Saturday, July 14, 2007
Wednesday, June 20, 2007
The Standards JCAHO choose to Police v
Did you Celebrate National Time Out Day?
Do We Need: “National Pass Out Day?”
“Try telling me it is safe to remain continuously
scrubbed into Surgery without a break for 12 hours:
not a single drink of water, any food or a chance to
urinate? Try convincing me that concentrating on
performing a critical, highly stressful, role in the
OR during Surgery while sick, dizzy and faint, does
not pose a serious risk to my patient, unconscious
on the OR table?
Control Understaffing Today!
A new C.U.T! CAMPAIGN PETITION will be posted shortly on the Care2, http://www.thepetitionsite.com/ under Health.
I am eagerly seeking the Constructive Input and Support of individual Nurses as well as Nursing Websites on Campaign Issues. Please contact me and also visit the new TRANSPARENCY for EQUAL ACCOUNTABILITY in MEDICINE site at:
Tuesday, May 22, 2007
DO THE MEDIA HAVE A DUTY TO INFORM THE PUBLIC WHEN “DELIBERATE NEGLIGENT UNDERSTAFFING” COMPROMISES THE SAFETY OF PATIENT CARE?
I posed the question: “How Long is Too Long for a Member of the Sterile OR Team to Remain Continuously Scrubbed into Surgery without a break?”
Fact: Nursing staff do not willingly accept or enjoy being “tortured” in the work place by inconsiderate Managers.
To review and consider signing my Petition go to:
Monday, April 23, 2007
Although the general public might not understand that medical professionals, including the Surgeon, must leave the OR briefly during a lengthy Surgery, most conscientious practitioners realize that this is a normal safety measure necessary to combat fatigue. I am trying to get a consensus of feedback, from those who must routinely face this dilemma in the OR, as to what time frame is universally accepted as the maximum period that any member of the sterile team should ever be expected to safely function while scrubbed into Surgery without a break?
I am now enrolled in the National Institute of First Assists, “NIFA,” training program to become a First Surgical Assistant, but even as a Surgical Technologist, performing the “scrub” role, I had to concentrate on anticipating the Surgeons needs during a case. After how long would you consider that scrub role jeopardized by fatigue to the point where I might have lost concentration and focus on the operation? Can we really afford to take such risks and blithely talk of the increased incidence of medical errors as if these issues were completely unrelated?
While a Surgeon can, and should, demand that the person assisting him in Surgery is relieved briefly during a lengthy case, Nurses and Surgical Technicians fall under the control of OR Management. This leaves them vulnerable to the vagaries of inappropriate OR coverage as determined by the Hospital. As a consequence of Hospital “downsizing” to cut costs, redundancy of personnel has been severely limited. This has reached the point where during the off-shifts, especially at night and on weekends, there are no free staff to break people out of Surgery for even a quick run to the bathroom!
At an inner city Level One Trauma Center these off-peak time periods are covered by a minimal compliment of essential experienced medical staff, who must frequently deal with critical trauma cases, emergency returns to the OR and major Transplant Surgery. This was my regular OR shift assignment at my former Hospital for the last 2years of my 5year tenure. With just one Nurse and two OR Techs on duty after 11:30 PM on a Saturday night, this challenging shift already required knowledgeable, highly adaptable and versatile staff. However, inhumane levels of endurance plus the ability to tolerate severe deprivation for extended periods shouldn’t be part of any job description. The real question is, can critical OR personnel maintain concentration during complex cases under such radical extremes as 12hours continuously scrubbed into Surgery? The lack of redundancy among Nursing personnel is harmfully impacting ICU’s and other critical care units of many US Hospitals, but the physical limitations are severest in the OR.
Calling in call team people just to provide relief breaks is considered an unnecessary expense, despite the fact that there is a clearly established link between fatigue and medical errors. The sterile team scrubbed into Surgery must remain trapped without food or water until they are relieved which represents an unacceptable deprivation strain on the body. The inability to urinate when necessary is very unhealthy too. To simply “break scrub” and leave the OR without handing over to an assigned relief scrub and completing the necessary controlled counts is considered “patient abandonment.” However, there are currently no real safeguards within the existing US employment laws or OCHA standards to insure that critical Hospital workers, including those in the OR, are not left for hours of continuous, and dangerous, practice without a break. Under US law in most States: “Breaks are at the discretion of the employer.”
I was left stranded at the field without relief for 8, 10 and on the worst occasion 12 hours straight during a Liver Transplant while my patient was on bypass! I worked off-shifts in the OR of a busy downtown Hospital famous for its active transplant program. We saw more penetrating Trauma than any other facility in Baltimore, a city with a homicide rate that averaged over 300 a year. These abandonment situations impacted my ability to concentrate as my blood sugar plummeted; each time I reported becoming sick, dizzy and faint to the point of nearly passing out. Who needs to eat at night anyway? My Nurse Manager wanted me evaluated for a “sugar problem!” When I dared to complain that my condition in response to this hardship presented a danger to my patients I was targeted for removal, forced to take unpaid leave and then fired.
Incidents where any member of the OR team is forced to remain on task for that long should be documented in an “Incident Report,” as an extreme of this magnitude presents an unacceptable, and in most cases unnecessary, danger to the patient. How many normal human beings are expected to go for 12 hours without water, food or urination? The Geneva Convention strictly prohibits such inhumane treatment of working POWs! Why is this acceptable for critical Hospital staff?
I offered this mandatory Incident Report requirement suggestion to my former Hospital via their Compliance Line, only to be ignored as a terminated and vilified unreliable informant. Healthcare facilities know that the most effective way to deal with concerns and complaints is to just “shoot the messenger!” Compliance Lines were established to allow employees to report negligence, fraud and abuse without fear of retaliation, but in some cases they have become another layer of defense from external scrutiny. No current legislation exists to protect Healthcare Whistleblowers and Hospital Compliance Lines cannot always be trusted with impartial internal investigations when they know there is no potential possibility for independent oversight. .
The campaign of silencing a dissenter goes on long after they have been ousted in disgrace. I have contacted JACHO and other Accreditation Agencies as well as the Maryland Board of Nursing, but my warnings are easily discredited by my untimely removal from my job. A minor protocol change needs to be enacted immediately to prevent future incidents like this from becoming more commonplace exposing patients to potential harm through preventable negligent under-staffing. I cannot understand why so many Government agencies remain so complacent in refusing to review this situation rationally in the best interests of public safety.
There is a lot of talk about medical errors right now, but far less mention of the toxic work environment that is increasingly encouraging mistakes. This situation is getting steadily worse. While “At Will” employment laws silence those who dare to speak out, lack of a humane break policy condones driving Hospital staff until they drop: No big surprise that fatal or damaging medical errors and “sentinel events” are on the increase? Is it any wonder that a sponge or an instrument is inadvertently left inside the patient when the scrub is almost comatose after a stressful 12hour ordeal in Surgery? All the cross checking and elaborate safeguards are irrelevant if the Hospital staff are trying to function while so severely fatigued, hypovolemic or hypoglycemic that they are at the point of either falling asleep or passing out.
When will the various safety advocacy groups in the US finally address this very real problem and insist on proper protective legislation? There have been advances recently with limiting the Residents working hours and trying to stop mandated overtime for Nurses, but much more emphasis must be placed on eliminating unnecessary fatigue among all of our medical staff. Managers must be held responsible for providing adequate personnel to cover all of their shifts, including a redundancy of staff to relieve OR teams during Surgery and in other critical areas. If a Manager’s failure to provide relief was documented on a routine basis it would no longer be an acceptable form of staffing coverage! Such incidents would become the rare exception, confined as they should be to genuine emergency situations where there is absolutely no other choice.
“No one is more important than the patient unconscious on the OR table.”
This was the statement I gave to Hospital Lawyers at an Arbitration Hearing to determine my reinstatement. For this very prestigious Maryland Hospital the “Nursing Shortage” was a convenient excuse to justify unconscionable Managerial abuse that seriously endangered my patient in the OR. They claimed that the ER was busy and I had not asked for a break. The ER is an unrelated clinical area and just try begging for relief on a phone you cannot even touch! Doctors and Nurses face severe discipline when mistakes occur, but why isn’t a negligent Hospital policy that condones drastic staffing cut backs ever recognized as the real culprit? In some cases the administration even offers financial bonuses to further encourage self-serving Managers to implement inadequate staff coverage: greed works! Then, after clear indications demonstrate that deliberate under-staffing is continually putting patients at serious risk, they fail to hold repeatedly abusive Managers accountable as they drive dedicated staff until they drop.
This dangerous Managerial policy is focused purely on drastically reducing vital staffing costs to save money at the expense of creating a safe patient care environment that saves lives. We need proper safeguards in place to curb this negligent profiteering strategy before more patients are harmed unnecessarily. Additionally, when Healthcare employees are courageous enough to come forward and expose a pattern of ongoing negligent under-staffing practices or other dangers to patients they must be protected from retaliatory Managerial misconduct that threatens their job. If a Hospital’s internal Compliance Hot Line fails in their crucial self-policing obligation by refusing to investigate negligence or provide protection from retaliation they must be held fully accountable.
Whistleblowers should not face the third degree from Government Agencies who are all too easily fobbed off with fictitious excuses indicating a disgruntled former employee is seeking revenge. .Few will risk jail time to “seek revenge” by making sworn statements under oath to a States Attorney! All complaints and allegations must be taken seriously by accreditation agencies who’s primary duty is to protect public safety. No medical institution no matter how iconic, prestigious or powerful should be immune from rigorous scrutiny, as this lack of oversight encourages bending the rules, ignoring regulations and cost cutting that is harmful to safe patient care.
Relentlessly abusive Managers are a very valuable tool in generating increased revenue by facilitating staff downsizing without obvious layoffs. I call this the spineless approach to cost cutting, but it makes our Hospital working environment extremely dangerous for the patients. The current so called, “Nursing crisis” has come about through a deliberate and calculated policy of dangerous downsizing to target Nursing staff, but particularly the most experienced Nurses who are higher paid. Minimally trained assistive personnel are plugging the gaps, working under the direction of overwhelmed new Nurse Graduates who are being forced to take on responsibility they are ill prepared to face. The creation of a toxic work environment is driving Nurses to leave their chosen profession in droves. When Nurses are powerless to change under-staffing, and powerless to report negligent practices, the only way to refuse the dangerous policy of keep taking unnecessary risks with patient care is to leave: hence the Exodus.
The US does not have a “Nursing Shortage” it has a “Nursing Exodus!”
The US healthcare industry is still consistently expecting all of our medical professionals to take bigger risks by making do with unsafe staffing practices. This important patient safety issue desperately needs to be addressed immediately, so please consider signing the Petition mentioned below and post your comments on this subject directly on the Petition itself.
THE PETITION SEEEKING TO ADDRESS THESE PROBLEMS CAN BE ACCESSED VIA THIS LINK:
GO TO: http://www.thepetitionsite.com/takeaction/938995258
A personal letter of appeal and explanation from the author can be read at Care2.com:
GO TO: http://www.care2.com/c2c/share/detail/91853
. The author is still struggling to overcome the severe damage that wrongful termination as a Whistleblower inflicted on her professional reputation. In August 2005 she returned from Tsunami ravaged Aceh Province, Indonesia where she had worked for six month as an unpaid Medical Volunteer in Surgery at Cut Nyak Dhien Hospital in Meulaboh.
PACTEC at the UN Compound in Meulaboh:
This conscientious and dedicated Medical professional is calling for your help in the hopes that her Petition will precipitate meaningful debate on important issue like Under-staffing, Compliance and Whistleblower protections for Healthcare employees; eventually becoming a catalyst for new legislation of vital regulatory safeguards. While it will be gratifying just to make a tangible difference, personal vindication might remove the remaining barriers that still prevent her from reestablishing a worthwhile career as an NGO Medical Volunteer overseas. The author is also in the process of writing a book called: “ICONIC IMMUNITY,” detailing her experiences and the lessons learned. Please post your comments...
Thursday, June 29, 2006
The “JOHNS HOPKINS HOSPITAL INVESTIGATION OF WHISTLEBLOWER’S DISMISSAL: demand Compliance Accountability” Petition is now posted listed under "Health" on The Petition Site http://www.thepetitionsite.com/takeaction/938995258
This new Petition is to urge two highly respected, influential Doctors, the Dean/CEO of Johns Hopkins Hospital, Dr. Edward D. Miller, and the Medical Director for the Center for Innovation and Quality Patient Care, Dr. Peter J. Pronovost to call for an investigation to uncover the truth and correct unsafe practices. With your backing I may be able to rekindle the support I once enjoyed as a well respected, if outspoken, member of Johns Hopkins OR team.
At a very early point in my five year Surgical career at Johns Hopkins I earned a letter of commendation from the Dean for advocating necessary changes in OR behavior to protect patient safety during Surgery. This occurred after a letter that I wrote was delivered to the Dean which then prompted months of interdisciplinary meetings to create: ”A Perfect day in the OR” culminating in an “OR Retreat.” This innovative strategy involved hundreds of OR employees who were left feeling disillusioned and jaded when the initiative was abandoned as the Hospital’s priorities changed.
Getting the attention of that same Dean/CEO, Dr. Miller, and others empowered to make a real difference regarding this latest issue has proven impossible thus far. If these safe patient care issues are important to you, then please seriously consider how adding your support to this Petition might become instrumental in enlisting Dr. Miller’s and Dr. Pronovost’s help in this matter. If the content resonates with you at all it will take just 30 seconds to add your signature. To link directly to this Whistleblower Petition and add your signature now, GO TO: http://www.thepetitionsite.com/takeaction/938995258
If you have already signed the Petition, thank you for adding your support in accordance with your conscience. Please understand that I bear absolutely no ill will towards this prestigious medical institution or the many dedicated staff I was genuinely honored to work alongside during my five year tenure in the OR at Johns Hopkins. All that I must still insist upon is a proper investigation. I genuinely hope that Johns Hopkins may finally address the wider implications of uncovering the truth regarding inappropriate or inadequate compliance protections for whistle-blowers both within their own institution and at other US Healthcare facilities. However, if you have time read the entire Petition and review all of the included Links.
Please note that there are over 250 links to assist you in researching the subject of patient safety. Each of these links connects to a separate web page to provide a very balanced perspective on the most serious issues confronting medical professionals today. Many of the links, including those featuring Johns Hopkins, demonstrate positive solutions and provide valuable information. Any and all links were inserted purely for this informative purpose; no support, agreement or endorsement is intended or implied by their inclusion in this Petition. Reviewing these links will offer an in depth analysis of the current patient safety situation and how nonexistent employee protections in the US, and quite possibly in other countries including the UK, continue to endanger Hospital patients.
Despite the advice of so many people who insist I must “give up and just let it go,” I would judge such abandonment spineless and cowardly, considering the gravity of the patient safety issues I have raised. While I deeply regret that it has become necessary to choose this far more public course of action, the ignored priorities have left me no other option. Allegations levied against specific members of the Hospital Management must be reviewed or proven solely based on valid evidence presented, past admissions and the facts as submitted to investigators. Those courageous enough to vigilantly advocate on behalf of patient safety deserve genuine, consistent and reliable protection from retaliatory Managerial practices. To correct this dangerous oversight, and restore the integrity of Johns Hopkins Compliance Line, new safeguards must be put in place immediately.
Wrongful termination can, and does, inflict lasting damage to professional credibility as job references are damaging or unobtainable under such circumstances. Those familiar with my conscientious efforts to supply vital warnings in good faith were appalled to witness the devastating consequences. This travesty has effectively silenced most former colleagues, potential witnesses and supporters who fear similar retaliation. On a personal level it still continues to sabotage all potential career prospects for me and now even jeopardizes my future commitments as an unpaid NGO Medical Volunteer overseas.
While potential legal options for recovering any type of personal compensation are no longer possible, I remain compelled to struggle for basic vindication. To this end I have begun working on documenting my experiences and the lessons learned in a book entitled: “ICONIC IMMUNITY.” However, it is still my most fervent wish that my prestigious former Hospital would agree to help me write a positive ending to this sorry episode by teaming up with me in my efforts to correct serious Healthcare regulatory problems for the public good. Meanwhile, in pursuing my current charitable endeavors, I would greatly appreciate garnering the moral support of valued former allies at Johns Hopkins including the Dean/CEO, Dr. Edward Miller.
Problems cannot be corrected by demonizing the messenger: this strongly discourages Hospital staff from reporting patient safety issues. When the bold and outspoken are punished; few will emulate their trusting naivety. The inappropriate cost-containment measures I have elaborated on in my Petition create the potential for negligent or dangerous under-staffing situations, but they are becoming more prevalent at Healthcare facilities throughout the US.
Nurses and other medical staff are exposing these problems on the Internet on Nursing and Union Blog Sites. They are appealing for action and media review of the widespread problems that Nurses are facing today. This Petition, posted at the close of National Nurses Week seeks to draw attention to these very valid concerns. Several links in my Petition visit these sites and my experiences are well documented on the allnurses.com Website under the name "TsunamiKim;" GO TO: http://allnurses.com/forums/members/105717.html to read the profile page on TsunamiKim on the allnurses.com Website. However, in reading my posts on the allnurses threads you will see from many other postings I am certainly not alone in my plight.
Corporate greed drives the compromises made by a few rogue Managers. However, their flawed decision making cannot be ignored and tighter restrictions on staffing are desperately needed to adequately protect patients from harm. While the misinformation and devious tactics used to silence my patient safety warnings remain unchallenged they will leave Hospital patients vulnerable to unnecessary risk and this demands the most urgent attention.
We must all work together for positive change to realistically improve patient safety and reduce medical errors. With this Petition I am throwing down the gauntlet: challenging Johns Hopkins to genuinely persevere in their leadership role in reducing medical error by taking immediate action to facilitate the investigation into my case. I am confident that with your persuasion they will finally realize that they are duty bound to address the wider implications of uncovering the truth regarding inappropriate compliance practices that fail to protect whistleblowers or Hospital patients.
It is my greatest hope, and most ambitious expectation, that John Hopkins will use their influential position in healthcare improvement and patient safety organizations like the Center for Innovation in Quality Patient Care and the Center for Law and the Public’s Health to usher in far-reaching, national, industry wide, policy and regulatory changes.
For those of you living in countries other than the US, situations very similar to the problems illuminated here may well be already adversely impacting patient care within your healthcare system or moving steadily in this disastrous direction. We certainly do not want to go down a similar road in the UK with the NHS! In opening up an important dialog I believe that this Petition really can make a difference, both in the US and elsewhere, so please sign it and forward it to all of your friends for their consideration.
Sadly, I do not have the relief of knowing that vital initiatives I pioneered during my five year tenure in the OR at Johns Hopkins Hospital managed to make a lasting difference, but it is never too late to appeal for help. The Dean/CEO of Johns Hopkins, Dr. Edward D. Miller, may be contacted at: (410)955-3180 or via his e-mail: firstname.lastname@example.org and the Medical Director for the Center for Innovation in Quality Patient Care, Dr. Peter J. Pronovost may be contacted at: (410)955-8032 or email@example.com (These are all publicly available contacts.)
Johns Hopkins also hold “Town Meetings” at their main Baltimore Campus. These open forums present an ideal opportunity where members of the public are encouraged to raise important issues and concerns such as this. Please urge these two respected, influential Doctors to do the right thing by insisting on the investigation and overhaul of Hospital Compliance practices to better protect patients from harm. In the near future, with your help, I genuinely hope I will be able to enlist the full support of Dr. Edward Miller, and Dr. Peter Pronovost in my ongoing efforts to forward their noble patient safety agenda.
Kim L. Sanders-Fisher.
"The time is always right to do what is right" - Martin Luther King, Jr.
Wednesday, June 28, 2006
Doctors and Nurses are increasingly being forced to work longer hours of continuous duty caring for greater numbers of sicker patients with fewer staff and zero backup or relief. Exhausted Medical staff are used as the convenient scapegoat when mistakes are made, while in fact it is the deliberate negligent under-staffing of Healthcare facilities that has led to dangerous care.
At a time when we face the possibility of terrorism, sabotage or a global pandemic the US Healthcare system is being disabled and dismantled to drain every last dollar of profit for greedy Corporate giants. Meanwhile to accomplish this goal the Healthcare industry is busy perpetrating a whole slew of deliberately deceptive PR lies to trick vulnerable Medical staff into remaining silent while the general public is defrauded out of safe access to Medical care; see my definitions in italics below.
These Repugnant Healthcare Euphemisms will Prove as Deadly as US “Peacekeepers!”
1. “Managed Care” definition: Too much Management providing far too little and increasingly more dangerous Care.
2. “Patient Safety Initiatives” definition: Impressive PR Campaigns that can help to obscure negligence practices.
3. “Risk Management” definition: Department dedicated to reducing the Risk to Management from outspoken Patient Advocates.
4. “Compliance Hot Line” definition: Early warning system to alert or assist Management in the prompt removal of outspoken Patient Advocates plus fool Government Accreditation Agencies and Patient Advocacy Groups with fake internal policing..
5. “Patient Centered Care” definition: Patients now forced to “Center” on their own Care due to chronic abandonment caused by the dangerous policies of deliberate negligent under-staffing.
6. “Patient Abandonment” definition: The threat of legal sanctions used to force Nurses to work unsafe hours without a break in order to support deliberate negligent under-staffing policies.
7. “ Medical Error” definition: Mistake made by overworked, overstressed, exhausted and habitually abused Medical staff
8. “Nursing Shortage” definition: Healthcare Corporation's deliberately engineered “NURSING EXODUS” resulting from the creation of a toxic work environment of torturous schedule demands, exhausting hours of overwork, with no breaks and numerous unsafe compromises in Patient Care driven by profiteering cut-backs and used to falsely justify further dangerous under-staffing.
9. “Downsizing” definition: Forcing the people delivering direct Patient Care to endure unworkable staff cut-backs to support bloated Management and Corporate greed.
10. “Trim the Fat” definition: Removal of basic benefits while increasing unrealistic schedule demands for regular Healthcare workers, an incentive to force all of the more highly paid experienced staff out of Nursing stimulating a "NURSING EXODUS," to increase the glut of money available as a reward bonus for abusive Managers and Corporate profiteers.11. “Mandatory Overtime” definition: A State sanctioned dangerous work overload forcing exhausted staff to risk charges of abandonment or compromise Patient Care by working intolerably long hours as a regular staffing coverage policy.
12. “Medicare Prescription Drug Benefit” definition: Drug Company extortion campaign endorsed and implemented by the Government to forcibly drive Medicare into Bankruptcy.
13. “Tort Reform” definition: Adjustments to make the deadly human cost of all of the above unethical compromises less financially devastating with zero accountability for facilities whose greedy profiteering results in ongoing negligent and increasingly dangerous Patient Care.
Unlucky 13 for Consumers receiving Unsafe Medical Care; Money making Bonanza for Corporate Healthcare Profiteers. Medical Professionals and the general public must demand an immediate end to this lunacy; we also really need Media help.
Please visit my Whistleblower Petition to leave your own comments on the need for staffing regulations and Whistleblower protections; GO TO: http://www.thepetitionsite.com/takeaction/938995258
To read a letter of appeal that further elaborates on my personal motivations behind filing a Whistleblower Petition, GO TO:
To read more about the specific healthcare dangers I was removed for trying to expose, GO TO:
Many Thanks for your Support, Kim