On Washington’s Primary, Or, It Might Be Time For Republicans To Worry

I’m supposed to be finishing another story tonight, but I’ve just come from Darcy Burner’s primary night party…and I have in front of me the results of the important races tonight in Washington’s newfangled “top two” primary.

It is unfair to extrapolate the results of elections in the “People’s Republic of Washington” directly onto a national map, but as I look as these results it seems fair to say that if any Republican strategists aren’t sweating bullets this morning it’s because they’ll be hustling for votes in towns like Maggie Valley, North Carolina (don’t forget to stop by Saratoga’s for the Wednesday night jazz…)…or, perhaps, Bessemer Bend, Wyoming.

For the rest of the Republican community, tonight’s events are not good news.

We have a fair amount to cover, so let’s get to it.

First, a few words on the unusual new primary system. The “top two” primary was brought to law through the initiative process after the United States Supreme Court declined to rule on the constitutionality of the old system.

How does the new primary work? Simple. The two candidates with the most votes in any primary election move on to the general. (There is an exception: judges are elected in this State; and candidates with “50% + 1” votes in the primary automatically win the election. They do not appear on the general election ballot.)

Odd results could occur. For example, there can be occasions where two Democratic or two Republican candidates are the top two finishers in a primary (or two of another party, theoretically…), which could leave either no Democratic or no Republican candidate—or potentially no Democrat and no Republican--in the general as a candidate for that position.

This will in fact happen in Washington’s Legislative District 7, Position 1 race, as four Republicans square off against each other today, with the top two Republicans making it to the general election ballot.

There is also great controversy over who can be a Democrat or a Republican; the current law allows the candidate to self-identify party affiliation, much to the frustration of both the Democratic and Republican Party establishments, who see the potential for considerable mischief in the arrangement. They also cite First Amendment “free association” issues and “branding” concerns.

All that controversy notwithstanding, about 75 well-wishers have shown up on a rainy night to see Darcy Burner, who is running for the second time against former Sheriff Dave (“I investigated the Green River Killer”) Reichert; each hoping to serve as the Representative from Washington’s 8th Congressional District in the 111th Congress.

She lost by about 7,000 votes to Reichert two years ago (out of 250,000 cast), and this race has attracted national attention as Reichert, naturally, is perceived to be vulnerable…and she is no longer perceived as unknown.

And judging by the results as they came in, she was again close…but she could not crack the 3% difference that was keeping them apart (47%-44%). In the King County voting she was only 462 votes behind Reichert, and the remainder of the difference is Reichert’s 2,100 vote lead in Pierce County.

Here’s the bad news for Reichert:

He’s a two-term incumbent from a district that has sent Republicans to Congress the past 8 elections—and he’s only leading by just those 2,600 votes—with lots of media money yet to come to the fight on the Democratic side and a public apparently ready to vote for change.

For the rest of Republican America…well, have a look at the Governor’s race:

Chris Gregiore (recently shortened from Christine) has the distinction of winning the closest gubernatorial election in American history (her margin, after two recounts and a lawsuit: 133 votes out of 2.8 million votes cast). She faces Dino Rossi, her 2004 opponent, again in this election…and you might expect the race would be just as tough for her. Rossi, and many others, certainly felt that was the case on August 14th.

It wasn’t. At the moment, with more than 98% of the primary vote counted, she’s leading by a 49% to 45% margin…suggesting the Don’t Know Dino ads are hitting the mark…and that the “fact check” response from the Rossi campaign is not.

Rossi issued this statement:

“We had a strong showing in the primary tonight. Current returns show we have received over 45 percent of the vote. To put these results into perspective, during the 2004 campaign I received just 34 percent of the vote in the primary and the General Election turned out to be significantly closer.”

Rossi’s name recognition will not be growing in this campaign, as it did during the ’04 cycle, and as a result he may have trouble growing his vote. Let me tell you, if your friendly fake consultant was working for Rossi, there’s a good chance that Prilosec might become part of the daily armor.

This is not the worst news for Republican strategists.

The worst news is found in the statewide “State Executive” positions that are partisan elected offices. For example…

…consider the State Treasurer position. “Treasurer-For-Life” Mike Murphy is not running for re-election, pitting two “zero name recognition” candidates against each other…and right now the Democrat, Jim McIntire, is losing by 29,000 out of 772,000 votes (44% to 40%), with only 24% of the voters showing up.

To make things a bit worse, the State’s three largest counties, with nearly 50% of the electorate between them (and counties that are often fertile ground for Democrats) are voting at less than the statewide average, suggesting turnout in Democratic-trending counties will be higher in November than it was today…especially with Obama at the top of the ticket.

…more downticket trouble for the Rs can be found in the Commissioner of Public Lands election, where Peter Goldmark (who might have been director of the State’s Department of Agriculture but still has no Statewide name recognition…) is running pretty much neck-and-neck with longtime incumbent Doug Sutherland, 50% to 49%.

Just so you know, Eastern Washington is fire engine red, electorally…and Western Washington’s more rural counties often provide the swing vote…which makes Goldmark’s success more surprising, as he’s an Eastern Washington Democrat.

…Democrat Jason Osgood, who previously worked with Washington Citizens for Fair Elections, pulled 33% of the vote in a Secretary of State race against the Republican incumbent Sam Reed, despite having no Statewide presence of any kind…or any name recognition, for that matter.

Of the nine Congressional Districts, the primary results suggest two safe Republican seats (WA-04 and WA-05), one uncertain race (the aforementioned WA-08), and at least six Democrats (WA-All The Others).

If Obama can raise turnout by an extra 3,000 new voters in WA-08, the resulting Delegation would be 7-2 Democratic…which would represent raising turnout by only 1% of the currently registered voters in that District.

…Spokane has two zero name recognition State Legislative candidates running for an empty seat, and the Democrat and Republican are running nearly even in a part of the State that should offer natural advantages to the Republican.

John Ahern, a 4-term Republican State Representative, also from Spokane, is also running in a near dead heat (50%-49%) against John Driscoll, who would be the first Democrat elected to this position since 1938.

In a Benton County race with no incumbent running (Conan O’Brien in the sun red, demographically), Carol Moser is stomping the Republican 40% to 18% in her Legislative race.

Incumbent Republican Jim Dunn is losing badly to Democrat Tim Probst (49% to 18%) in a Vancouver Legislative race that also would seem to favor Republicans.

I could go on and on, but this gives us a few general trends to examine:

Without Obama at the top of the ticket, Democrats are either staying close in Statewide elections—with no “name recognition” candidates—or grabbing the apparent lead in previously reliable Republican Legislative strongholds. In my quick search of the State Legislative results I could not find an incumbent Democrat who has fewer votes than a Republican challenger.

If Obama can bring enough new voters to the polls to raise turnout 1% WA-08 likely goes to Darcy Burner.

And finally, a Governor’s race that should have been much closer…ain’t.

There are several states (North Carolina, Virginia, Colorado…maybe even Indiana) where this trend could be a harbinger of very good things to come--and as I said at the top, outside of Maggie Valley and Bessemer Bend, the Republicans—especially downticket Republicans--might just be in a lot more trouble than they ever imagined.

On How The State Gave Me MRSA (Part II), Or, What, Me Worry?

We began a story this week that describes how poor clinical practice in a State-operated healthcare facility holds the potential to cause great injury and death to those vulnerable adults living in the facility, the workers charged with their care—and to members of the public who have never even set foot in the facility.

You might say it’s a bit of a “canary in a coal mine” situation, with pandemic flu hovering on the horizon and all. You also might say that since MRSA kills as many people in the US every year as six 9/11s the pandemic is already here.

So in today’s second installment, we’ll look a bit further: into facility management that now contends they are not required to follow guidelines that the Centers for Disease Control says “apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered”…into the concept that where your care is delivered should determine what protective equipment workers might require…and into a “magic ambulance” that apparently has the power to make you hazardous to some people--but not to others.

And just to add a twist--we have a Governor seeking re-election whom we hope to convince to put on her “superhero cape” by publicly coming to the rescue and making infectious disease control in all State facilities an important priority of her next Administration.

Because after all, do we really need six more avoidable 9/11s this year? And next year? And the year after that?

For those just coming to the story, let’s recap where we’ve been so far:

The Girlfriend (of over 26 years!), a nurse working for the State of Washington in one of the five “Residential Habilitation Centers” serving developmentally delayed individuals, recently brought home MRSA, which we now share—in our eyes.

MRSA, as you’ll recall, is one group among the variety of drug resistant organisms with which today’s medicine contends—drug resistant meaning that some, or virtually all, of today’s antibiotics will not “cure” the infection. There are several strains of MRSA, each with different drug-resistance characteristics. All this is discussed in more detail in the first installment of our adventure.

One reason this occurred is because the facility is lacking the most basic equipment required to prevent the spread of infection…and I’m not talking high-tech equipment here, either. For example, the facility does not see the need for sufficient eye protection for its medical care providers; this despite the fact that numerous procedures performed by each nurse daily (as well as other medical staff) “are likely to generate splashes or sprays of blood, body fluids, secretions and excretions” to quote again from the CDC.

IV. Standard Precautions
Assume that every person is potentially infected or colonized with an organism that could be transmitted in the healthcare setting and apply the following infection control practices during the delivery of health care.

--excerpted from the CDCs “Guidelines for Isolation Precautions in Hospitals”

There is also a failure of perception among management, who maintain that the community of clients residing at the facility are somehow epidemiologically “safe”…meaning the current facility policy is that the Standard Precautions which apply to everyone else practicing healthcare, everywhere else in the world (including Tamil, India) do not apply when working with this client population.

The likely outcome is that MRSA will spread among the vulnerable adults—and the staff--that this facility (and the other four like it) serves, and considering that 1 in 5 who get MRSA die as a result of the infection…well, 1 in 5 are probably going to die from an avoidable cause.

As we said before, it’s estimated that about 18,000 who were exposed to MRSA in 2005 died from the infection…which is about 20% of the annual total of 100,000 “avoidable” hospital deaths in the US.

Presumably there will be other members of the community beyond the facility affected as well…just like me, and just like the friends and relatives of some of you who have commented on the first story.

The Girlfriend and I are in the middle of an irritating series of adaptations designed to make it less likely that the MRSA bacteria will either re-infect us, or remain present in a dormant, or “colonized” state, ready to reappear without warning at some future time.

The most annoying adaptation?
I’ve just finished putting antibacterial ointment up my nose, as I do twice a day. To recreate the sensation, stick a Vaseline-covered Q-tip up each nostril. (Warning: stunt nose used for demonstration purposes only. Do not try this at home. Trust me, it sucks.)

Of course, the surgical soap we use constantly is a bit of a pain as well…

But enough about me.

The more important question is…how did the facility react when presented with the news that they have an infection control problem?

Well, that’s where it gets weird.

There seems to be a feeling that it is the type of facility that determines what sort of precautions are applied, rather than making a decision about the correct choice of protective equipment based on the procedure being performed.

A phone call to the Washington State Department of Health confirms this line of thinking goes farther than just this facility—the individual to whom I spoke (I did not identify myself as gathering news, so I’ll leave their name out of the discussion) answered my question about whether Standard Precautions should be applied at all healthcare facilities by telling me that it might depend on whether a nursing home is a healthcare facility…as opposed to a hospital.

Further discussion brought us to a point where we decided a better answer might be found by consulting with others at the Department of Health—and I’m awaiting that person’s return call as of this writing. (Please note that it is the weekend as I write, so the fact that no return call has yet occurred should not be construed as somehow sinister.)

If this line of thought is carried to its logical conclusion, here’s what we get:

Client X is an individual who is fed through a “G tube” (a tube that is surgically implanted and delivers liquid food directly into the individual’s stomach) in a nursing home which we’ll call “Site R”.

In that environment, according to current policy at our imaginary “Site R”, the only required protective gear while working with the tubes is gloves and a mask. What kind of work? A nurse might plug in a feeding or medicine tube, inject medicine into a port using a syringe, or “flush” a plugged food tube to allow it to again deliver food. Any of these interactions can easily cause the splashes or sprays of body fluids that spread disease.

Now suppose Client X were to encounter a medical difficulty requiring a move to the hospital. According to the CDC guidelines (and the “facility-based “logic we’ve seen so far) that same G tube work would require gloves, a non-permeable gown (no liquid getting through), a face mask, and eye and mucous membrane protection for the worker (the clear plastic “face shields” you see in use, or something similar).

Meaning that either something happened in the “magic ambulance” on the way to the hospital that made Client X more hazardous than he was before…or “facility based” logic makes no sense.

My guess: the ambulance ain’t that magic.

In this conversation we’re talking about MRSA…but imagine if Client X has undiagnosed Hepatitis C…or AIDS?

Is the nursing home worker less entitled to protection than the hospital worker?
Is it sound public policy that some healthcare workers are allowed to spread MRSA, hepatitis, HIV, and who knows what else…but not hospital workers?

As we previously mentioned, what comes home from work is going to get into the community—but did you know drug resistant bacteria are also now appearing in other species besides humans?

Try to imagine avian flu and MRSA in one superbug and you might understand why infection control is so, so, so critical.

If you need a further demonstration, the next time you’re walking down the street, try this exercise: count the people you see, from one to dead.

One to dead, you say?
How’s that work?

It works like this: MRSA kills 1 in 5…so when you see people during the day, all you have to do is count “1, 2, 3, 4…dead”. Repeat the process a few times, and you begin to get an idea of the reality of a pandemic.

We’ve covered a lot of ground today, so let’s wrap it up:

It is beginning to appear that many in the infection control community believe the location where healthcare is delivered is how you decide what protection the worker needs.

Others would tell you that disease is disease is disease…and if you plan on doing open heart surgery, it shouldn’t matter if you do it in a hospital, or a makeshift clinic in the real “Site R”…or in a bullring, for that matter…you still need to take the same precautions, every single time, if you want to prevent 18,000 or so deaths next year.

In my State of Washington the Governor is running for re-election…and she only won by 8 votes last time…so I’m trying to encourage folks to send her a note expressing your feelings about all of this here. I hope to encourage her to turn this to her advantage and make it an “issue that matters”—and Governor Gregoire, as I’ve said before, it’s always good to save the lives of registered voters in an election year.

It’s your lives and mine that are at stake here; so let’s put some pressure on and see if we can’t cut six 9/11s down to five next year.

If nothing else, you’ll have earned the appreciation of your grateful antibodies.

Author’s Note: We aren’t done yet. In part 3 we’ll discuss the response from the Health Department, we’ll be calling new experts…and we’ll be discussing the history of intimidation that the employer involved here is trying to overcome.

Stay tuned.