Opuscula Doctor's role

 

I have a new Primary Care Physician (PCP). My former PCP's practice was cancelled by AvMed, my longtime Medicare Advantage provider. The former PCP was an excellent diagnostician; the office operation was, to be kind, a disaster on the way to happen.

My old PCP and I had, I thought, a good relationship; it was close to a partnership.

My new PCP thinks the physician is god.

And he's not even a surgeon.

I think - and I'm adamant about it - that the PCP is a consultant and the patient - me - is the client. Since I "own" my body and since I am responsible for its health, that consultant-client relationship seems appropriate.

I don't know if we reached an understanding today.

If not, I'll be looking for a new PCP. Since the office is so well run, that would be a shame, but I go to the practice for the physician, not the office staff.

The bone of contention - besides having to wait more than 2 and a half hours after arriving for my scheduled appointment - was the fact that based on my latest lab reports he told a medical assistant to call me with a change of medicine order.

What's the problem?

I had seen him one time.

He had one lab report from my interim PCP (the one who refused to refer me to my ophthalmologist) - in other words, he lacked my history.

Based solely on the lab report he had the assistant call me with the medication change.

No one talked to the patient (me). No one asked about a history; I have been going to the medical lab every three months for several years for the same tests, and I have had the same results - plus or minus - every time. My first PCP knew that; the current PCP did not.

When I told the PCP du jour I wanted to repeat the lab test he was shocked. If he let everyone who wanted to redo a lab test my "until December 31 Advantage provider might cancel its relationship with the PCP's practice.

An "ah hah" moment - I thought Medicare, into which I paid a portion of my wages since its inception, was supposed to provide medical coverage. OK, I know that insurers and the government only care about income and profit, but it was nice to think, if only briefly, that my medical concerns were considered worthwhile by the people who got my Medicare money all those years.

I suspect the reason my previous PCP's practice was cancelled by AvMed was that the PCP put the patient's welfare ahead of AvMed's bottom line.

I finally convinced the current PCP that the test should be repeated, but I don't think he has yet realized that "MD" does not spell "god."

I was a consultant for many years and I know that even if I, the expert, told my client that something should be done or avoided, it was the client's prerogative to accept and act on my advice or to ignore the advice.

If my recommendations were not to the client's liking, we both knew the client could engage another consultant.

So it is with PCPs.

Opuscula Clippers owner scandal More than meets the eye

 

The media screams "Racist!" for remarks allegedly made by LA Clipper's owner Donald Sterling. That may be true. But no one seems to be asking why Sterling's (ex?) girlfriend, V. (nee Vivian) Stiviano had her cell phone out and ready to capture Sterling's remarks.

Two quick caveats:

ONE: According to CNN, Stiviano's attorney says she didn't release the tape that had racist comments.

TWO: As this is cobbled together, Stirling has not admitted it is his voice on the recording.

Here is a guy - 80 years old in April 2014 - who was about to receive a second award from the local NAACP, the owner of a basketball team of predominately black players (employees) who allegedly resents his multi-racial (by now) ex-girlfriend being in a photo with icon basketball star Earvin "Magic" Johnson.

Does that compute?

People from current and former basketball players to the present occupant of 1600 Pennsylvania Avenue, Washington DC 20500 have rushed to condemn Sterling and to insist he sell the Clippers.

It's possible Sterling had a "senior moment" and said what he truly believes.

Likewise, it's possible V Stivano set him up and goaded him into saying what he allegedly said.

It also is possible that V Stivano, facing legal action from Sterling's wife and perhaps feeling she would soon be a Sterling cast off completely fabricated the voice capture.

It's all conjecture on the morning of April 29, 2014.

One thing that is sadly for certain, America's vaunted "innocent until proven guilty" mantra has been proven to be no more than idle words. We - Americans - don't practice what we preach.

As a reporter, I covered a number of court cases in several states and a courts martial at Fort Dix (NJ).

I covered murders, rapes, desertions, and lesser crimes such as robbery and burglary.

I learned early on that it is foolish to make a decision on a person's innocence or guilt until all the facts were uncovered.

Sterling had an image problem before the comments were made (by someone).

A Washington Post article heded Alleged Donald Sterling recording is the latest in series of incidents involving Clippers owner. the WashPost journalist Kent Babb writes that

In 2009, Sterling spent $2.73 million to settle another suit, this time brought by the Justice Department, which alleged Sterling refused to rent his apartments to non-Korean tenants, preferring that black and Hispanic prospective tenants look elsewhere. The lawsuit quoted Sterling as saying in sworn testimony that “Hispanics smoke, drink and just hang around the building,” adding that “black tenants smell and attract vermin.”

Sterling also feuded with Elgin Baylor, a Washington native, NBA legend and the Clippers’ general manager for 22 years. Baylor, who has declined commenting publicly this weekend, sued Sterling in 2009 for discrimination and wrongful termination. In the lawsuit, Baylor, who is African American, alleged Sterling built his franchise with the “vision of a Southern plantation-type structure” and accused the team owner of a “pervasive and ongoing racist attitude.”

A jury ruled in Sterling’s favor in 2011.

A TMZ blurb under a hed that screams My Husband's Despicable And Prejudiced quotes Sterling's estranged wife, Shelly, as stating ""Our family is devastated by the racist comments made by my estranged husband. My children and I do not share these despicable views or prejudices."

While I hate to nit-pick TMZ, the hed fails to agree with the woman's statement. While she probably knows her husband better than most, she never said (a) she knows her (likely soon to be ex) husband to be a racist or (b) that she knows he said what is alleged.

TMZ notes she "has been estranged from Donald for years.."

On the other had, the WashPost article notes that Clippers President Andy Roeser issued a statement Saturday, as "questioning the legitimacy of the recording and suggesting the audio was leaked for the purposes of revenge. He said the woman in the recording is the subject of an embezzlement lawsuit filed by the Sterling family.

“Mr. Sterling is emphatic that what is reflected on that recording is not consistent with, nor does it reflect his views, beliefs or feelings,” the statement read in part. “It is the antithesis of who he is, what he believes and how he has lived his life."

Whether Sterling did make the racist statements is not the issue for this blog entry. What IS the issue is the rush to condemn a person sans any real, proven, evidence. When the U.S. president, in reference to Sterling tells am international audience that: “When ignorant folks want to advertise their ignorance, you don’t really have to do anything. You just let them talk. That’s what happened here,” he shows total disregard for the U.S. legal system.

That's not supposed to be the "American way."

Opuscula Credit where it's due

 

I have, on occasion, complained about Humana's Medicare Advantage program. At one point I took issue with one of Humana's recommended opticians (see Humana - Promises, just promises).

Apparently someone at Humana forwarded the blog entry to the Florida Optometric-Physicians Network (FOPN), of which the optometrist/optician practice was a member.

I received a call from Marlen Ayala, FOPN's Manager, Provider Relations. My initial reaction was "Who? What? Why?"

Humana reps occasionally call asking if everything is "OK," which is interesting since I know my blog is read by someone in Humana, but this call was from someone in an organization unknown to me.

Ms. Ayala told me she understood I was less than satisfied with the optician at the optometrist's office where I had an eye exam. (Absolutely NO complaint with the optometrist.)

She would, she volunteered, arrange for me to take my lens prescription to another optician in my area.

Excellent. I asked for, and promptly received, a list of perhaps a "baker's dozen" optometrists in my area.

From the list, I selected two and asked Ms. Ayala to make arrangements with either. I also advised her that one entry on her list refused to accept lens prescriptions from outside optometrists and another had a "For Rent" sign on the door to a vacant office.

She made arrangements with Dr. Selmo Satanosky's practice to see me anytime from Friday morning (25 April 2014) and confirmed this with an email.

Friday morning I present myself at the optometrist's office and announce that I am here to have a lens prescription filled. The receptionist looked up and then down at a list and greeted me by name; Ms. Ayala had indeed arranged for my visit and I was expected. The receptionist, whose name I regrettably failed to note, said the practice and Ms. Ayala have a good relationship.

After a brief chat with Dr. Satanosky we adjourned to the optician area where we decided upon a frame and he made whatever measurements necessary - and noted them on paper - no computer needed. I was told the information would be sent to Humana's lens grinding facility in Miami and that my new glasses would be ready in a week or two.

FOPN is an independent organization that, according to its web site "has relationships with most major health care plans in Florida and together are dedicated to providing you with the most comprehensive eye care possible."

It's nice to be able to offer a tip of the hat to a service provider - any service and any provider. Ms. Ayala earned that for herself and for FOPN.

Opuscula Are we nuts?

 

The Malaysian website headline screams US lawyers gearing up for MH370 suits after waiting period ends and the plane has yet to be found.

According to CNN, as quoted in The Malaysian, the United States enforces a 45-day rule for how long American lawyers have to wait before reaching out to a family that has lost a loved one in a plane crash.

The lawyers are, apparently following the old adage of "sue everyone, especially if the have deep pockets," and they obviously think Boeing has very deep pockets.

The problem is, unlike the BP oil spill and the Exxon Valdez tanker "mishap," there is no - zero, nada, sum - evidence that Boeing's plane failed in any way. If this were a criminal case, there is no corpus delecti, defined by The Free Dictionary as

1. Law The material evidence in a homicide, such as the discovered corpse of a murder victim, showing that a crime has been committed.
2. A corpse.

There is no plane; there is no wreckage.

In fact, there's very little evidence that the aircraft crashed at all.

But, the lawyers are lining up to sue Boeing.

Boeing will have to defend to protect its reputation and its financial resources.

Even though, so far, there is no evidence that the aircraft was faulty or failed in any way.

There IS some evidence that the aircraft was high jacked, but no one currently is speculating by whom, or to what purpose. There have been no ransom demands and no displays of captive passengers.

I'm sure the lawyers have a reason to be the first to file, even at the risk that they won't have a case later.

Meanwhile, Boeing has to spend its resources to try to hold off the lawyers until there is at least some evidence that the aircraft manufacturer failed to make a safe product.

Even some lawyers seem to realize actions against Boeing may be premature. According to The Malaysian, Aviation lawyer Daniel Rose, a partner at the firm Kreindler & Kreindler, told CNN, "If we don't have the black box with all the critical information on it, or we don't have any part of the wreckage, it would be very hard to maintain a claim against Boeing in any court in the United States."

I hope Boeing has good insurance to pay its legal representatives.

Opuscula Made in CHINA

 

The U.S. is importing too much from China.

In itself that might not be so bad (except for the balance of payments), but China has proven, time and time again, that it cares nothing for the health of its people or the people who purchase Chinese products.

It's time American's looked elsewhere for their merchandise

When I was much younger, everything was imported from Japan. The crafty Japanese even had a town called USA so it could label Japanese made products as "Made in USA." The original Japanese products were, to put it nicely, less well made then Japanese products of a decade ago.

Like the Japanese before them, the Chinese "appropriate" most technology from the west.

Chinese products are, more often than not, unsafe. Americans know that.

But, Chinese products are cheap - in all senses of the word. And "cheap" is what sells, especially in a collapsed world economy (for which the U.S. must shoulder the lion's share of the blame).

Back in the day - the day being 1967 - I bought a Honeywell Pentax H3v 35mm nothing automatic camera. Pentax was made in Japan, but the importer, Honeywell, put its name on the product after it performed a 100% inspection. Mind, the H3v was not an expensive (as in Leica or Nikon) camera; it set me back $125 borrowed from my then-employer, the Titusville (FL) Star-Advocate. The H3v eventually was given to a friend who gave it to a son-in-law who gave it to . . . who knows. As with my last 35mm camera, a brass Canon F-1, it is, for me, a collector's item, for others, something that just gathers dust.

We were looking for frozen tilapia today. We found plenty. All the kosher label fish were "Product of China." (There are unlabeled frozen tilapia from Honduras. Can't tilapia be raised in farms in the U.S.?)

The wife bought garlic the other day. When she got it home and started to open the net bag in which it was sold, she noted "Product of China." GARLIC!

We can't grow garlic in the U.S.? Unbelievable.

OK.

Let's assume that garlic and tilapia have such a low Return On Investment (ROI) than U.S. agri-comglomerates can't make a satisfactory profit to raise the products in the U.S.

If that's the case, that in order to make a profit on garlic and fish it has to be a "Product of Somewhere Else" then at least the U.S. government - charged with all things international - MUST inspect all incoming products to assure they are safe. The FDA samples U.S. food products and discovers - albeit infrequently - dangers to the consumers.

Products of places that are notorious for a cavalier attitude toward (a) their own people and (b) their customers - China, for example - need to have a high-ratio sampling. The cost, of course, must be passed on to the consumer.

Having the added cost might make "Products of the USA" more price competitive as well as being safer for the consumer.

When I worked in the mil-spec world (communications and process control systems), some of the incoming materials received 100% inspection; each unit was individually inspected to make certain it met our - and the government's - quality requirements. Other materials, from vendors with a long history of quality and strong Quality Assurance and Quality Control processes in place, were sampled at a much lower rate, perhaps one unit in 100 or 1000.

We have a "China only of there is nothing else available" policy for the Glenn household.

There ARE products that their point of origin is less than critical. Some furniture, for example. But even here, our preference is for products first from the U.S. then made any place OTHER THAN China.

When Wal-Mart was making a name for itself and Sam Walton still controlled the company’s direction, Wal-Mart bragged that it sold mostly "Made in America" products. Now you are lucky to find an "Assembled in the USA" product in the stores.

Certainly there are some good products made in China; I expect Chinese military products not-for-export get a fair QA/QC before being put into service. But commercial grade products - clothing, food stuffs, compact florescent light bulbs (CFLs), dry wall, tires, etc. - are proving to be less.

It's time Americans started looking for Made at Home (USA, Canada) products even if there is a minimal (10%?) surcharge to provide enhanced quality and product safety. (Sadly, many Made in the USA products - GM's ignition switch being an example - also lack a level of QA/QC that should be expected with local products. In GM's case, as was the case of Ford's Explorer transmissions, management apparently made a decision to ignore the faulty product rather than "do the right thing" and make design and production changes.)

Even with less than perfect products bearing the Made in the USA label, I feel safer with those products that I do with anything with a Product of China label.

Opuscula Exclude everyone Who is different New way for Shas?

The "new" Shas (so-called Sefardi) political party is proving to be a Litvak want-to-be by its exclusionary rhetoric is an organization with which I wish no association.

Jews in general and Israeli Jews in particular need to stop being exclusionary and work to become a little inclusionary.

Rhetoric by one group by another, casting aspersions that only serve to inflame with no respect either for truth or fellow has become a way of life for too many religious "extremists"- both haredi ("black hats") and heloni (non-religious) Jews. For the haredi, all non-traditional Jews (in the U.S. this includes Conservative, Reform, Reconstruction, Humanist, and occasionally "Modern" Orthodox) are "outside the pale."

Traditionally, Sefardi and most Mizrahi Jews either didn't know about, or ignored, the European invention of separation - Orthodox, Hasidic, Reform, Conservative. To a traditional Sefardi Jew, a Jew is a Jew is a Jew; that Jew may be less or more observant than the person setting the bar.

When someone asks me if I'm "orthodox" - I am shomer Shabat, shomer kashrut, I wear a black knit kippa (except on Shabat when I bring out my red and blue knit kippa) - I reply that what I am, how I am categorized, is not for me to say, it is for the person asking the question to decide.

If a heloni asks me, I'm probably "orthodox" (with a lower case/small "o" if you please). On the other hand, if a haredi from Bene Brak or Mea Sharim asks, then I'm barely Jewish at all.

It's always all the perspective of the person asking the question.

Shas, know as the "Sephardi" political party has been moving slowly, but consistently to the haredi side of the unfortunate religious spectrum.

Shortly before R. Yosef died, one of his Council of Sages said that anyone who wears a knit kippa was not a Jew.

In a story distributed by Israel HaYom heded^CQ Habayit Hayehudi: In Shas, politicians appoint rabbis we read that Rabbi David Yosef, son of the late spiritual leader Rabbi Ovadia Yosef, said: "Now, when the hatred for us is so strong, when respect for the Torah and those who study it has been trampled, we say we are not a part of them. The Yesh Atid and Habayit Hayehudi minions -- there is no difference between them. The Holy One, blessed be He wants us to distance ourselves from them. We are separating from them."

Question to R. Yosef: If Shas is going to "separate" itself from Jews who are different, how is that going to help either Shas OR other Jews? It might keep Shas' Jews tahor, pure, but it will leave non-Shas Jews to fend for themselves, sans religious leadership.

Reminds me of the Karaites. (If you want to know something about Karaites, visit http://www.karaites.org/ and http://www.karaite-korner.org/.)

I can understand why non-"black hat" (but otherwise "Orthodox") Jews in Israel look down on the haredim who refuse to do anything for the country - won't serve in the military, won't do national service; many won't do any work to support their families, preferring to let the non-black hat population pay for their non-productive time. I might sympathize - and I suspect other Jews would likewise - and support a few true hakhamim who can put their Talmud studies to advance Judaism into the 21st century.

Israel's first prime minister, in order to win his position, promised the black hats that their yeshiva boys would be exempt from the duties of all other citizens. But in 1948, when the the deal was made, there were only a few thousand yeshiva "boys." Today there are 10s of thousands, most of which never will become scholars of note.

Perhaps the average Jew will be better off if Shas and its ilk do "separate" from Am Israel; at the same time, let Am Israel "separate" itself from Shas and similar extremist organizations; insist that the yeshiva "boys" either do something for the state or lose their stipends.

When that happens you'll hear screams from the yeshivot that there are too many empty seats; empty seats mean lost money from the government, money the government took from the average Jew who works for a living.

Opuscula Call me Curmudgeon

 

I am not "politically correct." I am judgmental. I'm not ashamed to be either.

Driving around my town I wish for a return of the annual auto inspection.

I would settle for police checkpoints where drivers are stopped and required to produce license, registration, and proof of insurance while another office checks the vehicle's lights and tire tread. Random stops at random locations.

Stop the junkers and stop the showroom new Ferraris, Lamborghinis, and Bentleys. Show no favoritism. Brake lights fail on million dollar vehicles as often as they fail on clunkers.

My son, The COp, tells me that if a vehicle has 2 out of 3 brake lights that work, that's enough. But my risk management mentality tells me if one already is burned out, when will another fail? When? Before the driver notices one is burned out.

Checking to see if back and brake lights are working is easy; back up near a window and look at the reflection. Almost a "no brainer."

Florida used to do that - random stops. Likewise California. I have first hand experience in both states. Florida also once had annual inspections. Unlike many states, Florida controlled the inspection stations, and while the lines sometimes were long, there was no suspicion that the inspector would offer to fix your vehicle "for a fee." (True, there were rumors that some state employees would accept a "gratuity" to overlook a minor problem.)

The full-vehicle inspections ended, but emission inspections remained for a little longer. Now they, too, are history. Their absence is noticeable when the vehicle in front belches noxious smoke. (It's as bad as the turkeys who set their in-car boom boxes to "Deafen at 500 feet." There is a law, but I doubt its enforced.)

I live in a "gated community." That is supposed to give residents a warm fuzzy feeling of security. The community is surrounded by a low (5') wall that is an impediment only to someone 3-foot-tall, and even then . . . There's a rent-a-cop at the main entrance, but they cannot stop a determined trespasser.

It reminds me of my ulpan kibbutz in Israel. The kibbutz either found some extra money or suddenly was concerned with vehicles entering the kibbutz unannounced. It built a guard shack and put a wooden "gate" across the road. The guard, however, had no phone, no two-way radio, and no weapon. So much for security.

Guard shack with wooden barrier arms

If you walk in the community, as I do, you do so at your own risk.

Never mind that there are no sidewalks. The danger is from drivers who ignore traffic signs as if they were invisible. Stop signs. Not even there.

Squared corners? You've GOT to be kidding.

Worse, most walkers put their lives on the line walking with traffic rather than as safety and Florida law require facing oncoming traffic.

If anyone should say anything - and guess who DOES say something, albeit politely - they either ignore the person or they fail to comprehend the message - it's in a foreign language: English. It might not be so bad, but many walkers are mothers or baby sitters pushing their charges in carriages while they walk behind, hearing nothing but the noise from their headphones or cell phone.

Traffic inside the compound moves at a slightly slower pace than outside. A road I cross most mornings also is the preferred route for dump trucks loaded with sand for an airport expansion.

The road is posted for a maximum speed of 45 mph.

There is (at least) one driver who goes so fast he doesn't even TRY to stop his vehicle for a red light. Blast the horn and God help anyone crossing the street. The particular truck conveniently lacks any signage on the cab and the license plate is - as it is for all trucks in Florida - on the front of the vehicle, making it next to impossible for anyone to report the vehicle to the cops.

Call me a curmudgeon. Say I'm judgmental.

That's OK. I think there should be more judgmental people; maybe we'd have a more civilized, law abiding, and safe world.

Opuscula Humana Promises, just promises

Ahh, Humana. Can you possibly make my life more frustrating?

It states, clearly in my Member Benefit Package, Page 34, that

Mandatory Supplemental Benefit includes: - $115 annual eyeware^cq benefit for eyeglasses or contact lenses and fittings from the network optical provider OR - One pair of eyeglasses at no cost annually, including ultraviolet protection coating.

Moving back in the same document I find one and a half pages of "Vision Providers." Among these providers is the optician I want to use.

The optician works with the ophthalmologist I initially wanted to use. My then-Primary Care Physician (PCP) told me I had a choice: go to the ophthalmologist with whom he had a "capitated" agreement or find a new PCP. I found a new PCP.

I've been told that "capitated agreements" return more money to the referring practitioner and the patient be damned. Capitated, as defined by Merriam-Webster online is found at the end of this entry.

My initial Humana PCP insisted that Humana demanded that I see an optometrist before I could see an ophthalmologist.

I checked on line and found a Humana-approved optometrist (with whom I was pleased). The OD told me to see an ophthalmologist to determine if a cataract was ready for surgery. If it was not, come back to order new lenses.

It is my personal "Standard Operating Procedure" (SOP) not to have a prescription filled by the same practice that wrote the prescription; helps keep everyone honest. However, in this instance - since Humana was willing to pay $115 toward the package, I decided to return to the practice's optician.

It turns out that the practice's intranet was "down" and the optician was unable to access my prescription. She refused to look at a printout I received when the eye exam was completed, and she refused - despite twice being told about a work-around - to do anything sans the intranet.

No one bothered to try to find out WHY the intranet was down; no one called technical support; everyone was content to wait until the intranet finally came alive. I left before it did, if it did at all that day.

Having made an unnecessarily long trip (gas prices in Florida now average $3.64; about a dime above the national average) three times, I thought to use a Humana-listed provider closer to the manse.

I checked Humana's online provider's list. Sure enough, my preferred provider was listed, top of the list based on the search parameters I entered.

I went down to my nearby optician's office and talked to the Woman In Charge, hereafter The WIC.

I gave The WIC my Humana ID card and she tried - for several minutes - to find that I was covered. (Remember, the provider is on Humana's paper and online lists.)

Nothing, nada, effis. I'm the man who never was.

I went home and re-checked the Humana provider lists.

Then I called Humana Customer Service.

Pay attention, HIPAA

After playing 20 questions with Humana's voice response system I finally got a Customer Service Representative (CSR) to talk to me. First I have to answer - again - questions I already answered early in the call. (I shouldn't complain; it was Humana's dime.)

I explained the situation to the CSR and told him I found my preferred provider on Humana's lists.

Yes, they are on the lists, he agreed, only they are not on any list associated with my coverage.

Sudden thought: I wonder if the CSR was looking at a list associated with my initial Humana PCP. I'll try again tomorrow.

NOW, THE HIPAA CONNECTION. While waiting to the CSR to research the issue I could clearly hear other CSRs' conversations with Humana clients, conversation that, per HIPAA, I should not hear. I mentioned this to the CSR and asked if Humana really did record client calls. He assured me it did and I repeated the information about hearing other clients' calls. (I followed up with an email to Humana that might be read by a low-level clerk before end of year when I will have a new Advantage provider.

In the end, I think I'm going to go to one of the several "two pair for $69" opticians; it will cost me closer to $115 (which Humana budgeted but …) but at least I'll be able to read house numbers again.

I would rather that Humana not promise something it has no intent to deliver. I'll chalk this up to "Lessons Learned."

From http://www.merriam-webster.com/dictionary/capitated cap•i•tat•ed adjective \ˈkap-ə-ˌtāt-əd\ (Medical Dictionary) Medical Definition of CAPITATED : of, relating to, participating in, or being a health-care system in which a medical provider is given a set fee per patient (as by an HMO) regardless of treatment required

Opuscula Pointing fingers

 

In a NY Times article heded^cq Airline Blames Bad Software in San Francisco Crash , Asiana is blaming everyone except its own flight crew.

The NYT article reports that even though Asiana faulted its crew for failing to notice that the airplane was flying far too slowly to stay in the air it claimed that it was not the air crew's fault.

South Korea's Asiana management claims, according to the Times article that

1. Bad software design led to the unexpected disabling of airspeed protection without adequate warning to the flight crew,
2. A system to warn the crew of low airspeed did not sound soon enough, and
3. The approach ordered by air traffic controllers “led to an excessive pilot workload during the final approach.”

Question: Were the Korean airline pilots novices? Did they even have license to fly a Cessna 150 (the modern equivalent of an Aronica Champ or Piper Cub)?

Question: Were the Asiana pilots blind? According to Wikipedia, the weather was fair and the aircraft was cleared for a visual approach - translation: the pilots should have been watching as the aircraft made its final approach rather than depending solely on instrumentation.

Someone recently pointed out that while an airline pilot's log book may show the pilot has thousands of hours at the controls, most of those hours were flown on auto-pilot, cruise control for airplanes.

That's not entirely bad; it should mean the pilots are alert during the most dangerous times of any flight: take off and landing.

In Asiana's case, the pilots apparently were busy with "other" things, depending on automation to do their work for them.

The Times' article states that In the Asiana crash, the crew believed that an auto-throttle would manipulate the engines to keep the plane’s airspeed in the range needed for a safe landing, somewhat like the way the cruise control in a car will adjust the throttle to keep the speed constant. It later became obvious that because of a quirk in two tightly linked systems, the autopilot and the auto-throttle, and because the crew had manually adjusted the throttles at one point, the auto-throttle had gone into sleep mode.

Aside from the fact that it is foolish to depend solely on automation during critical flight periods (take off and landing in particular) there is the suggestion of human err; someone apparently forgot to confirm the auto-throttle was active. Allegedly the Asiana pilots had been trained to be alert for this situation.

To be fair, Boeing (perhaps in General Motors mode?) was warned by the FAA about the way the throttles went into sleep mode but it declined to make a change and agreed to put a warning into the pilot manuals, and, according to the Times, when test pilots from the FAA and the airline tried to fly the approach that air traffic controllers had given the Asiana flight, they had severe difficulties doing so while following other rules, according to papers filed with the board.

Other aircraft regularly successfully land at SFO using the same approach, difficult though it may be, so while the finger Asiana is pointing elsewhere, four fingers are pointing back at Asiana and its pilots.