narrative stands with those of Lewis and Clark as a cornerstone of Western Americana.
A fundamental map for Western American collections.
Condition Description
Evidence of old folds and some minor loss along folds, expertly repaired on verso.
Antique Maps / United States / South / Louisiana
Antique Maps / United States / South / Arkansas
Antique Maps / United States / Texas
Antique Maps / United States / Plains / Kansas
Antique Maps / United States / Plains / Missouri
Antique Maps / United States / Plains / Nebraska
Antique Maps / United States / Plains / Oklahoma & Indian Territory