Monday Morning Thoughts: State of the City Needs to Be a Call to Action

City Hall

The city of Davis suffers from two related problems.  One is the problem of stats and one is the problem of paralysis.  They are related to be sure, but the challenge for the mayor, and in fact the entirety of city staff and the mayor’s colleagues on council, is how to get past the problem of stats and implement a workable plan of action.

The problem of stats is one that is well understood but only in certain segments of the community.  That represents a challenge in and of itself.  The Vanguard readership is well aware of these problems.  On the fiscal side, there are hundreds of millions, both in infrastructure shortfalls and unfunded liabilities.  On the housing side, we have a shortage of student housing and workforce housing.

While the engaged public is well aware of these growing crises, the average citizen appears to be largely oblivious.

Our political leaderships suffers from a Catch-22 here.  Assuming political agreement on these problems – which is itself questionable, without public awareness of the depths of the challenges, there can be no action.

Mayor Robb Davis can lay out these problems until he’s blue in the face tomorrow, but somehow he needs to get past articulating the problems and into the solutions.  But the public is not going to be engaged on the solutions until they understand the problem.

In our view, the mayor has already made a powerful case for describing these problems.

On the unfunded liability front, as the mayor told the Vanguard in December, “The most updated analysis by the City-contracted actuary indicates that even if employee salaries do not grow at all over the next five years, our required pension contributions across all employee groups (police, fire and miscellaneous) will grow by over $4.8 million per year compared to today.”

He later added, “In fact, it is not clear to me at this point how we are going to cover everything over the next five years, given that we are not even covering critical infrastructure backlogs now.”

He concluded, “I believe we must discuss cost containment—broadly writ—and put a revenue measure before the population in the next two years.”

But to do that he has to convince his colleagues and the public that there is a crisis.

The council signed their name in an LRDP response letter to the university articulating the need for housing.  The city wrote that it must “continue to pursue consideration of all infill and apartment housing proposals within the City (with emphasis on student oriented housing proposals within 2 miles of campus in order to facilitate ease of access).”

But if we simply stop with the articulation of problems, we cannot get to action.  That becomes the tricky part, because even with an acceptance of the problem, there is no guarantee we will agree, let alone achieve a solution.

Here are some things that the city can do to address these problems:

  1. Cost Containment Strategy – the problem is going to keep getting worse unless the city figures out a way to contain increased costs. For the sake of simplicity we can talk in terms of three costs: (1) the cost of continuing to provide services, which is mostly a cost of labor and compensation for city employees; (2) the cost of providing current obligations for retirement benefits – pensions and retiree health care; (3) the cost of maintaining current levels of infrastructure.
  2. Revenue enhancement measures – these could include (1) increased fees for services; (2) hotels; (3) economic development; (4) increased retail supply; (5) revenue enhancement measures.
  3. Housing – (1) collaboration with the university to better provide student housing both on campus and on infill sites in the city; (2) redevelopment of existing sites with the prospect for increased numbers of units per acre – i.e. densification; (3) exploration of peripheral sites potentially suitable for housing.

The problem that we face is that all of these potential solutions include trade-offs.  The city has attempted to contain costs in the past.  This has led to pushback from employee groups, complaints about morale issues, and, last year, a council vote to slightly increase compensation for five employee groups.

The reality that we face is that, while we have dropped nearly one-quarter of our employees in the city, the costs over the last decade have continued to climb even as wages have largely been frozen.

We have attempted various revenue measures.  The council has now approved two hotels, and is considering a third in January.  However, one of the hotels – a hotel conference center counted on to generate additional demand – was locked into litigation and may not occur.  A third hotel is the subject of pushback and opposition from its neighbors.

The city’s plan for innovation parks has stalled.  The city council was able to pass a sales tax measure in June 2014, but has failed to put a revenue on the ballot in the fall of 2014, as well as either election in 2016.

Finally, while the city has pushed for more housing on campus, Nishi was narrowly rejected by the voters, and neighbors are strongly in opposition to other proposed housing projects.

Overall, the city suffers from paralysis, as we continue to see litigation measures used to stop further development.

The problems are easy enough to articulate.  The action plan is what is needed.

What we need on Tuesday from the city leadership is a unified call to action.  The first step is going to have to be a robust and intense educational campaign to the community.  Back in 2014, as Steve Pinkerton was leaving the city, he engaged civic groups on the issue of the budget.

What we need is a sustained media campaign where the council articulates the current level of challenges to the public.  The leadership needs to reach out to PTAs, service groups, non-profits, and even faith-based organizations to reach a far broader audience than the normal engaged members of the community.

The message should be simple, it should be fact-based, and it should be framed in terms of choices rather than ultimatums.  Does the public really understand the depths of the problems?  We need to articulate them.

More importantly, we need to do so in a series of choices.  On the revenue front, it means that we have three basic choices – we can cut services, we can pass additional taxes, or we can grow our revenue base through economic development.  Or we can do all three.  While we have choices in the type of taxes, the services we cut, or the way we do the economic development – at the end of the day, each choice has strengths and painful decisions.

The key here is that we need a call to action and but, in order to act, we must inform and that is the biggest challenge ahead for our community.

—David M. Greenwald reporting

About The Author

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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40 thoughts on “Monday Morning Thoughts: State of the City Needs to Be a Call to Action”

  1. Tia Will

    But to do that he has to convince his colleagues and the public that there is a crisis.”

    It will come as no surprise that I do not agree with this assessment. “Crisis” will indeed cause some to come running to help. But it will drive many more into apathy or despair or inaction since they perceive “crisis” as too threatening, or even worse as a signal that nothing can be done. One poster on a recent article said ( paraphrased) “Since it is already too late, why not just keep the money”. A fine summary of the defeatist attitude that can be sparked by the perception of “crisis”.

    What I would like to see from our city leaders is :

    1. a clear articulation of the problem, which I believe that the Mayor has done.

    2. an equally clear summary of the options including decrease in services, increase in taxes, and three increase in revenue base through business development. I would like to see this not in general terms, but in facts and yes, dare I say it , numbers. Something as stark as, if we decrease the number of street cleaners by “a”with a savings of “b”dollars ” you will have your trash picked up every other week rather than weekly. If we approve a new parcel tax of “x”, we will be able to maintain “y” benefit for 5 years.

    3. An end to” we don’t think there will be enough support, so we just won’t put it forward.” I believe that with a clear articulation of the issues and a clear explanation of what each change will mean in actual dollars ( yes, I know it will be an estimate) that the voters will make decisions that they perceive as in their best interest. Whether or not any particular individual agrees with that decision is beside the point. This is the heart of the democratic process and I believe that we should be allowing  all the citizens, to the degree that they choose to become involved, decide the future of the city rather than reserving that right of decision making to select groups of citizens such as developers, investors, anti development activists and lawyers.

     

    1. David Greenwald Post author

      Tia: We are at a point of insolvency – we don’t have the resources to meet our obligations – why don’t you see that as a pending crisis?

      1. Tia Will

        David

        First, that was a neat, but telling bit of journalistic sleight of hand. Your article states we are in “crisis”. Your reply post of 11:26 uses the term “pending crisis”. The addition of the word “pending” moves the goal posts, but I will address the issue as though “pending crisis” and “crisis” were synonymous.

        I thought that I had explained part of my resistance to the use of the word “crisis” previously. To clarify, I will try to frame it in two brief points.

        1. “Crisis” for a surgeon means life or death. Act effectively now, or lose your patient. You have been using the word “crisis” for at least the past three years. By my definition this does not meet my criteria for “crisis”. Pending “crisis”, yes……”crisis”, not yet.

        2. To reiterate today’s point. “Crisis” is as likely to immobilize as it is to invigorate. Many people will interpret “crisis” to mean that there is nothing that can be done, so “why bother ?”

        We have seen this in the previous postings of Frankly or his doppelgänger when he wrote about guns that they are ubiquitous so it is too late for gun control, casually lumping sensible regulations that might serve to decrease gun injuries in with “weapons bans” and the “government coming to take away your guns”. Or as another example, his statements about climate control that imply that there is nothing to be done except “adapt” completely ignoring the fact that it is possible for humans to take actions that improve local if not global environmental conditions.

        “Crisis” is too often seen as inevitable and therefore not worth addressing.

        We need to address our serious economic issues, not run from them or turn away from them in despair over their magnitude.

        1. Howard P

          Working on a “crisis” line, I think most intelligent folk see “crisis” as both danger and opportunity… if what you opine as a reaction to “crisis” was/is true, we would have been annihilated in every military action, including WWII, and that just didn’t happen.

          Not to mention economic and public health crisises…

        2. John Hobbs

          Would Dr. Will leave a stage 1 carcinoma untreated until it was stage 2, 3 or 4? The neglect of infrastructure, the loss of experienced and knowledgeable personnel, the unmet demands for housing and graying of the population would seem to leave Davis in a grave and darkening situation.

  2. Alan Pryor

    Cost Containment Strategy – the problem is going to keep getting worse unless the city figures out a way to contain increased costs. For the sake of simplicity we can talk in terms of three costs: (1) the cost of continuing to provide services, which is mostly a cost of labor and compensation for city employees; (2) the cost of providing current obligations for retirement benefits – pensions and retiree health care; (3) the cost of maintaining current levels of infrastructure

    According to data from Transparent California (http://transparentcalifornia.com/salaries/2015/davis/), the total compensation paid to the slightly more than 300 full-time City of Davis employees is almost $42,000,000. The median annual compensation for is almost $115,000 per year ($85,000 in salary and $30,000 in benefits). The average annual compensation is almost $120,000 per year ($90,000 in salary and $30,000 in benefits). Meanwhile, the same source reported that the median earnings for full-time, year-round private workers withing a 5 mile radius of Davis is just under $55,000.

    These numbers speak for themselves. I would be interested in hearing Mayor Davis speak in detail as to the strategy how the City is actually going to control and reduce these employee and other costs instead of just repeating over and over that the City is working really, really hard to contain costs.

      1. Howard P

        Let’s be clear… which #’s, David?  Davis?  UCD?  Private sector? Do the public sector #’s include PERS/UC pension contributions and health benefits?  Do the private sector #’s (as “quoted” by Alan P) include SS & Medicare?  What about DJUSD?

        Just looking for facts… Alan P’s private #’s have probably not been updated since the 2010 Census, considering that is the source that ‘Transparent California” (a mis-nomer for sure, as they are based in NV and don’t report on NV salaries nor pensions) #’s cited.

        Facts would be useful… I’m seeing a lot of apparent “cherry-picking”…

        Some UC employees have seen 20% total comp increases each year from 2013 to 2015…. [same source as Alan P’s]

    1. Robb Davis

      Happy New Year everyone.

      …instead of just repeating over and over that the City is working really, really hard to contain costs.”

      Show me where I have repeated this over and over Alan.  We have done very little to control costs, that is why I have called for the articulation of a comprehensive cost containment strategy.  It is in our goals for the coming two years but we will work on it sooner.  The only “cost containment” that has really happened in the past decade is NOT funding critical infrastructure–which looks like savings in the short term but leaves to higher long-term costs–and non-strategically reducing staff (attrition).  I have repeated these realities over and over and have laid out the outline of a cost containment plan.  I will push that further in 2017.

      And despite what David wrote above we HAVE started working on the revenue side.  We are just 2.5 years into a sales tax increase, have increased fees across the board (see the Enterprise article by Felicia Alvarez in Sunday’s paper to see how that is working out), have increased water, sanitation and solid waste rates over the past 2 years and will be taking up storm water drainage fees and solid waste fees this year with an update on water rates to follow.  Two weeks ago after all the reporters went home  we agreed to bring forward a discussion of further tax measures during the first quarter of calendar year 2017. It seems people missed that point.

      In the meantime we have moved forward with two innovation centers–both of which decided not to go forward, and voted 5-0 to send Nishi with a commercial component on the ballot, and approved final changes to the Cannery commercial project so it could move forward.

      I will also note that I have not voted to date for any salary increases and regret that I cannot change the reality of our statewide public pension system.

      1. Alan Miller

        will be taking up storm water drainage fees and solid waste fees this year with an update on water rates to follow.

        Oh good.  Higher city water rates on top of the tripling.  No problem there.

        1. Howard P

          Interesting point… tripling SW drainage and solid waste fees would be less impact (for most, if not all) than a parcel tax that would be meaningful… AND the two cited are parcel based “fees”… so either those functions are currently being subsidized by the GF (and that should, in my view, be corrected), or they become taxes… subject to a vote.

          Still, an interesting point…

  3. Tia Will

    David

    I know that you were an advocate of the “innovation parks”.  Let’s play “mayor” for the moment and lay out exactly what steps you would like to see taken now. I feel free to do so since I am completely unencumbered by any realistic knowledge of city planning.

    1. I would propose a community forum for deciding which services the community would be willing to cut back on after a full monetary disclosure of just how much each decrease in services would save.

    2. I would propose a parcel tax in the very near future.

    3. I would propose a sugary beverage tax, not because I believe it would generate huge amounts of money, but because it would generate some money while preventing future expenditures on completely preventable health problems.

    4. I would put forward a proposal for paid parking.

    5. I would encourage a retry at Nishi after appropriate air quality and epidemiology  studies that in my opinion should have been part of the initial proposal.

    6. I would encourage a re proposal of one or more innovation parks with/or without a housing component to allow the developers and citizens a wider choice rather than being hit with the “bait and switch” story line that pervaded previous discussions.

    Your turn.

     

    1. David Greenwald Post author

      Tia – all those seem fine with me.  I don’t think paid parking is going to generate a lot of revenue.  I strongly support a sugar tax but would prefer that to go to children’s health/ education programs.  The others look good to me.

    2. Howard P

      1.   And what services should be set aside to allow staff to hold such forums?  Should we have a pre-forum on that?

      2.  OK… what rate?  Given the recent DJUSD vote, am thinking that pond is pretty dry… pretty much “fished out”.

      3.  Good… locals pay a tax that might incrementally solve a state-wide/national issue, with no savings for the City… am thinking a cost/benefit mismatch.

      4.  OK, if the revenues exceed the costs of equipment, maintenance/operation and enforcement… but if the revenues exceed those costs, it is not a fee, but a tax… the rules are different for doing that.

      5.  No opinion, too vague.

      6.  See #5.

      Your turn…

      1. Tia Will

        Howard

        I thought that I had made it clear that what I have are ideas for consideration unfettered by any specific expertise in city planning or management. What I had actually hoped is that someone with more knowledge and or experience would add their thoughts. However, I am game to play.

        1. None. I can envision informing the community of an upcoming process from the dais and through media outlets. It could come in the form of a solicitation for ideas. A call for proposals could also be doled out to members of the city council and/or the commissions asking for their own ideas or to sort through the ideas generated by the citizenry thus avoiding taking paid staff away from other duties. When a significant number of ideas ( as determined by our council members) were accumulated, a forum could be announced with or without a formal mediator, or with a council member or perhaps even David serving as moderator.

        2. I have no idea of the “right amount”. But I believe that there would be more resistance to increased taxes if a vague statement of need is advanced ( such as “it’s for the children”) as opposed to if there is a very clear exposition of what the need is and how the increased revenue will actually be used . What I am calling for is absolute transparency.

        3. Not sure what your number 3 even means or how you arrived at the inference that this would occur.

        4. So someone would need to do some pretty accurate estimation. I  see that as a challenge, not an impossibility.

        5. I don’t see what is vague about the proposal of a project for Nishi. We already had one that narrowly lost. I think that it might have passed had more comprehensive studies been done in advance. I don’t see allowing the past to completely define the future as an effective strategy.

        6. We have need for both workforce housing and for innovative businesses. I see nothing any more “vague” about suggesting that they might be beneficially combined than I see it as “vague” for a patient to come in and suggest that she needs a hysterectomy even though I am aware that she does not know the steps involved in the procedure. I would certainly entertain her idea as a possibility even though she cannot recite the procedure nor begin to estimate its cost.

  4. ryankelly

    It has been mention often that, unless we did something to generate revenue, we would have to be willing to pay taxes and fees to offset our unwillingness to create space for expansion.  I read online today that fees are increasing substantially for youth and adult sports organizations to help pay for the City’s administrative costs and upkeep of sports facilities.  The cost of living in Davis is going up, making Davis more and more divided by economic class.  Yet people are suggesting that we pay our City staff a wage that makes it difficult to live in the town that they serve.   Is this really maintaining the Davis that people imagine that Davis is?  We have failed in providing and caring for the parks, facilities, and services that really define Davis and are making them less and less accessible for a middle class population.  We have failed to provide housing for employees and customers of the largest employer in town.  We seem to be turning into a senior, college students and an upper middle class city.  We build token low income housing, but, in reality, these people are not really desired.  We strive to separate ourselves from these people in our housing, in our schools, in our recreation.

    1. Alan Miller

      And “affordable” housing, especially in a fixed city footprint, leaves out the lower and middle middle class, the very people we should want to live here.

  5. Tia Will

    David

    My view is we don’t have enough money to pay for everything.  So at what point does that mean death?

    And my view is that not having enough money to pay for everything does not mean that we do not have money to spend on essentials. In the medical analogy, we might be able to get by with an amputation or organ donation to stave off death while we stabilize the patient.  If we only talk about “impending death” we may be neglecting uncomfortable but eventually life saving steps that we would otherwise miss or discount.

    1. Howard P

      Well, in the medical world, where death is impending, and life-saving measures will be of excessive cost and still might not cure, but only prolong the inevitable, the right choice is hospice and/or withholding of treatment, and pain management.

      I do not believe the Municipal Corporation known as Davis is facing “death”… really think David’s allusion to that is VERY weird.

    2. David Greenwald Post author

      Road are essentials. Public works are essentials. Infrastructure is essential. I think you and I would agree that parks and open space are as well. So?

      1. Tia Will

        Howard

        I do not believe the Municipal Corporation known as Davis is facing “death”… really think David’s allusion to that is VERY weird.”

        In fairness to David, it was me that introduced the analogy of “death” in the context of “crisis”. I think that he may be holding “bankruptcy” as the measure of “death” for the city, but am not sure as he used the word “insolvency”.

      2. Tia Will

        David

        Road are essentials. Public works are essentials. Infrastructure is essential. I think you and I would agree that parks and open space are as well. So?”

        These are “essentials” only by our current declaration. I grew up at the intersection of two unpaved roads. Clearly paved roads are not an essential for life. We had no trash collection. We stored it until my Dad decided it was time to go to the dump. My point is not to advocate moving to a more rural lifestyle, but rather to point out that there are many ways of societal organization. We need to be willing to pay for the ones we have chosen.

        For the sake of clarity, rather than speaking in generalities, I think it might help if we knew in actual dollars just how much each of what we consider “essentials” actually costs us. I used the example previously of our expectation that our trash and recycling will be picked up once weekly. But how was that determination of necessity made ?  Might we not get by equally as well if it were picked up every other week ? My partner and I do not generate enough for weekly pick up to be essential. Might we not choose a longer time interval if we could see the actual cost to us of what we currently consider a “necessary service” ?

        David and our long time readers are well aware that I believe that we should be willing to pay for those items that we choose to have. This should mean that part of the responsibility of our public leaders should be to spell out precisely how much each service ( not just water and trash) actually costs and how that cost might be reduced or added to according to our priorities.

         

        1. Howard P

          Let’s look at one of your points… refuse collection…

          Once a week keeps “garbage” (now also “organics”) less likely to go “unsanitary” [particularly in the summer]… am pretty sure a doctor would not recommend going from a daily changing of bandages on a wound to once every other day, to save money.  Will have to say, like you, our family of three only 1/3 fills the smaller DWR containers with ‘garbage’, but with the new rules on garden waste pickup, we often fill the ‘organics’ one, with clippings and leaves.

          The other implication is that  to go to once every two weeks, the business model would be to halve the collection staff @ DWR, or cut everyone back to half-time.  Fine, if that’s what you want to do.  But that would only mean a reduction of maybe 40% in the solid waste portion of your utility bill… would not loosen up any GF money.

          Likewise water… since that is an “enterprise fund”… not a GF fund…

          Police and Fire are GF funded… and very heavily personnel costs… not sure I’d want to reduce levels of service on those…

          Now, the “cost” of the same levels of services, and being aware of them, is reasonable… as would be knowing what the “drivers” of those costs are… it is generally personnel costs for municipal services… you can either reduce compensation, or expect higher productivity from each employee to achieve the same level of service.

          As Robb points out, the ‘attrition’ the City has had wasn’t ‘strategic’… if 5 engineers leave the City, you can’t expect 5 accountants to fill the gap, for example…

  6. Roberta Millstein

    How much of this is about CalPERS?  And if the answer is “quite a bit,” then why isn’t the State of California pursuing a more global solution rather than making every city struggle with the same problem?

  7. Tia Will

    Once a week keeps “garbage” (now also “organics”) less likely to go “unsanitary” [particularly in the summer]… am pretty sure a doctor would not recommend going from a daily changing of bandages on a wound to once every other day, to save money.”

    Thus illustrating the “need to know” what the actual outcome would be. It might surprise you that it was previously common practice to leave a bandage on until the second day post operatively unless the bandage had soaked through with blood or other secretions. More current practice is to remove on the day after surgery and then assess whether a dressing of any kind is necessary or not. I am not sure what “unsanitary” in terms of garbage collection really means. Does it just refer to objectionable smells, does it refer to attraction of vermin, in which case one week might be too long in some cases.  I think that we are far too invested in what we see as the norm, as opposed to what is actually necessary for our stated goals. Over the New Year’s weekend I had a conversation that encompassed the benefits of an extremely regulated and controlled society as found in Singapore as presented by one of the company as opposed to a much more free, and unregulated, but dirty community such as found in San Francisco.

    However, as made clear by Mayor Davis’ post, those of us who cannot stay awake through the entire city council meeting will frequently miss out on items that are mentioned from the dais and thus be unaware of many aspects of city functioning despite our best efforts to keep up. Thanks Robb.

    1. Howard P

      OK… after a surgery, I was told to leave the bandages in place for a week, then irrigate the surgical wound, and rebandage daily… yes, a Kaiser surgeon.

      Does it just refer to objectionable smells, does it refer to attraction of vermin, in which case one week might be too long in some cases.

      The short answer is “yes”.   Both.  In the case of dropped fruit, high on vermin and insects, such as fruit flies… and guess it depends how you define “vermin”… some think rats are cute and should be protected, nurtured.  Usually, a week, with a closed container, is sufficient to keep vermin and inspects “at bay”… two weeks not so much…

      As to objectionable smells… that is in the nose of the beholder… you are of course aware that some folk have “smell allergies” and companies have banned perfumes, etc. to accommodate them… protecting them from colognes/perfumes worn by co-workers (particularly in Marin Co.).

      And, as usual, you cherry-picked a fraction of my post, and avoided/ignored the rest.  Well done…

  8. Tia Will

    OK… after a surgery, I was told to leave the bandages in place for a week, then irrigate the surgical wound, and rebandage daily… yes, a Kaiser surgeon.”

    That may or may not have been reasonable advice depending on the type of surgery and the time at which the advice was given. When patient’s tell me that they were told one thing a number of years ago and are hearing something different today, my first thought is not that one of the doctors is necessarily a bad doctor, but may have been giving the best advice of their specialty at the time. My advice to patients is often not the same as it would have been 20 years ago. I celebrate that as progress.

    Not to be objectionable myself, but I believe that your preference for one week over two  garbage pick up may be more a matter of habituation than to factual evidence, but I am open to anything you may have to support your case.

    you are of course aware that some folk have “smell allergies” and companies have banned perfumes,”

    I am all too aware of this since I cannot walk past a perfume or cosmetics counter without being severely affected and have had to walk out on more than one interaction in an enclosed space with someone wearing a strong scent because of progressive sneezing, watering eyes, and ultimately constriction of my throat.

    you cherry-picked a fraction of my post, and avoided/ignored the rest.  Well done…”

    Do you feel an obligation to respond to everything that another poster has written ? Do you feel that others should have to address every issue you raise ?

    I consider posting on the Vanguard a conversation. Of course I choose to post in response to those items that strike me the most. I do not think that is unusual in posting. If you want my thoughts about other aspects of your post, a more effective strategy might be to ask rather than to make a snide swipe with “well done”.

    1. Howard P

      The surgery was a year ago… the surgeon was/is highly respected… complicated hand surgery…

      Tried to remove the “snide”, but missed it by a few seconds… I realized it was wrong, but was seconds too late to remove… my sincere apology for that… I was “in the moment” when I posted, but regretted it.  I honestly thought I had ‘beat the clock’, but failed… by about 3 seconds… best wishes in this new year…

      1. Tia Will

        Howard

        No problem. My send finger is sometimes faster than my self regulatory mechanisms.

        I am sorry that you did not get that 100% result you were doubtless hoping for. Living with suboptimal results is something that every surgeon has to come to terms with. Intellectually, you may know that you did your very best, but not achieving the best outcome for your patients is very hard to deal with.

        Just thought I would also let you know that I will be on the coast for the next couple of weeks…..so no intent to ignore, but may or may not be commenting either partially or fully at any given point in time. Wish you and all the rest of our Vanguarders the best this new year.

  9. Tia Will

    John Hobbs

    Would Dr. Will leave a stage 1 carcinoma untreated until it was stage 2, 3 or 4?”

    That is exactly what I am arguing against. I firmly believe in primary prevention and dealing with conditions at the earliest stage possible long before they are appearing in “crisis” form. “Crisis” often does mean that it is too late.  I prefer the term “serious problem” which does not convey the same sense of “the sky is falling”. A “serious problem” conveys a need for prompt analysis and problem solving. A “crisis” for many means that there is nothing that they can do, so why should they worry about it ?  A “crisis” which is prolonged, as in David’s designation over at least a three year period, may become stale hyperbole to some and therefore also not worth addressing.

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