An addendum to the story of my mother…well, they operated on her hip on Monday afternoon. She had also received a blood transfusion because she was a little anemic. I spoke with a friend of hers last night and he told me that she wasn’t eating, and still had an IV in. I also spoke with her PCP, who said that depending on how she was doing, she would be discharged to rehab on Thurs or Friday.

Well, my favorite caseworker called me this am to tell me that my mother was being discharged from the hospital today and going to rehab. She was her usual abrupt pseudo-friendly self. I can’t tell if she’s just overworked/underpaid (the usual drill) or if she really just hates her job. Maybe a combination. She couldn’t answer any questions, of course.

I’m at least glad that they waited for her anesthesia to wear off before discharging her. On one hand, its good to get out of the hospital asap, so you don’t catch something there. And a somewhat debilitated old woman, who just had surgery, is a likely candidate for the infection of the day. But on the other, it doesn’t sound like she is ready to go out into the world yet. I would think they would keep her at least one more day, just to make sure she is eating and drinking, and everything stable.

But as the world turns…of course we don’t need healthcare reform. Everything is just so peachy cool as is.

Grrr….

As many nurses and wanna-be nurses have realized, the late great nursing shortage has virtually vanished. In its place has come a shortage of jobs. So what the…?

To reiterate, as most of us intimately acquainted with healthcare know, there was never really a shortage of nurses, as in living breathing bodies with an RN degree. Rather, nurses were leaving hospitals and healthcare altogether for greener pastures. Hospitals claimed to be interested in hiring more staff, and the drum roll was on to open more nursing programs, shorten the programs currently in existence (to push out fresh new grads sooner), or to break down the barriers to hiring foreign workers.

The idea, as many guessed, would be to flood the field with warm bodies, so that for every nurse who quit, another was waiting to take his/her place. Thus, the perpetual revolving door.

And now, with the current economic status quo, hospitals have jumped full force into the “poor me/financial woes” bit, and have frozen hiring, laid off workers–the whole 9 yards and then some.

To be fair, many facilities were facing financial problems before the great bust, but many were not. And many, as we know, dished out exorbitant executive bonuses at the same time workers were being slapped with their pink notices. And the economic situation was a prime excuse not to hire on more nurses and other staff, and just “make do.” Who needs nurses, aides and housekeepers when you’ve got suits and stockholders to keep happy and smiling?

Here is an excerpt from an interesting story that appeared online at AJN, and it is the epitome of what many nurses are now facing:

Although patient acuity and nurse skill level are considered in making shift assignments, certain situations can’t be predicted or planned for. An extra workload will always negatively affect the nurse and the patient. In the best of circumstances, the nurse won’t get lunch or breaks and the nonessential elements of patient care, such as baths and linen changes, will be skipped. The busier the assignment, the more likely that something critical will be missed. (For more on this, see the Muse, RN’s blog post, Nurse-Staffing Ratios: Nurse’s Perspective.)

I heard her say, “An extra patient shouldn’t make any difference in the standard procedure for passing medications.”

Does anything more need to be said? It would be just karma if that nurse manager ever became ill or in an accident, and she was that “extra” patient that the nurse got stuck with. And then faced the consequence.

This is rather frightening and also disturbing, although not surprising. It has been known for a long time that people can become ill from “second hand chemo” but now the subject is finally getting some attention.

Thanks to InvestigateWest, the story has now come out across the cyberwaves. MSNBC picked it up, as did the Seattle Times and a few others.

What is most disturbing is that the federal Occupational Safety and Health Administration does not regulate exposure to chemotherapy in the workplace, despite multiple studies documenting ongoing contamination and exposures and their potentially deadly consequences for human health. Studies going back 30 and 40 years ago have already shown this, but amazingly enough, OSHA has no regulations in place.

And it’s not because it’s a girl thing. I know, that’s what a lot of you are thinking–that this mainly affects nurses and nurses are a bunch of powerless little girls, so who cares if they “catch” cancer from their patients. Well, one of the primary targets of second hand chemo are pharmacists, a profession well represented by the male gender. Another healthcare profession at risk are veterinarians.

So why is OSHA lacking here? Why do individual hospitals, clinics, offices, etc, have to mandate their own regulations? And for the ones that don’t, there is no penalty.

This video is really sad, and shocking.

….and hopefully not the same as the old boss. Enough with the ineptitude and corruption that is beginning to define the CDC  into a sinister joke (remember the small pox vaccine, and their continued muddling of real influenza stats–like how many people really die during an average flu year and not the exaggerated computer modelin). A new boss is taking over the agency, and hopefully, we will be leaving politics out of it and bringing in good solid science and common sense.

Physicians and Scientists Hail Choice of Thomas Frieden to Head the CDC

The Infectious Diseases Society of America (IDSA), HIV Medicine Association (HIVMA), and the IDSA/HIVMA Center for Global Health Policy applaud President Barack Obama for his appointment of Thomas Frieden, MD, as director of the Centers for Disease Control and Prevention. (CDC)

Dr. Frieden’s experience-as an epidemiologist, an administrator, a researcher and a clinician-make him an outstanding choice to lead the CDC at this critical moment in protecting America’s public health.

Dr. Frieden will bring to the CDC unwavering dedication, immense talents, and a strong track record of battling deadly epidemics, such as tuberculosis, HIV/AIDS, and most recently the 2009 Influenza A: H1N1 virus that threatens to spark the next influenza pandemic.

“Thomas Frieden demonstrated extraordinary vision, leadership and organizational ability in containing the multidrug resistant TB epidemic in New York in the early 1990s,” said Richard Chaisson, MD, a member of the Global Center’s advisory committee and director of the Johns Hopkins Center for Tuberculosis Research. “He then took that expertise to India, where he transformed that nation’s TB program, creating a model for the world and saving hundreds of thousands of lives as a consequence. His commitment to using scientific approaches to disease control will serve the nation well. He is an outstanding choice to lead the CDC.”

Roy Gulick, MD, chief of the infectious diseases division at Weill Medical College of Cornell University and a member of HIVMA, said Dr. Frieden will be a forceful advocate for putting evidenced-based science into practice in the battle against HIV/AIDS.

“As health commissioner of New York City, Tom Frieden increased community services for the infected community. He emphasized prevention by promoting needle exchange and condom use. He worked hard to promote routine HIV testing so that more New Yorkers would know their status.

He worked closely with HIV providers to monitor the HIV epidemic in New York and reached out to communities of color,” Dr. Gulick said. “With his training in infectious diseases and public health and his track record as New York City health commissioner, he is an outstanding choice for director of the CDC-he certainly will make a difference for those infected and affected by HIV in the U.S.”

“As an infectious disease physician and a New Yorker, I have been incredibly impressed with Dr. Freiden’s response to the recent Influenza A H1N1 outbreak and previous outbreaks of other diseases. Given the potential for an influenza pandemic, all of us should take comfort in having him at the helm at CDC,” said Anne Gershon, MD, president of IDSA and a pediatric infectious disease specialist at Columbia University College of Physicians in New York. “He will be a standout at CDC, but we will miss him in New York.”

How ObamaCare Will Affect Your Doctor

Is that really a word, Obamacare? I guess so. Anyway, this is the headline of an article in the Wall Street Journal, and it is interesting.  It is written by Scott Gottlieb, who used to work at the FDA, for Medicare and now is a fellow at the American Enterprise Institute and a practicing internist. He’s also partner to a firm that invests in health-care companies, so keep all this in mind as you read his take on healthcare.

That said, I do agree with what he is saying, about a need to fix the reimbursement for physicians and other practitioners, particularly at the primary care level.

From WSJ:

At the heart of President Barack Obama’s health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this “public option” will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Chad Crowe

Republicans and Democrats agree that the government’s Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama’s plan for a centrally managed government insurance program exacerbates Medicare’s problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors’ financial incentives.

Right now, Medicare pays docs 20-30% less than private plans, and the new public option will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. The intention is to help the uninsured, but may lead to something more–and the result, like now with Medicare and Medicaid, is for doctors to refuse patients covered by these policies.

There are other ways to lower costs, than cutting into reimbursement. For starters, we should make it less expensive to become a physician–most graduate about $150,00 in debt. And then there’s the cost of malpractice, running an office, paying staff, and so on. Let’s start at the very beginning…

Another Earth day. Have we made any progress since the first Earth Day way back when in those ancient times, circa 1970?

A few interesting tidbits. First, it seems that Earth Day had its humble beginnings in Seattle. Yes, Seattle of all places, during its pre-Microsoft days, when the waterfront was a bawdy spot for drunken sailors looking to get laid, and Starbucks just a mere twinkle in the eye of a caffeine lover. The city was green, because of all the rain, so perhaps that was the idea behind the green revolution.

Second, the person who first announced that there would be an Earth Day, in September 1969 at a conference in Seattle, was  U.S. Senator Gaylord Nelson of Wisconsin. Note, he has the same last name as me, so that must be some kind of omen that I was meant to be a radical veggie savior of the environment.  Anyway, at this meeting in rainy pre-Microsoft pre-Starbucks and pre-grunge Seattle, he  announced that in spring 1970 there would be a nationwide grassroots demonstration on the environment. This occurred during a time of great concern about overpopulation–that concern gets less press these days, but never fear, reproduction is alive and well and an out of control population still remains the greatest environmental threat.

Nelson viewed the stabilization of the nation’s population as an important aspect of environmentalism and later said:

“The bigger the population gets, the more serious the problems become … We have to address the population issue. The United Kingdom, with the U.S. supporting it, took the position in Cairo in 1994 that every country was responsible for stabilizing its own population. It can be done. But in this country, it’s phony to say ‘I’m for the environment but not for limiting immigration.’”

Senator Nelson first proposed the nationwide environmental protest to thrust the environment onto the national agenda.” “It was a gamble,” he recalls, “but it worked.”

Finally, the third most vital point is that the date chosen was April 22. No accident or coincidence, I assure you. That is today, and it is the day right before my birthday. So Earth Day is sort of the opening ceremony to my birthday, and then the real celebration is tomorrow.

Killer McCarthy

Now I’ve seen everything. Here is a website called the “Jenny McCarthy Body Count” and it blames her for all children in the US who have come down with an illness that is preventable by vaccine, and all deaths due to vaccine preventable illnesses. Now I realize that vaccination has been a hot button issue for many people, especially with the controversy over the HPV vaccine, but come on. Get a life.

The website was put up anonymously (come on, you feel so strongly about it then show your face), and puts up reproduced data from the CDC on morbidity and mortality. Note, and this is important, that the CDC data is just a table. It gives absolutely no information about the patients or their circumstances. While it might be quite true that the reason for the illness or death is due to the fact that the parent is opposed to vaccines, and as far-fetched as it may be, perhaps this parent was mesmerized by Jenny McCarthy and decided to ‘mimick her idol (including posing for Playboy), there is a good chance that its not the reason for most cases.

However, there are multiple reasons for the lack of vaccine protection, which the owner of this shadowy website doesn’t seem to have considered:

1) the vaccine may have been ineffective–yes, it does happen. Vaccines fail to “take.”

2) the child may have been unable to receive proper vaccination due to allergies to vaccine components

3) the child may be immunocompromised and unable to receive some vaccines

4) child may be otherwise ill with any number of serious conditions, and unable to receive vaccines

5) child may have recently immigrated to the US, and may have already been infected upon arrival

6) child may be recent immigrant, and family doesn’t understand vaccine policy, know that they are available, or whatever. It’s not like there is a great primary care health system in place in this country, and many immigrants are isolated

7) family situation may not be very conducive to child’s welfare, and parent is neglectful. This type of situation has nothing to do with any opinion about vaccines or Jenny McCarthy. In fact, in some case, the kid is lucky if he gets something to eat, let alone vaccinated.

child may have had a severe reaction to a vaccine, and parent is fearful and distrustful that all vaccines may cause a reaction.

9) May have received vaccines but immunity has waned. This is particularly true for the pertussis vaccine, and it has now been firmly established that immunity from that vaccine may be gone by the early adulthood or even late teens.

These are reasons that some children go unvaccinated, or not fully vaccinated, and it has nothing to do with any particular ideology, or a particular person, including Jenny McCarthy. But the anonymous website master wrote:

In June 2007 Jenny McCarthy began promoting anti-vaccination rhetoric.  Because of her celebrity status she has appeared on several television shows and has published multiple books advising parents not to vaccinate their children.  This has led to a dramatic increase in the number of vaccine preventable illnesses as well as an increase in the number of vaccine preventable deaths.

Has Jenny McCarthy been responsible for a “dramatic increase” in in the number of vaccine preventable illnesses as well as an increase in the number of vaccine preventable deaths? If so, then why does this person’s list only go back 2 years, to June 2007? Can we have a look at the number of cases prior to 2007, so as to make an intelligent comparison?

Also, there is not a steady climb in the death rate from June 2007 until March 21, 2009 (those are the beginning and end dates as of today). There seems to be a cluster of cases from early Feb 2008 to early April 2008, and then the number drops down. Then it climbs a little for March 2009. So it is uneven.

Now, the poster contradicts him or herself:

Is Jenny McCarthy directly responsible for every vaccine preventable illness and every vaccine preventable death listed here?  No.  However, as the unofficial spokesperson for the United States anti-vaccination movement she may be indirectly responsible for at least some of these illnesses and deaths and even one vaccine preventable illness or vaccine preventable death is too many.

He/she admits that McCarthy isn’t directly responsible, and may only be indirectly responsible for some of them….but yet, still has assigned McCarthy the title of unofficial spokesperson for the anti-vaccination movement. Uh, I hate to be a party pooper, but having worked in maternal/child health since the 1980s, I can assure all of you, that questioning vaccine safety did not begin with McCarthy. There have been very vocal critics of vaccine policy for the past 2 decades, who were out there on center stage writing books, getting press coverage, putting together websites as the Internet became popular–way before McCarthy ever gave birth. So trying to pile the body count on her conscience is just silly. And as I said above, there are numerous reasons other than an anti-vaccine stance why kids may not be getting all their shots.

Finally, while it is sad that anyone should get sick or die if it could be prevented, the numbers are extremely low. In two years, there were 142 deaths, which is 71 a year. Considering the amount of children (and the ages aren’t given on the CDC report for most categories so some of these may be adults/teens whose immunity has worn off!), it is a tiny percentage of the population. Even the 720 who became ill and survived, over a 2 year period. Still exceedingly low.

I really don’t have time to go searching through data right now, but it would be nice if the poster would put up some numbers prior to 2007, so we can see if the numbers did increase. And even if it is true, there are many reasons for it, other than Jenny McCarthy. I think the poster is giving this woman more credit than is due–I have barely heard of her, I had no idea what she thinks about vaccines, and I tend to think that for the majority of people living in this country, her opinion is of no consequence.

George Bush just keeps on giving. The man is history, and has exactly 1 month and day left as president in this country. But you know, its Christmas, and GWB is the gift that just keeps on giving.

His latest idiocy and insult to this country is the “conscience law” which allow health care providers to refuse to dole out treatment that is contrary to their conscience. The major problem with this law is that it is so broad that virtually anyone working in health care can invoke it. For example, a receptionist who feels that sterilization is morally wrong can refuse to schedule an appointment for a man to get a vasectomy. A nursing assistant can refuse to give a bedbath to a gay man, or change his bedpan if she feels that homosexuality is wrong and the man is a sinner and doesn’t deserve to be cared for.

The list is endless. But what is missing from this scenario is the patient. Healthcare is supposed to evolve around the patient, not the provider. If you work in healthcare, you better get used to people coming at you from all walks of life.

When I worked in the NICU, we had many families that made my flesh crawl. Like the 27 year old woman with a 14 year old daughter giving birth to her 10th kid. All with different fathers, on welfare–well, you get the picture. I’d personally like to snip her tubes, but the best we could do was counsel her, and take care of her baby. Get social services involved to make sure that the baby whose life we worked so hard to save would be cared for.

From USA Today:

Under the rule, which takes effect mid-January, anyone from the brain surgeon to the pharmacy cashier can opt out of participating in care to which they have a moral or religious objection. Health and Human Services Secretary Michael Leavitt described it as a rule to protect “the right of medical providers to care for their patients in accord with their conscience.”

The Family Research Council calls the rule “an early Christmas present to pro-lifers” which will “reinforce the rights of doctors, pharmacists, technicians, and even receptionists …

Protecting the right of all health care providers to make professional judgments based on their moral convictions is foundational to federal law. The next administration will inherit these rules, and we strongly urge President-elect Obama to defend them. True tolerance would allow the choice of conscience to be defined by individuals — not the government.

Are these people daft or what? Health care providers are supposed to make decisions based on standard practice, science, and the needs/wants of the patient. Not their moral convictions, which should play no part in any healthcare decision making because they can be in direct conflict with what the patient wants.

Well the Family Research Council must be drinking spiked Kool-Aid if they think that Obama is going to defend this assault on healthcare. Hopefully Congress will block it immediately, so that Obama doesn’t have to deal with it. Senators Clinton and Murray have already introduced a bill to repeal it.

Women seeing reproductive health care, gay individuals and couples dealing with emergencies or even routine treatment, even people who see vaccines or antibiotics for their babies will face health care roulette on all fronts. Who knows the beliefs of the triage nurse in the ER?

What the defenders of this law don’t realize is that it can affect them. Their brain is focused on abortion or emergency contraception, but little do they know that they can be a victim of moral conscience. Gee, what if a nurse invokes her Jehovah Witness status and refuses to give them blood? Maybe they can bleed to death? Or if the pharmacist refuses to fill their prescription for a drug he considers “objectionable” such as a painkiller, and he’s the only open one in town. Tough luck, kiddo, you’ll have to suffer all night.

People who are carrying around too much moral baggage should not be working in health care, or at least, choose a niche where it won’t be a problem.

Under this law, even a cashier can refuse to ring you up, if they don’t like what you’re buying. Gee, they think deodorant is immoral, hiding the natural scent that God gave you. Oh my, you should not be buying tampons–how icky.

Merry Christmas, George Bush. How about giving the nation a present and resigning now? Just remember, what goes around comes around. Wait until you’re sick, and the health care team refuses to care for you, saying that it is against their conscience to care for a mass murderer….

Photo courtesy of Clipartguide.com

I have a number of articles that I have sitting and fermenting in my draft box…some of them beginning to near retirement age. But with the election, and then spooning more work on my plate, and then revamping my website (yes, my official memo about that is coming), and then updating Windows this weekend–well, poor blog. Gets ignored and left out. Plus there’s my other blog (www.moneyfaithandchocolate.com) that is really being ignored, and I have great plans to start yet another blog.

This is an interesting little story from the NY Times about scrubs. It’s a short piece and designed primarily for reader input. It asks the interesting question:

Should hospital scrubs be worn in public places?

That’s one of the questions asked by my Well column this week, which looks at the role clothing may play in the spread of germs by health workers. The issue of scrubs on the subway and other public places has been raised often by readers of the Well blog.

“I cringe every time I see a medical professional on the subway in their scrubs, which is a regular occurrence,” writes reader A.K.

I don’t think wearing soiled scrub clothes poses a threat to public health, unless you work in a level 4 biosafety lab, or just emerged from a cholera unit. My problem with scrubs is that they have lost their purpose.

When I first started working in NICU, the hospital supplied the scrubs. You wore them, then dumped them in the laundry bin, where they were washed with hospital detergent. Then it came about that alot of hospitals required nurses to wear their own scrubs. So these scrub clothes were worn into work, ie, like outside in the street, then worn in the unit, and then worn home. And who knows how many times they were worn before washing? The only place that maintained a strict protocol on scrub clothes was the OR. Fortunately…

Scrubs are now commonly worn by nurses all over the hospital. There’s nothing wrong with that, except the scrubs that they are wearing in places that are supposed to be a little ultra clean (aside from the OR) are no better than a regular uniform. Like the NICU. Shouldn’t nurses, doctors, etc, be wearing scrubs that never leave the hospital? That are washed in the hospital after one use, and washed with whatever disinfectants that are used to clean hospital laundry? Doesn’t that make sense?

So what happens when a medical error causes a musician to lose part of her arm? She sues, right? Is she justified? Was it a real unavoidable accident or real negligence, or done maliciously?

Well, she is justified, as far as I can tell, and I would call it negligent. The musician, a woman named Diana Levine, received a relatively benign drug that was delivered in a manner that has the potential of causing great harm. The story is in the New York Times, if you want to have a look.

It seems pretty straightforward–at first.  The patient sued Wyeth, the drug manufacturer, because she said it failed to provide adequate warning about a drug. She was awarded $6 million. Okay, nobody sheds too many tears when a drug company has to shell out, because we always assume they are wrong and we are right. But now the woman is back in court, battling over whether she can keep the money.

When I read the first few paragraphs, I thought the usual–that the drug company had blundered and was now trying to cover its tracks and using all sorts of legal jargon and new fangled and obscure laws to get out of paying her. But then, I read on…

In the spring of 2000, suffering from a migraine, Ms. Levine visited a clinic near here for a treatment she had received many times: Demerol for the pain and Wyeth’s drug Phenergan for nausea.

“Nothing wrong with either drug,” Ms. Levine said. “They’re both safe when given the right way.”

But if Phenergan is exposed to arterial blood, it causes swift and irreversible gangrene. For that reason, it is typically administered by intramuscular injection. According to Ms. Levine’s lawyers, using an intravenous drip is almost entirely safe as well.

This time, though, a physician’s assistant used a third method. She injected the drug into what she thought was a vein, a method known as “IV push.” But the assistant apparently missed.

In the following weeks, Ms. Levine’s hand and forearm turned purple and then black, and they were amputated in two stages.

Uh, excuse me, but this case has nothing whatsoever to do with Wyeth. The drug is clearly labeled, and the fault lies solely with the physician’s assistant who administered it, as well as the clinic in general, for having a policy that permits the non-emergent use of IV push phenergren.  Nausea sucks big time, I grant you that, but there is no excuse for giving this drug as an IV push, rather than IM or a slower IV drip, to an ambulatory outpatient who has a migraine! Please.

Nurses, physicians, physician’s assistants–would you ever give this as IV push to a patient with a migraine? And let’s take that a step further–whoever injects a drug straight into a vessel like that without first flushing it through to make sure that you are indeed, in a vein? Since this wasn’t any sort of emergency, the PA could have quickly started an IV infusion, and then slowly gave the drug IV push into the line. And checked before hand if it was a vein or artery?  The only time you would stick a needle directly into a vessel, and not bothering to assess if you were in a vein or artery, if it is a life threatening situation where every second counts.

The Human Stain

This whole situation reeks of total negligence, on the part of Ms. Levine’s clinic. But yet, the article barely touches on it. It says that Ms. Levine settled with the clinic and then moved on to attack Wyeth because she thinks it needs a stronger warning.

“All they had to do,” Ms. Levine said, “was change the label and say, ‘Don’t give it this way.’ ”

But Ms. Levine, the warning clearly states that this drug should never be given into an artery. How much clearer does it need to be?  This is a case of pure negligence on the part of the clinic and the PA who administered it.

Ms. Levine and her lawyers apparently turned to Wyeth because the pockets are deeper than the clinics. That’s my guess.  Their assertion that they are entitled to a payout because the label needs a broad warning to cover all human errors, and for failing to say “do not administer using the IV push method just in case you hit an artery”, is beyond pathetic.

Perhaps the drug should also have a warning that it should not be administered directly into the eyes, or inhaled, or used intra-rectally or intra-vaginally.  Perhaps it should also read not to apply directly to an open wound, or do not swallow.

It is the responsibility of the healthcare provider to administer the drug in the prescribed fashion, and not use an alternative method not specifically mentioned on the label. If the label says administer intra-muscularly or intravenously, why administer it using the IV push method? And putting it into an artery is a blatant error.

So while I do feel sorry for Ms. Levine, that she lost part of her arm due to a medical error, that sympathy is tempered by her greed in trying to make the manufacturer responsible. Sorry, but I’ve had my fill of hearing about these bogus lawsuits. This is about as bad as the smoker who sues the cigarette companies–you know, the one who started smoking after warning labels appeared on cigarette packs that they could be harmful to your health.  And this same person, who never even tried to quit until after he was diagnosed with lung cancer. And now, its time to sue the manufacturer because he failed to adhere to warnings.

The Saga of Polyvisol

A little anecdote to make my point….when I was working in Florida many moons ago, a nurse working in the NICU failed to make use of her brain. This unit was small and sort of weird, and she was trained on the job–sort of. She used to walk around saying, “I just do what they tell me to.” I told her that no, you need to understand why you are doing something.

Well, she definitely wasn’t the sharpest knife in the drawer, because one day, she went to give a baby Poly-vi-sol. For those of you unfamiliar with this delectable item, it is an oral vitamin supplement. She drew some up in a syringe, and then proceeded to stick the needle into the infant’s IV line. A nurse standing nearby fortunately saw it as well, and grabbed her arm before she could push the syringe. The oral formulation, nice and greasy, could have killed that baby.

So should Poly-vi-sol be labeled–”DO not give IV?” “Do not give IV push?” Is the word “oral” on the label sufficient? Shouldn’t a healthcare practitioner be able to read and understand that 4-letter word? And if that nurse had gone ahead and given that dose, and the baby died or suffered from other damage, would the parents have been justified in suing the manufacturer of Poly-vi-sol?

Absurd, you may think, but it is an identical story to the one of the Vermont woman. Different drug, different circumstances, but it all boils down to one thing—gross human error.

Surely there had to be a nurse assigned to this patient at some point? An RN, LPN, or an aide? Surely this is not just a warehouse to toss living bodies into and watch them die…

From CNN:

A mental patient died after workers at a North Carolina hospital left him in a chair for 22 hours without feeding him or helping him use the bathroom, said federal officials who have threatened to cut off the facility’s funding.

The state sent a team Tuesday to help Cherry Hospital in Goldsboro draft new procedures to ensure patients receive proper care.

An investigator’s report released Monday found that 50-year-old Steven Sabock died in April after he choked on medication and was left sitting in a chair for close to a day at the facility about 50 miles southeast of Raleigh. Surveillance video showed hospital staff watching television and playing cards a few feet away.

The scene of the crime is Cherry Hospital, which is supposedly a JACHO accredited institution. Accreditation is supposed to mean that they meet a certain standard of care.

How can this happen, you may be wondering. Me too. I’ve worked in some pretty bad hospitals, but I couldn’t imagine anyone sitting a patient in a chair and then leaving him there for 22 hours.  Four shifts came and went, and still this man sat in his chair without food or being able to use the bathroom. I mean, what did nurses say at report?  Mr. Sabock is sitting in his chair and has been for the past 10 hours, and oh, I don’t think he’s hungry. Or has to go pee-pee.

And didn’t anyone stay with him when they gave him his medication, especially considering that he was a mental patient? You know, to make sure he took it? Or if they left it, to check back that he did take it instead of leaving him to choke on it?

Department of Health and Human Services spokesman Tom Lawrence said the state team also may investigate what, if any, disciplinary action should be taken after Sabock’s death.

Surely they jest? Are they questioning if any disciplinary action should be taking, or is this just a poor joke? Anyone related to this patient’s care should be fired, and have their license (if they have one) permanently terminated. And criminal negligence charges should be brought among the most guilty, like the nurse who dispensed the medication, or the workers who sat watching TV and playing cards while this poor man sat in a chair without food, and probably peeing and pooping in his pants.

The message has to be sent that no, this is not okay. And the hospital should get a stiff fine, and be investigated as to how it trains its workers. Surely there must have been a nursing supervisor walking around. Did she not say anything to the workers watching TV, like, “have you checked on all of your patients?”

Were there any nurses’ notes on this patient? Did anyone chart on him?

Did he call for help, I wonder?

Sorry, but I don’t think the hospital can blame this one on the nursing shortage.

A lot of news about more babies getting hit with heparin overdoses. But as much of the news in the popular media, the information is incomplete and vague. I’m assuming that since it’s for a general audience, they assume that the public is too stupid to understand anything more detailed.

From the Wall Street Journal:

This time, it’s more infant overdoses: 17 babies at a Texas hospital got too much of the blood thinner; one has died, though hospital officials told CNN that it remains unclear whether the heparin contributed. Nurses keeping IV lines clear apparently used 10,000 units of heparin instead of 10, and the error wasn’t caught until two days later.

What kind of IV lines are they talking about? No one routinely flushes an IV line with heparin, unless it’s an arterial line. And even then, a tiny amount of heparin is mixed in with the IV solution, and that is normally done by the pharmacy. So what kind of lines are they flushing? Hep locks? That would only take a minute amount of fluid to flush through.

It would be nice if they actually explained what happened. Did the nurses add the heparin to the IV solution that was running through an arterial line and make an error–like use the wrong concentration? Was the vial mislabeled?

But of course, everyone has an answer for cutting down on medical errors, while ignoring the obvious.

The quality gurus at the Leapfrog Group, a consortium of employers aiming to improve health quality, said the problems underscored safety issues at hospitals across the country.

“Incidents like this are the reason why computerized systems for ordering medication in hospitals has been The Leapfrog Group’s number one safety measure that it urges all hospitals to take,” said Leapfrog CEO Leah Binder in a statement. Studies cited by Leapfrog suggest that computerized systems could cut drug error by 50% to 100%.

They’re not wrong of course, but I got into a “discussion” with a physician at a conference who also thought that computerized systems were the answer to all our prayers. Perhaps the WSJ article might also have told us about the staffing at these hospitals where the errors took place. How many patients did each nurse have? How sick were they? How many hours of mandatory overtime were they working?

Most medical errors are generally caused by a cascade of events that happen that lead up to the error–and since the nurse is at the end of the food chain, she often gets the full blame. Which isn’t to say that nurses shouldn’t pay attention to what they’re doing, but the current working conditions actually encourage errors of all kinds, and no amount of computerized systems is going to make up for lack of staff.

But again, nurses should not be working in unsafe conditions. ICU nurses should not be taking 3 patients (I hear complaining about it, but still the good nurse takes the assignment for the “sake of the patient”), and nurses should refuse mandatory overtime. They should take the time to read the labels of the meds they are giving, and if they get behind in their work, then they need to speak up. If they have to stay over to finish, then demand overtime. I met a nurse once who kept talking about how she could never finish her work on time, and generally had to stay over at least an hour every day to finish charting, but never asked for overtime. Even though her workload made it impossible to leave on time. What a dream nurse she was–every CEO’s dream.

Anyway, these hospital error stories, particularly the ones about heparin, are really getting tiring. How about we hear a story about a hospital that has actually done something about it? Like increased their staffing, makes sure pharmacy double checks what gets stocked on units (especially NICUs), gives nurses safe assignment and “stocks” the units with ancillary staff like clerks, respiratory therapists, aides, etc. Uses a computerized system that is user friendly and that actually makes the nurse’s life easier rather than more difficult? Are there any stories like that around?

This post sort of continues the previous one, about violent attacks against nurses. There is an interesting new thread about on allnurses.com, about the Tao of being hit by a patient.

What I find astonishing, that in this day and age, the nurse is asking what to do about it. As though assault is still a fuzzy area, and the wonderful professional called nurse should still be wondering if it is okay for a patient (who is completely coherent and not suffering from dementia) to slap her across the face. And wondering what she should do about it.

Fortunately, most of the responses are positive, in that they are telling her to file charges against the person who hit her. Afterall, if someone slaps you in the supermarket, would you just smile and say that it’s okay? That the person who hit you is a little stressed and need to get out their aggression. What if you were working as a supermarket checker and a customer slapped you across the face, because she said you were moving too slow? Would it be okay?

Is it okay for a child/teen to smack his teacher? Does the teacher just say, “Oh, that’s okay. I know this is a rough class.”

What would your doctor do if you smacked him/her? Would the CEO of the hospital take kindly to be being whacked across the face? Or some middle-management weenie who crunches numbers all day? Would they just say that the customer is always right, even though that’s often still the message given to nurses?

If You Get Hit…

If you are working as a nurse in a clinical area, or any area, it is NEVER okay for anyone to abuse you. I don’t care about the idiocy that instructors are still dishing out, or the “customer training” that is becoming rampant in hospitals today (they think its a solution to the nursing shortage). It is not okay.

If the patient has dementia, or is otherwise not in the right mind, then it would be difficult to press charges. However, you should never again be alone with that patient and if the patient is prone to violence, the facility needs to take appropriate precautions. Do not place yourself in danger. Tell the CEO to go in and give the patient his medication, if he doesn’t think there is a need to hire on extra security.

But if anyone in their right state of mind (arguable, of course, as to who really is right in the mind) ever hits you, immediately react. I don’t care if its the Chief of Staff. Call the police and press charges. File an incident report. Don’t let anyone talk you out of it. If you don’t do it, then not only are you telling the world that nurses are somehow “different” from everyone else, and not entitled to the same protection, but it will happen again. The same person that hit you may again strike you, only next time harder. He/she may also feel free to attack someone else, since they know there are no consequences. And your hospital won’t do anything to protect its nurses.

As a human being, you have a right to a safe and stable work environment. Don’t let anyone tell you otherwise.

FYI, the person who posted this says she is a new nurse and still on orientation. That means that her schooling was insufficient, and that her instructors managed to skim over that huge white elephant sitting in the classroom–that nurses are vulnerable to physical and mental abuse. Or they delivered the old school line of thought about how the nurse should rise above that, she should report it to her charge nurse, etc. In other words, suck it up baby.

This is part of what this nurse wrote:

So, my question is this….at what point does a nurse actually look at a situation as being assaulted. If this lady slapped me across the face in the middle of the grocery store, I would have called the police.

What is that fine line? What if she bruised my face? Is that different?

I think she answered her own question, but isn’t it sad, that she thinks that because she’s a nurse, there is somehow another standard for assault. Or that a certain amount of damage needs to be done before a nurse can consider a physical attack “assault.”

It seems that’s what needed in addition to education and getting a license in the UK. A startling news release from Unison, a British nursing union, reported that one in three nurses in the UK have been attacked. Where is Rambo when you need him most?

Nurses are vulnerable to both physical and verbal attack in the U.S., but these stats are ludicrous. Why are nurses in so much danger? Do hospitals just consider violent attacks on nurses akin to vandalism–you know, that nurses are things not people, and attacking a nurse is similar to painting graffiti on the hospital wall? Do the words “increase security” ring a bell?

And then hospitals around the world wonder why no one wants to be a sweet nursey anymore.

From Unison:

04/03/08) Almost a third of UK nurses suffer frequent violence at work, according to new research.

UNISON has condemned the findings, which reveal one of the highest rates in Europe. Only in France are more nurses attacked.

The study, published in the journal Occupational Medicine, found that 29% of UK nurses had suffered frequent violent incidents at the hands of patients or their relatives.

“These statistics should make people in the UK ashamed,” said UNISON head of nursing Gail Adams.

“It is totally unacceptable for nurses to face rising levels of violence, when all they are trying to do is help and care for their patients.”

More needs to be done to protect staff, Ms Adams said.

She stressed that prevention is the key, coupled with better training and tough penalties for anyone found guilty of assault.

And she urged hospitals to review the support they offer staff, to ensure they offer good occupational health services.

“The survey shows many feel abandoned and depressed following an assault, which should not be allowed to happen.”

The researchers surveyed 39,894 nurses in 10 countries.

They found that violence had wide-reaching effects including recruitment and retention problems, increased amounts of sick leave and burnout.

Just when you thought that you couldn’t hear anything worse about the insurance industry, along comes the clincher that wins the pie in the sky. If there is actually pie in the sky, that is.

Blue Cross would like to enlist healthcare practitioners in a witch hunt, to seek out those infidels who dared to lie on their insurance applications. Those lowlifes who did not claim all, who failed to mention that they had their tonsils removed 50 years ago, or that they were treated for leukemia in 1965 and it has never returned so they kind of thought themselves cured and not worth mentioning the disease.

From ABCNews:

“Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately,” according to the letter obtained by the newspaper

Other than the fact that Blue Cross wants doctors to break patient confidentiality, there are 3 amazing things to note in this story.

1) Blue Cross was recently fined $1 million for unfairly revoking coverage to scores of its policy holders. You’d think that they’d lay low and keep a low profile until the fuss blows over.

2) The reason that people may be withholding this information is that they fear that they will be denied insurance. Blue Cross, did that ever cross your mind?

3) They must be truly living in an alternate reality if they think practitioners are going to supply them with that information. Aside from breaking confidentiality (and a patient may have grounds for a lawsuit), the physician will lose money from the deal. If patients lose their insurance, they are less likely to visit their physician, or to even have a primary physician. Thus, everyone loses out except Blue Cross.

They may look pretty enough to eat, but you really don’t want to be swallowing drugs spotted with paint. Do you? Or maybe you’ve already gobbled some down. It wouldn’t be all that unusual, according to this article from the Associated Press:

SAN JUAN, Puerto Rico (AP) — The first warning sign came when a sharp-eyed worker sorting pills noticed that the odd blue flecks dotting the finished drug capsules matched the paint on the factory doors.

After the flecks were spotted again on the capsules, a blood-pressure medication called Diltiazem, the plant began placing covers over drugs in carts in its manufacturing areas.

But the factory owner, Canadian drug maker Biovail Corp., never tried to find out whether past shipments of the drug were contaminated — or prevent future contamination, according to U.S. regulators.

Thirteen of the 20 best-selling drugs in the United States come from plants on this island. But an investigation by The Associated Press has found dozens of examples over four years of lapses in quality control in the Puerto Rican pharmaceutical industry, which churns out $35 billion of drugs each year, most of it for sale as part of the $300 billion market in the U.S.

This is pretty sad, if you ask me. How much money do pharma companies rake in, and they can’t even keep paint off their capsules? And the FDA–gee, maybe if they’d stop worrying so much about searching for elusive boxes of contaminated chamomile tea, ie, trying to put the herb and alternative medicine market out of business, they might find time to do their job.

This is another juicy little quip:

The FDA issued a warning letter to Wyeth in May 2006, after consumers reported finding machinery pins inside bottles of Effexor, a leading depression treatment, and the heartburn drug Protonix. The letter expressed concern that the plant was not “able to detect that the affected equipment was missing some of its parts.” The Madison, N.J.-based company faulted mistakes by workers who packaged the drugs.

They issued a warning letter after machinery pins were found in medication boxes. A warning! And such powerful language. Did the machinery need to be inside the drugs for them to take a little action? How about shutting down the factory? What about levying a stiff fine against Wyeth for not meeting quality controls? And maybe hiring workers with a little more intelligence, or teaching them the difference between a machinery pin and a capsule of medication.

There is no excuse for quality control at factories to be of the highest standards, and to be standardized across the board. No excuses. Every factory must meet them or be shut down until they do. And the companies should have to pay a stiff penalty for carelessness like this. And the FDA needs to do its job, not sit around and write wimpy little letters.

The article also says that some plants in Puerto Rico are three decades old. I guess that they haven’t been renovated since then, although I’m sure that none of the executives uses a company bathroom that’s gone 30 years without a tune-up, or has an office that hasn’t been redecorated in that time.

The United States is a leader in….drum roll…

Well, take a guess.

Okay, I’ll give you a hint. It’s stuff that you can get from having sex. It’s also stuff that happens when people aren’t being properly educated, and there is no comprehensive primary care network of healthcare.

See what we have to show for ourselves, from the Seattle PI

There is an interesting article from the Wall Street Journal online about workplace violence–healthcare workplaces that is. The scary thing about this article is not so much the degree of violence that healthcare workers, but how blase these people seem. They seem to take it in stride and “accept” it as being a normal part of the job.

From the WSJ.com:

The risks are part of the nursing job that doesn’t get talked about much or even reported. Most nurses I’ve known seem to figure it comes with the territory. It’s something that you can’t always guard against.

Many nurses and nursing assistants have had patients accidentally injure them. One obstetrics nurse at our hospital was injured when a patient grabbed her around the neck while pushing in labor. She needed medical treatment for a neck strain afterwards.

Certified nurse assistants, who do the bulk of patient lifting and moving, get back injuries frequently. They often work shorthanded because the pay is low, the work is hard and their co-workers don’t show up. Patients unexpectedly drop on them or grab them and pull them off balance.

A 2002 study in the Journal of Emergency found that at a large Florida hospital 88% of nurses reported being verbally assaulted and 74% reported being physically assaulted while at work in the past year. (Read the abstract)

With hospitals focused on patient safety and patient satisfaction, the nursing safety issue hasn’t gotten as much attention.

Nurses and doctors in the emergency department are the most likely to encounter workplace violence.

A 2005 study of Michigan ER doctors showed that 75% were verbally threatened, 28% were physically assaulted and 3.5% were stalked in the previous year.

No, I’m sorry, but these risks are not part of the nursing job. At least, not to the rate that they are occurring. Doesn’t the rate of 74% of ER nurses being physically assaulted send out shock waves? Shouldn’t these nurses (and the physicians and everyone else in the ER) be demanding increased security in their work area? Then again, that study was done in Florida, one of those glorious right-to-work states that prides itself on crushing labor unions. But even so, there are enough jobs all over the state, and no one should be forced to work in that type of situation.

This is really a case of where healthcare workers just have to refuse to take this kind of abuse. Working as a nurse, physician, aide, etc, is hard enough as it is. You shouldn’t have to worry about violent patients and an employer who doesn’t care what happens to you. I don’t care if the hospital has to post a whole squadron of armed security guards in the ER–healthcare workers need to be protected in order to do their job.

And as far as accidental injuries, well, many if not most facilities don’t really care either. If they did, patient lifts would be standard equipment, and they’d make sure that they had sufficient personnel to assist with moving heavy equipment and patients. Hire a team of muscle men if you have to, but nurses aren’t weight lifters. But yet, I’ve heard nurses complain about how they have to lift a 300 pound patient all by themselves, or have to go and beg for help…you know what? As long as the nurse will do it, things aren’t going to change. The outcome is that the nurse thinks that she’s “helping” the patient by moving a body that needs an electronic lift or ten pairs of strong hands. She’ll hurt her back or worse, and then the hospital doesn’t want to know her. They’ll fire her, do their best to deny workman’s comp….basically, nurses are often treated like pieces of equipment. You use it until it breaks or gets worn out and then toss it out.

Do doctors and nurses ever get mugged on the TV show ER? Or do they exist in a perfect world, where all patients survive and all are bursting over with gratitude?

When I worked in the NICU, we used to refer to the obsessive lactation consultants as “Nipple Nazis.” You know, the ones who are basically telling new moms that their baby will die without breast milk, and think that NICU nurses are being cruel by not permitting mom to nurse a 1 pound premie hooked up to a ventilator.

So it is in the realm of the nipple Nazi that I write this note. And I’m sure that breast feeding aficionados are rejoicing over this story, and will find my comments nothing less than sacrilegious. However, I find this story rather disturbing.

Which story? Well, it concerns the Harvard student who is taking her medical boards so that she can become a physician. The woman, 33 year old Sophie Currier, demanded that she be given extra break time during the exam so that she could pump her breasts. The allocated 45 minutes wasn’t enough for her, despite the fact that she had been provided with a breast pump and a private room in which to pump. But I guess pumping on her break was too demeaning, or maybe she’s got extra gigantic boobs that take more than 45 minutes to pump? Or maybe she should be allowed to bring her baby to the test, and let it nurse while she filling in the boxes.

From the Boston Globe:

The woman, Sophie Currier of Brookline, argued that it would be uncomfortable and possibly pose a health problem if she took only the allowed breaks.

The National Board of Medical Examiners offered to let her pump while she took the test, but she said that would put her at a disadvantage during the exam, which she must pass to graduate and begin her residency at Massachusetts General Hospital.

“I now feel that I am able to take this test without putting my health or my child’s health at risk,” said Currier. “I hope this decision encourages moms to breast-feed and employers of moms to accommodate their needs.”

Yes, I’m certain that her health and that of her daughter are going to be jeopardized by her being restricted to a 45 minute break. And here’s a great line from the anonymous breast feeding specialists…”Lactating women can experience pain and risk developing infection of their breasts if they don’t express milk at least once every three hours.” Uh, maybe when you’ve got a newborn who’s eating every 2-3 hours, but at four months, a lot of kids are sleeping through the night. I don’t know of any breast feeding moms who set their alarm clock to wake up every 3 hours to either pump or force milk on a sleeping baby.

But let’s back track. Now not only is Currier demanding extra break time, but she has already been given an extra day to take the test! Duh, doesn’t that help with the breast feeding schedule? She has dyslexia and attention deficit disorder, so while everyone else has to take the test in one day, she gets two. And she doesn’t think that she is being fairly accommodated?

Now let’s take a look at this more closely. The test is 9 hours, and most students do it in one day. Since Currier has two days, that gives her 4.5 hours each day. So how many times does she actually need to pump her breast in a 4.5 hour period? She can pump or nurse her baby before the test, and pump or nurse afterwards. But she gets a 45 minute break in there, so that isn’t sufficient? Why on earth does she need an extra hour? Something is very wrong with this picture.

A lot of articles are yapping about how this is such a great step forward for mankind (the Medical Board is going to appeal the ruling, by the way), but to me, this woman seems just overindulgent and wants everything her way. While I think accommodations should be made for people who need them (and it seems that the Board has bent over backwards for her), I think this chick is really pushing it. Sorry, but having a baby does put some restrictions on you. There are inconveniences, and sacrifice, but it is a choice that she has made.

Pray tell, what is she going to do when she starts her residency? Demand that she get less on-call time than everyone else, get more breaks, gets off Christmas and New Year’s, and doesn’t have to work on weekends–all because she has children and is breastfeeding? Residencies can be brutal, especially the first year, and it seems that she can’t even cope with taking the Medical Boards, let alone a residency.

What will she do if it’s time to pump but a patient is crashing? Tell everyone to wait so she can empty her breasts? Is she going to demand a “light” residency schedule so she doesn’t have to be away from her children so much?

She also had the option of delaying the test, which is given several times a year. I have a friend who took off a semester from dental school when she had a baby, so that she could relax and take care of him during his first few months. Would it be so dreadful for Currier to take the test a few months from now, when her daughter is older and maybe nibbling on rice cereal?

Apparently, she has already failed the test once. And rather than review her options (of which there are numerous), and make some sane choices that might better suit where she is right now, she chooses to file a lawsuit. Great going.

Her lawyer was quoted as saying, “As a society we should be supporting her efforts to become a doctor, not put roadblocks up for her.” That has to be about the most bogus statement I’ve ever heard. They’ve basically paved her path with gold, and jumped through hoops to accommodate this woman. I guess if she flunks again, she’ll blame it on not having sufficient time to pump (maybe they should allow her a break every hour and then give her a week to complete the test), or blame it on the “mental stress” of her traumatic ordeal.

Personally, I feel a little sorry for any of her future patients.

This is an interesting article that appears in today’s NY Times, about the usual suspects–greed and the deterioration of services in nursing homes. So what’s new about this? Same old story–a chain of nursing homes gets bought up by a private corporation, whose only goal is to make money. So the end result isn’t pretty, not for staff or patients.

From the NY Times

Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.

The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.

That alone should make your flesh crawl. Nursing homes are generally poorly staffed, with a serious lack of RNs. So this brilliant suit decided that halving the number of nurses was a great move. Oooo, the profit.

And this happened in Florida, one of those lovely right-to-work states, so the nurses weren’t unionized and couldn’t really fight back.

The investors and operators were soon earning millions of dollars a year from their 49 homes.

Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.

“They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.

So why didn’t the regulators shut the place down? Why didn’t they start fining the company about $1 million a day until the problems were fixed? I think that strong action needs to be taken, if this type of travesty is going to be addressed in a meaningful way.

Just a few more notes on the importance of nurses…

Nurses are often residents’ primary medical providers. In 2002, the Department of Health and Human Services said most nursing home residents needed at least 1.3 hours of care a day from a registered or licensed practical nurse. The average home was close to meeting that standard last year, according to data.

But homes owned by large investment companies typically provided only one hour of care a day, according to The Times’s analysis of records collected by the Centers for Medicare and Medicaid Services.

For the most highly trained nurses, staffing was particularly low: Homes owned by large private investment firms provided one clinical registered nurse for every 20 residents, 35 percent below the national average, the analysis showed.

Regulators with state and federal health care agencies have cited those staffing deficiencies alongside some cases where residents died from accidental suffocations, injuries or other medical emergencies.

And I also blame the nurses who stayed on there, and who didn’t keep reporting infractions. They should have leaked it to the press if need be, if they weren’t getting any response. There are plenty of jobs in Florida, and by working in a place like this, they are actively contributing to the abuse of the residents. No, they are not helping the patients. They are helping the CEOs, president, VPS, etc, make a fortune.

The article also explains how the corporations make it very difficult to get sued, and very expensive for the lawyers, because of the way the holdings are divided up among investors. Which goes to show, this system is very broken and no one is held liable. Oh, maybe they can sue the nurse who neglected the patient….never mind that she was the only one on duty.

The article points out that people are making huge profits at these homes, at the expense of the patients, and no one seems to be accountable. Aren’t there state laws? What’s the point of having the places inspected if nothing of note is going to be done?