With the birth of his son, Quincy, last spring, Phillip Williams took a six-month paternity leave from his job. “I wanted to experience the birth and the early days. I wanted to exhaust all of the resources I had to spend time with [him],” explains Williams, who was working as executive producer of BET.com at the time. According to the 2000 Family and Medical Leave Act (FMLA) survey, which was conducted by the U.S. Department of Labor 75% of workers took some kind of leave from their jobs in 1999.

Many employees are conflicted about taking extended leaves. Most are fearful of losing their jobs. But under the FMLA, employees are allowed 12 weeks a year of unpaid leave and a guarantee that they will have the same or equivalent job (in terms of pay, benefits, and other employment terms and conditions) if they work at a company with 50 or more employees, have worked at the company for at least 12 months, and have worked at least. 1250 hours over the previous 12 months: Requirements can vary from state to state.

Beverly Kaye is the co author of Love It, Don’t Leave It: 26 Ways to Get What You Want at Work (Berrett-Koehler Publishers; $17.95) and the founder and CEO of Career Systems International, a consulting firm that specializes in talent management. Kaye says that although many employees are reluctant to take leave right now, more will be willing to take time off as the economy improves. Kaye also says that progressive employers who want to keep talented workers will make it easy for their employees to do so.

Kaye advises workers who intend to take family or medical leave to plan for their departure as far in advance as possible. In preparation for his absence, Williams, who was responsible for the overall creative production of the Website, met with senior management to set up a plan that included dividing his duties among other staff members. While he was away, he would call in about once a week to see how things were progressing. But the positive reports he received were “somewhat discouraging,” he says. He began thinking that perhaps he was no longer needed.

But when Williams returned to work, he realized that instead of feeling threatened, he felt empowered. Williams firmly believes that the proof of a good manager is how well employees perform in his or her absence. “There were certain parts of my job I was comfortable letting others handle,” he says. “I felt like I had graduated. I wanted to take on new and more responsibilities.”

Upon your return to work, Kaye suggests meeting with your employees or co-workers to ask them about what they’ve learned, the skills and abilities they’ve developed, and the opportunities they’re ready to pursue. Meeting with them serves two purposes: It lets them know they’re valued, and it gives you the opportunity to get the information you need to resume your duties.

WASHINGTON — Medical debt is more common among families with full-time workers than among families whose members work part-time, according to University of Iowa researchers at the annual meeting of the American Public Health Association.

“Medical debt can result in credit problems and force people to file for bankruptcy,” said Matthew Levi, who is a graduate research assistant in the department of community and behavioral health at the university.

“These problems can be worsened if an individual stops going in for care and using prescription drugs, because untreated problems can prevent a person from returning to work. People with medical debt also report increased levels of stress and anxiety,” he said.

The researchers looked at Urban Institute data from interviews with more than 1,400 residents, some done in person and some by phone.

Subjects were located either in low-income areas of Des Moines or in surrounding Polk County.

Data came primarily from a single question in the survey asking whether the subject or their spouse was paying off any medical debt, although a few other responses also were included.

Surprisingly, people with full-time jobs were more likely to report medical debt, said Anne Wallis, Ph.D., of the department of community and behavioral health at the university.

“We suspect this reflects having full-time employment, but without health insurance, or with inadequate health insurance,” she said.

Families with private health insurance were more likely to report medical debt than families without such insurance. However, this result may have been due to the way data were collected, since Medicaid data were reported separately. “So [it may just show] that families with private health insurance are not adequately insured,” Dr. Wallis said.

Another surprising finding had to do with the household incomes of people reporting medical debt.

“We see almost an upside-down ‘U’ shape where, with increases in income, up to a point, people are more likely to have medical debt,” Dr. Wallis noted at the meeting. “They’re less likely to have Medicaid or some other type of coverage, and more likely to be among the working poor.” Respondents on welfare also were more likely to have medical debt, she added.

More than one-third of households with children reported medical debt–but without correlation to the child’s health status, Dr. Wallis said.

“Where parents reported their child’s health as being poor, 100% reported medical debt, in addition to 50% who reported debt if their child’s health was fair,” she said.

“But even when the child’s health was good or excellent, medical debt approached 40%.”

The researchers did not find a lot of differences in the amount of medical debt reported when comparing the ages of children in the house; however, there was a dip in the percentage of debt reported by families with preschool-aged children.

“We’re not really sure what that’s about, [but] a lot of children in this sample are Head Start children, so they would be receiving some services and referrals,” Dr. Wallis noted.

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It’s a hard issue to wrap one’s head around. Free market champions, such as the likes of Microsoft and Dell, tout outsourcing and offshoring as the logical developments of a global economy based on accelerated innovation and technology; the “invisible hand” surfs the net. American trade union leaders have made the issue their cross to bear, portraying it as the ultimate betrayal of the promises made for the overseas flight of manufacturing jobs. And Third World workers don’t understand why anyone should be angry in this free market world–after decades under “austerity” measures, this is their just reward for life with neoliberalism.

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There are many players in this puzzle adding their own perspectives, and sometimes their own math, to the national debate on outsourcing. There are two diametrically opposing poles of opinion on this highly political and racially-charged issue. One: end all business outsourcing until every American has had their pick of the jobs. And two: allow companies to be competitive by permitting them a free hand at diminishing labor costs while increasing profit margin. Absolute protectionism vs. absolute liberalization.

For progressives, the issue is knotty because we are being asked to stand up for workers on the basis of nationhood. Do we bash outsourcing when Indian workers at Microsoft in Bangalore are telling us they make three times what they would normally make? Do we support outsourcing when we know American workers have lost high-paying software development jobs and are now working at Wal-Mart? In order for us to decide where we fall on the spectrum of solutions, we first need to understand the underpinning issues affecting this debate.

The Jobless Recovery

Though no one source can pinpoint the exact number of jobs lost to offshoring, it is estimated that roughly 300,000 to 995,000 jobs have been lost in the U.S. to offshoring to-date. According to Goldman Sachs, up to 6 million white-collar jobs will be lost over 10 years. The United States has a workforce of 140 million workers. Companies are outsourcing to gain a labor cost savings of 70 percent, according to CIO.com, an online magazine for chief information officers of high-tech companies. The top five U.S. employers in India today are General Electric, Hewlett Packard, IBM, American Express and Dell. According to Todd Tollefson of TechsUnite.org, an online community for high-tech workers affiliated with the Communication Workers of America, “The jobs in jeopardy of being outsourced and offshored are basically any job done with a computer.”

The first outsourcing of work was in low-level “back office” production–help desk, call center work. Today high-level administrators, program developers and engineers are also being outsourced. The outsourcing of jobs is taking place not just in the high-tech sector, but also in healthcare (where transcription, medical records and radiologic imaging is at risk), as well as in the public sector. Even patent lawyers have been put on notice.

Coupled with news of offshoring, Americans are also bombarded with reports of the jobless recovery. In August, The New York Times reported that the Department of Labor found worker layoffs occurred at the second fastest rate on record during the first three years of the Bush administration. It also found that the layoff rate reached 8.7 percent of all adult job holders. In the same month the Department of Labor reported that only 32,000 new jobs were created in July. The facts may be dizzying, but the end result is an American populace inundated with bad news about jobs and the economy.

The actual number of offshoring jobs lost may seem insignificant compared to the overall size of the U.S. workforce, but the loss becomes more significant as wages and standards for workers in the U.S. continue to decline. Along with the flight of white-collar jobs, Americans contend with another substantial threat to their livelihoods. What has been infamously dubbed the “Wal-Martization” of jobs is a real, accelerated trend among U.S. companies to race to the bottom by rolling back wages and employment standards. A recent UC Berkeley Labor Center study by Arindrajit Dube and Ken Jacobs revealed that taxpayers in California are subsidizing Wal-Mart to the tune of $86 million a year by providing public assistance to thousands of Wal-Mart employees unable to afford healthcare. Wal-Mart employs a million workers in the United States. Even though workers at the giant chain work more than full-time hours, they are still unable to afford healthcare for themselves and their families. Offshoring and the low-waging of America, combined with recent memories of the loss of manufacturing jobs, leave the American electorate incredibly sensitive about protecting jobs in the United States.

Hot Under the White Collar

For many workers, offshoring seems like a new face to an old enemy. In the ’70s and ’80s the American worker movement experienced incredible hardship when companies began to move operation to the Global South. General Motors went to Mexico, the GAP went to Indonesia, electronics production grew in Taiwan and Japan, while U.S. companies imported steel from Korea and Japan–all resulting in the cost of production reduced and profit margins increased. The deindustrialization of the American manufacturing sector meant many Americans were out of jobs, and their labor organizations were faced with grave reductions to their memberships. “The loss of jobs to foreign countries during the period of the ’70s and ’80s occurred mostly in the manufacturing sector, which had high union density. Jobs in those sectors were a source of decent incomes for workers with a high school degree. The social basis for a labor response to the loss of jobs was very strong,” says Steven Pitts, an economist with the UC Berkeley Center for Labor Research and Education.

What we find today is that the sectors highly affected by outsourcing are mostly unorganized and were, at times, the most resistant to unionization attempts of the past. However, these high-tech service jobs represented the kind of jobs displaced manufacturing workers in the ’80s were told to train for–these were the American jobs of the future. “American workers are angry because they were told to accept the loss of blue-collar manufacturing jobs because these jobs will be replaced by better white-collar service jobs,” Pitts continues. “Now those jobs are being lost as well.”

The anger toward outsourcing among American workers has also revealed racial underpinnings in the national debate. Numbers of chat rooms and websites created by displaced high-tech workers air some of these sentiments. Far from the global unionism expressed by union officials, lie the very nativist and xenophobic sentiments of some of their rank and file members. Some of these sentiments spill into anti-immigrant racism against Indian workers here in the U.S. One website called “Texas Labor Champions” posts messages from displaced tech workers. One such techie wrote, “Being a woman, I would not hire an Indian either, because of their views towards women. Having said all of that, we have to remind ourselves that this isn’t a issue of discrimination, it is more an issues of Nationialism … even if they were the sweetest people on earth and really were smarter/harder working than Americans.”

That same website suggests that foreign workers at call centers are potential agents of Osama bin Laden, using their access to sensitive private information of consumers such as social security numbers and bank account information as a means to fund Al Qaeda. Though some of this might seem outrageous, the public has entertained these views by supporting legislation requiring call center workers to identify themselves and the country in which they live. Proponents of this legislation say they want consumers to be able to assess the risk involved with providing foreign workers their private financial information. Presidential hopeful John Kerry supports this measure as well by adding it to his national jobs reform platform. Though the unions that speak for these workers claim to hold a an anti-racist globalist approach to these issues, the reality is that on the cubicle floor, workers are using a racial and nationalist reasoning to define the cause of their displacement.

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Treating someone with a traumatic wound in a sterile environment can be stressful. Cover the patient with mud and add enemy fire and ice-cold rain and the experience can be downright daunting-even it the wounds and incoming fire only seem real.

For medics of the Texas Army National Guard’s 56th Brigade Combat Team, this was business as usual as they prepared for their Iraq deployment last . month at the Joint Readiness Training Center ORTC) at Fort Polk, La.

The soldiers have less than a month to refine their medical skills using training aides and simulated patients before they have to treat actual wounds on the battlefield.

Capt. James D. clay, a JRTC medical officer, said such training is making possible an evolution in Army field medical treatment. The plan is to reduce the number ol wounded soldiers who die en route to field hospitals by providing more trauma care on the battlefield.

“We’re changing the way we do things from the past,” clay said. “We’re now focused more on the frontline level of care ior our soldiers.”

The training at JRTC, where little is simulated, provided the 56th’s medics with a realistic sense what to expect in Iraq, he said.

Spc. John L. Westbrook still had crimson-red fluid on his hands minutes after performing a battlefield amputation on a mock patient under fire. He knows the next time the mixture ol food dye and vinegar could be the real thing.

Westbrook, however, has treated the same type ol wound in his civilian job as a firefighter. After the training, he is confident that he and the other medics will do their jobs in Iraq.

“As medics, treating injured soldiers is still our main priority,” he said. “That is what we do, that is our calling.”

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AS AN AGEING, wealthier and more demanding population grows to expect more from the NHS, politicians are belatedly waking up to the huge role technology will play in delivering on their promises. For the first time the government and the medical technology industry are attempting to hammer out a common approach that will benefit the health and the wealth of the nation.

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Over the next few months the recommendations of the Healthcare Industries Taskforce (HITF), a joint initiative between ministers and technology providers, are due to begin filtering through to tangible policy. Ministers are talking up the twin benefits of bringing new technologies into the NHS and stimulating growth in a sector that could deliver hi-tech jobs and export revenues for the UK. The industry itself is unsurprisingly delighted by the government’s attention, but is also keen to stress the urgency of acting on the recommendations.

John Wilkinson, director general of the Association of British Healthcare Industries, said a strong relationship between technology providers and the NHS was a vital component of a successful UK sector. This relationship has been erratic at best so far. According to Wilkinson, the NHS has often been a slow adopter of medical technologies. As the biggest single provider of healthcare in the world, this was hardly helpful to UK businesses operating in the sector. ‘It’s difficult to have a good industry base when you haven’t got a dynamic customer,’ he said.

That the NHS is a slow and difficult environment in which to introduce new technologies is hardly a surprise. As successive governments have discovered, imposing rapid and decisive change on the monolithic organisation makes turning around the proverbial oil tanker look straightforward. But if the HITF programme produces results, the NHS’s very size and purchasing power could turn a weakness into a significant asset, potentially changing the UK into a hotbed of advanced medical technology with a vibrant development base and an awesomely influential prime customer.

So what changes are planned? All sides agree that a quick and effective process for evaluating the performance and cost-effectiveness of new medical technologies is vital to the NHS and the industry alike. To this end, a new Device Evaluation Service (DES) will be developed that HITF hopes will deliver improvements over the current system. An important element of the plan involves moving the existing DES from its home inside the industry’s regulatory body and making it part of the NHS’s procurement operation, bringing it closer to those who decide whether to buy in to a new technology.

It is clear that the NHS’s purchasing and supply practices present a bewildering obstacle to external companies seeking a foothold for their innovations inside the health service. HITF hopes to establish a framework for procurement at regional level, giving technology developers a single point of potential access to more hospitals.

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HITF also recommends measures to stimulate a culture of innovation, including the establishment of a new innovation centre and a fund to promote the development and exploitation of new products and procedures. Allied with familiar commitments to strengthen ties with academia, create centres of excellence and focus more on R & D, the HITF programme has nothing anyone could object to in principle. Those in the medical technology sector are counting on it delivering practical results.

The ABHI’s Wilkinson, whose members include some of the big guns of the sector such as Johnson & Johnson, Smith & Nephew, Smiths Medical and Tyco Healthcare, claimed the very fact that the government had engaged with the industry proved it was moving on to the radar of policy makers. The prospect of closer co-operation between the NHS and the medical technology business should help it to emerge from under the shadow of the pharmaceutical sector and establish its credentials as a [pounds sterling]4.5bn industry in its own right, earning [pounds sterling]3bn in export revenues. ‘The HITF report is very significant,’ said Wilkinson. ‘It is the first material engagement between the government and this industry as a whole.’

Despite his enthusiasm for the HITF programme, however, Wilkinson knows that no reform of medical technology uptake in the NHS can succeed without the support of doctors and nurses, who will be its end users. ‘We believe clinicians have been disengaged from the process and want to pull them back in,’ he said, adding that ‘tussles’ over procurement between clinical specialists and managers were frequently unhelpful.

Wilkinson also expressed fears that senior doctors would be too stretched ‘doing the day job’ to be able to contribute to the R & D process needed for the successful introduction of new medical technologies.

Despite these concerns, Wilkinson said senior doctors are increasingly aware of the huge opportunities presented by advances in medical technology, and the implications for their career prospects. ‘Technology is producing huge shifts away from certain skills and towards new skills,’ he said. ‘Surgeons, for example, are using technology that requires a completely different skill set from what went before. The medical community is realising that if they don’t use the leading-edge technology, their reputation is in danger of slipping.’

For HITF to bring decisive impetus to the UK’s medical technology sector, however, it will have to reach beyond the big multinationals and make an impact on the growing number of SMEs operating in the area. According to estimates quoted in the HITF report, 85 per cent of healthcare companies in the UK have an annual turnover of less than [pounds sterling]5m.

If the major players, with their multimillion-pound marketing budgets, have problems introducing new technologies to the NHS, the situation is harder still for businesses that may comprise no more than a few dozen highly skilled technical staff.

Diana Hodgins, managing director of European Technology for Business (ETB), a developer of advanced engineering systems for the medical sector, said of the HITF agenda: ‘The intention is right and the words sound good, and we should be positive. However, the questions I always ask about these things are: how and when?’

Hodgins said that HITF at least represents a statement of intent that medical technology SMEs can use to fight their case when presenting innovations to healthcare buyers.

Smaller companies are also aware of the benefits of banding together to give themselves extra weight in the sector. Hodgins is a leading figure in Medilink East, a body set up to represent medical technology SMEs in the east of England that now numbers about 130 members. ‘We’re growing and we’re starting to get a bit of clout,’ said Hodgins. ‘With that type of scale you begin to command far more attention than a little company on its own.’

Either via HITF or the efforts of SME innovators to push their case, the UK’s medical technology sector is determined to raise its profile. Whether the vagaries of the NHS will allow it to reach its potential remain to be seen, but all agree that this is crunch time. ‘We have a two-year window,’ claimed Wilkinson. ‘We’ve got a vibrant sector with the potential to deliver high value-added jobs, but the government hasn’t always been aware it’s there. As a country we have to have an industrial base, and we are arguing that this sector is a highly promising one.’

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NANCY Aossey has had little time to sleep. With devastation in South Asia still front-page news last week, a flurry of phone calls was swamping the offices of international Medical Corps, the aid organization that Aossey has headed since 1986.

The Santa Monica-based group was already working in the Indonesian province of Sumatra when a massive earthquake triggered the tsunami on Dec. 26, so it was able to put a team on the ground quickly in some of the hardest hit areas.

Aossey has been directing the group’s response from her offices, focusing in on the urgent need for clean drinking water and sanitation.

Although the scope of the disaster is staggering, it’s familiar territory for the Iowa native, who has spent years traveling to some of the most dangerous and impoverished countries around the globe.

In fact, the International Medical Corps, founded in 1984 by a Los Angeles emergency room doctor, has sent workers to more than 40 countries. Its niche: providing health care services in high-risk countries, including Afghanistan, Iraq and Somalia. Aside from providing direct health services, the group specializes in long-term training to build up local health care systems.

Question: So who are all these people calling in?

Answer: When there is an emergency and it hits the newspapers there is an outpouring of support. People call and they want to help. Often they want to make a donation. Sometimes they want to volunteer here in our offices and a lot of times they want to go overseas and volunteer. We talk to a lot of people during emergencies like this to see how we might use their assistance.

Q: Can you actually find a use for people off the street?

A: Some of the hardest people to find are people with good logistics experience, communications experience, administrative skills, finance skills, management skills. Those are tough skills to find, especially to ask people to work in a war zone or in a natural disaster. We do get a lot of health professionals who are interested and we put them through a process where we evaluate whether or not they are needed, how they might fit in the local culture and how much time can they spend in a particular country.

Q: Do these people have jobs?

A: Some are retired doctors. Some people are in the prime of their careers. We have a trauma surgeon in Kansas who will shut down his very lucrative (plastic surgery) practice. He will go overseas for a month or two and volunteer his time.

Q: Whom do you have in Indonesia right now?

A: We have 130 people on the ground. Many of them are local Indonesian health care professionals, people we have worked with for many, many years. We are communicating with them and sending them supplies. Indonesia is very large. We were working on several islands. We had a presence in Sumatra, but we were not in Banda Aceh.

Q: Are things as bad as the pictures make it seem?

A: Yes and probably worse. We are getting daily reports from our teams and they are witnessing major devastation–entire villages gone, people in a state of shock. IMC will focus on what we think we can make the greatest impact.

Q: And what might that mean?

A: We will be focusing on securing the water supply, hygiene and sanitation. The water is contaminated. There is a need for water purification tablets. People do not have the right medicines. There are a number of injuries where the right antibiotics are not available. We are going to have to transport them in. We are looking at putting together mobile clinics, vehicles typically. IMC has experience with that. We are looking at trying to help put together health posts. We also will assist rescuers, providing body bags.

Q: Will this be your biggest disaster response ever?

A: I make it a point of never comparing suffering, but yes. We have been involved in a lot of significant disaster: genocide, ethnic cleansing. We have been there and seen it all. This one is unique in that it’s huge and sudden. Sometimes man-made disasters (such as civil wars) occur over a period of weeks or months. A number of workers lost family members and friends and are pitching in. Can you imagine how hard that would be?

Q: Are you seeing record donations like other groups?

A: So far we have raised about $1.2 million in private donations. It’s a record for this period of time. We’ve got it online, phone calls, checks. We have had people walk up to our office and drop a check on, our desk. We have set our goal at $5 million.

Q: How can you make sure you are not duplicating efforts of other agencies?

A: We know everything that is being done on the ground. If we are in an area that is well covered we will set up in an area not well covered. A lot of the coordination is done in the field.

Q: Will you be going there yourself?

A: If I need to be there because I can help IMC I will go. I am very sensitive to the fact that when I travel somewhere I am taking up resources and people’s time.

Q: What have you done in some other situations?

A: In Mogadishu, Somalia in the early ’90s we were the first American-based organization to work there. It was complete anarchy: bombings, shootings, guns on the street. We saw people shooting at the heads of children as target practice. For a local infrastructure, we had doctors and nurses who stayed behind to help their people, but who had no experience with trauma. We took doctors who didn’t have a lot of trauma training and we gave them new surgical techniques.

Q: It sounds like you have seen some really grim stuff.

A: I’ve seen some very horrific stuff. In Somalia, security was so bad we actually had to have armed guards. There was this really nice, nice man that we worked with, his name was Jackson. We were at the airport. He came to watch us load up the airplane, and all of a sudden we hear these gunshots. I looked up and watched him die. A guy came up behind him with an AK-47 and shot him four times in the back. It was some kind of a blood feud.

Q: Doesn’t it haunt you?

A: Well, I am human. After Somalia, I did have nightmares for a long time. It’s tough. You try to separate what you see from what it is you need to do to get to work.

Q: What keeps you going?

A: I see the very, very worst side of human nature, truly evil, and I see the very, very best side. There is not a lot in between. In many of the countries where we work the leadership lies in the hands of people who care a lot about power and money.

Q: How did this organization get going?

A: The founder, Dr. Bob Simon, made the first trip into Afghanistan as a private citizen in 1982 and 1983 after it had been invaded by the Soviets. He noticed that all the relief organizations were on the border working in refugee camps and no American organizations were inside Afghanistan. So he sold his house in Malibu to raise $80,000 or $90,000 to found the organization. He still chairs our board.

Q: What did the organization do?

A: We started a medic training program that lasted nine months and taught lay Afghans how to treat 85 percent of the injuries and diseases that they saw. We sent them with supplies and they opened up clinics in their regions and they started providing medical services to the civilian population.

Q: You were there during the Taliban. How was that?

A: Tough, very tough. Scary too. Because Afghanistan is very tribal and to some extent the power centers are remote, there were certain areas in Afghanistan where we could operate a little bit more freely. We also had a very, very good strong local staff there.

Q: You were one of the first aid agencies into Iraq too. What’s it like there?

A: (She clinched her lips shut.)

Q: So mum’s the word?

A: It’s very bad. The security situation is very bad. We are carrying out programs in large part through working with our local Iraqi staff who are the unsung heroes.

Q: How many workers do you have there?

A: About 12 non-Iraqis. They are outside of Baghdad. They are spread through the north. We have over 1,000 Iraqis. They are doctors, nurses. We run a lot of nurse training programs. The nursing system was totally devastated when we went in. The problem is a lot of times they are targeted because they are working with international organizations, or just because they want to help their people. We worry a lot but we have managed.

INTERVIEW

Nancy A. Aossey

Title: President and Chief Executive

Organization: International Medical Corps

Born: Cedar Rapids? Iowa, 1958

Education: B.A. and MBA, Northern Iowa University

Career Turning Point: Learning about International Medical Corps from friends and being offered the job of chief executive

Most Admired People: Native people who overcome tragedy and devastation to work with International Medical Corps in their home country

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In July 2001, Capt. Monica Hill was just another Air Force physician on reserve duty. Then she was summoned from a civilian hospital in Ohio to work at Andrews Air Force Base in Maryland.

No big deal, she thought.

Sure, she was a lesbian in a 14-year committed relationship, but Hill had long lived as an out lesbian only at home and kept her military coworkers in the dark. She joined the Air Force soon after the military’s “don’t ask, don’t tell” policy went into effect, knowing the system was flawed but also thinking it would protect her. She now admits that was naive thinking.

Two weeks after Hill was ordered to Andrews, her partner, Terri Cason, was diagnosed with terminal lung cancer that had metastasized to her brain. “There wasn’t a way to take care of Terri and serve in the Air Force,” says Hill. When she asked the Air Force for a deferment from her assignment to be with her sick partner, her request violated “don’t ask, don’t tell.” Hill was dismissed.

From 1993 to 2003 nearly 10,000 gay men and lesbians were discharged from the U.S. military due to their sexual orientation. Now 12 ejected service members, including Hill, are putting human faces on that daunting statistic by suing the U.S. Department of Defense to be reinstated. The lawsuit, Cook v. Rumsfeld, may not be heard until 2006.

Notes Steve Rails, a spokesman for Servicemembers Legal Defense Network, which is backing the suit: “They are not asking for promotions, pay increases, or other advancements”–just to get their jobs back.

Cason died in September 2001. Three months later Hill was called to her discharge hearing. She was forced to produce a death certificate for Cason to prove that her request for a deferral was not a ploy to escape active duty. She was asked invasive questions: Had she been faithful? Did she intend to sleep with women again?

“It was just cruel,” Hill says quietly. “It was like I was dirty and a criminal. I had no value in the world. I was just astonished and shocked and dismayed.” As if that weren’t demoralizing enough, the Ah” Force demanded that Hill immediately repay her medical school tuition–about $65,000.

SLDN officials believe that Lawrence v. Texas, the U.S. Supreme Court ruling that overturned sodomy laws in 2003, has made it possible to fight “don’t ask, don’t tell.” Lawrence was successfully argued by putting consensual sodomy in the context of privacy rights for gay men and lesbians. Also helpful is a November military court ruling that cited Lawrence in overturning a male Army specialist’s guilty plea for engaging in private, consensual oral sex with a female civilian. In the past the military has argued that military law is not antigay, simply anti-”sodomy”–a rule that must apply equally to gays and straights.

Yet the current administration’s unabashedly conservative tilt has many legal experts concerned that while the case of the SLDN 12 will keep the military’s unfair gay bashing and expulsions before the media, the accused will not be putting on uniforms again anytime soon.

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In the film “The Graduate,” a neighbor gave one hushed word of business advice to Dustin Hoffman’s character: “plastics.” That screenplay was written more than 30 years ago. If it were written 15 years later, that word might have been “medical.” The exploding growth in the market for medical components, such as metal joints, bone screws and laparoscopic tools, has helped many job shops survive when orders from other industries lessened or disappeared in the late 1990s. The medical market is expected to continue to be strong as life expectancy lengthens, the Baby Boom generation crosses into senior citizenship, and orthopedic and microinvasive surgical advancements continue to evolve.

Before a shop seeks out medical customers, there are factors to consider to help ensure the shop’s success in the medical market. These have to do with the nature of orthopedic parts, the optimum way to produce them efficiently, quality requirements by both medical companies and the government, along with labeling and packaging.

JKB Tool in Milford, Connecticut, is a company that made a leap to medical machining about 6 years ago. The shop made its reputation in the 1980s as a designer and builder of sophisticated automatic assembly and test systems. An adjunct to that business was a small contract production shop and, later, a stamping business. Jason Blake, son of the founder, has worked with his dad since the business started, deburring parts in the family’s basement.

“When I graduated from college, I came to work at JKB full time,” Mr. Blake says. “That was 1994, and by 1997, the automation projects were getting bigger and more complex, but were less profitable. We were making money in the stamping business, but more jobs were going to China and Mexico, so the future in that was questionable.” As Mr. Blake tells it, the company was on the verge of despair by 1998.

“We had one hopeful spark going for us,” he says. “We had a small machining contract for a laparoscopic tube running on our CNC milling machine. We saw a future in medical parts and made a commitment to do whatever was necessary to go after more of that business; we had to become more efficient if we wanted to be successful at it.”

Mr. Blake was particularly interested in the orthopedic segment and understood that the shop would have to invest in new multifunction equipment to be competitive. In a typical bone screw, for example, the operations are thread whirling, broaching, gundrilling and micromilling. If conventional equipment is used for each operation, then three or four machines would be required.

“I went to the EASTEC trade show in ‘98 and looked at CNC screw machines for the bone screw parts that we wanted to attract, plus additional laparoscopic parts,” Mr. Blake says. “I knew that these were multi function machines, but that’s all I knew. I had never worked on one, nor had any of our employees.”

JKB purchased a “Deco” Swiss-type sliding headstock turning center from Tornos Technologies (Brookfield, Connecticut) in 1999. The machine was 60 percent faster (41 seconds) in a competitive test involving the laparoscopic tube part. Today, 6 years later, Mr. Blake and his crew produce that part even faster (36 seconds) as a result of gaining expertise in the technology.

First Machine

Once the machine was on the floor, the shop employees began working to master bone screw manufacturing. Titanium bone screws are used for spinal corrective surgery, trauma, and other types of bone repair and correction. Other bone screws are made of 316 stainless steel. They are produced by the millions in the United States to strict demands for tolerance, surface properties, cleanliness and packaging. The titanium screws range in length from 6 mm to 80 mm and have ODs from 2 mm to 8.5 mm. They typically require a 0.4-micron to 0.8-micron surface finish and dimensional tolerance of [+ or -] 0.025 mm. Customer specifications also often include the addition of an anodized coating for color coding different sizes and types of screws. Surface finishes and tolerances must take into account the coated layer, allowing for additions or reductions in material.

“It was a difficult time,” Mr. Blake says. “Remember, this was a new discipline for us, using a new technology in a new market. This was our very first screw machine.”

It was a challenge for JKB to adapt to the large volume of parts coming off the machine.

“If we made a mistake in programming or setup or tooling, it set us back in production time,” Mr. Blake says. “The bone screw machining process is not very forgiving.’”

Mr. Blake and his staff also had never worked with titanium, which is a tough, flammable material. If a tool breaks, the material’s temperature is so high that it can ignite the cutting fluid. It’s necessary to have fire extinguishers at every machine. According to Mr. Blake, he and his employees worked 14-hour days, 7 days a week for about 4 months to learn how to make the parts.

“But we were driven. We were hungry. We persevered,” he says. “The only thing we didn’t worry about during that learning phase was threading, which is usually the big problem for people requiring expensive, dedicated equipment. The Deco has a thread whirling attachment that puts the thread on so easily. They come out burr-free; we can put any shape we want into it; and we get tremendous life out of the tooling inserts.”

First Contract

JKB won a bone screw contract in 2000. The company sold off its press equipment and bought another Deco.

“We got the business because we could produce it for less than our competitors and with better quality and faster delivery,” says Mr. Blake.

Armed with confidence and experience in the technology, and driven by the spirit of survival and perhaps also by youth (Mr. Blake is 34; most of his employees are younger), the orthopedic part business grew.

“There were bumps and challenges along the way, of course,” he says. “One part comes to mind–a fixed-angle bone screw. We worked on that part for 2 years to make it successfully. We use all 20 tool positions on the Deco to make this part complete in one setup. The elliptical shape of the head posed unique challenges, such as part holding and the many operations that have to be performed in the machine’s counter spindle. The Deco gives you eight tool positions for counter operations, all of which can be live tools.”

JKB’s goal is to always make a part in what it calls “done-done” in the machine. The shop always tries to avoid secondary operations.

Art Deco

The ten-axis Deco machine can use two turning tools at the same time, completing rough and finish cuts in the same operation. One of the machine’s cross slides accepts up to four live tools for operations such as cross milling and off-center drilling. A gundrilling and high-pressure coolant attachment can be mounted on the end-working unit. This feature is a plus when producing cannulated bone screws, which are screws with a 1.5-mm to 2.5-mm hole through the entire length. JKB prefers to gundrill the hole rather than to buy cannulated stock, which is often unavailable. Polygon milling of flats or contours can be accomplished using the machine’s optional C axis on the main spindle.

While the bar in the main spindle is machined, operations are performed on the previously parted piece mounted on the counter spindle. For example, the counter spindle can present the part’s cut-off end to as many as four live tools or turning tools. In effect, the user gets these operations at zero time because they occur while the part in the main spindle is machined. Users such as JKB can minimize part cycle times by balancing operations between the main and counter spindles. As many as ten axes can be controlled simultaneously on the Deco, and up to four tools can be operating simultaneously.

“The programming is a different approach,” Mr. Blake says. “Tornos calls it PNC, parallel numerical control, because so much is happening simultaneously, but it’s the control and dedicated software that give you the productivity. The machine goes from operation to operation before you finish an eye blink. The payoff is worth learning it.”

The machine’s software automatically calculates real machining times, taking into account tool paths, operation sequences and other cutting data entered by the user. It also incorporates canned cycles that speed programming, such as barstock advance, cut-off and pick-up by the counter spindle. It also displays the part’s production rate.

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It’s now a core tenet of employer-sponsored health care: The more employees know about their health options and their own health status, the better off everyone is.

With good health education resources, experts say, employees can make more-informed decisions about medical matters, be more judicious in their health spending habits, and get problems diagnosed and under treatment before they mushroom into costly major illnesses. In turn, as employees become smarter health consumers, employers will be able to tighten their rein on premium increases and productivity losses.

Although employee-centered health education could be a plus for employers no matter what types of health plans they offer, it may be especially important, experts say, for employers offering consumer-directed plans. Those are the high-deductible plans that require employees to decide how to spend health care dollars that are, in effect, theirs. As employees take on more responsibility for health decisions, they should have access to resources to make the best possible decisions, experts explain.

In fact, many employers with consumer-directed plans already provide such resources, typically through health plan providers or other third parties. But even some companies without such plans are offering health education–not only to make employees more careful in their health spending habits now but also to prepare them for possible consumer-directed options in the future.
Another, perhaps more speculative, reason for employers to provide such education, however, is to shield themselves from potential complaints–and even litigation–centered on whether employees’ health problems stemmed from a lack of proper health decision tools.

Although no such suits are believed to have materialized, they are “theoretically possible,” says Helen Darling, president of the National Business Group on Health in Washington, D.C.

Timothy J. Stanton, a benefits attorney with Gardner, Carton & Douglas LLP in Chicago, says that although he has not seen any such lawsuits, “I could imagine cases where a participant who made ill-advised … decisions in a [consumer-directed] plan could sue a plan sponsor, alleging a breach of an ERISA fiduciary duty for failing to educate participants.” (ERISA is the Employee Retirement Income Security Act of 1974, which governs private health and welfare plans.)

“As fiduciaries,” Stanton continues, “employers should never put employees into plans the employees don’t understand and won’t be able to navigate successfully.” And because employees stand a greater chance of making mistakes in deciding about their health care under consumer-directed plans than under conventional plans, he adds, “I think education will be very important with the new consumer-directed programs.”

Schooling Needed

Although health care consumerism is still in its early stages, HR has been engaged from the start. HR professionals at many companies have been implementing health education and communication strategies–many of them online–for some time, and such efforts are spreading. (For more information, see “Health Education Turns Proactive” in the April 2005 issue of HR Magazine.)

But newer, better efforts may be needed because there is evidence that many employees lack the skills necessary to use the health information already available to them–which can be costly for employers.

According to a report issued last year by the Institute of Medicine, a private science advisory organization in Washington. D.C., nearly half of U.S. adults suffer from “health illiteracy” and cannot adequately use the mass of data already available to them.

About 90 million people have trouble obtaining, understanding and using information to make decisions about their health, which results in billions of dollars in avoidable medical costs, according to the institute’s report, Health Literacy: A Prescription to End Confusion. The report explains that those individuals who know little about health matters get less preventive care and use more emergency services than those who are health literate.

Health illiteracy crops up in many ways, from misreading drug dosage information to misunderstanding patient consent forms. Moreover, it spans the educational spectrum–from Ph.D.s to those with poor reading and writing skills to those for whom English is not their native language–according to William Smith, who served on the committee that wrote the report.

Smith, executive vice president of the Academy for Educational Development, a Washington, D.C.-based organization focused on the least-advantaged people in the United States and in developing countries, adds: “If you employ a significant number of employees, some of those with health illiteracy are working for you and costing you money. They’re using more health care than they should.”

Employers can do their part to make employees better informed about health matters, Smith says, by testing the read-ability of their benefits materials, making sure employees understand the health information they receive and guiding them to objective sources of information.

“Employers are very credible sources of information to their employees,” Smith says. And HR leaders can be especially effective, he adds, because they possess good interpersonal and communication skills.

Education For Now–And Later

While the driving force in health education for employees is the growth of consumer-directed plans, even companies with conventional health plans find they have to educate their employees on the facts about health costs–while also preparing them for a possible consumer-directed future. It happened recently at VML Inc., a marketing company in Kansas City, Mo.

VML, which last year was named one of the 25 Best Small Companies to Work for in America–a list created by the San Francisco-based Great Place to Work Institute and featured in the July 2004 issue of HR Magazine–had been picking up the full tab for health insurance for its 285 employees and their families. But the company had to make changes after two high-cost cancer cases in 2003 led to a proposed 40 percent premium hike last year, says Kristi Veitch, HR director.

VML negotiated a 25 percent increase with its provider after eliminating coverage for “lifestyle” drugs such as Rogaine and Viagra and for prescription drugs with over-the-counter equivalents–a change that affects mainly those who take allergy and acid-reflux drugs.

The company still pays the full premium for employees’ health coverage, but it has also helped them better understand the costs of various types of prescription drugs. “Now people are paying attention,” Veitch says. “People say, ‘Ah, this is going to cost me more money.’”

While VML was able to benefit from the situation by reducing drug coverage, workers also benefited by gaining a better understanding of certain health care costs, Veitch adds. “The awareness we’re teaching will help them if they go to other jobs or a consumer-directed health plan.”

Laying the Groundwork

Another company educating its employees on health coverage, even though it currently does not have a consumer-directed plan, is Washington Mutual Inc., a Seattle-based bank and financial services company. However, it has rolled out a number of health education tools in advance of the possible offering of a consumer-driven health plan next year, says Marilyn A. Guthrie, assistant vice president and manager of health promotion.

Faced with substantial health expense increases, Washington Mutual three years ago laid out a cost-containment strategy that included employee involvement, Guthrie explains. “The biggest issue for us was to engage employees in the cost and quality of health care.”

Washington Mutual’s 55,000 employees include many young individuals who generally are not sophisticated health care consumers, Guthrie says. “We wanted to hit them with the message of what’s in it for them” by emphasizing the ability to choose care and avoid wasteful spending.

The bank last year introduced an employee health portal as part of its corporate web site. The portal offers one-stop shopping for benefits enrollment and health information, including a personal health-risk assessment that, if completed, will earn employees points redeemable for gift cards. (For more information on health-risk assessments and other pre-emptive methods of curtailing employees’ health costs, see “Getting Personal” on page 98.)

Guthrie says employees haven’t used the health education tools to their fullest extent, but she adds that it’s too early to judge success or failure. What is clear is her ultimate goal: “We expect to see a reduction in the [health care cost] trend increase and an improvement in the overall health profile of our population.”

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Dozens of GE Healthcare software engineers will soon begin work alongside Intermountain Health Care staff in Utah. The two health IT noteworthies announced plans Wednesday to jointly develop systems that do not just verify that patients receive medications as prescribed by doctors, but also make sure that the medication makes sense.

Moreover, constant interaction between engineers and clinicians will make sure that the computer connects caregivers and patients rather than coming between them, said Brandon Savage, medical director of health care IT at GE Healthcare.

“What makes this [project] distinct is that we’re really focusing on how you build a monitor directly into the workflow.”

Clinicians and engineers will work side by side on the project, planned as part of a 10-year, $100 million collaboration between Intermountain Health Care Inc. and GE.

GE is providing its Centricity IT technologies across institutions within IHC’s network, which serve more than 2 million patients.

These installations will enable the widespread use of new software throughout the IHC network, including both hospitals and outpatient facilities.

IHC is known for inventing technologies to help clinicians make better decisions.

“We don’t have databases, we have knowledge-bases,” said Laura Heerman, a registered nurse and medical informaticist with IHC.

IHC and GE staff will work in a joint research center located within an hour’s drive of six IHC facilities, said Heerman, so engineers can readily observe clinicians at work. In addition, clinicians will visit the research center daily.

The program is just one of several collaborations between nonprofit health institutions and software companies.

In April, IBM and the University of Pittsburgh Medical Center inked an eight-year, $402 million deal to overhaul the medical center’s IT infrastructure. Duke University Health System has been working with McKesson to implement computerized physician order entry. However, the coordination between GE and IHC seems unusually deep.

IHC has used and designed decision-support software since the 1970s, often working with outside experts, but this is the first time it has joined forces with a global presence, said Heerman.

Headquartered in the United Kingdom, GE Healthcare is a $14 billion unit of General Electric Company with more than 42,500 employees. Some GE software engineers will move to Utah, said Savage, but others will be hired locally.

IHC and GE estimate the research center could create up to 100 new jobs.

“The rich clinical data IHC has collected over the years combined with GE’s clinical information technology programs will enable clinicians to capture and learn from embedded protocols, leading to a significant reduction in medical errors,” said Vishal Wanchoo, president and CEO of GE Healthcare Information Technologies.

The system will integrate physician ordering, pharmacy support, and bedside administration using bar codes and handheld devices linked into patient medical records.

The latest vital signs and other information will alert nurses to consider overriding medication orders. The software should be in use at some IHC hospitals over the next 12 to 18 months.

Heerman said that the software would improve both efficiency and patient safety. “The information is presented in a more useful manner so that less time is spent looking for data, and the decisions can be made more quickly and more accurately.”

To make information accessible, said Savage, GE would be leveraging open-source standards and contributing to them. Barriers to exchanging data cut down on innovation, said Savage, and innovation is what provides value in terms of clinical capabilities.

Read the full story on CIOInsight.com: Intermountain Health, GE Healthcare Join Forces on Electronic Medical Records

Check out eWEEK.com’s Health Care Center for the latest news, views and analysis of technology’s impact on health care.

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