Burton Knight, with his daughter, Talula, and his mother, Toni Inglis, has managed to survive despite a childhood without a decent pecan tree.

For Christmas, he and his family had given Ian and me a nice bag of cracked pecans. Their majestic backyard tree in Dallas had produced 120 pounds that year.

I emailed his wife, copying Burton, to thank her and to tell them how plump, nutty and juicy they were, with a wonderful flavor.

I explained to her that when Burton was growing up, we had a large pecan tree over our back patio and that the pecans from it were not particularly memorable. I then innocently added, “Burton, do you remember that tree?”

Burton “replied all” in classic, characteristic form. (You may have read some of Burton’s reflections on these pages before.)

FROM: Burton Knight

SUBJECT: Re: Thank you for the pecans!

DATE: January 15, 2005

As a child who lived through that dark period, let me just say that I can’t ever forget the pecan tree. To a helpless and vulnerable child, the seemingly innocent moniker of “pecan tree” meant: omnipresent-and-abusive-symbol-of-our-pathetic-caste-in-society tree.

That’s right, the pecan tree was my social pink elephant in the room that nobody would acknowledge, but everyone could see.

Sure we lived in Tarrytown, but that tree in our backyard was a clear beacon to all who beheld our sorry hovel that we were basically the “Pecanos,” “Pecan-Americans” or “Nut Brothers” of the neighborhood.

We vainly hid behind our aluminum siding, fancy brick walkways and hardwood floors, trying desperately to fit in. Yet it was clear we were different. All thanks to that tree! Oh, if I could have my adolescence back without the SCARLET LETTER that was our PECAN tree.

How I hated it. Children can be so cruel.

I was constantly ridiculed and assaulted with rocks because of our special pecan tree. Had it been a source of food or a thing of beauty, I might have been merely pitied instead of scorned.

But no. The sentinel of our back patio had to be a living (expletive)-stick, lousy with squirrels and fall web-worms, that only occasionally blessed us with nuts whose rotten and flavor-impotent nutmeat’s wizened staleness was rivaled only by their diminutive yet indestructible shells that littered the patio like broken glass under our feet.

Yet we lived with it like one would live with a family member who refused to wear clothes and beat us in public.

Living in the fetid shadow of that hideous arboreal abortion, I managed to survive by self-medication and a Mohawk.

My sister tried to escape through academic excellence and togetherness. My brother, John, tried to rebuild his life by fleeing to Texas A&M to study history. All for that (expletive) tree.

Were we too (expletive) poor for dynamite? Perhaps we were Austin’s legendary idealistic hippies, too compassionate to euthanize the woody stain on their children’s social status?

Well, you’re damn right our Christmas pecans are plump, nutty and juicy with a wonderful flavor. The tree is beautiful, too. Life is different here in Dallas. We use deodorant and pay taxes.

So, dredge up the past if you must, just know this: My wife already knows how it was and Talula will know when she’s old enough to handle it.

I am no longer ashamed of the past and have moved on to a “plump, nutty, juicy” place where I feel safe and clean. Those flavorful nuts are who I am now. Can’t you just be happy for me?

Your son,

Burton

One neighbor was Jack Lambrecht. Retired from the military and a construction business, he watched out over all of us, whether we were at home or at work. Before we awoke on trash days, our cans were standing at the street, and they were returned before we got home. A giant branch fell into my yard, and there he was at age 85, sawing it up. This quiet, calm gentleman was all about loyalty.

Jack died last week at 94. His obituary made brief mention that he was a World War II glider pilot.

I worried that so many readers wouldn’t know what that meant. I know about them. But only because of Emeril Lagasse’s four-layer Classic Black Forest Cake.

In 2003, Ian and I became empty-nesters, and feeling romantic for Valentine’s Day, I set out to treat him to a spectacular chocolate cake.

In an act of insanity, I spent serious cash buying the ingredients and drove all over town buying weird things like an elevated cake turner.

I robotically followed Emeril’s directions exactly, but his cake didn’t rise. Frantically, I made another chocolate cake from scratch, made the horizontal cuts, lavished expensive kirsch syrup over each layer to soak, and dutifully assembled layers with dark, sweet cherry filling poured between.

But when adding the frosting, time broke into freeze-frames as the entire cake and filling began to fall apart and drip down from the elevated perch onto the counter — despite my frantically piercing it with wooden skewers and weaving a tapestry of obscenities that could be heard throughout the magic that was Scott Crescent.

Alarmed, Ian rushed out of the shower onto the unholy scene and froze. Endless seconds ticked by as it dripped.

I collected myself enough to call Jack. He would know what to do, and he always wanted leftover desserts. He arrived instantly to find me like a stick of lit dynamite and Ian like he were about to wade ashore at Normandy.

He commenced to laugh — heartily! We spooned what we could into a bowl, and he left with it, absolutely thrilled.

Jack’s reaction changed the mood, and we went on to have a romantic Valentine’s evening.

The next day, I spoke with Jack about perspective. It was then that he told me he was a glider pilot in the Second World War. I had no idea what that was. He told me, but to this day it seems surreal.

There were only 6,000 glider pilots. They volunteered for their do-or-die mission to fly glider planes loaded with troops, cargo, vehicles, anti-tank guns and explosives to the front lines.

To save weight, these pilots wore no parachutes. They knew that with each mission, 20 percent of them would die and three times the number killed would be wounded or taken prisoner.

Everyone knew the “G” on their silver wings stood for guts.

Spearheading the major invasions, glider pilots would crawl into their unarmed, motorless, wooden planes and be hooked by tow planes — swept airborne from a dead standstill to 120 mph in seven seconds.

After detaching, their planes would float in the dark of night deep into enemy lines amid anti-aircraft and sniper fire.

Utter pandemonium would ensue as the planes crashed on land or sea. If they survived the landing, the pilots helped unload the gliders, fought alongside the glider troops and guarded the nearest airborne division headquarters.

The glider pilot program ended after the war and is widely considered to have played a decisive role in the spectacular air operation success of World War II.

Jack was with the 76th Troop Carrier Squadron in campaigns in Sicily, Normandy, southern France, Holland, Bastogne, the Rhine crossing and Central Europe. He flew three glider combat missions beyond enemy lines into Normandy, Holland and Germany, for which he was awarded a Bronze Star. Like the glider pilots before him and the few who remain, he will be inurned in a national cemetery with military honors.

Jack taught me something about loyalty. And perspective. He had seen real tragedy, and it didn’t look like a failed black forest cake.

At the age of 59, her candle burned out too soon. She helped unify this nation, and we need her now more than ever.

When she was sworn into office as U.S. representative in 1973, the Congress had about a 40 percent approval rating. Gradually the body has become fully polarized. With approval ratings of 10 percent, Americans were amazed last week when the Congress functioned enough to pass needed legislation extending payroll tax cuts.

During the Republican presidential primaries, we’re not hearing words to reaffirm our shared values and try to unite us. Instead, the flames of the most disgruntled among us are being fanned. The chair of the Federal Reserve is treasonous; the president’s Christianity is not real; the government is waging war on religion; we should wage war on Iran; the free press is evil; Planned Parenthood and the U.S.-Mexico border should be shut down.

The essential message is that government is the enemy. Divided we stand. The most radical candidate will become the party’s nominee, driving the wedge down deeper into the body politic.

Yes, we need Barbara Jordan back now to unify this nation once again, like she did 38 years ago.

In 1972, President Richard Nixon was running for re-election against Sen. George McGovern. His campaign committee paid five men to break into the Democratic headquarters in the Watergate Hotel in Washington, D.C. (Pretty unnecessary — Nixon’s victory was one of the most lopsided in history.) The men were caught.

Washington Post reporters Bob Woodward and Carl Bernstein uncovered the cover-up, and all the president’s men (the five burglars and two others) were convicted in 1973.

The ordeal rocked the political world. Hearings were called to consider whether to impeach the president. Jordan served on the House Judiciary Committee. Americans were glued to their televisions.

On July 25, 1974, a 38-year-old, relatively unknown black representative in her second year in Congress delivered the opening statement to begin the hearings. In 15 minutes, Jordan electrified and focused a nation in turmoil. She united us and changed the course of history. Fearing impeachment or removal from office, Nixon resigned from the presidency two weeks later.

In 1992, the gods smiled upon me, and by some accident of fate, I was allowed into Jordan’s policy seminar at the University of Texas’ LBJ School of Public Affairs. A nursing graduate student, I was out of place among 10 confident political science graduate students, selected for their accomplishments. I was old enough to be their mom, and the only knowledge I had of government, beyond the basics, was from a UT government class that I slept through in 1965.

I’ll never forget how I felt when I actually saw her in person. Chills went down my spine when I heard her first words. Her voice rang from the mountaintop.

That semester in Jordan’s class was a period of extraordinary learning and personal growth for me. I would not be writing this column were it not for her class. She assigned readings by the most respected authors on basic democratic principles, the Constitution and topics of national debate. We each argued a side and respected each other’s informed opinion. Riding the fence was unacceptable. She gave us each a little blue handbook of the Constitution.

I absorbed the conviction that public service is a high and honorable calling. I learned that the Constitution is a purposely vague and sacred document that forged a government in which our liberty was not entrusted to a particular branch, that one branch would check the others. I learned that in America’s great experiment in democracy, the people hold the power, and rightly so.

Above all, I learned what government of the people, by the people and for the people really means. We are the government, and the government is not our enemy.

In her keynote address to the National Democratic Convention in 1976, Jordan said, “This is the great danger America faces: that we will cease to be one nation and become instead a collection of interest groups. … A spirit of harmony will survive in America … if each of us remembers, when self-interest and bitterness seem to prevail, that we share a common destiny.”

Happy birthday, Barbara Jordan. On this day, we need to remember her clarity of thought, her voice, her message of unity.

The words “missed opportunity” understate.

The visionary Berwick, champion for patients, was picked for the job because his “triple aim” (his words) at health care was the same as President Barack Obama’s reform goals: improving the patient experience, improving population health and reducing costs — and because Berwick had decades of experience successfully achieving those goals in this country and worldwide.

Through the organization he founded in the early 1990s, the Institute for Healthcare Improvement, care has been redesigned and hospitals trained to prevent thousands of injuries and deaths.

How has Berwick achieved these changes? Intractable problems in health care are identified, and IHI, often in partnership with the Robert Wood Johnson Foundation, take aim at them.

In the hospital system where I work, we know about Berwick, and we’ve worked with people from the IHI and the RWJ foundation. In 2003, we were chosen as one of 13 pilot sites to transform care at the bedside in medical-surgical units.

Direct-care, front-line nurses were challenged and given full license and encouragement to develop and test methods to improve care. And that we did. Many of the innovations Seton nurses designed are practiced in thousands of hospitals worldwide.

In the eight years since the project began, physicians, patients and families have become engaged in care; bedsores, patient falls, infection and birth trauma have been drastically reduced; communication during shift report has improved; multidisciplinary rounds are made to enhance discharge planning, teamwork and safety; patients are checked on hourly; response teams rush to a patient in crisis before it’s too late; and patient and nurse/doctor satisfaction and retention have dramatically improved. Hospital readmissions have fallen.

Through the transforming care project, in the perinatal area, birth trauma has effectively been eliminated. Clinicians developed a bundle of best practices for obstetricians.

This safety initiative has saved the government a bundle of money. In 2003, Seton billed Medicaid $500,000 for birth trauma; in 2009, zero.

Berwick has promoted understanding of this concept as a way to curb government spending on health care. As part of the Affordable Care Act, Berwick implemented financial incentives for doctors and hospitals to coordinate care and improve patient outcomes.

Stunningly, Congress refused to confirm the nomination of this proven, accomplished and promising leader. Eager to demonstrate contempt for the Affordable Care Act, Republican demagogues seized on Berwick as an irresistible target.

They dubbed him Dr. Death Panel. Why? Because he — and the Affordable Care Act — encourage end-of-life discussions between doctor and patient/family when medicine can do no more.

In addition, they exploited his remarks as an academic praising Britain’s health care system for covering all its people and reining in costs while improving outcomes.

Taking his remarks out of context, Republicans portrayed him as an advocate of rationed care and socialized medicine. This, despite Berwick’s insistence all along that the British system cannot be copied here and that America’s system, having evolved around insurance, needs its own solution.

If you repeat “Dr. Death Panel” and “rationing care” enough times, you begin to brand and unfairly define Berwick and the health care reform law.

Marilyn Tavenner, a nurse and his top deputy, will succeed him. Let’s hope that she will be able to execute his goals. Congress will be more comfortable with her, as she is more manager than visionary.

Back to his triple aim. Has his work improved the patient experience? Yes. Has it improved population health? Yes. Has it reduced costs? Yes.

Have we missed an opportunity? Oh, and how.

The legal community has a saying for it: “A person who chooses to represent himself in court has a fool for a client.”

Here’s the background: More than two years ago, two Winkler County nurses anonymously reported a doctor to the Texas Medical Board. The board notified the doctor that he was being investigated. The doctor elicited help from the sheriff to find out who made the report. The hospital administrator fired the two nurses and the county attorney charged them with misuse of official information, a felony. Charges against one nurse were dropped, and the other, Anne Mitchell, endured a criminal trial in which she was acquitted in less than an hour. The attorney general’s office jumped in and charged the four good ol’ boys with retaliation and misuse of official information, all felonies. The hospital administrator, sheriff and county attorney all lost their jobs and were sentenced to jail time. Now it’s the doctor’s turn.

As it turns out, Arafiles didn’t come off too badly in court. In a plea bargain Monday, he pleaded guilty to both felonies — retaliation and misuse of official information. He was sentenced to 60 days in jail, five years probation, a $5,000 fine and, in a triumph for patient safety, had to surrender his license to practice medicine.

Arafiles’ bizarre decision to represent himself in court against such serious charges mimics his reckless and bizarre medical practice, which got him reported in the first place.

The guy sold herbal remedies and prescribed non-FDA approved “ozonated” olive oil to his patients, sewed a rubber packaging tip onto the end of a guy’s crushed finger, rammed a needle into a woman’s crushed toe over ER nurses’ objections and sent home a 10-year-old boy with severe lower abdominal pain and nausea after giving him three enemas — the most dangerous thing you can do with acute appendicitis.

And let’s not forget a failed skin graft, what he called his “masterpiece.” In a non-sterile environment and without surgical privileges, Arafiles removed skin from a 74-year-old diabetic’s abdomen and sewed it onto his injured hand. In Anne Mitchell’s criminal trial, he testified under oath that he did not remove the man’s skin, but when asked to look at the chart, he admitted he did cut it off.

When he testified that diabetics “heal as well as anybody else,” the response in the courtroom was so intense that the judge called for order and warned that he could have people removed.

Arafiles is not out of hot water yet.

He still faces charges of aggravated perjury, another third-degree felony. In Anne Mitchell’s criminal trial, the doctor was asked under oath if he knew how the sheriff came to possess patient contact information in the cases reported to the medical board.

He answered, “I don’t know, sir.”

An Andrews County grand jury found reason to believe Arafiles himself gave that information to the sheriff, who contacted the patients to determine who had made the unsigned complaint. The alleged perjury was “aggravated,” as it was material to Mitchell’s case.

Had he chosen legal representation, he would have maximized his chances of a lighter sentence, including the possibility of the aggravated perjury charge being dismissed.

Patients worse off than before they saw him, six careers ended, a dusty West Texas town shaken and divided, multiple extensive and expensive investigations and trials. What a guy.

At least he can’t hurt anyone else as a doctor — thanks to the nurses who reported him.

One by one, the Winkler County sheriff, county attorney and hospital administrator all lost their jobs and have been sentenced for their roles in retaliating against the nurses who registered an anonymous complaint of dangerous practice with the Texas Medical Board against the town doctor. Though the doctor has been disciplined by the medical board and could be disciplined further, he also faces criminal charges arising from the scandal.

In June 2009, these four prominent Winkler County good ol’ boys orchestrated the prosecution of Anne Mitchell and Vickilyn Galle, who were fired from their jobs and indicted on third-degree felony charges of misuse of official information, each nurse facing a possible 10 years in prison and $10,000 fine.

Responding to their report, the medical board publicly reprimanded Arafiles, fined him, and required classes and supervision.

Charges against Galle were dropped, but Mitchell stood trial and was acquitted in less than an hour. For exercising their ethical duty to protect patients, their careers were destroyed. The Texas attorney general opened an investigation and prosecuted the four men.

Arafiles is the last of the four to have his day in court. The other three have all served jail time.

The first of the four, hospital administrator Stan Wiley, was indicted on two felony charges of retaliation. He pleaded guilty to the lesser charge in exchange for his cooperation. He also spent 30 days in jail and was fined $2,000.

The second, Sheriff Robert Roberts, was convicted in less than two hours of all six charges — two counts each of retaliation, misuse of official information and official oppression. Roberts was removed from office, fined $6,000, received four years of felony probation and was sentenced to 100 days behind the bars of the jail he ran for 20 years. He will retire from the county with full benefits.

The third, County Attorney Scott Tidwell, was convicted Oct. 4 on all charges — four felonies and two misdemeanors.

Against the advice of the executive director of the Texas Medical Board and the Andrews County attorney, Tidwell prosecuted the case against the nurses, acting as district attorney, even though he was county attorney.

The prosecuting attorney in Tidwell’s case told the jury that Tidwell’s motive to prosecute the nurses was that Arafiles was a “cash cow” for the hospital, ordering expensive (and well reimbursed) tests and admitting patients, which Mitchell and Galle reported as unnecessary.

Tidwell opted for the judge to assess his sentencing. The defendant’s character and criminal past is normally part of sentencing considerations. During the sentencing phase, Tidwell’s past contact with prostitutes surfaced. Tidwell pleaded guilty to charges of hiring a prostitute in 2004.

Judge Robert Moore sentenced Tidwell to 120 days in jail, 10 years of probation and a $6,000 fine. He is appealing, but the judge already had removed him from office.

The judge said, “Lives have been altered and changed in a way that there is no undoing … The ones most profoundly and permanently affected are, of course, Anne Mitchell and Vicki Galle.” After trial, it was reported he approached Tidwell and asked in hushed tones, “What were you thinking?”

It’s a tragedy that the careers of these brave women ended for doing the right thing by exercising their ethical — and in some cases — legal duty to report unsafe practice. The medical board depends on the eyes and ears of nurses and others on the health care team to report subpar practice to achieve its mission — protecting patients, the same duty nurses have.

Criminal prosecution of nurses for reporting a doctor is unprecedented, and to help it from happening again, the Legislature passed a bill this year increasing medical whistle-blowers protections as well as fines for nurse retaliation.

Eyes have been opened about nurses’ important duty to protect patients against harmful medical providers.

Alternate juror James Fair’s eyes were opened. Knowing nothing of the case before he was picked, he said, “It just goes to show you how people with power can abuse it.” Though he was not part of jury deliberations, he said he would have handed down the same verdict and that he sees the role of the nurses and patient care standards with a whole new appreciation.

“As time went on,” Fair continued, “it became more and more clear exactly what was going on and in my opinion, there was no defense. They should have never even went to trial. The whole thing was ridiculous.”

He faced his own mortality at the age of 48 when he was diagnosed with pancreatic cancer in 2003. A year later, the commencement speech he gave to the graduating class of Stanford University was flowered with his reflections on life. At the end, he described the back cover of the last issue of his beloved Whole Earth Catalog. Under a photo of an early-morning country road, four words were written: “Stay hungry. Stay foolish.” You don’t always find wisdom in simplicity, but you do in these four words.

The beginnings of the man who changed the world were hardly auspicious.

Jobs was put up for adoption when he was born, in the Silicon Valley. He attended Reed College, dropping out bored after six months. With no dorm room, he slept on the floor of friends’ rooms, returned Coke bottles for the five-cent deposit, and walked across town every Sunday for a good meal at the Hare Krishna temple. “I loved it,” he said in his address.

Now that he had dropped out, he was free to drop in on the classes that interested him. One such class was calligraphy, for which Reed was famous. “I learned about serif and sans-serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great,” he said. “It was beautiful, historical, artistically subtle in a way that science can’t capture, and I found it fascinating.”

Poetically made with a typewriter, scissors and a Polaroid camera, the bible of the 1960s, the Whole Earth Catalog, fascinated Jobs as well. “It was idealistic and overflowing with neat tools and great notions,” he said.

In 1976, when Jobs was 20 years old, he and “Woz,” technical wizard Steve Wozniak, launched Apple Computer out of Jobs’ parents’ garage. Influenced by the beautiful typography that engaged him in calligraphy class, they designed a computer with artistic fonts. With the release of the Macintosh computer in 1984, they became accidental millionaires, and Apple grew into a $2 billion company with more than 4,000 employees.

To help him run the company, he recommended someone to Apple’s board of directors, but the two executives’ visions for the company soon collided. The board sided with the new executive, and at age 30 Jobs was fired from the company he started. He was devastated, but gradually pulled himself out of it. “I had been rejected,” he said, “but I was still in love.”

He started two companies, NeXT and Pixar. The latter created the world’s first computer-animated feature film, “Toy Story,” making it the most successful animation studio in the world. NeXT was bought by Apple, and at age 40 Jobs found himself back at the computer company he started. “The technology we developed at NeXT is at the heart of Apple’s current renaissance,” he said.

Now worth more than $300 billion, Apple plays hopscotch with Exxon Mobil for the most valuable public company in the world.

In 1987, I bought a Macintosh SE for $3,000, an amount I couldn’t really afford. It turned out to be the best investment I ever made. It simplified my children’s education, and it changed the course of my life.

He changed the culture of our global family as well. His sleek, elegant, futuristic devices have brought elegance, appreciation and accessibility of music and fingertip power to our everyday lives.

He changed the business culture, too. Sociologist Daniel Bell condemned aspirations for pleasure and self-expression as “cultural contradictions of capitalism.” But Jobs, in his turtleneck and sneakers, turned those qualities into its fuel. No one asked why he worked after he was rich; everyone understood.

We will miss this iconic man’s energy, inventiveness, idealism and sense of adventure. His parting words to us would undoubtedly be, “Stay hungry. Stay foolish.” The advice is oh-so Steve Jobs, and it’s wonderful counsel for us all.

On his watch, Texas has held the disgraceful rank of last in access to health care, as well as last in percentage of residents without health insurance. Of Texas’ 254 counties, 194 (wholly or partially) are designated by the federal government as having acute shortages of primary care physicians. Of that number, 21 counties have one; 27 have zero.

There’s an elephant-in-the-room solution for the problem. It wouldn’t cost a dime but would save millions of dollars every year. Answer: Remove unwarranted constraints that limit advanced nurse professionals from practicing to the full level of their education.

In all 50 states, advanced practice registered nurses are credentialed and licensed by their boards of nursing to diagnose, treat and prescribe. About 80 percent provide primary care; the rest, specialty care. All provide preventive care and health teaching, and they’re great at what they do.

Texas is fortunate to have a large cadre of these qualified nurses, licensed by the Texas Board of Nursing, who are eager to practice to the full extent of their preparation. Their education involves extensive study of pharmaceutics, as the ability to prescribe medications is essential to providing primary care. As part of credentialing, nurses have this authority, but state laws vary on how they are allowed to prescribe.

Texas has the poorest access to care in part because it has the most restrictive laws in the nation on nurses’ ability to prescribe. Eighteen states grant independent prescriptive authority; 17 require a collaborative agreement with physicians; and 15, including Texas, require physician delegation to prescribe. Five states in the past three years switched from collaborative to independent authority.

Given the federal government’s designation of a widespread, acute physician shortage in areas of Texas, you can imagine how collaboration and delegation agreements would be tricky, if not impossible.

Why hasn’t Texas removed barriers to advanced nurses practicing to their full potential? Under the iron grip of deep-pocketed organized medicine, legislators have held back advanced practice nurses for 40 years.

Each legislative session, doctors dress up in white lab coats and explain to the health committees why they should remain the quarterback, the gatekeeper to health care. They say nurse practitioners are dangerous, but that they hire them and keep a close eye on them to ensure safety. They talk about how much longer their education took.

What they’re not talking about are the hundreds of studies showing safety and outcome levels equivalent to physicians and a higher rating for communication.

It’s as if they’re saying, “If you give them an inch, they’ll take a mile.” Legislators swallow their arguments hook, line and sinker, and with the governor’s approval, the phony hierarchy is kept alive. Perry and other governors fail to lead by not challenging the status quo nor placing the issue on their agendas.

Doctors’ arguments are curious, given they can’t come anywhere near producing enough providers. Family doctors are retiring. Medical students graduate with enormous debt and opt for the specialties over less lucrative primary care. If every nurse practitioner and family doctor were deployed, Texas still could not meet its need for accessible primary care.

Last session, Perry could have called for emergency legislation to alleviate the dire need for health care access, which disgraces his state. Instead he chose abortion legislation, despite 2011 data showing a significant and steady decline since 2000 — bucking the national trend. The nefarious law that he signed has landed in federal district court.

People suffer when they don’t have access to primary care; they stay sick longer. When the problem gets unbearable, they face long-distance drives for care and long waits in crowded emergency rooms — the wrong setting. At least in an ER they’re assured of eventually seeing a medical professional. This common and unnecessary Texas scenario is dangerous, causes needless human suffering and burdens health care systems.

By putting these nurses to work to their full potential, a visionary leader would create jobs while increasing access. It’s a shovel-ready project, and with the absence of Perry’s attention for 11 years, legislators continue to miss the boat.

A friend of mine was born, raised and educated in Texas and is heartbroken that she can’t practice as an advanced nurse in her native state. She could if she lived in three bordering states: New Mexico, Louisiana and Arkansas. She chose New Mexico.

Perry, you could be touting your health care record on the campaign trail. Be a real leader. Let the public interest be your guide and free up nurses to elevate us from last in the nation in access to care.