Fracking: At our peril

Hydraulic fracturing, which involves injecting millions of gallons of chemical-laden water at high pressure into a well drilled both vertically and horizontally into a rock formation deep within the earth to extract natural gas, is rapidly spreading. There are approximately 500,000 natural gas wells in 34 states, and the industry projects that 19,000 new wells will be drilled this year. Fracking is one of the significant recent technologies through which this nation hopes to attain energy independence.

There are real problems, however. Fumes from drilling rigs and wastewater pits in Colorado and Pennsylvania have caused a variety of alarming symptoms in residents, forcing them from their homes. Spilled drilling fluid containing antifreeze has killed pets and livestock. After fracking has occurred, drinking-water wells have been tainted with barium, arsenic and other toxins. Leakages from large pits, resulting in dangerous chemicals becoming airborne, have poisoned homeowners. Soil at a wastewater impoundment that blew up and burned in Avella, Pennsylvania was found to have dangerously high levels of arsenic and tetrachloroethene, a carcinogen and central-nervous-system suppressor.

Because its end product is a relatively clean fossil fuel, fracking has been touted by industry and government as helping the U.S. achieve energy independence while combating climate change. However, the process itself is so energy-consumptive that some scientists believe it produces more greenhouse gases than the burning of coal.

New York State is one of two states — the other is New Jersey — that has imposed a temporary ban on fracking. The New York State Department of Environmental Conservation (DEC) is in the processing of completing its review of a supplemental environmental impact statement. When it is approved, governor Andrew Cuomo is expected to lift the moratorium.

The DEC must first address the more than 66,000 comments submitted last year in response to the second version of its environmental impact statement and proposed regulations, which DEC commissioner Joe Martens characterized as “a very long and tedious process” at an Albany conference two weeks ago. He said he hoped to complete the process by summer.

An industry publication reported that Martens recently met with Norwegian company Norsk Energy, which has leased 180,000 acres in New York and is particularly keen on Utica Shale, a rock formation underlying the Marcellus that extends into Ulster County. The company, which began applying for drilling permits last summer, was “encouraged by the meeting.” It noted that the commissioner had appeared to backtrack from previous comments that New York would wait until the EPA completes its study of hydraulic fracturing before moving ahead.

Numerous health professionals and environmental groups who found the environmental impact statement’s assessment of fracking’s health risks lacking had requested an independent study. But the New York State Assembly’s proposal for a $100,000 study of fracking’s adverse health impacts was dropped during last month’s budget negotiations.

Fracking injects hundreds of toxic chemicals into the ground, disposes of thousands or millions of gallons of chemical-laden wastewater per well (which may be further contaminated by radionuclides, or radioactive particles, and other harmful substances from deep within the earth), disposes of the even more toxic “brine” fluid that comes up with the gas once the well is in production, and burns up large quantities of diesel fuel.

Fracking was exempted from the oversight of federal environmental laws, such as the Clean Water Act and Safe Drinking Water Act, as a result of the so-called “Halliburton loophole” in the Energy Policy Act of 2005. Government support for the unfounded assertion that hydrofracking was safe has had the effect of shifting the burden of proof of a health impact onto the citizen.

Though the companies, citing proprietary privilege, didn’t reveal the types of chemicals they use, a couple of states now require more disclosure. The industry is failing to comply fully. In Wyoming, for example, Halliburton and other companies have gotten 50 “secrecy” exemptions from the regulatory agency.

Opponents of fracking have charged that the states and local governments have lacked the political will and don’t have the resources to protect public health. Because the companies haven’t revealed the chemicals they use, it’s difficult for citizens, health professionals and municipalities to assess the health risks from drilling.

Residents at risk

In 2004, the EPA released a study claiming that hydrofracking was safe. According to ProPublica, however, information buried in the study did note problems. The EPA identified some of the chemicals as biocides and lubricants that “can cause kidney, liver, heart, blood, and brain damage through prolonged or repeated exposure” and “found that as much as a third of injected fluids, benzene in particular, remains in the ground after drilling and is likely to be transported by groundwater,” reported ProPublica.

According to another ProPublica article, in 2010 the University of Colorado-Denver School of Public Health did a study in Garfield County that concluded benzene and ozone-forming emissions from drilling was carcinogenic, putting residents at risk for respiratory and neurological ailments as well as for birth defects. The analysis found volatile organic chemicals five times above the federal Environmental Protection Agency’s Hazard Index level of acceptable amounts. The school recommended long-term monitoring for a cluster of wells to be drilled in a new area. Instead, the Garfield County board of commissioners ended the researchers’ contract.

Other efforts to track cases and assess the health impacts from fracking have been thwarted. For example, Pennsylvania had planned to budget $2 million this year to create a statewide registry to track respiratory problems, skin ailments, and other illnesses related to gas drilling — data that’s desperately needed to assess and measure the dangers and protect citizens. The funds were withdrawn. Legislators also recently passed a law requiring doctors to sign a confidentiality agreement in return for access to information on chemicals used in fracking that had affected their patients, which prevents valuable information that could protect the public from being disseminated.

However, with thousands of cases of contamination of drinking wells from fracking fluids reported in the past four years, along with alarming increases in air pollution in heavily fracked areas, government can ignore the threat only at its peril. The EPA is currently conducting a review of the health impacts from fracking. The agency has just issued its first rule, a requirement that drilling companies capture the methane gas, a potent greenhouse gas, that’s released when a well is first drilled, and transfer it to pipes for use as fuel. The companies, however, don’t have to comply until 2015. Legislation introduced in Congress to restore EPA oversight and override the 2005 law has failed to pass.

TEDX

The EPA has confirmed that hydrofracking was the cause of the contamination of drinking-water wells with arsenic and other toxic chemicals in Pennsylvania and Wyoming. Even the Pennsylvania Department of Protection, a sorry excuse for environmental regulation, had to admit after a university study of toxic metals that fracking wastewater trucked to municipal wastewater treatment plants on the Monongahela River was poisoning the drinking water of the people in Pittsburgh. That department asked the fracking companies to stop using sewage plants to treat their waste. But here in New York the DEC’s proposed regulations would allow disposal of fracking waste, which it termed nonhazardous, in municipal sewage treatment plants.

Independent sources have been compiling data on some of the chemicals and products used by the fracking industry, of which the most comprehensive is The Endocrine Disruption Exchange (TEDX). TEDX has compiled an as yet incomplete list of nearly 1000 products and has evaluated the health impact of each chemical. The findings include the following:

Over 78 percent of the chemicals are associated with skin, eye or sensory organ effects, respiratory effects and gastrointestinal or liver effects. The brain and nervous system can be harmed by 55 percent of the chemicals. Usually appearing right after exposure, the symptoms include burning eyes, rashes, coughs, sore throats, asthma-like effects, nausea, vomiting, headaches, dizziness, tremors, and convulsions. Other effects, including cancer, organ damage, and harm to the endocrine system, may not appear for months or years later.

A total of 210 chemicals (58 percent) are water-soluble while 131 (36 percent) are volatile, meaning they can become airborne. Of these volatile chemicals, over 93 percent can harm the eyes, skin, sensory organs, respiratory tract, gastrointestinal tract or liver. Compared with the soluble chemicals, far more of these chemicals (86 percent) can cause harm to the brain and nervous system.

Seventy-two percent of the volatile chemicals can harm the cardiovascular system and blood, and 66 percent can harm the kidneys. Because they can be inhaled, swallowed, and also reach the skin, the potential for exposure to volatile chemicals is greater than exposure to those that are soluble in water.

Many of these chemicals, particularly those that affect the immune systems and reproductive development, are harmful to humans in extremely low doses. The industry argues that the chemical composition of the fluids are too diluted to be dangerous. But some 80 to 330 tons of chemicals are required for each well, according to estimates published on the non-profit organization Earthworks.

When the gas surfaces, produced water, called brine, comes up with it, in a process that continues through the 20- or 30-year life of the well. The brine, which contains a more potent brew of chemicals, is hauled away to evaporation pits. Some municipalities in New York State are using brine from vertically drilled wells, which contain the same harmful substances, as road deicers and dust suppressors on county fairgrounds. (The Ulster County Legislature, which has banned fracking on county property, this month introduced a resolution for a law prohibiting such of the brine on county roads and property.) The DEC doesn’t consider the wastewater and brine to be hazardous waste.
Another concern is depletion of water resources. According to EPA figures, 70 to 140 billion gallons of water are required to frack 35,000 new wells — equal to the annual water consumption of dozens of cities with a population of 50,000. Fracking contaminates fresh water, in some cases withdrawn from municipal drinking sources (such as the Susquehanna River), with chemical waste.

Air pollution is yet another concern. Tons of toxic chemicals, including benzene, toluene, ethylbenzene and methane volatize into the air and mix with nitrogen oxides from the exhaust of diesel-driven equipment and trucks which make thousands of trips per well result in ground-level smog which can spread to a distance of 200 miles, notes TEDX, Fumes from 27,000 wells in formerly pristine areas of Wyoming have caused the state to fail federal standards for air quality for the first time in history in 2009; the levels of smog exceed at times those in Los Angeles.

Pennsylvania to Ithaca

Tom Shelley, a retired chemical safety specialist who formerly worked at Cornell University and New York State, claims air pollution from fracking operations in central Pennsylvania is wafting over his home town of Ithaca. Monitors in the air have identified hydrocarbons and elevated levels of methane, he said.

Shelley said that the rate of asthma among children who live near drilling rigs is six to nine times higher than normal. He fears low-level impacts on fracking chemicals and pollution, experienced over a long period of time, might result in a bigger health impact than a more pronounced one-time exposure — meaning the effects may not show up for years.

Paul Rubin, an outspoken hydrologist based in Ulster County who does consulting work on fracking’s impact for environmental and citizen groups, said the chemicals from drilling could eventually infiltrate the groundwater supplying drinking water to urban populations. “The bottom line is that the cement and steel sealant in the well casing, no matter how thick, will fail. Once the chemicals have entered the groundwater, the chemicals will migrate to the river valleys, where most of the population lives. It may take a long time to get into our valleys, but at the end of the day when you have thousands of wells you end up with contaminated loads. We need to protect our aquifers.”

Rubin said he’s been advocating for tracers in the drilling fluids, which would enable people to track contaminants back to a particular well and operator, establishing the link between the drilling operations and their harmful effects.
Shelley said he was optimistic that fracking won’t make much headway in New York, thanks to a battle being fought at the grass-roots level. “Right now there are almost 100 towns in New York that have passed land-use laws banning industrial activities like hydrofracking,” he noted. “Such a spotty pattern of land use allowed for hydrofracking won’t be profitable. It’s at the town level one can ban industrial uses through zoning. So far, the cases have held up in court.”

A shot in the arm

Bringing our little bundles of joy to the pediatrician to get needles stuck in them that contain elements of a deadly virus might seem an odd concept. But most of us do it, and we do it over and over again. As counterintuitive as it may seem to hold them down as they scream, we go along because we’ve been schooled about the often-fatal and crippling illnesses that immunizations prevent.

Each state has a mandated table of immunizations for children. While the requirements differ from state to state, New York will only exempt from required vaccinations on the basis of medical history, including an adverse vaccine reaction experienced by a family member, or religious belief. In New York State, children are not allowed to attend public school, Head Start, or most private schools, day-care centers and camps without proof of the required number and dosages of vaccines.

Yet a highly vocal war over the safety of vaccinations continues. Much of the medical and scientific community strongly believes that failure to vaccinate children for deadly diseases puts them as well as those around them at great risk. Locally, some pediatric practices are refusing to treat young patients who have not been vaccinated. These physicians believe that government-approved vaccines have been adequately tested and pose no threat to most children.

On the other side is the largely anecdotal evidence of millions of parents who report that their otherwise normal kids seem to have regressed into illness and mental isolation after receiving vaccinations. They believe — and there is some support for them within the scientific community — that certain toxins found in vaccines may be causing autism and other disorders like Asperger’s, ADD (attention deficit disorder) and ADHD (attention deficit, hyperactivity disorder).

Opponents further argue that vaccines, one of the most lucrative areas of the pharmaceutical industry, are often approved by individuals who are close to the industry, a conclusion supported by a congressional investigation report issued in 2000. Critics of the mandated vaccination schedule believe there is a limit to how many viruses and toxins should be introduced to the immature body of a small child.

With the national average of autism cases at one in 150 children and increasing — Minnesota now reports its number of autism cases at one in 81 children — the battle shows no signs of abating.

Some doctors insist on immunizations

Dr. Herschel R. Lessin, of the Children’s Medical Group, one of the larger pediatric practices in the area, said his practice is one that will not provide treatment to children who have not been vaccinated according to the accepted immunization schedule of New York State. “We have 20 pediatricians in our practice and we will not treat children who have not been immunized because we strongly believe that by not vaccinating your child for deadly diseases you not only put them at great risk but you put all of our children at risk,” said Lessin, a former director of the neonatal special-care unit at Vassar Brothers Medical Center in Poughkeepsie. Lessin said his practice will treat children who are on a “delayed immunization schedule” as long as the immunizations they are postponing are not among those used to prevent potentially fatal illnesses.

Strong advocates of immunizations like Lessin believe that herd immunity (the theory that it is more difficult to maintain a chain of infection when large numbers of a population are immune) is key to keeping the population free of many deadly diseases that once spread with plague-like mortality rates. They are concerned about the increasing number of parents refusing to vaccinate their children.

“If less than 95 percent of a population is immunized against a specific disease, then it can return,” said Lessin. “We’re seeing this happen now and it’s terrifying. Measles have returned in 20 states,” he said. “Hib [Haemophilus influenzae type b] has returned locally in a half-dozen states. I haven’t seen that in 20 years, and I don’t want to see it in our children.”

According to Lessin, people who choose not to vaccinate their children are “a danger to your one-month-old and a public health hazard.” While he concedes nothing is 100 percent risk-free, he believes we’re fortunate that polio and diphtheria are no longer threats.

Environmental causes?

Dr. Ken Bock, a founder of the Rhinebeck Health Center, is at the epicenter of the autism debate. The author of Healing The New Childhood Epidemics: Autism, ADHD, Asthma, and Allergies (Random House, 2007), Bock devotes much of his attention to the treatment of these illnesses and regularly lectures on the subject at medical conferences. He believes the spike in autism as well as ADHD, asthma and allergies in the 1990s had to do with the presence of mercury in the Hepatitis B and Hib vaccinations given to young babies starting in the 1990s.

Though the mercury-containing preservative Thimerosol was removed from vaccinations several years ago, it is still present in some seasonal flu vaccines recommended for pregnant women and children over the age of six months. Bock believes it’s not just the toxins in vaccines that are the culprit. Exposure to the toxins emitted from coal-burning plants; the lead from lead paint, as well as that in dust, soil and water; arsenic in non-organic chicken; and the toxins in such things as pressure-treated lumber are responsible too, he believes. He likens a child’s body to a rowboat that finally sinks after taking on too much water.

Removing Thimerosol was important, according to Bock. But studies of umbilical-cord blood have continued to show the presence of metals and other toxins routinely well above safe levels, he noted.

Emphasizing he is very conscious of the “public health concern,” Bock said he has advocated for administering vaccines “in as safe of a way as we can.” His book proposes an amended schedule for immunizations. He believes it may not be one vaccine that is to blame but the overload given to very young infants.

Said Bock, “What I tell any parent is that there are risks involved with not getting your child vaccinated at a very young age. They’re more susceptible to contracting the disease that they would have been protected against. At the same time, I believe that to achieve the optimal immune response children have a better chance if those vaccinations are limited to one per visit and not three at one time …. Everything in life is risk management, and I’m very clear that there are risks involved with whatever choices we make.”

Bock remains wary. “We’ve seen a meteoric increase in the number of children being diagnosed with autism,” he said. It used to be one in 10,000 and is now estimated at one in 150. “That’s astronomical, and epidemics are not genetic,” said Bock. “There are environmental factors at work here, and we as doctors, as parents, clinicians, researchers and as a society need to come together and figure out what is causing this epidemic, who is susceptible, and how we deal with it.”

Dr. Stephen Auerbach of the Highland-based Auerbach Family Chiropractic Center also lectures extensively on the charged issues surrounding immunizations. “I’m not opposed to anyone getting immunized,” said the chiropractor. “I’m very strongly opposed to mandatory vaccinations. I’ve never told anyone not to get vaccinated, but I don’t like [to see] people being forced to make uninformed decisions and having our children be used as guinea pigs.”

Some parents are refusing

Meanwhile, some parents are choosing not to vaccinate, choosing not to allow all the required vaccinations, requesting reduced dosages, or delaying vaccination until their children are older.

Rebecca Stacy of New Paltz is adhering to a modified immunization schedule for her children.

“I want them walking and talking before they receive many of those vaccines,” she said, “and I also want to make sure that the sulfur lining in their stomach is fully developed to be able to better handle any traces of mercury that are still being concealed in many vaccines.”

One mother of four in Hurley who asked that her name not be used is convinced that the cause of her son’s autism was the overload of vaccines he received as an infant and the traces of mercury in the vaccines. “If you look at his eyes in these pictures,” she said, pointing to several closeups of what appeared to be a healthy, normal 2-year-old, “and the one’s shortly after his vaccines, you can see the difference in his expression. It’s distant, unfocused. He was not like that prior to the vaccines.”

As for her other three children, she added, “They will not be getting that flu shot [required for the sixth grade], and I put my younger two on modified immunization schedules after my son was so dramatically affected.”

Poughkeepsie resident and parent Donna Steele is angry for opposite reasons. “What really frustrates me is that these immunizations do not work unless everyone is vaccinated,” Steele said. “I get my kids immunized, but then I find out that many of the children in school with them are not vaccinated. That puts my kids at risk. Those diseases are waiting to come back. Do we want the polio epidemic again? Measles? We have it so good we do not remember a time when child mortality rates were at 50 percent.”

Bock suggested a safer approach to vaccination would be to make sure all vaccines were free of toxins like Thimerosal, aluminum, formaldehyde, Phenol and ethylene glycol.

Lessin is adamant that there is no scientific proof that vaccinations are causing autism. “There is absolutely zero, I mean zero, research out there which concludes that there is any link between vaccinations and autism,” he said. “What we have is a celebrity-driven culture and some celebrities who are not doctors advocating against immunization, which is a real shame. I spend half my day now explaining to people how critical it is that they get their child immunized and debunking these myths.”

Audacious goal

Dr. La Mar Hasbrouck. (photo by Dan Barton)

Last Friday was La Mar Hasbrouck’s last day of work in Ulster County. He had been serving as the county government’s combined health director and commissioner of mental health. His departure from the job, the highest-paying in the Ulster County budget, came 11 days after the announcement was made that he had been appointed director for public health for the State of Illinois.

In his statement, Ulster County Executive Mike Hein had put a positive spin to the considerably greater responsibilities Hasbrouck was taking on in his new job. “I think it’s a testament to Dr. Hasbrouck and his talents as well as the reforms he put in place in Ulster County,” Hein’s press release said, “that an organization the size of the State of Illinois has selected Dr. Hasbrouck to be their director of public health.”

The job was not left vacant for long. On Tuesday Hein appointed Dr. Carol Smith, medical director for urgent care providers Emergency One, as head of the two departments. Smith, whose position is subject to county legislative approval, will serve on an interim basis starting May 7. Smith, 58, is board-certified in internal medicine and is completing a master’s degree in public health.

Illinois’ population is close to 12 million, about 75 times that of Ulster County. In their announcements, none of the Illinois news organizations Googled referred to Ulster County as the location where the state’s new health director had served. They instead followed the formulation established in Gov. Pat Quinn’s press release that the new guy had been health director “in upstate New York.”

Two and a half years ago, Hasbrouck, now 44, had succeeded Dean Palen, who was fired by Hein from his Ulster County job under cloudy circumstances. Last year Hasbrouck became mental health commissioner as well. His initiatives included the development of a prevention-based health agenda, the establishment of a stakeholder-inclusive process, and the securing of hundreds of thousands of dollars of outside grants to increase local services.

In the public eye, Hasbrouck might have been most noticed for his involvement in the Healthy Ulster initiative that Hein had proclaimed, an effort whose long-term goal was to make Ulster the healthiest county in New York State. The University of Wisconsin’s Population Health Institute keeps county data, based on a potpourri of 13 extremely varied indicators for all the counties in every state, and in the past three years has published the rankings on its website.

In 2010, Ulster ranked 33rd out of the 62 counties in New York State. In 2011, it ranked 35th. The statistics for 2012, just published on April 4, show Ulster County as ranking 29th among counties in the state.

Healthy Ulster County Week this year runs from May 19 to May 28.

Nearing the end of his last day of work, Hasbrouck predicted that Ulster would rise further in the rankings as the improved efforts of the organization that had been established would bear fruit. “You’ll see a turning of the tides as we lower the risk factors and establish beachheads in the areas we want to improve,” he said.

Hasbrouck’s view was that Ulster County now had the framework, the energy and the political will for continued improvements in public health. His role, he said, had been “to breathe life into the framework and to galvanize the community” to support the department’s efforts. The operational framework was now in place. “It takes a community,” he said. “I’ve been enriched by the partnerships we’ve made.”

What qualities and ambitions did he think his successor in the position should have?

First, he said, with the county public health framework now in place it was not necessary “to re-create the wheel.”

Secondly, it was important to continue and to grow the partnerships the department had worked hard to enrich.

And finally, he suggested, “Try to get a visionary, because we have a pretty audacious goal.”

A unified medical staff

They’re called “mirror committees.” As of February, members of the medical staffs of Benedictine and Kingston hospitals are meeting to make decisions for one hospital. After they adjourn that meeting, the same staff immediately holds a meeting to make the identical decision for the other hospital.

Strange but true. According to the state-sponsored agreement that brought the Kingston hospitals under the same administrative umbrella three years ago, Benedictine and Kingston hospitals aren’t allowed to merge their medical staffs. Nevertheless, a couple of months ago they elected a first-ever unified set of medical officers and physician department heads.

According to anesthesiologist Dr. Martin Cascio, an ex-officio member of the HealthAlliance board of directors and now the first president of the unified medical staff, the medical staffs of the two hospitals meeting separately proved an increasingly cumbersome and repetitious arrangement, with many of the same participants in both meetings.

Doctors are busy people. “We had so many meetings in the past couple of years,” reported Cascio. “It was a waste of everyone’s time.”

In his unpaid but lofty position, Cascio acts as liaison to the medical staff. His job is to get feedback from the staff and to incorporate the staff in HealthAlliance strategies for encouraging best practices. “If you can get the feeling of team,” he said, “everyone buys in and feels validated.”

Cascio sometimes has mixed emotions about his administrative responsibilities. “It’s great,” he said, “but it’s really hard.” He likened the job of leading doctors to herding cats.

The other new officers include doctors Mark Josefski (vice president), Fabio Danisi (secretary) and Richard McNally (treasurer).

HealthAlliance of the Hudson Valley’s CEO Dave Lundquist expressed support for the new arrangements in a press release. “We applaud and support the efforts of our physicians to work effectively together in providing the physician leadership necessary to establish excellence in our health-care services,” he said.

Dr. Frank Ehrlich, chief medical officer for HealthAlliance, was similarly positive, calling the unified structure “an enormous boon” both to medical functionality and to the interface between administration and physicians. “We have two sets of customers,” said Ehrlich about HealthAlliance, “patients and doctors.” As the only physician on the organization’s executive team, Ehrlich often communicates with Cascio and other members of the doctors’ executive committee.

HealthAlliance is in the beginning steps of creating clinical integration, which can be defined as a connected community of health-care providers sharing patient information, streamlining administration, and increasing the potential for high-quality heath care. The goal is often associated with the increased sharing of computer information in various locations through a secure web portal.

Best practice

Meanwhile, the department heads at HealthAlliance are striving to build and follow best practices within their departments, striving to achieve ever-higher standards of patient care.

“It’s like following a checklist. Sometimes following a checklist doesn’t go well with original thinkers,” conceded Cascio. But studies have shown that repetition of details constitutes the core of best practice. He compared the job of a doctor to that of a pilot: It’s often not good enough to be right 99 percent of the time, he said.

Building a high-quality medical staff, said Cascio, begins with a focus on improving quality. That’s accomplished among other ways by careful attention to recruitment and credentialing. There are two paths leading to the provision of new medical services at HealthAlliance. In some cases, the administration sees an opportunity and reaches out to the medical staff to explore it. In others, physicians discuss opportunities they see with Cascio and other medical staff.

In one example, Cascio worked with Orthopedic Associates of Dutchess County in another institution. This relationship helped lead to one between Orthopedic Associates and the administration of HealthAlliance. A contract was negotiated by which the Dutchess-based partnership would provide on-call emergency orthopedic services in Kingston. Orthopedic Associates, whose website lists 26 physicians, is now occupying a renovated facility on Ulster Avenue, and performs a lot of surgery in Kingston.

Eleven medical department heads were selected at HealthAlliance in February. Fareed Fareed is head of the emergency department, John Anderson is head of family practice. Donald Louie is chair for anesthesiology, Joseph Christiana for internal medicine, Bruce Moor for radiology, and Gerald Kufner for neurosciences. Dominique Delma is chair for obstetrics and gynecology, Casey Rosen-Carole for pediatrics, Richard McNally for pathology, and Carlos Valle for psychiatry. Stephen Maurer and Darren Rohan are co-chairs for surgery.

Dr. Cascio signed contracts to provide anesthesiological services for both hospitals separately back in 1997, when he moved to Rhinebeck. He has served on the executive committee at Benedictine Hospital and was vice-chair of medical staff there.

Authority is leadership

The TV spot for a bank showed a 30-something mother with her pre-teen daughter and friends. Instead of talking to each other, they were — what else? — both texting. The daughter was hot on the heels of some boy named Chas, while Mom was in pursuit of financial freedom. At one point, the mother became terribly excited and exclaimed (I am paraphrasing) to her daughter: “The bank is texting me about my checking and letting me know how much we have in our account.”

My husband groaned out loud. Was he in pain?

“Only existential pain,” he said as waved his hand at the screen. “I mean how much information do kids need these days?”

“What do you mean?”

“A healthy, happy family is not a democracy,” he said and changed the channel.

At first I thought it was just his formal Montana upbringing that found the new intimacy between parents and children a bit unwieldy, even awkward. In his family it would have been inconceivable for his parents to place themselves on such an equal footing with the four children. There was an abundance of love and involvement (they were all musicians and played together nearly every night after dinner), but not at the expense of a very clear hierarchy of authority. One’s mother or father was not one’s buddy.

Being from the Northeast, where people stood on stoops and yelled down to the other end of the block at dinnertime and where our emotions were as visible as our shirts, I dismissed his disapproval as an archaic remnant.

But over the course of the day, as I watched parents interacting with their children at supermarkets, hardware stores, in therapy sessions and at school yards, I began to see his perspective differently.

Parents as friends

What I saw was that most parents wanted desperately to be friends with their children. They dressed the same, talked the same, giggled the same with them, jockeyed for position to be cool or hip. No topic was out of bounds. They discussed their sex lives, their finances, their politics, and the issues they had in their social and work relationships.

I thought I would be appalled, but I wasn’t. I was embarrassed. It was a feeling not unlike watching someone leave a bathroom with her dress tucked into her pantyhose or seeing a colleague do something horribly revealing or inappropriate at a party. In those situations, I would have felt like covering my face to avoid being a witness the next day.

I took to wondering why. Why are parents so reluctant to be parents? What has happened in our culture and in our families that we are more worried about whether our kids like us than whether we properly prepare them for a life that is almost always challenging and sometimes damned unfair?

Many adults today have a difficult time with true authority. They vacillate between a laxity that is boundary-less and a sporadic struggle for power. I don’t believe there is just one reason for this. Authority for some of these parents may have been excessive, unyielding, irrational or capricious. Those people would certainly confuse authority with dominance and cruelty. Precisely because they love their children, they naturally want neither to be that way nor for their children to suffer as they did. That’s understandable. But I think it is still erroneous.

Authority for others may be antithetical to their more modern understanding of love, which is easygoing, permissive, unconditional (often in the wrong way), and blooming with constant emotional reassurance and validation. In their minds, authority says no when love says yes.

Anyone who has trained dogs knows that love and “no” are not mutually exclusive. In fact, I believe the only way to truly give unconditional love is to be able to say no, to love the person and loathe the behavior.

Still others seem to have misinterpreted biblical injunctions about authority with children. They have rejected them out of hand because they have mistakenly come to associate them with corporal punishment and shame. The most obvious interpretive error is the popular one which reads the Hebrew for “rod” (as in “spare the rod and spoil the child”) for a reed or a stick. That’s a misinterpretation. A biblical authority is not punitive. Parents are given the injunction to educate their children and to hold them accountable to the performance of all the commandments — after the children have been helped to understand them.

Authority is compassionate

It is a shame that authority has earned itself such a miserable reputation because it is perhaps the most essential element of truly effective and loving parenting. Authority can be quite kind and loving even when it is correcting negative behavior.

Nature abhors a vacuum. So do children. When parents do not provide authority, children assume the dominant position. It is not necessarily a bad thing. It is survival. Someone has to be in control.

So what is a parent to do? Start by revisiting ideas on authority. Authority is calm, sure-footed, firm, confident and compassionate. If you are tentative, hesitant, punitive or vacillating, you are giving mixed messages and can no longer be trusted to lead. Authority is leadership. Children naturally gravitate to leaders, to adults who seem to know what they’re doing. Children want someone to guide them while at the same time allow them to make mistakes and learn. Authority says: Follow me. I know what I’m doing. Authority says: I understand what you need. Authority says: I will keep you safe.

Most parents do not give themselves permission to be the boss and loving at the same time and are terribly relieved to hear that they may. So are most children.

When as a therapist I did behavioral contracts with children I always warned parents of the imminent dangers of setting new limits. “One, you may be a bit awkward at first. Be patient with yourself and your adjustment to a new role,” I urge. “Two, the better you get at it the more your child is going to test you. He is going to rebel. He may fly in the face of your authority. Stay still. Let him spin. Research has shown that there is a predictable learning curve to that reaction and that the tumult will pass — if you are consistent and maintain the authority over time.”

I have done a lot of hand-holding with parents as they experience the back draft of their newfound authority. But when it’s all done and the heat has passed, there is a new relationship to be enjoyed, one in which the parent is the parent and the child is able to relax in their loving, sure hands.