Posts Tagged ‘nursing’

Week in Review (May 2 – 6, 2011): The Eye Opener Health, Law and Just Interesting Stuff Blog

Saturday, May 7th, 2011

From Brian Nash (Editor)

We appreciate your stopping by to see what this past week’s posts covered in the world of law, medicine, health and safety – and then some.

You’ve been told you need to undergo treatment. The doctor tells you (hopefully) the risks and benefits of what’s being proposed. You’re wondering – “Is this my only choice?” In a non-emergency situation you usually have a choice you may not have considered – a second opinion. Theresa Neumann’s piece this past week addresses this usually available but very under-utilized resource for patient’s facing this situation.

Sarah Keogh writes about a topic that makes a lot of sense – when you stop and think about it. Who are the people on a hospital’s medical team that are with you more than anyone else? Your nurses, of course. Just how does a nurse’s working conditions not only affect him or her – how does it affect your health? Read Sarah’s piece and find out.

Asthma affects the lives of 20 million people in America. It does not discriminate since it affects the young, the old and all in between. This past week, Jon Stefanuca, who has been immersed in a case involving a young man who tragically died as a result of asthma shortly after being discharged from a local hospital, shared his “4 tips” to make sure you get the health care you need when you have an asthma problem. If you or someone close to you has asthma, take the time to consider Jon’s suggestions. As always, if there are some suggestions you could share with others, please do in the comments section.

Recently our firm started using QR Codes on our business cards. I’d heard about them but wasn’t quite sure what they were all about. After a little bit of study and discussion, I was amazed at what they can do – you will be too. So many now use their phones and mobile devices as their primary means for connecting with the world via the internet. Just download a free mobile application, snap a picture using the app and the QR Code will whisk (at a blazingly fast speed) you away to more information than you can imagine. Jason Penn, who was the first to get his QR Code business card, was apparently fascinated by this new technology, so he wrote a post this week about it and shares with you some interesting information about some others who have been using it for some time now.

Our Posts of the Past Week

Medical Second Opinions: An Under-utilized Option for Patients

By: Theresa Neumann

Today’s medical world is vast with various technologies, treatments and options.  So, if a patient is diagnosed with a medical condition, and doctor A recommends treatment A, what keeps the patient from seeking a second opinion? This is an interesting phenomenon.  After performing intake summaries and client interviews for quite a while now, it still amazes me how many people have bad outcomes from surgery simply because they never requested a second opinion. Second opinions are not simply reserved for surgery, though; cancer treatment options, medical therapies for chronic conditions like rheumatoid arthritis or inflammatory bowel disease….read more

 

Working Conditions for Nurses Impact Patient Health

By: Sarah Keogh

I suspect that anyone who has spent even as much as one day or night in a hospital knows just how critical the nursing staff is in the , health, care and comfort of a patient. A compassionate and personable nurse can put a patient at ease and help them feel better in ways that go beyond just medicine.

Recently, I wrote about how different schedules impact nurses’ lives and how they cope with shifting from day to night schedules. This week, I was drawn to write about nurses again after seeing an article on medicalnewstoday.com that spoke about a study done by the University of Maryland School of Nursing.  Read more

Having an Asthma Problem: 4 Tips for you to use to get the medical care you need

By: Jon Stefanuca

Did you know that approximately 20 million Americans suffer from asthma?  Every day, about 40,000 of them miss school or work because of this condition. Each day, approximately 30, 000 experience an asthma attack.  About 5000 patients end up in the emergency room. Asthma is also the most common chronic condition among children. Can there by any doubt it is a very serious and potentially deadly medical condition that needs equally serious understanding and attention? The good news is that with proper education and treatment, most asthmatics have active and productive lives.

Bronchospasm and inflammation: the key features of asthma

This chronic airway disease has two primary features: bronchospasm and inflammation. Bronchospasm refers to the mechanism by which airways become narrower. In asthmatic patients, the muscle within the wall of the airway contracts, thus narrowing the lumen (a cavity or channel within a tubular structure) of the airway and causing respiratory obstruction. Inflammation refers to the process by which the wall of the airway becomes thicker in response to inflammation, which also causes the lumen to narrow and produce respiratory obstruction. Bronchospasm is usually treated with….read more

Bar Codes, QR Codes and More: The Intersection of Life and Technology

By: Jason Penn

The business cards I ordered arrived yesterday.  I tore into the package to do the usual inspection.  Is my name spelled correctly?  Is the card stock heavy enough?  Did they use the desired typeface?  Yes. Yes. And Yes.  But I needed to ask one additional question: Does the QR code link correctly?   I know what you are thinking:  What is a QR Code and why is it on your business card?  Let’s try an experiment. Read more…

Don’t forget, however – you can learn about Jason but just using your QR Code reader right now….

Sneak Peak of the Week Ahead

That was it for last week. What’s coming in the week ahead? Here you go -

  • Mike Sanders has a piece about our wonderful canine friends and how they are being used for those with special needs.
  • Sarah Keogh will be investigate the role and responsibility of our schools to warn parents about potential health problems involving their children
  • Jon Stefanuca will be taking a look at ovarian cancer and suggesting some key issues to discuss with your physician
  • Jason Penn will be telling us more about stroke and a very interesting problem that his research has revealed
  • I will be writing about a brand new project we are starting to take our social networking to a whole new level – stay tuned.

Again – many thanks to all who stopped by. Take a few minutes, read our posts and maybe have some interesting topics for discussion this weekend after reading last week’s Eye Opener.

Have a great weekend, Everyone!



Working Conditions for Nurses Impact Patient Health

Tuesday, May 3rd, 2011

I suspect that anyone who has spent even as much as one day or night in a hospital knows just how critical the nursing staff is in the , health, care and comfort of a patient. A compassionate and personable nurse can put a patient at ease and help them feel better in ways that go beyond just medicine.

Recently, I wrote about how different schedules impact nurses’ lives and how they cope with shifting from day to night schedules. This week, I was drawn to write about nurses again after seeing an article on medicalnewstoday.com that spoke about a study done by the University of Maryland School of Nursing.

According to the article, the study determined that “[b]etter working conditions and better staffing of nurses can significantly improve the care of patients with serious conditions…” The study examined the psychological demands and work schedules of nurses:

…they measured high psychological demands by very fast work, lack of time to complete work, excessive required work, being slowed by delays from other workers, and frequent interruptions.

The data showed “…pneumonia deaths were significantly more likely in hospitals where nurses reported increased psychological demands and more adverse work schedules.” Equally troubling, “…patients were more likely to develop deep vein thrombosis after surgery in hospitals where nurses reported high psychological demands.” These were not the only areas in which the demands placed on nurses negatively impacted patient health.

The researchers calculated the association between job demands on nurses, both psychological and physical, and work schedule, against outcomes of patients with heart attacks, congestive heart failure, stroke, and surgeries that open a bone flap of the skull [craniotomy].

Also, they discovered that deaths from congestive heart failure were also significantly associated with long shifts and with nurses continuing to work while sick.

They found that deaths from heart attacks were associated with nurses frequently working with awkward postures and heavy weekly burdens.

Patients were more likely to experience postoperative hemorrhaging when their nurses were frequently interrupted.

And, where nurses reported a lack of time away from the job, patients were significantly more likely to develop respiratory failure and infections.

While difficult working conditions for nurses have a negative impact on patient health, the article reported that “[p]ositive aspects of the practice environment, such as peer and supervisor support, did not offset, or balance, the adverse impact of these demands.” Only, “[h]ospitals where nurses reported a focus on patient safety were less likely to have such complications or adverse patient outcomes [compared to] hospitals where patient safety was not a stated focus.”

What should be done with this information? To me, the critical lesson here is that work conditions for nurses dramatically influence patient outcomes. Attention must be paid to the conditions for nurses in terms of scheduling, interruptions, time off, and other work conditions. Do hospitals currently examine nurses’ psychological and physicals burdens as part of a comprehensive focus on patient safety? How as a patient do you chose a hospital – do you look only at the doctor’s qualifications or do you look also at other factors such as nursing at the hospital? Is it the duty of a hospital to provide working conditions for nurses that promote optimal patient safety?

 

Week in Review (April 18 – 22, 2011) The Eye Opener Health and Law Blog

Saturday, April 23rd, 2011

From the Editor:

This past week, our blawgers (guess I’ll use this term now since we are legal bloggers) were busy on their keyboards once again. They covered a number of topics relating to law, medicine, health and patient safety. This week we posted a primer on aortic aneurysms and how they can present as back pain, a blog about “robot” anesthesiology, a disturbing post about how the recent threat of a federal government shutdown was averted but at a cost to those who are in dire need of healthcare, an interesting piece about laughing gas making its way back into the American medical scene for labor and delivery and finally, and a highly read piece on a not-to-often discussed topic but one of potential grave concern – shift switching by nurses and how this might impact patient safety.

Here’s our usual “quick summaries” for you to peruse, click on, read and comment:

Aneurysms – a deadly condition you need to know about!

Our in-house medical specialist, Theresa Neumann, wrote another highly educational and need-to-know piece about a condition that can present as back pain but which has deadly consequences for those who have this condition.

As Theresa’s research made us aware – “1 in every 50 males over the age of 55 have an abdominal aneurysm, this is a more common pathologic diagnosis than some others.  Men also corner the market at an 8-to-1 ratio as compared to women with abdominal aneurysms.”

As is the case with all of Theresa’s writings, we offer through her valuable information from someone who’s “been there” and “done that” in the clinical setting. Don’t miss her post entitled Aneurysms: A Potential Deadly Condition That May Present as Back Pain.

Who’s using remote control and a joy stick to put a breathing tube down your throat?

Mike Sanders brought to our attention a new practice of anesthesiologists – in Canada – that may soon be part of anesthesia management in the United States as well – using robotics to intubate patients. While you can certainly learn about the concept of intubation by reading Mike’s blog, basically, this is placing a small tube down a patient’s airway so that the anesthesiologist can control the airway and provide ventilation to a patient undergoing surgery.

Here’s an except -

Medical News Today is reporting that Dr. Thomas Hemmerling of McGill University and his team have developed a robotic system for intubation that can be operated via remote control.

For more on this fascinating new project by Dr. Hammerling and his team, read Mike’s post entitled Robot Anesthesiologists?

Government Shutdown Avoided – but who will pay the price for the “deals” that were cut?

The newest member of our blogging team, Jason Penn (fast approaching veteran blawger status) did a fascinating piece of the story-behind-the-story of the recent crisis our country faced when the federal government was on the verge of a shutdown. We all know about deals being cut in the back rooms of congress. We all know that the government avoided a shutdown this time around when the senate and house worked out a compromise that resulted in millions of dollars being earmarked for cuts in the budget.

Jason tells us what programs relating to healthcare will suffer as a result of these negotiated cuts. As some wise person once said, “why is it always those who are least represented who bear the burden of budget cuts?” Maybe it’s because they can’t afford lobbyists to protect them like those who need protection the least can.

Read Jason’s eye opening and no-punches-pulled report on just who will be the victims of the deals in his post of this past week Budget Crisis Avoided, But What About the Babies? Can They Live With $504 Million Less in Funding?

Will moms-to-be now be “laughing” their way through labor and delivery?

One of our seasoned blawgers, who every now and then is driven to report on the off-beat issues of law, medicine and healthcare, Jon Stefanuca, stepped up to the plate once again and took a swing at the return of an old-timer to the arsenal of pain relief for mothers-to-be undergoing labor and delivery – laughing gas!

As Jon’s piece in Eye Opener this past week tells us -

It appears that a number of hospitals are now considering making laughing gas available as a pain relief measure for women in labor. A hospital in San Francisco and another in Seattle have been using laughing gas in their labor and delivery units for a while. Hospitals like Dartmouth-Hitchcock Medical Center plan to offer laughing gas to laboring mothers in the immediate future.

For more about this return of laughing gas to our obstetrical units, read Jon’s piece Laughing Gas Making Its Way Back Into the Labor and Delivery Department.

Nursing and Sleep Deprivation: Is it a risk factor for patient safety?

I suspect somewhere along the line you have done “an all-nighter” – whether it was getting ready for a big test, a social event, or for some other reason. Remember how you felt as you made it through that night or the next day? Have you ever done it several nights in the same week? How about doing it a few times one week and then do the same thing the next week and the next…. Well you no doubt get the idea. You’ve been exhausted, right? Well what about nurses, who have to do this for a living?

Nurses have lives too. They have children, home responsibilities and obligations, and some form of social life. What happens when they swap shifts or are asked to do “a double”?

Sarah Keogh was back blogging this past week and wrote a fascinating (and concerning) post entitled Nurses Switching Shifts: Does a Lack of Sleep Put Patients at Risk? We invite you to read Sarah’s piece and share your comments. Are you a nurse who lives this lifestyle? What are your thoughts about nurses being allowed to work multiple shifts or back-to-back shifts in terms of patient safety? Should there be restrictions on nurses’ shifts just as there (finally) are work restrictions on doctors-in-training?

A “Sneak Peak” of the week ahead

As part of our continuing effort to “get the word out there” on issues relating to health, medicine, patient safety and the law, we post from time to time more extensive research pieces called White Papers. Well, the time has arrived for another White Paper to be posted on our website. Marian Hogan has completed her piece on a very important topic – Patient Controlled Analgesia in today’s hospital environment. She examines how some hospitals are now heavily marketing a spa-like environment so you choose them over the competition. Yet lurking in the shadows of these facilities which promote flat screen TV’s, valet parking, in-room safes and the like is a very dangerous practice: placing patients on patient-controlled-analgesia (for pain relief) without vital monitoring devices and patient safety practices. It’s at the “printer” now; we hope to have it online this week.

From our blawgers you can expect reports on a disturbing fight between manufacturers and child safety experts over – blinds! After decades of controversy, you’ll find out where the battle lines are now drawn, who’s winning and who the real losers are in this war. Wonder how healthcare safety is doing since the report To Err is Human was published by the Institute of Medicine over a decade ago? Jason Penn will be providing an updated report card, which you should not miss. Alcohol and surgery – not a good combination! Jon Stefanuca plans on posting a piece that looks deeper in the obvious problems with this potentially deadly combination.

This is just a taste of what’s to come. I better wrap-up now. I’m working on finishing the third installment on Medical Technology and Patient Safety. Oh yeah, if time permits, I might even get to post a piece I’ve been working on this past week – a lawyer’s rant about our modern day love affair with mediation practices and trends.

As always, don’t forget - subscribe to the Eye Opener and tell your friends about us too! …and… don’t forget to join our social networking communities on Facebook and Twitter.

Hope you have a great weekend!

Nurses Switching Shifts: Does a Lack of Sleep Put Patients at Risk?

Friday, April 22nd, 2011

Image from scrubsmag.com

Many of us take it as a given that if we end up in a hospital, we will be taken care of by an around-the-clock group of health care professionals. These doctors, nurses and other staff will be awake and alert to care for us and prevent any potential problems during our stay. However, how many of you have thought about how this impacts these health care professionals on their days off? I know that I had not thought too much about this issue. I had taken for granted that if I or a loved one were hospitalized that the professionals involved in their care would be at least well rested enough to avoid major medical errors.

I have read lots of different reports about all of the rule changes for doctors in training regarding how many hours they can work in a week or at one time. I had never before read a report regarding the impact of work schedules on nurses. While I knew that most nurses worked 12-hour shifts, I have to admit that I had not thought about how this impacted their own lives or patient care. That changed when I read a recent article in medicalnewstoday.com. This article discusses a study published in Public Library of Science One that was conducted “…to examine the strategies that night nurses use to adjust between day and night sleep cycles.”

What seems obvious in retrospect, but that I had never really considered before, is that nurses who work the night shift (typically 7 pm until 7 am – or “7p to 7a” as they like to call it), normally do not stay up all night in their “non-work” lives. On their days off, they often want to live a more typical life with daytime awake hours. The ramification of this is that they need to switch their sleep schedule back and forth several times throughout the week. Can you image having to do that yourself and still perform your job properly?

The medicalnewstoday.com article explains that “[a]s many as 25 percent of hospital nurses go without sleep for at least 24 hours in order to adjust to working on the night shift, which is the least effective strategy for adapting their internal, circadian clocks to a night-time schedule.”

The “First Shift” Effect

So, the first issue in this revelation is that as many as a quarter of hospital nurses are going without sleep for at least 24 hours when adjusting to working the night shift. I shudder to think of how many nurses around the country are therefore working at least their first night shift every week while on hours 12-24 of not having slept.

While others may function better than I do without sleep, I don’t think that I would ever feel comfortable being cared for by a nurse who had not slept in the prior 12 hours before starting their shift. It seems to me that this opens up the possibility for many medical errors and patient injuries.

The Circadian Clock Effect

The second issue I had was that this is also “the least effective strategy for adapting their internal, circadian clocks” – which I take to mean that if a nurse who has not slept for that first shift is not bad enough – it also does not work very well to help them be adjusted and well rested for the rest of the week.

If the concerns about the health of the public being cared for by tired nurses is not bad enough, this can also be quite damaging to the health of the nurses themselves. These selfless individuals who are caring for others are – frankly – at risk.

A number of previous studies have found that repeated incidence of circadian misalignment the condition that occurs when individuals’ sleep/wake patterns are out of sync with their biological clocks is not healthy. Jet lag is the most familiar example of this condition. Circadian misalignment has been associated with increased risk of developing cardiovascular, metabolic and gastrointestinal disorders, some types of cancer and several mental disorders.

So, these nurses are risking their own health in addition to potentially the health of their patients.

Just how important is sleep?

Just how much does sleep matter? Well, another article from medicalnewstoday.com recently looked at sleep in a very different context. It examined a study from the Journal of Clinical Sleep Medicine, which showed that “…automobile crash rates among teen drivers…” were dramatically higher in otherwise similar school districts where teens started school earlier in the morning (a difference of about 1 hours and twenty minutes). While there is no proof yet that this connection is causal, there certainly seems to be a strong connection even after adjusting for other possible factors. The article also mentions that:

Another study in the April issue of the Journal of Clinical Sleep Medicine suggests that delaying school start times by one hour could enhance students’ cognitive performance by improving their attention level and increasing their rate of performance, as well as reducing their mistakes and impulsivity. The Israeli study of 14-year-old, eighth-grade students found that the teens slept about 55 minutes longer each night and performed better on tests that require attention when their school start time was delayed by one hour.

While teens and teenage behavior can be different from that of adults (thank goodness), I still think that these studies highlight some of the key issues of sleep deprivation. Adults seem likely to also make more mistakes, lack attention and act more impulsively when functioning on less sleep.

However, a review of a study from Nursing Economics entitled “Shift Work in Nursing: Is it Really a Risk Factor for Nurses’ Health and Patients’ Safety” suggests that other factors put nurses’ health at greater risk and that shift work does not impact the number of medical errors. The study was conducted in Israel in 2003. It is important to note that this study looked at nurses working alternating 8-hour shifts and did not directly look at the issue of nurses not sleeping in order to switch between 12-hour shifts.  The investigators in the study were surprised by some of their findings:

Shift work and organizational outcomes. In the present study, we investigated the impact of sleep disturbances on shift nurses and on two organizational outcomes: errors and incidents and absenteeism from work. Based on our literature review (Morshead, 2002; Muecke, 2005; Westfall-Lake, 1997), we expected that “non-adaptive shift nurses” would report on more involvement in errors and adverse incidents as compared to “adaptive shift nurses.” We also assumed that non-adaptive nurses, who by definition have more sleep-related complaints, would have higher absenteeism rates due to illness compared to their adaptive colleagues. Neither of our hypotheses was supported by the results of this study.

Instead the study found that:

It appears that gender, age, and weight are more significant factors than shift work in determining the well-being of nurses. Moreover, nurses who were identified as being non-adaptive to shift work based on their complaints about sleep were found to work as effectively and safely as their adaptive colleagues in terms of absenteeism from work and involvement in professional errors and accidents.

What do you think? Would you want a nurse who has been up for 24 hours to be caring for you or your loved one? Should it be the nurse’s decision whether they are alert enough for work? Should rules be created for nurses just as they were for physicians in training? What about nurses who enjoy the flexibility and freedom allowed by this sort of schedule? Have you worked as a nurse? What are your experiences and feedback on whether this is a problem?

Related Post – you may want to read:

A Surgeon’s Sleep Deprivation and Elective Surgery – Not a good (or safe) combination.

The New England Journal of Medicine published a Perspective on December 30, 2010, that screams common sense and should be embraced as a starting point to implement some new patient-safety standards of practice. Place yourself in the position of a patient getting ready to undergo an elective (i.e. non-emergency) surgical procedure. You’re wheeled into the operating room for your surgery and are greeted by your surgeon in the process. Read more…


 

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding

Friday, March 25th, 2011

Image from fooducate.com

In the United States today, one of the major health problems is obesity. The CDC reports that “[i]n 2009, only Colorado and the District of Columbia had a prevalence of obesity less than 20%.”  The number of both adults and children who are obese is huge and continues to rise dramatically.  The CDC website provides maps that show just how prevalent this problem is in our country. Particularly troubling is that “[t]hirty-three states had a prevalence equal to or greater than 25%; nine of these states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia) had a prevalence of obesity equal to or greater than 30%).  This represents an enormous number of people in our country who are at risk for major health complications, such as “cardiovascular disease, certain types of cancer, and type 2 diabetes.”

While there has been an emphasis in our country on various ways to decrease these obesity statistics (including improving nutrition and increasing exercise), I wonder whether additional emphasis should be paid to children being given a great start to health. A recent article in the Baltimore Sun caught my attention. The article explains how diabetic moms, including those who had gestational diabetes during pregnancy but are not otherwise diabetic, are both more likely to give birth to a larger than average baby and also how their child is “more likely to become obese in childhood.”  The good news, the article explains, is that:

…a new study says that if you breastfeed your baby for at least six months, your child will be no more likely to put on weight than those whose moms are not diabetic.

This is just one more example of how breastfeeding for at least six months can dramatically improve your child’s chances of lifelong health.  Through breastfeeding alone, these moms can erase the increased risk that these children will become obese.

What they found appears to be a real advantage for breastfeeding: If the babies had been breastfed for six months or more, children born to diabetic moms looked nearly the same as the children of non-diabetic moms. And they were no more likely to be obese.

On the other hand, children who were breastfed for less than six months — and who had been exposed to diabetes in the womb — had significantly higher BMIs, thicker waists and stored more fat around their midsections than the other children in the study.

While I was excited to read about one more reason to support breastfeeding, I was concerned about whether this is a realistic choice for many families in our country.  Many moms who are committed to breastfeeding their children and who are successful at the start, do not continue breastfeeding for at least six months. The CDC Breastfeeding Report Card for 2010 says that “…3 out of every 4 new mothers in the United States now starts out breastfeeding… However, rates of breastfeeding at 6 and 12 months as well as rates of exclusive breastfeeding at 3 and 6 months remain stagnant and low.”  The national average is that while 75% of moms have breastfed, only 43% are breastfeeding at all at 6 months and only a mere 13.3% are exclusively breastfeeding at 6 months.  At 3 months, a time when infants would not have started solid food, only 33% of moms are still exclusively breastfeeding.  This means that there is a large drop off from what moms do when their babies are born and what they are doing by the time their babies reach 3 months.

However, the study about diabetes found that at least six months of breastfeeding was essential in protecting these kids from the increased risks of obesity. From both personal experience and anecdotal evidence, I suspect that many families are facing hard decisions about employment and breastfeeding. I suspect that a significant part of the large drop off between the numbers of moms’ breastfeeding at birth and those breastfeeding exclusively at 3 months has to do with employment. Given that the US lags so far behind other countries in paid parental leave, most moms have no choice but to go back to work full-time by the time their infants are 3 months (if not earlier).  Many moms face no choice at that point but to stop or severely limit breastfeeding, as few employers offer the time, space or scheduling to truly make moms successful at the difficult job of trying to pump while working.

I believe that the health care costs of treating individuals with obesity and all of the associated health problems should be examined against the costs of providing more complete support to new families.  What do you think?  Could employers better support breastfeeding in an attempt to increase the number of healthy children whose risks of obesity are lowered? Do you think that lack of paid leave or increased support in the workplace for breastfeeding is really the reason for decreased breastfeeding or are there other factors at play?

 

 

Anne Mitchell, Whistle-Blowing Nurse, Is Acquitted in Texas – NYTimes.com

Thursday, February 11th, 2010

Just a few days ago – somewhat as a Johnny-come-lately it appears, I wrote about a nurse in Texas charged with a crime for reporting a doctor (anonymously) to a medical licensing board.   The nurse, Anne Mitchell, was acquitted today after a 4 day trial.  After digging out from under our second huge snow storm  for most of the day, I finally had a chance to check the news  and here it was - Anne Mitchell, Whistle-Blowing Nurse, Is Acquitted in Texas – NYTimes.com.  And GOOD NEWS it is.  The good people of Texas were able ot come to the right decision in less than an hour.

You may recall the story – Nurse Mitchell filed a complaint with the state medical board after she observed what she believed was unsafe medical practice by a physician at her hospital.  Turns out the doctor had a patient and close friend – the local sheriff.  Next thing Nurse Mitchell knew – she was facing criminal charges.

As we also reported, she and a fellow nurse (who had also been originally charged but against whom charges were dropped prior to trial) have filed a lawsuit against the doctor, the hospital, the prosecutor – anyone and everyone who had anything to do with the absurd prosecution.  That’s apparently going to be the second round- more to come on that one.

The prosecution charged that they had violated the statute by using their positions to obtain and disseminate confidential information, namely patient file numbers, with intent to harm the doctor, Rolando G. Arafiles Jr.

This charge is a third degree felony under Texas law and carries a maximum sentence of 10 years and a $10,000 fine.

Here’ s how the Times reporter, Kevin Sack, presented the arguments of the prosecution and the defense:

The prosecutor, Scott M. Tidwell, the county attorney, argued during the trial that Mrs. Mitchell had waged a vendetta to force Dr. Arafiles from the hospital almost since his arrival in April 2008.

But Mrs. Mitchell’s lawyers presented broad evidence that her concerns about the doctor were well-founded, and that she violated no laws or regulations by alerting the governmental body that licenses and regulates physicians.

The quote by her lawyer after the ‘not guilty’ verdict tells all you need to know if Nurse Mitchell intends to go forward with her civil lawsuit:

“We are glad that this phase of this ordeal has ended and that Anne has been restored to her liberty,” said Mrs. Mitchell’s lawyer, John H. Cook IV. “But there was great damage done in this case, and this does not make them whole.”

Good for her!  If you think going through a criminal prosecution with possible jail time and a fine is not ‘an ordeal’ – try it some time.  We’ll try to keep up on this story to let you know what happens with this civil lawsuit – why do I think I hear the word  ”settlement”  - maybe because that’s what those who are liable for this fiasco should do if they have any common sense (which is debatable).

Healthcare providers, who are concerned about patient safety, should not be silenced by the threat of prosecution when they take steps to correct what they perceive to be a lack of quality care.  Nurse Mitchell should have been applauded for her action, not prosecuted.  At least this evening – she can rest comfortably – and get ready for Round Two – hope she knocks them out!

Public beware: disciplined nurses crossing state lines to practice anew.

Monday, January 4th, 2010

A recent report posted on ProPublica tells a shocking and scary tale of how some nurses, disciplined in one state, have taken up new jobs as licensed nurses in a different jurisdiction.  This story was brought to light by the combined investigative efforts of Charles Ornstein and Tracy Weber of ProPublica and Maloy Moore of the Los Angeles Times on December 27, 2009.

According to this report, there exists a “dangerous gap” in the way states regulate nurses.  As an example of just how serious a problem this may be, the reporters found that in California alone, a months-long review of the 350,000 registered nurses in that state revealed that there were at least 177 nurses, whose licenses had been revoked, suspended, surrendered or denied elsewhere.

The online article gives the following example (among a number they discovered):

In May 2005, a 3 year old boy, Jexier Otero-Cardona, died while under the care of a home health nurse, Orphia Wilson. The child suffered from chronic respiratory failure and muscular dystrophy.  Early one morning, Nurse Wilson frantically summoned the child’s parents for assistance when the child stopped breathing.  After heroic efforts at CPR by his mother, the child died the  next day at a hospital in Connecticut.

This was not the first child to die under Nurse Wilson’s care, the state’s investigation revealed.  Just seven months before, Nurse Wilson had lost her Florida license due to apparent lapses in the care of another child in that state in 2002.

In the months of investigation by Connecticut officials that followed Jexier’s death, it was determined that Wilson “had fallen asleep, then ignored – or possibly turned-off – the ventilator alarms that were intended to warn when the child was not getting enough oxygen.”

The following quote from the article tells the tragic story of a failed system of regulating the licensure of nursing in our country:

“Florida officials, for instance, didn’t notify Connecticut authorities when they sanctioned Wilson – even though she’d told them that she also held a Connecticut license. And Connecticut’s nursing board renewed Wilson’s license three times after Thierry’s death, relying on her pledge that she hadn’t been disciplined or investigated elsewhere.”

The reporters identify several key failures in our country’s system of regulating the licensing of nurses.  First, they note that in some instances some states do not do a simple check of a national database, which can within seconds reveal (if the data  has been timely and accurately supplied) that a nurse has been disciplined elsewhere.  This has dire implications in many hospitals and health care employers rely on state nursing boards to verify a nurse’s licensure status and fitness to practice.  Secondly, they tell a tale of how long a disciplinary process may take and how long the reporting of that finding will occur, if ever.  The tale of horrors goes on and on.

Just a bit of digging (much more to come!) into the background of this issue reveals that The Medicare and Medicaid Patient and Program Protection Act of 1987 led to the creation of the National Practitioner Data Bank (NPDB), which was a tracking system designed to protect program beneficiaries from ‘unfit’ health care practitioners.  The NPDB was implemented in the fall of 1990 and required reporting of adverse licensure, hospital privilege and professional society actions relating to quality of care by physicians and dentists. According to one source, proposed rules adding other practitioners, including nurses, were published in March 2007.

Query:  does anyone know if those “proposed rules” were ever made into final rules?

The full scope of the legislative history, the awarding of three grants to the National Council of State Boards of Nursing by Robert Wood Johnson Foundation (RWJF) in excess of $1,000,000 between 1990 and 1997, the commendable activities of the National Council of State Boards of Nursing over many years to get better control and surveillance of licensure and ‘fitness’ to practice for nurses are all topics well beyond the scope of this blog.

Research is underway by our firm to determine the current status of federal legislation in this area as well as a myriad of other related topics – for example, what states boards of nursing do not yet have an agreement with the National Council?  What are the current requirements for timely reporting of adverse actions against nurses?  What legislation, if any, is pending to address this situation?  What other sad stories like that reported by these investigative writers are out there?

All the hard work to establish reporting guidelines and a national network for avoidance of these types of tragedies can not go for naught due to provincial and/or political interests that can result in serious harm to the public.

If you have any information about the current status of legislation or stories like that reported by ProPublica and others, let us know.