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Full Legalization of Addicting Drugs: A New Direction for the ‘War on Drugs’

According to a recent article in the Enquirer over 13,000 heroin users spent time in Greater Cincinnati’s jails last year and 300 ended up in the morgue.

Introduction

There are six compelling arguments for decriminalizing and legalizing the sale of all banned addictive drugs.

  1. Legalization would decrease the crime to support drug habits and homicides related to drug trafficking.
  2. Producing inexpensive standardized doses of addictive drugs under government supervision could put the drug cartels out of business and decrease the incidence of fatal drug overdosing.
  3. The border problems of interdiction of illegal drugs would be nullified and the drug fueled gang warfare suppressed.
  4. Drug addiction could be treated openly as a medical disorder and the punitive ‘war on drugs’ could refocus on rehabilitation, education, housing and job training.
  5. The cost savings to law enforcement would be huge enabling a shift of resources toward improving community relationships
  6. Finally, taxing of currently banned substances could stimulate job creation and become a rich source of tax revenues.

During the past 40 years, the ‘War on Drugs’ has cost more than $1 trillion for the American tax payer. In 2014, according to the FBI there were 620,000 people arrested for simple marijuana possession and of all the drug arrests in 2013, 82.3 percent were for the simple possession of a controlled substance. In Cincinnati, about 85 percent of criminal arrests that are processed through the Hamilton County Justice Center relate in some way to drugs. Even in the affluent suburbs a large share of police activity focuses on the nonviolent possession of illegal drugs and drug paraphernalia.

There are 2.3 million Americans in prison or about one in every 100 American adults. Over 48 percent of these inmates are there due to drug offenses and it is estimated that the annual cost to warehouse these offenders is about $80 billion per year.

According to the American Bar Association, a single misdemeanor conviction for marijuana possession can be ruinous. In many jurisdictions, a drug indictment cannot be expunged and is discoverable. As a result, this black mark may make finding a job very difficult and preclude access to public housing and college loans plus risk the suspension or revocation of a driver’s license.

The Federal Drug Enforcement Agency (DEA) employs about 10,000 agents and support staff. At the local level, policemen and law enforcement spend millions of hours arresting, processing and prosecuting nonviolent drug offenses. Additionally, attorneys interview, defend, appeal and plea bargain for those that have been arrested and this produces a mountain of paper work and expensive transactions that clog the court system.

William F. Buckley Jr, the conservative pundit who founded the National Review magazine, and Milton Friedman, an economist focusing on free markets, were some of the first to advocate legalizing illegal drugs. Buckley’s basic premise was that nothing had worked to address any of the many facets of the drug problem and Friedman believed that individuals had the right to choose without government interference.

Of course, most advocates for decriminalization draw upon the analogy to the prohibition of alcohol from 1920 to 1933 that filled the prisons with bootleggers and mobsters. The 18th Amendment that imposed prohibition was repealed by the 21st Amendment to the Constitution. Government regulation of the booze industry has succeeded even as alcoholism continues to be a pervasive medical and social problem that dwarfs illegal and prescription drug abuse.

In the United States, the ‘drug problem’ surfaced as a major issue in the early 1900s, a time when cocaine and heroin were unregulated and widely prescribed by physicians.  In 1922, the Federal Government restricted the importation of raw opium and the Bureau of Narcotics was created in 1930.

In the early 20th century, the menace to society from opium addiction was greatly exaggerated. The threat of a drug epidemic conjured up the image of the Chinese opium den. A quote from Harry J. Anslinger, the first commissioner of the Bureau of Narcotics was “How many murders, suicides, robberies, criminal assaults, holdups, burglaries and deeds of maniacal insanity it causes each year, especially among the young, can only be conjectured”.  There was a cultural hysteria that developed about drugs. For instance, in 1948, Robert Mitchum was arrested for the possession of marijuana. This was abhorrent and unimaginable at the time and it hijacked his acting career.

The Supply of Illegal Drugs

On the supply side, addictive illegal mind altering drugs have always been readily available. The opium poppy is widely grown throughout Asia and the Middle East. Afghanistan is a major supplier and attempts to switch Afghan farmers from growing this lucrative crop to other crops had only temporary success.

The leaf of the coco plants from which cocaine is extracted is native to large areas of South America. Cocaine powder can easily be converted to crack cocaine, the free base form of cocaine that can be smoked. In the past fifteen years American contractors have sprayed an area the size of New Jersey with weed killer to wipe out the coco crop in Columbia. In response, some of the production just shifted to adjoining countries, especially Peru. In Columbia, the drug trade is so lucrative that it has fomented a guerrilla war that has lasted decades and the drug barons of Columbia are allegedly some of the wealthiest individuals in the world.

The three species of the marijuana plant are indigenous to Central and South Asia. Of course, marijuana can be grown most anywhere such as your neighbor’s back yard or using grow lights in your basement or attic. A Google search for marijuana seeds turned up hundreds of suppliers in the US.

Methamphetamine and its purified derivatives such as ICE are relatively simple compounds. Although Meth labs explode periodically, Meth can be manufactured using a few basic chemicals in an improvised laboratory. Many other illegal psychoactive drugs exist. These include MDMA or ecstasy that is similar to Methamphetamine; Mescaline or Peyote derived from several species of cacti; PCP an intravenous anesthetic agent; psilocybin a hallucinogen found in certain types of mushrooms; bath salts or synthetic cathinone; and LSD or lysergic acid.

New psychoactive boutique drugs surface frequently. Jil Head, a forensic chemist at a DEA research lab in Dulles, Va., estimates that in the past five or six years over 350 new derivative drugs have emerged that are unstudied and usually synthesized in modern laboratories that, in some cases, receive state support from countries such as China, India and North Korea.

The Trend toward Decriminalization

The advocates for decriminalization of drug possession of small quantities of marijuana are legion. The principle arguments for decriminalization are that it would decrease the prison population of nonviolent offenders, unclog our court system and open the door for drug dependent individuals to seek treatment without the threat of recriminations and incarceration. The fairness issue of social justice reflecting the disproportionate number of minorities that are incarcerated also drives this debate.

The decriminalization initiative seems to be gaining traction. In 2002, a non-profit organization called Law Enforcement Against Prohibition (LEAP) was formed to speak out about our existing drug policies. This group of law enforcement and criminal justice representatives contend that the war on drugs pursued by the US government has worsened the problem instead of alleviating it.

In this author’s opinion, partial decriminalization of drug possession without legalization is only a Band-Aid approach to the problem and may carry with it unintended consequences. Decriminalization alone does little to eliminate the suppliers and dealers that profit from the illegal drug trade. Thus while the jailhouse population decreases, the lucrative drug trade remains intact.

If addicting drugs were legal, profits from the sale of these drugs would plummet. Certainly, one or more pharmaceutical companies under the auspices of the Federal Government could inexpensively produce them in bulk to quickly deflate street prices and displace the drug dealers.

The purity and standardization of prescription painkillers and other Schedule II medications support premium street prices for drugs like OxyContin and Percocet. In contrast, inexpensive street heroin is often watered down or modified with unsafe additives such as fentanyl. Especially in the Midwest, a heroin epidemic has spread and in some areas fatal overdosing is so common that naloxone, a lifesaving pure opioid antagonist that directly counteracts the effects of heroin, is now available in pre-filled syringes without a prescription.

Sealing the Borders: the Problems with Interdiction

Interdiction and policing our borders and coastlines to prevent importation is a daunting task as illegal drugs come in easily portable small packages. Drug sniffing dogs, drones and border patrols may lead to the confiscation of caches of illegal drugs but it is only a small sampling of the amounts crossing the borders. Likewise the air traffic controllers and the coast guard have similar challenges in intercepting smugglers. The drug cartels have proven to be very creative in transport with their use of submersibles, aircraft, vast network of tunnels and concealment by ingestion of sealed packets of drugs. Often those transporting the drugs are only couriers or runners taking the risk for a quick buck without even knowing the dangerous contents of their cargo.  About 80 percent of the illegal drugs imported into the United States come through Mexico.

Meanwhile, ‘drug money’ and drug trafficking has bred gangs and gang warfare in many countries and across borders. The high homicide rates in New York, Chicago and even Cincinnati largely reflect the activities within the drug trade. In Mexico, since former President Felipe Calderon declared war on the cartels nine years ago, 160,000 people have been killed and 26,000 have gone missing. The American thirst for illegal drugs has largely contributed to this chaos while straining American’s diplomatic relations with Mexico and other South American countries.

Money: the root of the Problem

Money and money laundering are the heart and soul of the illegal drug trade. The cash-and-carry incentives filter through the entire supply chain from growers, processors, laboratories, mules and distributors to street vendors. At the bottom rung of the food chain are usually disadvantaged youths looking for a quick buck. Once recruited into the drug trade and gangs, they enter the downward spiral of school dropout, addiction, crime and incarceration. Moreover, this subterranean drug culture comes with a high price tag for our communities where the violence and corruption causes the flight to safety of legitimate business and responsible families. This leaves behind urban blight and decay.

The ‘war on drugs’ provides employment for thousands of law enforcement workers and consumes a significant percentage of public funds to build and maintain lock-up facilities. The cultural shift from search, seizure and arrest to a stance of help, education and rehabilitation would transform police work, ripple across the social landscape and involve a sizeable investment.

Any viable solution to the drug problem must first nullify money within the illicit drug trade. Only by deflating drug prices to the point where the drug trade is no longer profitable for dealers can you contain this blight on society in the longer term. Illegal drug dealing must be replaced with inexpensive, readily available and regulated substitutions. Then the war on drugs can refocus on education, treatment and rehabilitation. It is the primary premise of this paper that education can decrease the rate of experimentation and addiction. Moreover, better rehabilitation for the addicted populations can stabilize this group of addicts realizing that just like alcoholics they are ‘addicted for life.’

New Approaches

According to several surveys, the majority of heroin addicts claim they became hooked after taking prescription painkillers supplied by their physicians, family or acquaintances. These disturbing responses may in part relate to the tendency for addicts to shift the blame for their addiction to the system, but are nevertheless significant. In the realm of addiction you must also add cigarettes and alcohol as threshold or gateway drugs to addiction.

This road to addiction confirms the need to shut down the prescription pill mills and indiscriminate dispensing of addicting pain medications. There is a pressing need for better guidelines and tracking of the prescribing practices of physicians and allied health workers. In the State of Ohio, the Ohio Automate Rx Reporting System (OAARS) tracks the dispensing of all controlled medications by physicians and pharmacies. If implemented in all states, programs like OAARS could share information to make the control more seamless. If illegal drugs were legalized under government auspices, a similar type program could track these substances nationwide. This would provide data to shape public policy and help in directing educational, treatment and rehabilitation services.

Medical studies support the fact that certain personality types are more susceptible to addiction than others with genetic, epigenetic and environmental factors all playing a role. Research has shown that the various types of addictive behaviors follow a common pathway in the brain with the euphoric effects related to a surge in the release of the neurotransmitters dopamine and GABA in the nucleus accumbuns. This region of the brain has been labelled the brain’s pleasure center that triggers motivation, pleasure and reinforced learning. Unfortunately, current brain science is still in its infancy but the large research projects now underway may give better insight into how to more effectively prevent and treat drug addiction in the future.

Due to the abject failure of the punitive war on drugs, it is time for law enforcement to ‘call in the dogs’ and change direction. It is quite apparent that you cannot arrest your way out of the drug problem. There has been no change in drug policy in the past 40 years. Richard Nixon’s “war on drugs” and Ronald Reagan’s “zero tolerance” moralistic viewpoint have failed with the end result that America has gotten the reputation of being the jailhouse nation that costs taxpayers a fortune.

Marijuana: A Special Case and Outlier

Marijuana as a habit forming drug has properties that are much different from opoids, cocaine and methamphetamines. The psychoactive cannabinoids in Marijuana are remarkably safe and there are virtually no deaths directly linked to overdosing. Users may develop dependence upon the drug but marijuana is not highly addictive like many of the other major banned substances. Moreover, withdrawal does not produce physical signs and symptoms but may be associated with mood disturbances. This contrasts sharply with the serious withdrawal effects for addicts that ‘cold turkey’ from opoids, cocaine, methamphetamine and alcohol. When the health risks from Marijuana are compared to those of cigarette smoking and alcohol, they are miniscule. The long term effects of marijuana on the developing brain remain to be adequately studied.

The movement to legalize the medical and recreational use of marijuana has evolved state-by-state into a tug of war between politicians, law enforcement, medical experts, users, home growers, farmers, retailers, ethicists, concerned citizens and tax collectors to name just a few interested parties. Cultural, ethnic and generational differences also muddy any objective approach to addressing the complexity of the marijuana issue and the Federal laws remain proscriptive of legalization. Even the medical benefits of marijuana to combat the side effects of chemotherapy for cancer are controversial and unproven.

In Colorado and other states the economics of legalization have produced a rush of entrepreneurship. It is projected that in Colorado legalization of marijuana will create over 20,000 jobs and billions in tax revenues and license fees from the cultivation, processing, distribution and retail sales. Additionally, it seems to have provided a windfall of commerce to Colorado’s treatment centers, tourist industry, college enrollments and new business development.  But the picture is not all rosy. In Colorado, even as the rate of robberies and burglaries has fallen, there has been an increase in DUI/OVI. In 2014, 12.2 percent of these violations were linked to marijuana. Traffic deaths are also on the rise as is some petty crime due to teenagers doing stupid things while under the influence.

In Ohio, the ResponsibleOhio ballot initiative to legalize marijuana failed but was projected to produce $554 million in tax revenue and 35,000 new jobs. Across the nation, polling shows that over 50 percent of Americans favor legalization suggesting that in addition to the four states in which marijuana is currently legal, more states will pass similar legislation. Indeed, the receipts from the taxation of marijuana and job creation are too tempting to ignore.

As with cigarettes and alcoholic beverages, regulation and legalization of marijuana will fall within the province and jurisdiction of state governments. This is assuming that the Federal government repeals its current prohibition statutes that force the trade in marijuana to appear as a money laundering and subterranean cash business.

A New Model

Historically, prohibition did not work to ameliorate alcoholism and it will not work to solve the hard drug problem. A better approach is to decriminalize and legalize addictive drug as you implement a strategic plan based upon objective sound management principles and medical studies. The Federal Government must take a leadership role in this major initiative. Logically, the ownership of drug policy would reside with The Bureau of Alcohol Tobacco, Firearms and Explosives (ATF) and Health and Human Services (HHS).  A ‘drug czar’ appointed by the President and approved by Congress would be in charge of the new mandate. The new power structure would take into consideration the ‘lessons learned’ from prohibition and the legalization of marijuana. It would also seek the imputes from a broad range of experts and scientists working in law enforcement, the pharmaceutical industry and mental health. The privacy and legal issues are beyond the scope of this paper, but in all probabilities, the congress would have to draft a Constitutional Amendment to legalize.

At present, there are many overlapping agencies within federal and state governments that are involved in the regulation of illegal drugs. At the federal level you have The National Institute for Drug Abuse (NIDA), the National Institutes of Health (NIH), Federal Drug Administration (FDA), Department of Justice (DOA), Department of Labor (DOL), National Institutes of Mental Health (NIMH), Department of Homeland Security, Bureau of Alcohol Tobacco, Firearms and Explosives and many more with some regulatory responsibility. Each state and municipality has multiple agencies that are entrusted with the regulation and control of banned substances.  This highlights the need for a single agency on the federal level to have ownership of drug policy with a number of task forces to centrally coordinate and bring together the host of agencies to achieve a consensus for implementation. Rolling out a new ‘drug czar’ framework may be critical to the success of this major cultural and policy shift.

Drug Safety

Drug safety is a major issue in legalization. Overdosing, bad trips, crack babies and HIV are costly to society. Today, most drug users are putting their faith in the street vendors that represent the lowest tier of the drug supply chain. These street dealers are often addicts that are interested in taking your money to support their habit and life style and quickly disappear if complications occur. Thus, the user trusts these street-wise dregs of society who are generally marginally informed about the potency and additives of the products they are selling.

An addict develops drug tolerance and often needs progressively higher doses to achieve the same effect. These dosages might be fatal to the first time user or even those addicts that have stayed ‘clean’ for a period of time. Drug tolerances also relates to age, gender, weight, general health and interactions with prescription medicines taken for medical problems.

The euphoria and highs produced by addictive drugs are generally of short duration and followed by the lows that reinforce the drive for the next fix. At the end of the day, depression, fatigue, personality change and even suicide may result.  You might think that the rigors of withdrawal and social disruption caused by drugs would cause addicted individuals to seek treatment. However, the criminality and social mores intercede to prevent follow-through in drug rehabilitation programs for this desperate population.

Lack of Scientific Study

The process to legalize would be a gradual one. As a first step, the scale, scope and chemistry of the problem would need to be studied. Often naturally occurring drugs have many synthetic imitations and the introduction of one radical into a chemical structure can profoundly alter the physiologic effects on humans. Many of the laboratories producing contraband drugs use different manufacturing processes that produce wide variation in composition, concentration and effects. Add to this the adulteration of addicting drugs sold by street dealers and the complexity of research challenge becomes apparent.

The dosing and medical side effects of standardized doses of opioids, cocaine, LSD and methamphetamine are fairly well established. But there are a number of boutique substitutes and other hallucinogens that lack scientific study. This poses a real challenge for the FDA that has limited resources.

Academic centers and pharmaceutical companies are not prone to conduct controlled trials on humans to study these drugs because of liability, funding, supply and purity issues as well as the need for animal studies and Phase I and Phase II clinical trials. And where is a legitimate market for an illegal drug? As a consequence, a lack of drug trials also precludes finding out if some of these compounds might have therapeutic value to treat mental illness or other medical disorders.

More resources need to be directed toward controlled studies of these compounds with more direct involvement by the FDA. Perhaps a new division of the FDA could be formed to focus on these banned substances.

Many questions need to be answered about each drug:

  1. Safety features and what is the minimum lethal dose (MLD) of each drug and its variants?
  2. What are the potentials for addiction?
  3. What long and short term side effects might the drug have?
  4. Does the drug have any therapeutic value?
  5. How does the drug interact with other medications?
  6. What are the blood levels at which the drug impairs performance?
  7. How do you screen for drug use and test blood levels?

Education: ‘An ounce of prevention is worth a pound of cure’

No one denies that addictive drugs disrupt lives, families and industry while having a terrible ripple effect across the global community. No reasonable or responsible educator, guardian, parent or even drug addict would encourage their sons and daughters to experiment with drugs or become involved in any way in the drug trade.

Unquestionably, the best way to reduce the prevalence of drug usage is to reduce the incidence of individuals taking drugs for the first time. A preventative medical approach to the war on drugs is more effective than building elaborate rehabilitation centers.

Yet, there is no powerful lobby or poster child for drug policy that draws the public into the debate even as drug addiction affects all socioeconomic strata of our society and festers under a mask of stigmatization and immorality. The punitive ‘war on drugs’ mentality remains largely unchanged.

As a medical student on a field trip to the Federal drug treatment center in Lexington, Kentucky I interviewed a number of recovering heroin addicts. All conceded that drugs had ruined their lives as their addiction took hold and became their sole reason for living. Most were young robust African American men. I came away thinking; what a waste and why would anyone self-destruct in this way? If these individuals had known the consequences of addiction, would they have made the same choices?

For most addicts, the withdrawal process from their addiction is a horrific experience. Just like the DTs when alcoholics dry out, going ‘cold turkey’ from heroin after incarceration or forced withdrawal produces a week or more of agony and life threatening medical issues. The fear of the withdrawal, of course, is one of the drivers to get the next fix. Rehab centers generally use a gradual withdrawal process that decreases the acute suffering and medical risks.

Education about the dangers of addicting drugs should begin in the home at an early age. Parents need to learn the key essentials about the dangers of drug addiction and openly discuss this threat with their children. They should be poised to counter any misinformation and confront any temptations to experiment that may pervade a neighborhood culture. The churches, preschools and nonprofit agencies can also play a role in directly confronting the problem with accurate information.

Often the gateway to addiction begins with tobacco and alcohol. Any educational program designed to curb addiction should also include an added focus on these legal substances that cost the society dearly.

In many public and private school systems health and sex education are a part of the curriculum. Information about the dangers and consequences of addictive drugs should be added to these courses. Video interviews with drug addicts can detail the dangers of addiction and experimenting with drugs. Have school assembly programs for both students and parents dedicated to inform and combat drugs in the local communities. Encourage school student councils and other school organizations such as honor societies, Key Clubs, athletic teams and band members to take a drug free oath and submit to urine testing. Mobilize peer pressures against students that deal or use drugs and encourage students to report incidents of drug abuse to their superiors anonymously. Offer instructive programs to parents that provide a guide as to how to suspect drug usage among their children. Just because drugs are legal does not mean they need to be tolerated in our schools. Expulsion and disciplinary action would still be an enforcement measure. Drug education should be extended to the college campuses as well.

Drug Testing

As with performance enhancing drugs, testing for illegal drug abuse offers many challenges. No simple inexpensive quick urine or blood test currently exists that broadly screens and quantifies the majority of illegal drugs. Recent studies suggest that saliva testing looks promising to check for heroin, amphetamines and cocaine. Adequate funding should enable modern bioscience to produce cost/effective and speedy testing solutions.

Drug testing would involve two steps; one qualitative and the other quantitative.  The first would broadly screen and, if this were strongly positive, lead to a more precise test to quantify blood levels. Newer standards for safe blood levels consistent with acceptable performance and judgement would need to be developed.

Legalization would in no way interfere and probably enhance the appropriate use of drug testing in the work place, schools, athletics and law enforcement.

In the workplace, corporations could continue to have random drug testing as a condition for employment. Driving under the influence of drugs would remain in place and a policy of a drug free school environment would not change. Prenatal clinics would have to provide a routine drug screen with those testing positive encouraged to enter drug rehab programs.

Drug Rehabilitation: Once an addict, always an addict.

To accommodate the surge of drug dependent individuals seeking treatment after legalization, a marked expansion of drug rehab programs and facilities would be necessary. A no-questions-asked approach would help to remove the stigma of drug addiction and deal with the problem as a medical disorder.  Compassionate medication assisted treatment (MAT) rather than ‘cold turkey’ withdrawal would become the standard as newer approaches to addiction became available. Rehabilitation programs in prisons would need to integrate with community programs to insure continuity of care as drug addiction becomes a coded psychiatric medical disorder. Taxes on drug sales would finance the increase in capacity necessary for public, nonprofit and for-profit funded rehabilitation centers to expand and prisons programs to take root. Clinical and scientific research into the causes of addiction would be carried out in these centers and results of this research shared and molded into better prevention and treatment models

An improved curriculum for mental health workers specializing in addiction would be developed. Pharmaceutical companies would receive tax incentives and financial aid to develop new drugs to treat addiction. This would add to the assortment of drugs that are currently employed such as methadone and suboxone.

Downsizing the Judicial System

          No other groups of public servants would be impacted more than law enforcement officers. Because drugs consume a large proportion of law enforcement work and half of all prison inmates are warehoused due to drug offenses, the cost savings secondary to drug legalization would be huge. Additionally, legalization should decrease the rate of violent crime, robberies and burglaries.

The actual cost savings in ‘right sizing’ law enforcement is hard to quantify. There are many vested players in this ‘war on drugs’. Even as legalization would create public and private sector jobs, it would also put many law enforcement jobs at risk.

Especially among minorities, the punitive war on drugs fuels the perception that the policeman is the adversary. Models like New York City’s stop-question-and-frisk concept do little to improve the relationship between the police and the community. With legalization the number of outstanding warrants for parole violations and arrests for drug offenses would diminish and the police officer could have the time to become a mentor and coach for risky behaviors and not just the ‘got you’ enforcer.

The Role of the Federal Government

The Federal Government must take the lead if legalization is to become a reality. Such a dramatic cultural shift, by necessity, would need to be instituted in measured steps that took into consideration all parties. In the author’s opinion, if the federal government offloaded the process to state governments it would devolve into a mishmash of 50 plans tainted with personal agendas and moralistic stances.

A task force of experts representing the major disciplines involved could be convened to assess the barriers to smooth implementation and come up with the outlines of a strategic plan. A master congressional subcommittee would be involved in the planning process and a federal agency would be responsible for crafting the final comprehensive plan in consultation with the FDA, NIH, pharmaceutical industry, state governments, law enforcement and other interested parties. If a consensus is achieved, a legal decision would be necessary to decide if congress alone could approve the legislation to legalize or whether it would require a constitutional amendment.

Replicating the Supply Chain

In general, marijuana, opioids, cocaine and methamphetamine are the four major psychoactive drug classifications that are sold illegally on the street. If legalized, the American pharmaceutical industry under the auspices and control of the federal government could fairly easily, economically and expeditiously produce an abundant supply of these drugs and their various derivatives. If these new legal drugs were supplied at very low prices, it is reasonable to assume that the drug cartel supply chain would implode.

The production and distribution of alcoholic beverages and cigarettes is carefully regulated by states and the federal government. With the regulation of illegal drugs, the division of responsibilities between the federal and state governments would need to be defined. Who would be the suppliers and how would they be regulated? How would the costs and tax revenues be divided? How would law enforcement deal with the residual supply of alternative or designer drugs that remained on the street?

At the state level, the local pharmacies or government licensed outlets would probably be the distribution points. How would the retail outlets track sales and usage? Would they have an integrated and coordinated program that could compile data similar to the way the OAARS program works in Ohio? How would the revenues be directed toward new services for education and rehabilitation?

At first glance, the abundant supply of cheap legalized drugs suggests that it would encourage drug abuse and cause a meteoric rise in the number of lethargic pot heads and euphoric thrill seekers in our society. There is some scientific evidence to suggest otherwise. In 2000, Portugal decriminalized the possession of limited quantities of addictive drugs. This resulted in no rise in drug usage rates and a marked decrease in the rates of drug overdose, HIV and other sexually transmitted diseases.

Most addicts are aware of the dire consequences of drug abuse and are familiar with the terms poverty, homelessness, destroyed families, gun violence and crime that are indicative of drug addiction. Most articles in the media describe the addicting highs from mind altering drugs, but infrequently discuss the soon to follow aftereffects and devastating lows that are compelling reasons not to experiment or become regular users of addicting drugs. Most addicts are highly motivated to quit but ‘the war on drugs’ and traditional norms create barriers to rehabilitation. The penal system remains geared to arresting and warehousing addicts and not medically assisted treatment (MAT) and drug rehabilitation.

In America, legalization might usher in an initial spike in drug experimentation and even addiction. But nothing has worked in the past 40 years to curb illegal drug usage or suppress the illegal drug industry. Cocaine, heroin, methamphetamine and a whole range of deadly illegal drugs destroy lives and undermine our societies. An informed individual is not powerless to ‘just say no’ or quit, and if already addicted seek no-questions-asked help from good rehabilitation centers.

The experience in more than 25 or more countries supports the removal of criminal penalties for drug use.

At the very least, it is time to have a serious conversation about new approaches toward solving the drug problem as the current ‘war on drugs’ is too wasteful of lives and resources. In a more perfect world there should be better solutions, but all else has failed dismally and it may be time to throw in the towel and search for less punitive solutions. One thing is certain, you must be able to nullify ‘drug money’ and illegal drug trafficking, if you are going to make inroads in solving the drug problem.

 

The Arguments for Legalization of Drugs

  • Smaller percentage of Americans incarcerated for nonviolent offenses
  • Decrease in the number of drug related homicides and crime
  • Decrease in the number of deaths from overdosing (43,982 in 2013)
  • Improved access to appropriate treatment for addicts
  • Increased number of addicts and drug abusers rehabilitated back into the mainstream of society
  • Fewer cases of HIV and Hepatitis C due to contaminated syringes
  • Improved tracking of addictive drugs and prescription medications
  • Greater research to find treatments for drug addiction, mental illness and medical disease
  • Elimination of a contentious international political issue
  • Cost savings in law enforcement and improved police/community relations
  • New jobs, tax revenues and entrepreneurial innovation in a new industry
  • A safer world
  • Improved drug screening tests
  • Greater emphasis on rehabilitation, education and drug screening

 

The Arguments against Legalization

  • The potential for an increased rate of addiction
  • Economic and social disruption to the legal system
  • The complexities of regulating and supplying currently illegal substance and Scheduled prescription medications
  • Constitutional and jurisdictional challenges that include privacy and drug testing
  • The moral and ethical dilemmas of legalization
  • Crime syndicates that turn to other types of crime

Richard G. Wendel MD, MBA

 

 

Things to Consider for the Future of Mariemont

Things to Consider for the Future of Mariemont

If you are progressive in your views about the future of Mariemont, I believe that you would support many of the following initiatives during the next four years.

  1. Cooperative agreements with adjoining communities to share police and fire services to reduce redundancy and cut taxes.
  2. Development of the South 80 into a more complete recreational destination.
  3. A long term solution to the chronic parking shortage in Mariemont.
  4. See new agencies emerge like 3CDC in OTR in Cincinnati to spur economic development and the rejuvenation of Old Town.
  5. Electric aggregation for Village residents.
  6. The hiring of a City Manager/ Village Administrator.
  7. New Village Ordinances that imposes term limits, reinstitutes the elected position of Village Treasurer, and increases the number of Council Members.
  8. A balanced budget without erosion of the Capital Improvement fund.
  9. Renovation of the Municipal Building
  10. A comprehensive tree management program
  11. Continued trash collection in the back.
  12. Revision of the Murray Intersection and support for Columbia Township to improve the Southern gateway to Mariemont.
  13. A revisiting of Mariemont Preservation’s Vision 2021 plan.
  14. The demolition of the Steam Plant with condo development. (Work in progress?)
  15. A better rating for Mariemont in Cincy Magazines’ Best Burbs.
  16. Measures to decrease the polarization of the electorate in Mariemont with a more democratic and participatory Village Government.

Best Regards.

Dick Wendel MD, MBA

The new Mariemont Firetruck

The new fire truck is a firefighter’s dream. This type of fire truck is called a ‘quint’ reflecting four capabilities that include an aerial ladder, pumping capabilities, a tank for water and storage of ground ladders and tools.

The span of the aerial ladder is 107 feet with a 750 pound tip load that easily accommodates the weight of both the firefighters and rescued victims. The truck has a 400 gallon water tank and can pump 1500 gallons of water per minute.

The vehicle accommodates six firefighters and a 1000 foot large diameter supply hose and many smaller hoses. Its state of the art toolbox includes the extricating ‘jaws of life’ that can cut through metal and other barriers to remove trapped accident victims.

Notably, Mariemont’s old fire truck was sold for $8,000 and the purchaser refurbished it for $2,500 and it was placed back into service. I wonder why another community could repair the truck and use it when Mariemont could not?

Thus it begs the question, did Mariemont really need a $750,000 fire truck that ate into the reserves of the Permanent Improvement Fund (one final installment of about $250,000 due this year) as opposed to a standard fire truck? It is also noteworthy that there are two fire departments with ladder trucks within a radius of 3.2 miles and most structures within the Village of Mariemont are just two stories tall. Those that are over two stories have sprinkler systems that meet code.

I know it is comforting to have a fire department with a superior ISO rating of 2, but is this really necessary, and when did we last have a significant fire? Most insurance companies do not base their rates on ISO ratings. Moreover,  Terrace Park residents feel quite safe with an all volunteer fire department (24 volunteers) that annually costs between $130,000 and $150,000 per year to maintain versus Mariemont’s cost of $821,187 in 2013 (exclusive of the $254,000 installment for the fire truck).

– Dick Wendel, MD, MBA

The South 80 in Mariemont: history, transformation and future

The South 80 in Mariemont: history, transformation and future

The South 75+ acreage was bequeathed to Mariemont in 1976. Historically the acreage was used to grow corn and beans although, at one time in the early 20th Century, it was a nine hole golf course with a club house, the remnants of which still exist. During recent years H. Hafner & Sons have cultivated the acreage without land rent in exchange for disposing of the yard waste and leaves in the Fall. Few Villagers even knew that this acreage was a part of Mariemont until small garden plots were offered to Mariemont residents in recent years and the Eastern Corridor project resurfaced.

During most of my 52 years as a Mariemont resident, the ‘South 80’ was considered just farm acreage in the flood plain adjacent to the train tracks at Clare Junction. In the days when Clare Junction was an active switching yard, the din from the steam engines and coupling of railroad cars was fairly continuous. Plus the smell of smoke or diesel fuel often settled like an early morning fog over the community. There was also an artesian well with a water tap at Clare Junction where anyone could fill containers with the pure Silver Springs water.

When my children were small, the ‘bottoms’ as we called the South 80 was a great place to shoot off bottle rockets, fly model airplanes and skip stones in Whiskey Creek. At that time, unbeknownst to most parents, the kids used to climb through the large pipes running to Whiskey Creek as well as climb up to the top floor of the abandoned steam-power plant along the railroad tracks.

Now let’s fast forward.  Almost overnight, this fertile farm land has become a remarkably prized piece of real-estate. It has morphed into the site of an ancient Indian Village and has allegedly become a lynch pin for Mariemont’s designation as a National Historic Landmark. Most now refer to the South 80 as a Park. Indeed, it has a nice hiking trail for a pleasant walk in the out-of-doors and numerous small garden plots for residents to grow vegetable and flowers. Additionally, a well with a hand pump has been dug for clean but non-potable water for the gardens.

Three major public work projects have catapulted the South 80 into prominence in the media and conscience of Mariemont. These include the Eastern Corridor Project for Route 32, the Oasis Trail Transit for light passenger rail and the Wasson Line Bicycle Trail. The foremost project creating the most pushback from the residents of Mariemont, Newtown, and Madisonville is the Eastern Corridor Project that entails building a “boulevard” extension of Red Bank Road to act as a connector to Route 32 in Newtown. The argument for building this extender is to relieve traffic congestion on Route 50 and the Beechmont Levee and provide a more direct route to Eastgate, Clermont County and beyond. ODOT contends that this boulevard would stimulate economic growth in the region even as the proposed route would bypass the business district in Newtown.

One of the Routes under consideration by ODOT for building a part of the Eastern Corridor carries the Route 32 connector through the South 80. Supposedly, this route is being considered because a more direct extension of Red Bank Road to Route 32 across the Horseshoe Bend in the Little Miami River would be more costly and challenging from an engineering standpoint.

At this juncture, this segment of the Eastern Corridor Project is unfunded even as it has been on the drawing board for over three decades. Furthermore, where is the $100 billion coming from with so many other competing infrastructure needs such as the Bent Spence Bridge? At the end of the day, I think it will be the no build option that wins out and, if the Ohio State Route 32 project ever moves forward, it will not be in our lifetimes.

The following objections were expressed in the Mayor’s Bulletin in early 2013 concerning the rerouting of Route 32 through the South 80.

  1. Destabilization of the Miami Bluff hillside and further loss of the Indian serpent mound earthwork at the top of the Bluff from landslides caused by major excavation at the base of a volatile hillside
  2. Possible loss of National Historic Landmark Designation
  3. Destruction of Native American Archeological Site (Prehistoric village just discovered by University of Cincinnati)
  4. Negative environmental impact on our park and nature trails
  5. Significant reduction in Village of Mariemont parklands
  6. Increases in the amount of air pollution in the Village
  7. Terrible noise pollution
  8. Water pollution to the Little Miami River, which is listed as a National Scenic River and must be protected
  9. Loss of wildlife habitat (In what other Hamilton County community can a short walk from your home lead you to a natural wildlife area and scenic river? Do we want to lose this unique characteristic of our Village?)
  10. Destruction of the track used by our high school Cross-Country Track team
  11. Impact on Concourse resulting in loss of one of the most beautiful valley views in Hamilton County
  12. Major impact on the nearby Prevey Bird Sanctuary
  13. ODOT’s flawed analysis of alternative routes

In the 2013 Mayor’s October Bulletin, he showed how the Eastern Corridor opposition was gaining momentum. The Mayor was appealing to the court of public opinion and listed the groups showing support to preempt any ODOT plans. This opposition list included the Village of Newtown, the Madisonville Community Council, the Village of Terrace Park, Little Miami Incorporated, Sierra Club, the National Trust in Washington, D.C., John Ruthven, Dr. Ken Tankersley of the University of Cincinnati, the Cincinnati Preservation Association, the Mariemont Preservation Foundation, Hamilton County Commissioners Chris Monzel, Greg Hartman and Todd Portune, Laure Quinilvan, Dr. Stanley Hedeen, the National Trust of Historic Places, the Hillside Trust, the Ohio River Way, Heritage Ohio, the Ohio Ornithological Society, the Cincinnati Bird Club, the Cultural Landscape Foundation, State Representative Peter Stautberg, Brad Wenstrup, and the Piqua Shawnee Native American Tribe. To obtain the endorsements from this mind-boggling array of individuals and agencies must have consumed a huge amount of the Mayor’s time. In general, it seems like overkill and an invitation to make ODOT a hostile advisory to the interests of the Village.

In another Bulletin, the Mayor disclosed that he had enlisted the services of an attorney, Matt Fellerhoff and Bob Newman, to represent the Village in this matter and initiated a program to raise money for legal defense and appeals.

To further muddy the waters, ODOT sponsored community poster sessions for the Oasis Trail Transit Project and the Eastern Corridor Project. Even though the whole engineering crews was present at these meetings, the presenters shed little light on the specifics concerning the rerouting of State Route 32 and Light Passenger Rail.

At a recent scheduled ODOT meeting in Fairfax to explain the programs, I attempted to get some answers from Andy Fleugemann, the 8th District Deputy Director of ODOT. Despite intense probing, he provided no specifics and seemed indifferent to the rising tide of negative public opinion. At that meeting there were no less than 6 engineer representatives from ODOT and I came away with the impression that these Projects were insuring long term employment for this cadre of engineers.

There are many questions to answer if the State Route 32 extender were to go through the South 80.

  1. How wide an easement or swath would the road occupy and how many lanes would it have. What assurances do the residents of Mariemont have that this would not be an expressway or Interstate Highway?
  2. Would the highway or boulevard be separate or run parallel to the railroad tracks?
  3. Assuming the Oasis Rail Line and Watson Road bike path became a reality; how would they integrate with the Ohio 32 extender?
  4. How many of the South 80 acres would be consumed and what would be the configuration of those left for development?
  5. How would you insure improved access to the residual acreage for recreational activities?
  6. How much and to what height would the connector need to be elevated to address the flood plain issue and to what degree would this obstruct the view from the Mariemont Concourse?
  7. Would the high tension wire towers need to be moved, relocated or would these utilities be buried?
  8. The traffic would cause what decibel level of background noise and what steps would be taken for noise abatement?
  9. Would the project cause any instability to the Miami Bluff or cause rerouting of the Little Miami River?
  10. How would you safeguard or preserve any antiquities that might be uncovered during construction?
  11. How much money as ‘sweeteners’ to the deal would ODOT give to the Village of Mariemont to build access to the South 80 and create recreational facilities such as ball fields, picnic areas, parking lots, camp grounds, gardening sheds, electric outlets, city water and a fishing dock?
  12. How will ODOT deal with the Mariemont Historic Village issue and manage all the concerns expressed by the residents of Mariemont as well as other effected communities?

None of these questions have been answered to the satisfaction of the vast majority of Mariemont Residents.

When I hike the trail, I see additional opportunities for the Village to consider in the utilization of the South 80 such as:

  1. A couple of baseball diamonds or soccer fields with a parking lot and portable toilets. This would alleviate some of the congestion and improve safety around Dogwood Park in the heat of baseball and soccer season and provide practice fields for the Mariemont School System.
  2. An elevated open air shelter house that can be easily cleaned if flooding occurs and provide shelter for campers, hikers and picnickers.
  3. Make the garden plots more appealing by offering rentable sheds to house farming equipment and provide electric
  4. Improved access and parking

This is just brainstorming to produce food-for-thought for the council committee that oversees the South 80. The minutes of their meetings have been posted on this blog in the past. As the first step the 1.4 mile scenic trail around the South 80 acres below Miami Bluff is a great addition. The community is indebted to the volunteers for the hard work that brought this about.

Missed Opportunities come home to roost

Missed Opportunities come home to roost

Village Residents that follow the political landscape in Mariemont are dismayed that Mariemont was ranked 28th among the suburbs in Greater Cincinnati by Cincy Magazine. Let’s try to sort out why Cincy Magazine might make this assessment. It certainly does not relate to our school system or safety services. Indeed, Mariemont is a safe, walk able community with many amenities that make it an outstanding place in which to live and raise a family.

Perhaps, our high comfort level with the way things are may breed complacency that fosters an acceptance of the status quo. In business school parlance, the residents of Mariemont might be “dumb, fat and happy” so why change or become circumspect as to why Cincy Magazine does not rate us amongst the very best suburbs? Maybe it may relate to the management of Village finances and strategic planning during recent years.

In 2014, the Village posted a General Fund budgetary loss for the first time in many years of $28,652. Also, the Permanent Improvement Fund or Capital Fund notably decreased by $183,272.  Taken by themselves, these losses are fairly modest but they do suggest a downward trend in Village finances.

The financial position of the Village has been and will be impacted by the following factors.

  1. The loss of Ohio State estate taxes and subsidy that historically produced about $250,000 in annual revenues. Indeed, Governor Kasich has balanced the Ohio State budget by cutting back on the funds that the local communities receive from the State.
  2. The missed opportunity to form a JEDZ with Columbia Township which probably would have produced over $200,000 in unfettered annual revenues. This directly led to the formation of a JEDZ between Columbia Township and Fairfax.
  3. The possible winding down of Kellogg operations in the business district that would put $600,000 in revenues at risk (about 18 percent of the total budget).
  4. The continued maintenance of a fully-equipped independent Police, Fire and EMS service without sharing these services with surrounding communities.

With these threats to Village income, what is left to cut to balance the budget? At this time, it appears that the Village is poorly positioned to meet the coming financial crunch without higher taxes.

In retrospect, when the Village was flush with revenues during the past ten years, many strategic initiatives could have been undertaken to enhance the standing of the Village amongst the suburbs in Hamilton County. These might have included:

  1. Give financial support and incentives to rejuvenate the Historic District
  2. Plan and build a parking garage to alleviate the shortage of parking
  3. Renovate the Municipal Building
  4. Develop the South 80 into a recreational destination
  5. Hire a Village Administrator
  6. Work with surrounding communities to save money by sharing services
  7. Put in place a plan for a community center
  8. Use creative financing to foster business development

When I first heard that Mariemont was ranked 28th among the suburbs in Hamilton County, I was incredulous. However, this ranking does point to the fact that the status quo may not be good enough.

Does Village Government cede too much power to the Mayor?

Does the current structure of Village Government cede too much power and control to the Mayor?

Mariemont has always had a strong mayor or mayor-centric form of government which is the norm for small communities. In Mariemont the Mayor is elected for four years without term limits.

Six Village Council members with four year terms are the only counterbalance to the authority of the Mayor.  In January 2014, the two elected official positions of Village Clerk and Village Treasurer were eliminated and replaced with a Mayor appointed ‘Fiscal Officer.’

Typically, two or four Council candidates are nominated at an annual Village Town Meeting in March or April every other year and generally run unopposed. Many prominent residents believe the Village Town Meeting construct is an outmoded and antiquated system that as a ‘default result’ produces weak candidates due to a lack of resident participation. Moreover, councilmen receive nominal compensation of about $1000 per year for their volunteer time and efforts that includes many meetings that deal with mundane matters. It is easy to see why so few Villagers wish to become involved in local government and at the present time, most new recruits for Council are ‘persuaded’ as ‘friends of the Mayor’ to run for Council. It is not surprising that the turnover rate for Village Council members is quite high due to term expiration, resignations and relocation.

Unlike corporate America and larger nonprofit boards, the members of the Village Council are not selected based upon their competitive range of skills, knowledge and abilities and, as a consequence, there is limited diversity and narrow skill sets in council membership. Additionally, there is no formal Village Administrator to handle operations and provide input and feedback to the Mayor and Council.

To understand the dominant power and control equation enjoyed by the Mayor consider the following:

  1. All Departments report directly to the Mayor
  2. The Mayor crafts the agenda for Council Meetings
  3. The Mayor controls council committee appointments
  4. The Mayor restricts committee activities to those he personally assigns
  5. The Mayor unilaterally, without review or approval by Council, produces a monthly Mayor’s Bulletin for distribution to each household in the community
  6. The Mayor is a voting member on the Architectural Review Board
  7. The Mayor is the Chair of the Planning Commission and a voting member
  8. The Mayor maintains an official Village website that gives little transparency to Village Government
  9. The Mayor presides over very perfunctory bi-monthly Council Meetings that last an average of 18 minutes, in which real issues are seldom discussed
  10. The Mayor has a three minute time limit for any Village resident coming before Council.

My suggestions to improve the make-up of Mariemont Village Government include:

  1. Form a Membership or Governance Committee of Council to recruit qualified candidates for Council. The committee could be chaired by the Vice Mayor and comprised of an additional Council member, a Village resident appointed by MPF and a representative from the School Board for a total of 4 members.
  2. Modestly increase the compensation for the Mayor and Council members
  3. Hire an empowered Village administrator that has more than just clerical duties
  4. Reinstate the elected Office of Village Treasurer to act as an independent voice
  5. Increase the number of elected Councilmen to eight with the addition of two at-large-members identified by the Governance Committee
  6. The Mayor should be only an ex-officio member of the Planning and Architectural Review Boards
  7. Term limits: two successive terms for both the Mayor and Council members

 

Responses to this post from Mariemont Residents:

  1. “Agree with your assessment. There are likely 20 more examples of the lopsided nature of government in Mariemont.”
  2. “The problem stems from the mayor being too power hungry compounded by voter apathy and fear of reprisal. Without new faces, nothing will change.”
  3. “I think we would be better off pursuing term limits and would further support the hiring of a Village Administrator as the remedy for the over control of the Mayor.”
  4. “It should be emphasized that the Code of Ordinances governs the Village, and it specifically states that the Mayor reports to Council, not vice versa.”

Can Mariemont’s chronic shortages of parking be solved?

In the MPF’s Vision 2021, a shortage of parking spots around the Mariemont Square is mentioned many times because it creates an inconvenience and obstacle for visitors going to the Theatre, Quarter, Greaters and the Inn during peak hours. Events in and around the Square also overload parking. One quote from the Vision 2021 Plan states, “While parking changes have been instituted on an as-needed basis, much of it has been reactive and not proactive in solving the underlying parking problems. Parking decks and an increase in on-street parking might curb such issues as the Village aims to attract new businesses and conveniently serve the needs of visitors to the village.” Others suggest, “Create a parking deck behind the cinemas/create garage parking behind The Strand” and “solve the existing parking problem—not enough parking.” For as long as I have lived in Mariemont, inadequate parking has been a chronic problem that has resulted in friction between property owners, businesses, the Mariemont School Board and Village government. It would seem reasonable that a long term strategic plan for Mariemont address this problem in a definitive way.

A parking garage in Mariemont is not a new idea. When the Mariemont Inn was renovated, there was talk and push back about an underground garage.

The parking area behind the Mariemont Theatre currently accommodates approximately 100 cars. I would conjecture that increasing this number to 200 or 250 parking spaces would address Mariemont’s parking needs once and for all. The topography and space behind the Theatre is quite adequate to accommodate an underground parking garage with the upper deck providing the foundation for restoration of the existing storefronts. Parking garages are not cheap and each space typically costs about $20,000 to build. Thus projected costs would run between 4 and 6 million dollars.

The development costs may seem overwhelming, but there are many financial instruments to consider in funding such a project including: TIF financing, municipal bonds, grants, a Community Development Corporation and investment by owners and businesses. To financially succeed, parking fees probably would become a necessity in Mariemont so as to generate funds to service the debt and make up for the lost revenues due to tax abatements. Moreover, with the disappearance of estate tax revenues for the Village, an additional revenue stream may be necessary to balance the Village’s budget in the near future with or without the garage.

A project such as this warrants a feasibility study conducted by outside consultants, qualified local residents and interested developers. If successful, Mariemont would have a real trump card to attract and retain businesses as well as foster gentrification and new business development.

— Dick Wendel, MD, MBA

How can local governments cut expenses?

In a recent editorial in the Enquirer, Mr. Harris, a former city Councilman, contends that in Ohio the operation of local governments is antiquated. He points out that Hamilton County alone has 48 local governments and that each of these has a fully equipped police department. In 2009, Hamilton County taxpayers spent $275 million for these police facilities, some of which provide safety for areas less than 1 square mile.

Let’s focus upon the Mariemont and Fairfax Police Departments within the context of overlapping and duplication of law enforcement services. First, it should be pointed out that the Village of Mariemont occupies .89 square miles and the Village of Fairfax .76 square miles with a combined census of 5,103 citizens.

The Mariemont Police Department has 10 police officers and the Fairfax Police Department has 9 for a total of 19 to cover this total service area of 1.65 square miles. In 2013, Mariemont’s total expenses to maintain their Police Department were $1,248,776 (approximately one-third of the entire budget) whereas Fairfax’s Police Department cost $1,147,240.

I queried a number of friends and our educated guess is that 40 percent of cost to maintain a standalone Mariemont Police Department could be saved by merging Mariemont’s and Fairfax’s Police Departments. If you take 40 percent of Mariemont’s $1,248,776 expenditure on police protection, it comes to a yearly savings of about $499,510. And note that this is just the cost savings referable to the police department.

The next question was whether a merging of the two police departments would compromise safety. The group agreed that it would have a negligible effect upon police services and safety.

Granted, change is always easier said than done when it comes to jurisdictional and power issues, not to mention personalities. At a minimum, if the Mariemont and Fairfax Police shared the night shift coverage, it would equate to roughly $100,000 in yearly cost savings.

Just consider what the Village of Mariemont could do with a half million additional funds a year, or even a hundred thousand. Possibly, hire a part-time Village Administrator, improved street maintenance, free garbage collection (eliminate those stickers), no fee memberships in the swimming and tennis clubs, free land rent for a garden in the South 80, new recreational facilities, rejuvenation of the Historic District and lower taxes could be considered. Longer term, the Village could certainly use better parking facilities, a community center and improvements to the Municipal Building.

 

–Dick Wendel, MD, MBA

Who are the best Doctors?

As a physician, many of my friends ask me to comment on the doctoring skills of my medical colleagues. Admittedly, a positive testimonial from a physician about your private physician is reassuring, but is it reliable? Outside of my specialty of urology, I found it very challenging to assess the competency of my colleagues other than by the three A’s of medical practice, first Availability, second Affability and finally Ability in that order. Yet, each year both Cincinnati and Cincy magazines glibly put forth a list of the Top or Best doctors in the Greater Cincinnati area.

Currently, statistical measures do not differentiate the best from the average also. Web site such as Healthgrades.com may crunch the numbers of millions of medical claims from federal and private sources to rate and rank doctors but their parameters that allegedly factor in experience, complication rates and patient satisfaction are grossly incomplete and subject to arbitrary standards of care.

You might think that primary care physicians and pediatricians (PCPs) would be knowledgably about the quality of medical care rendered by the specialists to whom they refer. But today’s PCPs are generally hospital employees and do not follow their patients in the hospital if they are admitted and thus rarely interact professionally or socially with the specialists. Moreover, the hospital systems (Christ, TreHealth, Mercy Healthcare, UC Health and St. Elizabeth Healthcare) have incentives for their ‘owned’ physicians to refer exclusively to other doctors in the network. The advent of the ‘Hospitalist’ and ‘Intensivist’, new breeds of physician that manages hospital care, has added an additional layer of isolation between the PCP and other physicians.

Moreover, insurance plans often change their panel of physicians and enrollees often change health plans. And when you go to see the doctor, you may be seen by a physician assistant (PA), nurse practitioner or anyone of the physicians covering the practice.

Interestingly, patient satisfaction has become a major focus in Medicare and medical insurance reimbursements to hospitals and medical practitioners. Many patients have already received the 3 or 4 page satisfaction surveys after a routine office visit, outpatient surgery or a hospital admission.  The soft data of patient satisfaction does correlate with quality of care, but the response rates to these surveys are much higher in the outliers of either the very satisfied or very dissatisfied. From a physician’s perspective, they do not paint an accurate picture.

So how does one latch onto the best doctors. Probably word of mouth from satisfied patients remains the best method upon which to judge a doctor. In the hospital setting, possibly, the floor nurses and operating room technicians with whom the doctor works day-over-day give the most reliable testimonials about the behaviors and capabilities of individual physicians.  But there is no surefire way to select the very best. In most instances, it is a leap of faith that ends in a good match based upon trust, bedside manner, accessibility and previous treatment outcomes.

And yet the magazine lists of the best doctors, ambulatory care centers, emergency rooms, hospitals, and medical testing facilities goes on and must certainly sell magazines. However, if your doctor or medical facility does not make the cut, don’t get concerned; the lists are very arbitrary and have little correlation with quality of care.

 

— Richard G. Wendel MD, MBA

Passive Aggressive Poison

How passive/aggressive individuals can poison a work environment even more than overtly antagonistic employees

The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes passive-aggressive personality disorder as a “pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational situations.” In my experience, it most frequently occurs in the workplace as indirect behaviors that subtly undermine efficiency, authority and interpersonal relationships.

The lazy hostile employee with an attitude is usually not the most disruptive to a functional work environment. You might ask why? It is because those types of individuals are easily identified and, at least, you know where they are coming from. Moreover, management usually terminates these folks before they disrupt organizational culture. On the other hand, more problems are created in the office culture by employees who appear to be doing a reasonable job… but in fact are slowly eroding the performance, attitude, and morale of the people around them through passive/aggressive behaviors.

What do they do?

  1. They frequently use the expression, “That’s not my job.”

To get the work done, it is important to have employees that do whatever it takes to get things done regardless of their title, position or seniority and not procrastinate. “It’s not my job,” really says, not only do I not care about you but I am passively indifferent to the needs both of the company and fellow workers.

  1. By virtue of their position, they think they’ve already paid their dues.

They wish to rest on their laurels and assume that they no longer need to work very hard. This type of passive/aggressive behavior can be especially malignant since it is infectious to other workers that may feel that they have a right to coast also.

  1. They feel that experience is enough.

Experience is certainly important but it is not an excuse to sit in the office waiting for someone to drop by to be mentored and intimidated by showing them your superior knowledge. Holding back and not proactively sharing your knowledge is characteristic of the passive/aggressive type personality.

  1. They lead the meeting after the meeting.

After the group holds a meeting that garners a degree of consensus,

the passive/aggressive tends to hold the “meeting after the meeting” about issues that had seemingly been resolved. They create passive resistance by raising issues that undermine the decisions so that no agreed upon actions can be implemented.

  1. They love to gossip by innuendo and a form of a negative grapevine effect.

Casual back biting and rumor are common tools of the passive/aggressive individual. Even under the guise of harmless banter and being a ‘fun guy’, nothing can more quickly destroy employee morale than negative sarcasm. This can also cause key employees to leave or act as a barrier for promotion based upon merit.

  1. Passive aggressive personalities excel at fence sitting.

This trait is, in my opinion, the most disturbing of this personality complex. They tend to hide and flip-flop on issues at will. Because they avoid making any waves, they are often promoted into managerial positions where the negative impact of their passive/aggressive behaviors is amplified. This is supportive of the Peter’s Principal that proposes that employees have a tendency to be promoted to their level of incompetence.

Transparency, teamwork and congeniality punctuate an ideal work environment and passive/aggressive behaviors do the opposite. Do any readers have experiences to share where these types of negative resistance have created a hostile work environment?