Do I need a Regulation to Breath?

Greetings from the bunker!!
I talked the other day about bureaucrats and the internet, and the idea of the free market. Today, let's talk about just a few more examples of the government's interference with Healthcare. One of the hospitals I work with expanded their OR recently. Really, I should say, about six months ago, but we did not start using the new rooms until a week ago. In the interval, the rooms sat empty and unused. Why? Because before the new rooms could be opened for service, they needed a state approval. So why did we wait so long to get this approval? It wasn't for lack of our requesting it. While the hospital space and money were sitting idle, the state Board of Pubic Health waited almost six months before they performed the inspection. They didn't schedule an appointment, give us a date, nothing. And you think the cable guy with, "between 2 and 5 on Friday," is a pain. Keep in mind that OR space is the some of the most expensive real estate in a hospital, very specialized, with very specific requirements. There's no fine for the state for everyday over 'X' that they don't show up, no penalty. That's because there is no accountability. These bureaucrats are faceless, nameless, and unelected. They have no boss to complain to, no supervisor to appeal to, and even if you could find one, firing a government employee is pretty near impossible. I think God himself would have to fill out paperwork to try to fire a government employee.
In a pretty similar vein, any idea of what's required if you, as a private corporation, wish to expand in the hospital business? Let's see. Find some land in what looks like a good market. Maybe do some market studies to see if it looks like a good market. Buy the land, hire an architect to design the building, of course meeting federal, state, county, and city building requirements and zoning codes. Hire a contractor, and build your hospital. Oh, whoops. Missed a little detail. Before you can build, you have to get permission from the state. They'll look things over, and then tell you IF you can build a hospital. If so, HOW MANY beds it can have. How many OR's it can have. If the nice people in the specific bureaucracy don't think THE PEOPLE need a new, better, nicer, bigger, etc, hospital, you can't build. period. OK, so maybe you'll just expand the hospital you've already got. Whoops. Same deal, gotta get the state's permission, and they'll decide if you can get bigger or better. Free Market? What's that?

The Joint Commission on Accreditation of Hospitals, or JACHO (pronounced "Jay'-Coe" started in the early part of the twentieth century under the auspices of the American College of Surgeons. It's purpose was to evaluate hospitals to determine if they were safe for doing surgery in. As the number and size of hospitals increased, the program became more unwieldly, and was then merged with the College of Physicians to expand it's scope. It is now simple, "The Joint Commission," and from friends who've recently been inspected, they get a little prickly if you even refer to them as Jaycoe. What was once a service to physicians to help them provide the best care to their patients is now an unholy monster, whose sole purpose is to justify it's own existence. Where once the concern of JACHO was determining whether a hospital scrubbed down the OR between patients and had appropriate, properly used sterilization equipment, they now focus on such things as, "Do you keep appropriate records of all your staff meetings?" "How often are your staff meetings?" Do you have protocols to deal with patient complaints?" JACHO will get in a particular mood, and the entire culture of a hospital will change, almost yearly. I remember one year, JACHO's hot button was door stops, you know, those little rubber wedges used to keep a door open. JACHO decreed that if a door was meant to stay open, it would be built that way, and so door stops were a clear violation of.... something. So hospitals around the country cleaned out the door stops. I read an editorial in a surgeons' journal about one year when JACHO's blood thirst was for whether meeting minutes were typed up in portrait or landscape.
In recent months, the decree has come down from on high. Telephone orders, those middle of the night directions we give nurses when the patient has a fever, a temp, a pain, etc, must be countersigned within 24 hrs. Or maybe 48 hrs, I've seen both times listed. JACHO law. In addition, it has been decided, By His Royal Majesty, The JACHO, that ALL signatures, including, these telephone order countersignature, must be dated and timed. I see this as pretty much a no win situation for me. If I date and time my signature, it's a pretty good bet that I will fall out for not getting those signatures done with in the 24 hr window. If I don't date and time, well, I'm in trouble again. My question: Since the nurse dated and timed the order for when I gave it, and that's when I expected the order to be done, what difference does it make when I countersign the order? Answer: Not a damn bit.

Nuff said.

Goodnight