Another Keystone XL setback: environmental review ordered
By MATTHEW DALY
Monday, November 12
WASHINGTON (AP) — In a setback for the Trump administration, a federal judge has blocked a permit for construction of the Keystone XL oil pipeline from Canada and ordered officials to conduct a new environmental review.
Environmentalists and tribal groups cheered the ruling by a U.S. district judge in Montana, while President Donald Trump called it “a political decision” and “a disgrace.”
The 1,184-mile (1,900 kilometer) pipeline would begin in Alberta and shuttle as much as 830,000 barrels a day of crude through a half dozen states to terminals on the Gulf Coast.
Trump has touted the $8 billion pipeline as part of his pledge to achieve North American “energy dominance” and has contrasted his administration’s quick approval of the project with years of delay under President Barack Obama.
The Trump administration has not said whether it would appeal the new ruling. The State Department said it was reviewing the decision, but declined further comment, citing ongoing litigation.
The pipeline was first proposed by Calgary-based TransCanada in 2008. It has become the focal point of a decade-long dispute that pits Democrats, environmental groups and Native American tribes who warn of pollution and increased greenhouse gas emissions against business groups and Republicans who cheer the project’s jobs and potential energy production.
U.S. District Judge Brian Morris put a hold on the project late Thursday, ruling that the State Department had not fully considered potential oil spills and other impacts as required by federal law. He ordered the department to complete a new review that addresses issues that have emerged since the last environmental review was completed in 2014.
New topics include the cumulative effects of climate-changing greenhouse gas emissions of Keystone XL and a related pipeline that brings oil from Canada; the effects of current oil prices on the pipeline’s viability; updated modeling of potential oil spills; and the project’s effect on cultural resources of native tribes and other groups along the pipeline’s route.
The review could take up to a year to complete.
Environmentalists and Native American groups had sued to stop the project, citing property rights and possible spills.
Becky Mitchell, chairwoman of the Northern Plains Resource Council, a plaintiff in the case, said her organization is thrilled with the ruling.
“This decision sends TransCanada back to the drawing board,” Mitchell said, calling the ruling “the results of grassroots democracy in action, winning for water and people.”
TransCanada said in a statement that it was reviewing the judge’s 54-page decision. “We remain committed to building this important energy infrastructure project,” TransCanada spokesman Terry Cunha said.
Environmental groups declared victory and predicted the long-delayed project will never be built.
The court ruling “makes it clear once and for all that it’s time for TransCanada to give up on their Keystone XL pipe dream,” said Doug Hayes, a senior attorney with the Sierra Club, the nation’s largest environmental group.
The fight over the project has spanned several presidencies and involved standoffs between protesters and law enforcement.
After years of legal wrangling, Obama rejected a permit for the pipeline in 2015. The company responded by seeking $15 billion in damages.
Trump signed executive actions to again advance construction of the project in 2017.
TransCanada had recently announced plans to start construction next year, after a State Department review ordered by Morris concluded that major environmental damage from a leak is unlikely and could quickly be mitigated. Morris said that review was inadequate.
TransCanada has promised continuous monitoring and says automatic shut-off valves would help officials quickly identify a leak or rupture.
Tom Goldtooth, executive director for the Indigenous Environmental Network, a Minnesota-based advocacy group that also is a plaintiff in the case, said the ruling was a win for tribes, water “and for the sacredness of Mother Earth.”
He called the pipeline “the enemy of the people, the climate and life as we know it. It must be stopped.”
On the 100th anniversary of WWI’s end, lessons on life in health care’s trenches
November 8, 2018
Chancellor’s Professor of Medicine, Liberal Arts, and Philanthropy, Indiana University
Richard Gunderman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Indiana University provides funding as a member of The Conversation US.
It is common these days to hear physicians, nurses and other health professionals refer to their daily work as “life in the trenches.” The phrase usually contrasts the experiences of patient-facing professionals with those of administrators and others who labor “behind the lines.” (In many medical practices and hospitals, non-clinical staff outnumber health professionals by 5 to 1 or more.)
Nov. 11 marks the 100th anniversary of the end of World War I, the first large-scale military conflict in which trench warfare – combat between opposing troops hunkered down in ditches – played a major role, making this an opportune time to explore the similarities between the lives of contemporary health professionals and those once literally in the trenches.
Historically speaking, the introduction of trench warfare can be traced to advances in military armaments, especially small arms and artillery. Such weapons proved effective against exposed enemies, such as troops advancing in formation, but they offered limited advantage against an enemy out of the line of sight or sheltered by large amounts of earth. In other words, firepower leapt forward, while mobility advanced relatively little, an imbalance that led later to the development of tanks and air power.
The height of trench warfare was reached on the Western front in France, where well-protected troops were separated by “no man’s land,” resulting in long stalemates for which trench warfare became a byword.
For soldiers, life in the trenches tended to be highly monotonous. Both sides were so deeply entrenched that most attempts to advance were doomed to failure. Soldiers devoted most of their time to constructing and repairing the trenches, cleaning their weapons, transferring food and supplies, and attempting to mitigate rats, lice and ailments such as cholera and trench foot. By contrast, they spent very little time engaged in combat, a role that was soon largely reserved for elite units. Simply put, soldiers in trench warfare endured many miseries, but almost none stemmed from their defining purpose – fighting.
As a practicing physician, I believe that many contemporary health professionals can relate to this experience. Though trained to focus on direct patient care, many find that they spend a remarkably high proportion of their time on activities that draw them away from patients – activities such as filling out electronic forms, wrangling with coding and billing requirements, and demonstrating compliance with rules and regulations. One study showed that nurses spend less than a third of their time actually caring for patients. This gives rise to a number of professional afflictions – among them depersonalization, inefficacy, and loss of purpose, which take their own toll on “battle readiness.”
Flooding, heat and terror
During WWI, conditions in the trenches were typically terrible. For example, soldiers remained entrenched in all seasons and weather conditions. In heavy rains, the trenches flooded. In winter, a flooded trench would often freeze. Under the hot sun, by contrast, heatstroke and dehydration became the principal threats. Furniture was scarce, and many soldiers slept on the damp earth. The typical trench diet offered little in the way of wholesome nutrition or relief from the monotony. In the case of British soldiers, it often consisted of tea, biscuits and tinned beef – a regimen that, over prolonged periods of time, resulted in malnutrition.
Something analogous is afoot in contemporary health care. Health care is being transformed in ways that seem to take little heed of the individual health professional. New health information systems not only reallocate precious time from patients to information systems but actually increase the total amount of time health professionals must devote to completing the paperwork associated with each clinical encounter, typically amounting to an hour or two of physician “pajama time” at home each night. Many health professionals feel overfed on information but undernourished when it comes to the human contact that provides genuine fulfillment in patient care.
The monotony of life in WWI’s trenches was punctuated by moments of sheer terror. For example, snipers could fire at any moment, and artillery attacks could produce instantaneous panic. It was during WWI that the condition of “shell shock” was first identified, and it was thought to be the result of sustained exposure to the deafening roar of such bombardments. We now know that witnessing the often unthinkable aftermath of such attacks, such as the dismembered bodies of comrades, played a role as well. With time, the stalemate of trench warfare led to the development of new modes of assault, such as poison gas attacks, against which the trenches offered no defense.
Although most health care professionals’ lives aren’t threatened in the same way as soldiers are, the parallels with contemporary health care are striking. Health professionals have weathered a number of dramatic changes in the environment of health care, including the introduction of new health information systems, changes in the way health care is organized and financed, and waves of consolidation, increasing the size – and bureaucratization – of health care organizations. When viewed from the perspective of health professionals attempting to care for patients one by one, the rapidity and magnitude of such changes can quickly induce a siege mentality, in which they feel they can do little more than hunker down and wait for the next assault, hoping it does not bury them.
Firsthand descriptions of life in the trenches are harrowing. After five months at the site of one of the bloodiest battles in the war, the Somme, one soldier wrote that “everything visible or audible or tangible to the sense … is ugly beyond imagination.” Future British Prime Minister Harold Macmillan wrote, “In those miles of country lurk (like moles and rats, it seems) thousands, even hundreds of thousands of men, planning against each other perpetually some new device of death.” Another solider wrote of his surroundings, “The mud there wasn’t liquid, it wasn’t porridge, it was a curious kind of sucking mud … a real monster that sucked at you.”
A focus on survival and not relationships
Likewise, life in the trenches of contemporary health care can overload the senses and cast a dark shadow on even the most essential features of daily life. The increasing pace and bureaucratization of the daily work of health professionals mean that interpersonal relationships tend to play a smaller and smaller role. Data and forms displace personal knowledge, and the “no man’s land” between health professionals and patients grows progressively wider. It is not uncommon to hear doctors and nurses talk about how their work is sucking the life out of them, rather than building a sense of purpose and fulfillment.
To turn the tide that is making the work of contemporary health professionals increasingly resemble life in the trenches, we need to learn some important lessons from WWI. First, we need to let history speak, recognizing that in difficult times, considerations of human dignity and compassion should always trump technical needs. Second, unintended and even unforeseeable consequences can inflict great suffering, which needs to be recognized and responded to promptly. Finally, both warfare and health care are ultimately more about human beings than technologies. If we stay focused on good relationships, a great deal of loss and heartache can be averted.
Bishops will delay votes on steps to combat sex abuse crisis
By DAVID McFADDEN and DAVID CRARY
Monday, November 12
BALTIMORE (AP) — In an abrupt change of plans, the president of the U.S. Conference of Catholic Bishops opened the group’s national meeting Monday by announcing it will delay for at least several months any votes on proposed new steps to address the clergy sex abuse crisis that is rocking the church.
Cardinal Daniel DiNardo, of Galveston-Houston, said the delay was requested by the Vatican, which asked that the U.S. bishops wait until after a Vatican-convened global meeting on sex abuse in February.
DiNardo expressed disappointment but told the U.S. bishops, “I remain hopeful that this additional consultation will ultimately improve our response to the crisis we face.”
The bishops are meeting through Wednesday in Baltimore and had been expected to consider several steps to combat abuse, including a new code of conduct for themselves and the creation of a special commission to review complaints against the bishops.
At their meeting, which continues through Wednesday, the bishops may proceed with discussions of these proposals, which were drafted in September by the bishops’ Administrative Committee. But there will be no immediate vote.
Cardinal Blase J. Cupich, of Chicago, suggested that the bishops hold a special assembly in March to vote on the measures after considering the results of the global meeting in February.
Abuse scandals have roiled the Roman Catholic Church worldwide for decades, but there have been major developments this year in the U.S.
In July, Pope Francis removed U.S. church leader Theodore McCarrick as a cardinal after church investigators said an allegation that he groped a teenage altar boy in the 1970s was credible. Subsequently, several former seminarians and priests reported that they too had been abused or harassed by McCarrick as adults, triggering debate over who might have known and covered up McCarrick’s misconduct.
In August, a grand jury report in Pennsylvania detailed decades of abuse and cover-up in six dioceses, alleging that more than 1,000 children had been abused over the years by about 300 priests. Since then, a federal prosecutor in Philadelphia has begun working on a federal criminal case centered on child exploitation, and attorneys general in several other states have launched investigations.
DiNardo, in his address opening the bishops’ assembly, told survivors of clergy abuse that he was “deeply sorry.”
The church, he said, should not revictimize survivors “by demanding they heal on our timeline.”
Announcement of a delay in the voting drew skeptical reactions.
“We had this agenda, we were moving forward on these documents, this was our goal,” said Bishop Christopher Coyne, of the Vermont diocese of Burlington, and the communications chair for the three-day conference. “And now … it will look like we don’t have to come up with much.”
Coyne said he believed there were “no machinations” leading to the delay, but he had concerns about how it would be perceived outside the assembly hall.
“The Vatican just made a big mistake in asking US bishops to delay their votes on clergy abuse protocols,” tweeted John Gehring, the Catholic program director at Faith in Public Life, a Washington-based clergy network. “The optics are terrible, and it sends a message, intended or not, that Rome doesn’t recognize the urgency of the moment.”
Crary reported from New York.
IT’S ‘UTILITY SCAM AWARENESS WEEK’; AEP OHIO REMINDS CUSTOMERS TO BE ALERT
GAHANNA, Ohio, Nov. 12, 2018 – Scammers continue to target and strike unsuspecting victims every day. That’s why AEP Ohio is joining utility companies across the country in observing the “Utility Scam Awareness Week” starting November 12.
AEP Ohio is reminding customers that criminals will do anything to steal their money. Scammers don’t work regular hours or observe national holidays; they can be on the prowl at any time. The most common scam involves someone pretending to be a utility company employee. Scammers target customers over the phone, by email and even on their doorstep. They threaten to shut off the power if a customer doesn’t make an immediate payment.
Scammers often target those who are most vulnerable, including senior citizens, low-income residents and small business owners during their busiest hours.
Spotting a Scam
The most important step in protecting your money is knowing how to recognize a scam. You’re probably talking to a scammer if the person:
Demands immediate payment
Insists a payment be made with a prepaid credit card
Asks to meet at another location to make a payment
How to Stay Safe
If you’re told your account is past due, check your account status online.
Make payments only to authorized AEP Ohio agents or through AEPOhio.com.
Remember that AEP Ohio employees are always willing to show their company ID. Just ask.
If you’re ever in doubt about someone’s identity, call AEP Ohio at (800) 672-2231.
If you think you’re being targeted by a scammer, end the conversation and call AEP Ohio to report it. Representatives can verify your account status.
Follow us on social media. AEP Ohio monitors the latest threats and alerts customers through our Facebook and Twitter accounts.
“Scammers continue to get more clever and sophisticated. They can be convincing and we want our customers to be alert,” said Katie Grayem, director of AEP Ohio customer experience. “It’s important that our customers know how to spot scams, and what to do if they believe they’re a victim. Education is the key to preventing this from ever happening. We want to make sure our customers are aware and remain vigilant.”
For more information visit AEPOhio.com/StopScams.
About AEP Ohio
AEP Ohio is based in Gahanna, Ohio, and is a unit of American Electric Power. AEP Ohio provides electricity to nearly 1.5 million customers. News and information about AEP Ohio can be found at AEPOhio.com.
American Electric Power based in Columbus, Ohio, is focused on building a smarter energy infrastructure and delivering new technologies and custom energy solutions to our customers. AEP’s more than 17,000 employees operate and maintain the nation’s largest electricity transmission system and more than 219,000 miles of distribution lines to efficiently deliver safe, reliable power to nearly 5.4 million regulated customers in 11 states. AEP also is one of the nation’s largest electricity producers with approximately 32,000 megawatts of diverse generating capacity, including 4,300 megawatts of renewable energy. AEP’s family of companies includes utilities AEP Ohio, AEP Texas, Appalachian Power (in Virginia and West Virginia), AEP Appalachian Power (in Tennessee), Indiana Michigan Power, Kentucky Power, Public Service Company of Oklahoma, and Southwestern Electric Power Company (in Arkansas, Louisiana and east Texas). AEP also owns AEP Energy, AEP Energy Partners, AEP OnSite Partners and AEP Renewables, which provide innovative competitive energy solutions nationwide.
How nurses rate daily job difficulty plays key role in patient care
Pressure on nurses extends beyond number of patients, researchers say
A neonatal intensive care unit nurse’s ability to provide optimal patient care is influenced by a variety of factors – not just how many babies he or she is caring for or how sick they might be, a new study suggests.
The study, which appears in the journal JAMA Pediatrics, highlights the importance of considering multiple pressures that nurses experience and developing a broader toolkit of workload strategies that enable high-quality nursing care at the bedside, said lead researcher Heather Tubbs Cooley of The Ohio State University.
The study found that a nurse’s perception of the difficulty of the workday – everything from being squeezed for time to the mental pressures of the shift – had a bearing on his or her ability to provide the best care possible, regardless of how many patients the nurse was tending to.
“We were surprised to discover how important subjective workload is to care quality, and it’s something we typically don’t measure in health care. This is really the nurse’s voice telling us how intense things were,” said Tubbs Cooley, an associate professor of nursing and member of the College of Nursing’s Martha S. Pitzer Center for Women, Children & Youth at Ohio State.
The study included data collected during 332 12-hour shifts from 136 neonatal intensive care nurses.
During each shift, the researchers collected objective measures of infant-to-nurse staffing ratios and infant acuity – a measure of the severity of a patient’s illness.
Nurses also filled out a simple questionnaire that measured perceived workload based on mental demand, physical demand, temporal demand (how hurried a nurse felt during a shift) and overall effort needed to accomplish patient care. The tool, called the NASA Task Load Index, was developed in the aeronautics industry and is used to assess workload in other industries where a performance lapse can have catastrophic results, including aviation and some health care settings.
The nurses in the study also gave the researchers reports on tasks considered “essential care” that they missed during shifts.
The research team compiled all of that information and created multiple statistical models to evaluate the relationships between objective and subjective workload measures and quality of care.
Regardless of the model, the nurses’ perceived workloads had a consistently strong influence on missed essential care – activities that included hourly assessments of the patients’ intravenous sites, oral feedings, collection of laboratory results and safety checks of equipment and alarms. This study did not evaluate patient outcomes, but other research has established that missing the type of essential care tracked in this study is linked to poorer patient outcomes.
Some of the models showed that higher patient ratios contributed to missed care, which has been demonstrated in other studies. But the researchers saw little connection in this study between the severity of patients’ health status and missed care.
“Subjective workload was the one variable that was consistently and strongly associated with missed care. Staffing ratios get a lot of attention – and they’re important – but nurses’ in-the-moment workload judgments matter as much or more,” she said.
NICU nurses care for the most fragile infants but the study’s implications likely extend far beyond that setting, said Tubbs Cooley. “I think this is likely a universal phenomenon among front-line caregivers in hospitals and even those in outpatient and community settings.”
Rita Pickler of Ohio State and researchers from Cincinnati Children’s Hospital Medical Center and the University of North Carolina at Chapel Hill also collaborated on the study.
Written by Misti Crane, 614-292-5220; Crane.firstname.lastname@example.org