Archive for the ‘History’ Category

From imagination to reality in less than a century: Telemedicine and Electronic Health Records

Tuesday, March 20th, 2012

1925-feb-science-and-invention-sm-cover

Today, we slip back in time to 1925 and put on our Flash Gordon glasses to speculate about the future, a time when a doctor not only “sees what is going on in the patient’s room by means of a television screen” but also employs a robotic-like instrument called the Teledactyl (Tele, far; Dactyl, finger — from the Greek) to “feel at a distance.”

This image and the story comes from a delightful Smithsonian blog called Paleofuture in a post entitled Telemedicine Predicted in 1925. The post discusses an article by Hugo Gernsback that appeared in the February, 1925 issue of Science and Invention. You can read more about the intriguing robotoic Teledactyl device and Gernsback’s predictions for medicine of the future.
Fast forward to 2010, and we see how remarkably prescient Mr. Gernsback’s predictions were. Courtesy of a blog comment by Christoph Hadnagy, we find this link to a New York Times story on Denmark Leads the Way in Digital Care, in which 77-year old patient Jens Danstrup talks about what it’s like to be a telemedicine patient:

“You see how easy it is for me?” Mr. Danstrup said, sitting at his desk while video chatting with his nurse at Frederiksberg University Hospital, a mile away. “Instead of wasting the day at the hospital?”

He clipped an electronic pulse reader to his finger. It logged his reading and sent it to his doctor. Mr. Danstrup can also look up his personal health record online. His prescriptions are paperless — his doctors enters them electronically, and any pharmacy in the country can pull them up. Any time he wants to get in touch with his primary care doctor, he sends an e-mail message.

All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago.

Adoption of Electronic Health Records in the US
The Centers for Disease Control issues an annual survey on the use of electronic health records in physician’s offices. Last year, partly bolstered by meaningful use incentives in the Affordable Care Act, use grew by 6%. Dr. Elliot King blogs on the EHR increase, noting that:

“In 2011, 57 percent of office-based doctors used electronic medical records/electronic health records (EMR/EHR), according to the CDC. That number compares to the 50.7 percent of physicians’ offices using EMR/EHR’s in 2010 and 48.3 percent in 2009.”

Some physicians are also taking to telemedicine via Skype, FaceTime and other video conferencing services. In Doctors who Skype: Renegades or Heroes?, Jean Riggle looks at the pros and cons of video chat as used by physicians. She notes that there currently aren’t any guidelines for electronic communication between physicians and patients and there there are several important questions yet to be solved:

  • How can these chats be integrated into the patient’s medical record?
  • Can the actual video be captured and inserted into the record or should a summary of the call suffice?
  • How should physicians be reimbursed for the time they spend using social media?

To follow developments in telemedicine, we offer a few sources:
HealthIT.hhs.gov
Federal Health IT programs
American Telemedicine Association
iHelathBeat
Healthcare IT News

Remembering Two Prominant Risk Takers

Thursday, June 30th, 2011

We are about to observe the 235th anniversary of the Declaration of Independence. As is so often the case with holidays, the ways we celebrate will not have much to do with the original events. As we indulge in a weekend of family reunions, sporting events, cookouts, libations and fireworks – along with hours sitting in traffic – we are unlikely to give much thought to the conditions that led to the promulgation of that remarkable document. So as we prepare to hit the roads, let’s take a moment to acknowledge two of the remarkable risk takers who helped make this all possible.
Let’s begin with John Adams. He trained at Harvard to become a minister, but chafed at being told what to believe and what to think, so he became a lawyer instead. On March 5, 1770, six years before the formal break from England, an unruly mob gathered in front of Boston’s Customs House. After pelting British troops with snowballs and rocks, the crowd surged forward; the troops fired into the mob, killing five people. From the colonial viewpoint, this was the “Boston Massacre.” As far as the British were concerned, it was a riot. Both views are credible.
Unpopular Cause
Captain Thomas Preston and 12 soldiers were charged with murder. No Boston lawyer would take their case, so the plea was made to John Adams, who at the time was practicing law (not all that successfully) in Quincy, about 15 miles from Boston. Adams took on the case, at considerable personal risk. His words at the time should be taken to heart by any politician seeking a vote:

“Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passion, they cannot alter the state of facts and evidence.”

Under Adams’ skillful defense, six of the soldiers were acquitted. Two who had fired directly into the crowd were charged with murder, but were convicted only of manslaughter. Adams was paid eighteen guineas by the British soldiers, or about the cost of a pair of shoes. Beyond the fee, Adams wanted to prove to the world that American justice was balanced and fair.
Self-Evident Truths
Just six years later Thomas Jefferson wrote – and Adams helped edit – the Declaration of Independence. After ratification of the final language (which, to Jefferson’s chagrin, excluded a ban on the importation of slaves), a prayer was said and in silence the delegates to the convention applied their signatures to the document.
In the entire history of risk taking, there are few events of greater magnitude. The document would be considered treason by the most powerful government in the world; should the revolution fail – and that itself must have seemed highly likely – each signer would pay with his life, .
The Perspective of Time
One month before his death, Adams wrote of the upcoming July 4, 1826, festivities:

My best wishes, in the joys, and festivities, and the solemn services of that day on which will be completed the fiftieth year from its birth, of the independence of the United States: a memorable epoch in the annals of the human race, destined in future history to form the brightest or the blackest page, according to the use or the abuse of those political institutions by which they shall, in time to come, be shaped by the human mind.

Somber thoughts from one who was there at the beginning – and who would likely be appalled by some of the subsequent uses and abuses of his work.
As most Insider readers probably know, Adams and Jefferson both died on July 4, 1826, fifty years to the day after the Declaration was issued. Adams desperately wanted to outlive Jefferson; just before he died, he said – perhaps bitterly – “Thomas Jefferson survives.” Ironically, word had already gone out from Monticello that Jefferson had died earlier the same day. It is perhaps reassuring that such great souls could also be small minded and petty. There is still hope for us all.

Illinois Comp: The Nuclear Option?

Tuesday, May 17th, 2011

Illinois is struggling mightily with its bloated workers comp system. Currently ranked 3rd highest for overall cost in the Oregon study, the governor and legislature are under intense pressure from the business community to lower the cost of comp insurance. Aiming its powerful bulldozers at the state capital, the Caterpiller Company has threatened to move their business somewhere else if reforms are not implemented immediately. In exploring all options, the legislature has gone so far as to think the unthinkable: abolishing workers comp.
In looking for ways to save money, Illinois does what all states do: first, identify the cost drivers and then try to change the statute to bring down costs. Among the hot issues on the table are the medical fee schedule (too generous), employee choice of doctor (too flexible), duration of benefits (too long), causation (too vague). Ah, behind every cost driver is a vested interest (perhaps literally vested, with many of the lobbyists wearing three piece suits). The common denominator among all states struggling with high comp costs is the omni-present stakeholder, who is deeply committed to the status quo.
Governor Quinn would like to see a number of reforms, including the capping of carpal tunnel benefits, denying claims where employee intoxication is a significant factor, attacking fraud (see our blog on Illinois’s dubious arbitration services), capping wage differential benefits at age 67 or five years after an injury, and implementing utilization review for physical therapy, chiropractic and occupational therapy services.
Going Nuclear
The Illinois legislature is so frustrated with the slow progress and with stakeholder resistance to change, they are now threatening to blow up the entire system. Interesting to note, this pressure is coming from the Democrats. John Bradley (D-Marion) has filed House 1032, a bill to repeal the workers comp act and send all workplace-injury issues into the court system. Should this happen, Illinois will find itself in the world prior to 1912, when injured workers had to sue their employers and could collect benefits only if their injuries were caused by someone other than themselves. They would collect no benefits while awaiting adjudication of their claims. They would be out of work and out of luck.
In all likelihood, repeal of workers comp is not a serious option in Illinois; it’s a political strategy for getting the attention of inertia-bound legislators. But the prospect of abolition does raise an interesting issue. Workers comp came to America 100 years ago. By the end of the World War II, every state had implemented the program.
What if there were no workers comp programs today? What if each state were starting from the beginning and tackling the issue of protection for injured workers? I find it hard to imagine that state legislatures would be willing to implement a program, totally funded by employers, that provides indemnity for lost wages and 100 percent medical benefits for injured workers. Why so generous? Why so inclusive? It’s too expensive. It will create disincentives for working. The cost will drive employers out of business or out of state.
With today’s acrimonious, ideology-driven debates, workers comp would be a hard sell. That’s too bad, for despite its problems and inequities, despite the wide variations in benefits and costs from state to state, comp is a compelling example of effective social engineering. In Illinois, cooler heads will likely avoid the meltdown option. To be sure, Illinois comp is a mess, but the alternative – a workplace without workers comp – would be far worse.

Are events in Wisconsin part of a union busting initiative?

Tuesday, March 8th, 2011

Later this month, we will mark the 100 year anniversary of New York’s horrific Triangle Shirtwaist Fire, an event that claimed the lives of 146 garment workers – young girls and women – who had been locked in the sweatshop to prevent theft. Most died in stairwells, jumping down the single elevator shaft, or by hurtling themselves from 9th story windows in desperate attempts to escape the fire. PBS recently ran a special on this disaster. (If you missed it, you can watch online: Triangle Fire). My colleague Jon Coppelman has also written about the fire in his post The Original “No Exit”.
This fire was a watershed event that galvanized the nation. It occurred in an era where there were no regulations or labor protections. Workers often worked 12 hour shifts, 7 days a week. There were no child labor laws or safety mandates. Ironically, the day before the Triangle Fire, New York courts had struck down the state’s first compulsory workers compensation law as unconstitutional.
This tragedy, along with some of the horrific mine disasters that resulted in wholesale loss of life, were catalysts which led to the enactment of various worker protections – including statutory workers’ compensation.
Meanwhile, today in Wisconsin …
We think this bit of history is an important backdrop to what’s going on in Wisconsin today.
Wisconsin has the distinction of being the first state in the union to have enacted a workers’ compensation law that survived legal challenge in May of 1911. In fact, the state of Wisconsin has a long, storied and sometimes bloody history of being on the front lines for worker rights. Workers and labor unions were in the forefront of the fight for the 8-hour day and the 40-hour work week. In 1932, Wisconsin was the first state to enact unemployment compensation.
To any who know this history, it comes as no surprise that, once again, Wisconsin is on the front lines in the battle for labor’s future.
It’s the budget, stupid – or is it?
The ostensible issue, according to Governor Walker, is that the state of Wisconsin is broke and a large part of the problem lies with overly generous benefit packages of public workers – teachers, prison guards and the like – which are said to be crippling the state. He called on unions to do their part and to make a sacrifice for the greater good.
All that might be well and good. The unions have indicated their willingness to take a financial haircut. But the part of Governor Walker’s Budget Repair Bill that is going over somewhat less well is a call for the elimination of collective bargaining — and therein lies the rub.
With a Republican majority in Wisconsin’s House and Senate, the bill was all but a given until the Democratic senate contingent fled the state to prevent a vote. Since that time, there have been massive protests over three weeks and the so-called Fab 14 remain holed up in un-named Illinois’ hotels. And there has been no shortage of drama in this story: an embarrassing and revelatory 20-minute prank call to Governor Walker from an impersonator of corporate financier David Koch; and a sheriff’s refusal to play the role of “palace guard”, among other things.
Part of national union busting agenda?
Critics of Walker’s Budget Repair Bill say that the issue is not about budget balancing or overly generous benefits, but an ideological push to eliminate or curtail public unions – in a phrase, union busting. Opponents say that this is a corporate-funded campaign to eliminate public unions in Wisconsin and other states, and to privatize many institutions that are currently staffed by public workers. No less a staunch Republican than former Congressman and now host of MSNBC’s “Morning Joe” program, Joe Scarborough, has publicly called Governor Walker’s actions, “Un-American.”
In Wisconsin, suspicions are high because Koch enterprises funded a large part of Walkers gubernatorial campaign. The fact that the budget bill contains a provision authorizing Walker to conduct no-bid sales of some state properties also heightens suspicion. Many are troubled by his plans for privatization of some public services. In his prior role as Milwaukee County Executive, Walker also used budget emergency as a justification for privatizing security guards, a move that proved less than successful.
Other states have also embarked on this path: Ohio may be making more headway in curtailing unions. In Indiana, Democratic legislators have followed Wisconsin’s lead and left the state to postpone a vote. In Rhode Island, nearly 2000 teachers have been dismissed. Other states may be contemplating similar measures, although some may be a bit shy of action given the shifting public sentiment, which favors retention of collective bargaining and has given Walker a black eye – to a point where voters say they would not elect him again if they had a do-over. (see Wisconsin Public Research, Rasmussen, USA Today/Gallup, Public Policy Polling and various other polls. )
It’s uncertain what will happen in the next chapters, but we will be watching. It is clear this is another watershed point in labor history, a public policy fork in the road, perhaps the beginning of the end of the movement that was propelled into mainstream America by that terrible fire 100 years ago. While polling indicates that sentiment is currently on the side of the teachers in this dispute, the future of public unions is under serious threat. Is the role of unions obsolete? Has the public dialogue achieved an equilibrium between the rights of workers and those of management?
At Lynch Ryan, we have great respect for unions, which have historically played a critical check-and-balance role in labor-management power dynamics. They have also been in the forefront of the fight for worker safety and other worker protections. We also admire and respect many employers we have been privileged to work for who are perceptive and wise enough to manage their companies so well that unions are not needed. We’d like to say that all employers are this enlightened and do not need union checks and balances to do the right thing, but unfortunately our experience tells us that this is not always the case.

Cavalcade of Risk; interesting workers compensation history

Wednesday, February 9th, 2011

Feeling risky? Catch up on your reading – Jaan Sidorov of The Disease Management Care Blog hosts this week’s risky roundup: The 124th Cavalcade of Risk
Work Comp history
Yesterday, we posted a feature on window washers as a dangerous profession, which included some vintage photos of workers pre-OSHA. Later, via Complex Care Blog, we were alerted to Peter Rousmaniere’s excellent article in Risk & Insurance, Into the Work Killing Ground, which turned the clock back even further. Peter offers a fascinating and chilling glimpse into what the working world was like at the start of the last century, before workers compensation laws had been enacted. He notes that, “The fatality rate at the time, if transposed to today’s population, would exceed 300,000 deaths a year. Our rate was twice as high as England’s.” He talks about one young attorney, Crystal Eastman, who began documenting injuries and fatalities just in the Pittsburgh area alone. Her report became a catalyst for the ensuing law. If, like me, you didn’t know about her contribution to workers’ comp, you can learn more about Crystal Eastman at Wikipedia.

Dangerous jobs: window washing at extreme heights

Tuesday, February 8th, 2011

Lunch-atop-a-skyscraper-c1932

Image from Wikipedia

Master Cleaners Ltd a central London cleaning company, has posted a fascinating photo feature on their blog called The World’s Most Fearless Cleaners. We issue a vertigo warning in advance. Also, the caveat that we are not endorsing the safety procedures or lack thereof that are depicted in the photos.
Here are a few more detailed stories associated with the above photos:

We also recommend this dramatic photo gallery from the New York Public Library’s digital archive of Empire State Building construction workers. There are few belts, lifelines, or tethers in sight so it is rather surprising that only five workers were killed during construction. We also found a rare video clip of 1940s-era window washers working on the Empire State Building. (With a bonus of some acrobats doing a stomach-churning stunt on the ledge) And here is a vintage 1934 feature on skyscraper window washers from Modern Mechanix.

Two years ago this month, we wrote about miracle survivor Alcides Moreno, a window washer who survived a 47 story plunge. In that post, we cited the ever-fascinating Free Fall Research Page, which documents reports, stories, and personal accounts of people who survived falls from extreme heights.
If tall structures are your thing, you might enjoy this skyscraper site which tracks the world’s tallest buildings. This thread in Skyscraper City features a few articles about cleaning skyscraper windows.
Related resources
OSHA Fall Protection
OSHA: Scaffolding
No such thing as a free fall

A Hand for Dr. Woolley

Tuesday, January 4th, 2011

For nearly 15 years, beginning in 1990, Bradley Clark was a baggage handler for United Airlines. He started at age 33, and by the time he was unable to perform the work, he was nearly 50. Ten years in, he began experiencing pain in his thumb joints. In 2004 he banged his hand against a cart and was diagnosed with bilateral carpal tunnel, for which he had surgery. Unfortunately, the surgery did not stop the pain. (NOTE to claims adjusters: This is yet another example of unnecessary surgery, based upon the wrong diagnosis.)
With pain continuing after the surgery, Clark sought treatment from a hand specialist. He treated with Dr. Charles T. Woolley, who performed surgical fusions on both thumbs. Coverage of this surgery was denied, as a succession of five physicians concluded that Clark’s problem was osteoarthritis, which is hereditary and unrelated to work. The opinions included an IME performed by two doctors, who concurred with the other doctors that the condition was not work related.
Slam dunk for the employer, right?
Making the Case
In his choice of a hand surgeon, Bradley Clark stumbled upon a stubborn and determined physician, one more than willing to disagree with his colleagues. Dr. Woolley diagnosed bilateral trapeziometacarpal joint arthritis and insisted that it was work related. Among his impressively detailed findings:
– Clark was too young to develop osteoarthritis, as he was only 43 years old when the pain first developed.
– He found no genetic pre-disposition to developing osteoarthritis, as none of the other joints in Clark’s hands, such as his fingers, revealed osteoarthritis. There was no osteoarthritis in any other part of his body.
– Osteoarthritis in the thumbs is typically seen in women, in particular post-menopausal women. Clark rather obviously did not fall within this category.
– Clark performed significant lifting for 16 years, which required repetitive pinching of his thumbs. This kind of grabbing/pinching activity places significant loading on the thumbs and ultimately leads to a wear and tear of the thumb joints. Wear and tear over time led to instability of his joints causing the osteoarthritis. His TMC or thumb joints became unstable over time because of the repetitive grabbing/pinching use. Over time with continued use, his cartilage in his thumbs wore off due to the repetitive friction from the pinching/grabbing.
– Contusions/strains, such as the work injury he sustained in November 2004, also contributed to the osteoarthritis, because they cause damage to the cartilage which leads to instability of the ligament. Jamming one’s thumb also contributes to the development of osteoarthritis because it damages the ligament causing instability and then osteoarthritis.
– The thumb basal joint (where the thumb meets the wrist) is exposed to very high stresses with grabbing activities and the forces felt at the tip of the thumb are multiplied twelve times in their effect on the thumb base, thus predisposing this joint to wear and tear. Clark’s work activities as a ramp serviceman are the exact kind of activities to cause wear and tear to the thumb joint because of the grabbing involved; this wear and tear led directly to the osteoarthritis in his thumbs.
Deep Knowledge
While there were five doctors lined up against him, Woolley was the only hand specialist among them. The duelling docs bolstered their differing cases through articles in medical journals. The Oregon Court of Appeals was faced with a choice: side with the majority or side with the expert.
Ultimately, Dr. Woolley’s opinion prevailed. His compelling testimony, combined with his intimate knowledge of hands, won the day. So let’s have a little hand for Dr. Woolley, who could have taken the easy way out and deferred to his colleagues, but instead fought the good fight for a hard-working man who could no longer do his job.
(For the record, we duly note that Clark retired from his job long before the onerous baggage fees went into effect, at which time many of us lost a bit of sympathy for these harried and ultimately blameless workers.)

Remembering Katrina

Monday, August 30th, 2010

If you haven’t discovered the gem that is the Boston Globe’s “Big Picture” yet, you are missing a wonderful feature. Billed as “news stories in photographs” it is a themed news essay curated by Alan Taylor. From the BP oil disaster to the floods in Pakistan, the photos add a visual narrative to breaking stories of the day.
This past week, as in many media outlets, the focus was on Katrina. With a human toll of more than 1,800 dead and an economic toll exceeding $80 billion, the 5-year anniversary merits our attention.
For many of us, the anniversary is a look back, but for many of those who experienced it first hand, Katrina is a continuing nightmare. News reports point to ongoing health problems, from mental health issues to general health problems, such as skin infections and respiratory illnesses: “A recent study published in a special issue of Environmental Toxicology and Chemistry found elevated concentrations of lead, arsenic and other toxic chemicals were present throughout New Orleans, particularly in the poorer areas of the city. It suggested that widespread cleanup efforts and demolition had stirred up airborne toxins known to cause adverse health effects.”
Many residents, particularly children, are still still experiencing severe emotional and psychological disturbances. The National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health has been conducting studies on Gulf coast residents, and recently issued a white paper in coordination with the Children’s Health Fund:

“Together, these documents indicate that although considerable progress has been made in rebuilding the local economy and infrastructure, there is still an alarming level of psychological distress and housing instability. Investigators believe that housing and community instability and the uncertainty of recovery undermine family resilience and the emotional health of children. These factors characterize what researchers are calling a failed recovery for the Gulf region’s most vulnerable population: economically disadvantaged children whose families remain displaced.”

Looking back to look ahead
It’s no mystery why FEMA would designate September as National Preparedness Month. Between the man-made disaster of 9-11 and nature’s twin-wallop of Katrina and Rita, it’s certainly been a month fraught with peril, at least in terms of the last decade. In particular, FEMA is calling on businesses to be ready with disaster plans, and offers resources for that purpose.
A crisis by its very nature is unpredictable and random. But from a risk management point of view, it’s important for businesses to examine past events so that lessons learned can become part of planning for future crises with an eye to minimizing losses and disruption.
Perhaps one of the best articles we’ve seen on this theme is Crisis Management of Human Resources: Lessons From Hurricanes Katrina and Rita. This article discusses the three phases of crisis management: planning and preparation; immediate event response; and post crisis, or recovery. It cites specific companies and the way they problem-solved aspects of the Katrina crisis, and points to the importance of putting some plans in place: having and circulating an alternative emergency communication systems plan; keeping contact information and next-of-kin data current; maintaining communications with employees during an emergency; having updated policies and procedures for compensation and benefit continuation; making resources such as EAP services available to employees; and having flexible and alternative work arrangements.

Marking 100 Years: The history of Workers’ Compensation

Wednesday, June 16th, 2010

Workers comp is 100 years old this year and by way of Roberto Ceniceros’ informative blog Comp Time, we learn that there is a Workers’ Compensation Centennial Commission (WCCC), which was formed to celebrate the anniversary of the first constitutional workers’ compensation law in the United States. The WCCC was organized by a bi-partisan coalition of Wisconsin-based labor and government leaders, which is reaching out to other states to commemorate the anniversary of the landmark legislation. It’s pretty appropriate that this initiative is kicking off in Wisconsin because that was the state where the first state workers’ compensation law was signed on May 3, 1911.
The WCCC site has collected some really interesting resources, including a photo gallery and various historical documents. And one of the centerpieces of the collection is a terrific 10-minute video that was created by students from Nimitz High in Houston Texas for the 2008 National History Day.

Great job on the film – thanks, Nimitz High students!

Salverio Todaro: Inspection Certificate as Death Warrant

Tuesday, April 27th, 2010

Salverio Todaro, a 68 year old entrepreneur, ran a safety inspection company called SAF Environmental Corporation. You may never have heard of Todaro, but if you live in the New York City area, Todaro may have succeeded in damaging your brain or shortening your life by a number of years. Certified to inspect buildings for lead and asbestos, Todaro rarely actually tested for the deadly substances. Beginning in 1989, he routinely filed bogus inspection reports, including phony lab results, on buildings scheduled for renovation or demolition across the five boroughs. (William Rashbaum of the New York Times provides the appalling details here.)
Think about the consequences of Todaro’s failure to do his job. He gave the green light for projects that put construction workers on hundreds of jobs at immediate risk for exposure to lead and asbestos. These workers ripped apart buildings contaminated with asbestos, raising clouds of toxins for all to breath – construction workers, neighbors, passers by. It will take years for the toxins to do their work, but rest assured, that dreadful work will be done.
NOTE: I hardly need add that construction workers on the job sites certified as safe by Todaro are unlikely to qualify for workers comp benefits: thanks to Todaro, there are no records of hazardous substances on these sites.
In one documented case, Todaro was asked to examine an apartment where a young child had suffered from exposure to lead. Todaro gave the building a clean bill of health. As a result, the family had no reason to move, no reason to suspect that every breath their child took put him at risk for further brain damage.
A Punishment to Fit the Crime
In an earlier time, we might have pondered Todaro’s fate after his death. In Dante’s Inferno, the Ninth Circle of Hell is reserved for traitors, who find themselves eternally locked into awkward positions, encased in ice. Todaro betrayed his city and his fellow man, and made a few bucks in the process. But his actual fate is pretty mild by Dante’s standards: he is facing four to six years in jail. After that, I imagine, he’ll head south to a quiet retirement in Florida. No eternity encased in ice for this despicable betrayer of the public trust.