Let's see if I can get this straight. A killer (acquitted by reason of insanity in the 1987 slaying of an elderly woman whose body he soaked in gasoline to throw off search dogs) who has been declared criminally insane, with a history of escape, was taken on a "field trip" to the Washington State Fair, whereupon -- guess what? He escaped, duh! (Video here.)

While the nurses at the hospital had warned against letting such risky patients go on public outings, in recent years, "the types of patients allowed to participate in the outings has become more inclusive."

(Inclusivity, as many of us have been forced to learn, is an important government concept. A friend who is a public school teacher told me that many staff meetings are devoted to the constant need for its implementation.)

So, the trip was allowed despite the murder of the elderly woman*, despite his previous escape (during which he "attacked a sheriff's deputy in the jail booking area, knocking him unconscious"), and despite a recent ruling that he was a threat to the public:

A Yakima County judge had ruled two weeks ago that Paul remained a threat to the public because of his aggressive behavior and his decreased awareness of his psychosis, The Spokesman-Review reported Saturday.

The Spokane newspaper reported that Paul had repeatedly tried to win full release from his court-ordered commitment, especially after fathering a child with a woman during a conditional release.

Davis said allowing patients like Paul to go on field trips can put hospital workers and the public at risk.

But I don't mean to knock the union workers assigned to watch him, for at least they did report the escape immediately. Their "administrators," however, "waited nearly two hours before calling law enforcement." Naturally, this delay "gave Paul plenty of time to disappear."

He was finally caught, but don't worry! There's now tough talk from government bureaucrats, one of whom went so far as to actually call the situation "unacceptable."

"He is in a bad mental state," his brother, Tom Paul, told The Associated Press. "Why would they load him on a bus and take him to a fair?"

That's a question many are asking.

Authorities at Eastern State Hospital are being criticized for allowing Paul to visit the fair despite his violent criminal past and history of trying to escape. Spokane County Commissioner Mark Richard has called it unacceptable, and the state Department of Social and Health Services ordered an immediate end to such trips and launched an investigation into the practice.

Is there no common sense?

Or is the problem that common sense and bureaucracy do not mix?

That's the larger issue here, because remember, this is a government run hospital. If despite all their funding and employees and committees and meetings they can't figure out that a dangerous murderer with an escape history shouldn't be going to the State Fair, how can they be relied on to make tough decisions about whether your gall bladder should be cut out? Or whether your child's leg really does need to be amputated? Or which doctor is best qualified to do it? I find it unacceptable, for example, to read that routine gall bladder surgery led to the amputation of an air force veteran's legs.

By the way, the story of how the airman lost his legs is a classic example of government ineptness, and because this is about government medicine, I don't think it's off topic. The gruesome details were reported in a link sent to me in an email over the summer, and while I didn't write a post at the time, I didn't forget.

It's a chilling story, but worth reading:

...A resident had punctured Read's aortic artery, which is near the gallbladder, with one of four ports that had been inserted into his abdomen. The resident hadn't even removed the gallbladder. The resident and the chief surgeon, Maj. Kullada Pichakron, who was observing, raced to clamp his artery and sew it up in time to save his life. At 11 a.m., Pichakron brought Jessica Read into the operating room to explain that Read was alive but the artery was leaking. A vascular specialist was needed to properly repair the valve, but the specialist at David Grant had separated from the Air Force eight days earlier. The replacement wasn't scheduled to arrive until Aug. 5.

Dr. Michael Hines, Jessica Read's uncle who is a surgeon in Texas, credited the doctors with saving Read's life after the aorta was punctured.

"A mistake was made, but it is a tribute to those doctors that Colton is still alive," Hines said.

During the discussion, Jessica Read looked down at her husband's feet. They were blue

"They rushed me out of the operating room after I noticed," she said.

The two main arteries carrying blood to Read's legs were clogged with clotted blood. As time ticked by, the tissue and muscles in Read's legs began to die.

"Anytime you lose blood supply to any tissue in the body, that tissue will die," said Dr. Tim Gardner, a heart surgeon and former president of the American Heart Association. "Once blood is blocked from the legs, the legs go pretty fast."

Jessica Read said that at 2:30 p.m., Pichakron and two unidentified medical center officials came to tell her they decided to transfer her husband by helicopter to University of California Davis Medical Center, some 40 miles north.

The three explained Read's legs could go without blood six hours before being permanently damaged. More than five hours had already passed. And because of unexplained delays in transportation, it would be four more hours before the emergency surgery would be conducted.

Hines questioned why Read's doctors didn't do more to monitor the circulation to Read's legs.

"Not having blood flow to your legs for nine hours is like having a truck lie on top of your legs for nine hours," Hines said. "They are going to die."

The helicopter was scheduled to take off 20 minutes after the conversation. Medical personnel, though, didn't carry Read onto the helicopter for nearly two hours, at 4:23 p.m.

Neither Jessica Read nor the rest of Read's family has received an explanation from the Air Force why it took three hours to transport Read to UC Davis.

"It almost feels to me that my husband's life was not important to them because why did it take so long, and why did he arrive here in the condition that he did," Jessica Read said. "They didn't feel the urgency, it seemed."

We are of course more horrified by a criminally insane killer escaping at the state fair, even though no one lost his legs and nearly died.

Yet each horror story involved government medicine, and a lack of accountability.

Whether we should be more horrified by one than the other is a good question.

MORE: * Since he was found not guilty by reason of insanity, does that mean the woman was not murdered? I might be mistaken in the legal sense, but were she my mother, I'd probably be inclined to think of her as having been murdered anyway.

But because of the legal finding, she was no more "murdered" than she would have been murdered by an escaped tiger which mauled her to death.

So I stand self-corrected.