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Posts Tagged ‘PATIENT SAFETY.’

Is Healthcare Harm a Misadventure or a choice?

December 31st, 2012 1 comment

As a nurse, a patient and a consumer, I know I have to make wise choices for my Health and my healthcare.  Last year, I had to choose the best doctor and best Hospital for my cancer surgery.  It was no small task.  I also had to choose a healthy approach to my surgery.  I drank more water for several days, ate iron rich foods, exercised more (better late than never), clipped and scrubbed under my nails and did antiseptic showers each of the 3 days up and to the day of surgery.  I had a stellar healthcare outcome.  Since my surgery, I have made even more choices to be healthier, like going on a weight loss diet and moving more.  Although I stumbled a bit with this effort over the Holidays, I will continue in the New Year to lose excess weight.  That chore will be accomplished by even more choices…choosing healthier foods, less sugar and fat, and more protein, fruits and vegetables.

I believe I am making a lot of the right choices for myself.

Are Hospitals making the right choices for patients?

It’s all about choices isn’t it?

When a Hospital chooses not to invest in patient safety and infection control programs and practices that are known to work, patients suffer.

When they choose to chronically under staff, and patients are not getting the direct care they need when they need it, patients suffer.

When they fail to coordinate admissions and keep infected or colonized patients separate from unaffected patients, patients suffer.

When a direct caregiver chooses not wash their hands before patient contact, or chooses not to use the 5 rights of medication administration,  or chooses not to use a check list or a time out prior to surgery or other medical procedures, patients suffer.

This is a short list of choices that are made by Hospitals and caregivers every day.  So, when I heard recently that medical harm is called a “misadventure” by the Centers for Medicare and Medicaid, I was dumbfounded.    Healthcare is not an adventure or a fairy tale.  Illness and injuries are a brutal reality for human beings.  None of us choose to be sick.

My colleagues in Patient Safety have treaded lightly when talking about medical harm, errors and infections.  None of us believe that these things are deliberate or intentional.  We do however believe that most healthcare harm is preventable. Errors and infections that occur over and over are no longer errors. They continue to occur because poor or inadequate preventative choices have been made.    Patients suffer every day because of healthcare harm, and I believe that much of that harm is because of poor choices.   Choices are made every day in Hospitals and other healthcare settings that can cause preventable harm to patients and unnecessary suffering.

Let’s all work together to make  better Patient Safety choices in 2013.

Healthcare Industry Push Back, Patient Safety Activism

September 13th, 2012 3 comments

I am now well into my third year in Patient Safety Activism.  My father’s preventable death because of a hospital acquired infection continues to drive my passion.  Although he was old and he had health problems, the infection that took away his independence, his strength, his appetite and his ability walk and to live out his remaining days with my mother should not have happened.    Nobody except  hospital insiders and the grieving family and friends of the other 2 deceased victims of that MRSA outbreak knew about it.  So, my father was not only a victim of MRSA, a deadly superbug, he was also a victim of hospital secrecy. Hospitals generally sweep hospital harm under the rug and schmooz patients and families into believing it is part of doing business.  I do see a gradual change in this, but it is taking way too long.

Yet, when victims or their loved ones become patient safety activists we are expected to be kind, polite, and above all calm.  Many of us have been characterized as angry whiners. I’m sure we have been called worse behind closed doors.   Imaging that!  Let me just say, I am angry.   My anger is completely  justified.   But, when I testify anywhere, or when I share my father’s tragic story, or I work with anyone on patient safety, I remain polite, and I restrain that roaring lion inside me.  I am a professional, and I use the manners that my parents taught me.  This brings me to healthcare industry push back.  I knew when I stood up to fight for patients and patient safety, that I would be exposing the underbelly and preventable horrors of healthcare…the infections, the errors, the short staffing, the disrespect and paternalism,  the ‘toxic hierarchy’, the big bad truth of what happens inside hospitals and other healthcare facilities.  I knew it would not make me popular with the “industry”, but of course that was not the reason for my work.  Patients and their safety were my priority, much like when I practiced as an RN for over 30 years.  I saw so much during that time, but I had bosses…in fact, I layers upon layers of bosses and my family depended on me for that paycheck.  How far could I realistically go with my advocacy during my employment.  This is why I find retirement so liberating.

Healthcare industry push back is alive and well.  My first bitter taste of that was in my very first meeting with Hospital people about MRSA. A contentious doctor  proclaimed that the new Maine law to screen high risk patients for MRSA on hospital admission was  “irrelevent”.  I had just run a patient safety campaign and spent about 4 months writing and rewriting a very involved and detailed legislative proposal for MRSA prevention for the Maine HHS committee, to end up with a tiny part of it in Maine law.  That big old lion was roaring inside my head and I wanted to let him out to attack that doctor.  But, being the lady that I am, I  kept my cool, and moved  beyond that arrogance, because we were all in that room to do a job, and that was to make patients safer.   The rule making work continued in that committee for months, and his attitude never changed. If I said white, he said black.  So much for collaboration.  Interestingly, the rest of the group was mostly nurses and none would contradict that doctor.  Perhaps I am a little biased, but I love nurses and the herioc work they do, but those nurses ’just went along’.    “Toxic hierarchy” is a new term I recently learned and it describes this group’s behavior perfectly.

This summer, I spent most of my time working on a campaign to stop the acquisition of my local dialysis clinic services by a large for profit dialysis corporation.  My reasons for this action are described in an earlier blog, but the greatest concern over this is patient safety and access to care.  I talked with experts, dialysis patient advocates and former patients and employees of that corporation.  I worked with the Maine State Nurses Association, the Maine Peoples alliance and other local socially responsible groups.  I did my homework and research and compiled resources and documents. Most importantly, I collected stories of patients who said they were harmed and dismissed.  I took all of this and carefully prepared testimony for the Maine Certificate of Need hearing on July 10.  In August, I came upon a letter that the corporation had written to Maine officials. The letter was almost entirely about me!  It contained misleading and downright dishonest comments about my work, how I go about it, and my character.  It was apparently an attempt to discredit me, and my work and to silience me and the patient’s voices. It appeared that the letter was also written to pander to the current pro business and anti union sentiments in our State governement. This guy covered it all, and if one didn’t know me, and saw that letter, they would  think that I am a monster!   This carefully crafted letter and  packet of “evidence” against a  retired RN volunteer, who is now an honest hard working patient safety activist  was  the biggest and longest piece of push back rherotic I have experienced yet!    And, it is now an offical State document!     My first thought was, if they treat me this way, imagine how they treat patients.  Oh my, those poor vulnerable patients.  The good thing about this letter is that it validated my beliefs about how ‘small’ this corporation really is.

I didn’t expect to make new friends or win over the healthcare industry with my work.  I did expect to help save lives, make patients safer, and to be treated with respect while I am doing it.  All of us who do this work have the same expectation. Because we have chosen to lead in Patient Safety because of personal tragedies, instead of waiting for the industry to do it all on their own or even to invite us in, we are sometimes criticized and disrespected.    I have watched two of my passionate colleagues experience push back when we were included in industry leaned events.  One was a nurse who tried to talk about her mothers tragic healthcare debacle in a federal DHHS HAI meeting a  few years ago. The physician moderator of the group rudely cut her off mid story and she was terribly upset by that.  The second one was a presenter at the recent Patient Safety Academy in Portland, ME.  He was doing a detailed and well prepared presentation on C Diff.  His beautiful and healthy middle aged mother died of the horrible infection and he has done tremedous work on awareness and prevention.   A very rude crabby infection nurse, cut him off and ‘told him a thing or two’.  She was obviously in denial of the imperfections in hospitals, and took my colleague’s accurate and non accusatory presentation as a personal affront.  Her actions were embarrasing to her two coworkers and to everyone else in the room.  This was my colleagues first time doing a presentation at such an event.

Civility.  Is there any such thing in patient safety advocates’ conversations with the healthcare industry?  I think so, but it isn’t consistent.  All of us need to take a deep breath and think about who really matters in our discussions.  We need to put away the egos, denial and the defensiveness. Al Gore would advise us to put the anger in a lock box, and I really do make an effort to do that.  We all need to consider what and who our conversations are about.  They are about patients, suffering, hurting human beings, who need all of us to survive, heal safely and live.  Come on….let’s get along, and have these conversations without push back.  

Backbone.  That is what it takes to do this patient safety activism job and do it well.  The industry has a lot to learn from us, and perhaps the first thing they need to learn is manners.   I have never seen any of my patient safety colleagues be impolite during patient safety events or conversations.

Patient Safety Activists/Advocates Support letter

August 22nd, 2012 3 comments

When I read a letter,  written by a Davita lawyer and submitted as public document to the Maine Certificate of Need officials, I was stunned.  His letter seemed to be an attempt to belittle my work, my reputation and to silence me, and in turn the patients’ voice.

After I consulted with trusted and wise colleagues in Patient Safety, I decided not to write a rebuttal letter.   Instead, my colleagues wrote a strong letter of support to my State officals.  I can’t express how this made me feel.  That virtual group embrace was overwhelming.   We all work very hard to engage and empower patients, to give them a voice, and to help keep them safe.  Each of us has had an impact in our own communities and States, and we also work as a cohesive unit  in a Nationwide network to tackle Patient Safety issues together.  We are unstoppable and our collective  voice will not be silenced. 

The following letter of support was sent yesterday to Maine State officials,  and others.  This letter is a collective effort that brought many of my colleagues together to demonstrate our unified and solid stand for safer patients everywhere.  It was signed by 27 Patient Safety Advocate/Activists.

Without my nationwide Patient Safety network , including Roberta Mikles RN, who put me in touch with Advocate Arlene Mullin, and 5 very brave patients, Maine State Nurses Association, Maine People’s Alliance and Carl Ginsburgh,  this Patient Safety campaign in Bangor, ME,  would never have happened.

 There is power in the truth.

 

Date:    August 17, 2012

 To:       Phyllis Powell

Assistant Director

Planning, Development and Quality

Division of Licensing and Regulatory Services

Department of Health and Human Services

State House Station #11

 41 Anthony Avenue

Augusta, ME 04333-0011

 

Re: Letter in support of patient safety activist Kathy Day, RN concerning proposed

       DaVita acquisition of Eastern Maine Medical Center dialysis services

 

 

The Centers for Medicare and Medicaid Services (CMS) [1] has designated patient safety as a top goal in reforming our healthcare system, reducing costs, and improving public health. Across the nation federal and state agencies, hospital systems and research institutes, auditors, advocates, and activists are working to protect patients and especially vulnerable populations from preventable medical harm.

 

Given this sea change, speaking up and out about patient safety failures is hardly an act of revolution, yet one courageous activist in Maine has drawn fire for doing just that. We write to you today in support of patient safety activist Kathy Day in her quest for serious deliberation of the DaVita acquisition of Eastern Maine Medical Center dialysis services.

 

We know of Kathy Day’s work as an advocate for patient safety in Maine.  Because of her compassion, caring, and advocacy, patients in Maine are receiving better care with less risk from hospital-acquired infections. Her advocacy for dialysis patients is consistent with the growing national concerns reported in the press about the quality and safety of patient care at DaVita dialysis centers.[2] Ms. Day has no personal financial stake in the DaVita matter; her interests lie solely in the outcome of Maine’s dialysis patients.

 

We urge Maine to reject the proposed DaVita acquisition pending a more thorough review of patient quality and safety concerns. This action has precedent. The State of Vermont recently rejected the out-of-state-for-profit acquisition of dialysis centers by Fresenius Medical Care because it reportedly failed to pass their patient quality and safety muster.[3]



[1] Medicare and Medicaid programs cover the costs of 96% of dialysis patients. See: http://www.medpac.gov/chapters/Mar12_Ch06.pdf

[2] DaVita patients historically have had the highest hemoglobin levels of any company, according to congressional testimony and the U.S. Renal Data System. See: http://www.denverpost.com/news/ci_18613171

[3] State of Vermont Banking, Insurance, Securities, and Health Care Administration. Docket No. 11-004-H. See: http://7d.blogs.com/files/proposed-decision-12-1-2011.pdf

Additionally, it appears to be statutorily prudent[1] to require regulatory investigations[2] and whistle-blower lawsuits[3] regarding DaVita operations be concluded and prescribed corrective action taken before giving further consideration to a business transaction that may negatively impact the quality of care for Maine’s dialysis patients.

 

While healthcare is delivered one patient and one community at a time, national coalitions support the grassroots work of state advocates and activists like Kathy Day to promote policy action that recognizes patient safety as not only a moral highground, but also as a financial necessity for program sustainability.

 

 

Sincerely,

 

*** Please note that all supporters are non-conflicted individuals and organizations. ***

Signed by 27 Patient Advocates and Activists



[1]Maine statutory requirements for certificate of need: Title 22: HEALTH AND WELFARE

Subtitle 2: HEALTH Part 1: ADMINISTRATION Chapter 103-A: CERTIFICATE OF NEED HEADING: PL 2001, C. 664, §2 (NEW) §335. Approval; record. C. Ensures high-quality outcomes and does not negatively affect the quality of care delivered by existing service providers; [2003, c. 469, Pt. C, §8 (NEW).] 7. A. The applicant is fit, willing and able to provide the proposed services at the proper standard of care as demonstrated by, among other factors, whether the quality of any health care provided in the past by the applicant or a related party under the applicant’s control meets industry standards; [2001, c. 664, §2 (NEW).]

4 It is reported that DaVita has been under review/investigation by the U.S. Office of the Inspector General for The Department of Health and Human Services, the U.S. Attorney’s Office in Colorado, and the U.S. Attorney’s Office in Missouri. See: http://www.denverpost.com/news/ci_18613171

[3] It is reported that DaVita settled one whistleblower lawsuit in Texas 07/2012, agreeing to pay $55 million over allegations of drug overuse. See: http://www.denverpost.com/news/ci_21002816/denver-based-davita-settles-case-overuse-kidney-care Another whistle-blower lawsuit was reported to have been filed in Georgia. See: http://www.nytimes.com/2011/07/26/health/26dialysis.html?_r=1&pagewanted=1&sq=davita&st=cse&scp=2

 

cc:

 

Mr Larry Carbonneau , DHHS Manager Healthcare Oversight

Karynlee Harrington,  Director, Maine Quality Forum

Mary Mayhew, Commissioner DHHS

Janine Raquet, AAG

Rep. Adam Goode, Bangor

Rep. Joe Brannigan, Portland

Rep. Herbert Clark, Millinocket

Rep. Michael Michaud

Office of the Inspector General for Department of HHS

Larry Ramuno, QIO

 

 

The debate over the sale of EMMC dialysis to Davita

July 14th, 2012 7 comments

 July 12, 2012 

 The debate over the sale of EMMC dialysis patients to Davita is not a Union vs EMMC issue, as some choose to say.   It is a Patient Safety issue.  Patient safety is an issue for every single Maine resident who uses our healthcare systems. This Davita issue is also about relinquishing local control and governance over the quality and safety of care provided to local Maine patients.  Unforeseen illness, injury or medication complications could put any one of us in a dialysis chair some day.  This should frighten every single one of us.

  I asked for a tour of the EMMC (BOYD) dialysis services the other day. The clinic supervisor seated me in the waiting room for about 10 minutes while he made the necessary calls to EMMC bosses to address my request. That gave me the opportunity to talk with the spouses of 3 local dialysis patients.  They were uncertain and fearful of Davita coming to Bangor.  One dedicated husband said he wished he had known about the hearing because he would have attended.  It’s a shame they didn’t know. Patients and families would have benefited more than anyone from the DHHS Certificate of Need  hearing. It seems that EMMC staff should have posted the hearing information in a dominant spot for all to see…especially patients and their families.  Sadly, the patient’s voice is left out of decisions that are most important to them.

 I was denied a tour of the facility.  Apparently, my concern for the safety of EMMC dialysis patients was not a good enough reason to be allowed to see it. Before I left, I had a brief conversation with the clinic supervisor.  He said he had done research on Davita.   I asked if he had read about how Davita has sued doctors because they resigned and left to work elsewhere because they believed Davita policies were not safe for patients. They bucked Davita policies.   Yes, the young supervisor had read about that.  “How did that make you feel?” I asked.  He said with a very non expressive face “indifferent”.  Wow.  I didn’t have anything else to discuss with this man.  His indifference over something this damning of Davita was alarming. He was responsible for every patient who was hidden behind those securely locked EMMC clinic doors.  Even though his response floored me, I realize that EMMC and Davita have wedged him into the middle of a situation that he has absolutely no control over.  If Davita comes, he and every other person, including doctors on staff at our dialysis clinics had better get use to not having control over anything in the “business” of Davita.

 

I am extremely concerned for EMMC dialysis patients if this financial deal goes through.  At the July 10 Certificate of Need hearing, I displayed  3 posters. Two of them had the real life stories of 5 patients from Davita clinics from across the US. The patient heroes (whose photos and stories were displayed) wrote their own testimonials about personal harm from their Davita clinics.  Most of them had been dismissed from their clinics, simply because they were vocal about their concerns and harm.  These 5 people were just a tiny sample of thousands of patients who have experienced the exact same thing.  I didn’t observe one single Davita rep, EMMC manager or dialysis staff person reading those stories, even after repeated welcomes to all to do so.  Could it be that they don’t care about patient harm?  Dr Razcek, EMMC vice CMO described the patients’ experiences  as anecdotal.  It’s odd that he would describe the stories of real life dialysis patients anecdotal, but swallow the stories or “so called” evidence of Davita whole. Dr R’s comment was insulting to the integrity of those 5 people who have suffered through harm, retaliation, segregation, bullying, physical and mental abuse, and now someone is questioning their honesty?   I have spoken with each and every one of those patients and they are real, their suffering is real and their stories are real.  I offered to put EMMC leaders in touch with those patients and that offer was refused.  These patients’ stories are the absolute and dangerous  truth about Davita.  

 

 “The right care, at the right time, in the right place” was in bold print in the half page EMHS ad in today’s BDN. .  Apparently, that promise is made to everyone except dialysis patients.  EMMC/EMHS  will have no control over Davita policies or the quality of care that our Maine citizens receive in Davita managed dialysis clinics.  There will be no local governance. Davita skewered the EMMC dialysis care  outcome reports during the public hearing.  If I had been an EMMC manager, that would have made me very angry. In fact, although I am no longer employed by EMMC, I do remain loyal, and it made ME angry. My family and I receive some of our healthcare services from EMHS and EMMC.  Who validated Davita’s data?  Davita did.  Conspicuously missing were Davita’s records of dismissals and patient harm.  Records of their care outcomes, patient safety measures,  and regulatory violations in California are available online.   The 5 patient stories I displayed were just a sample of many who have been harmed and dismissed by Davita.  As a Mainer, a retired nurse and as a former employee of EMMC, I was insulted by Davita leaders and their condescending presentation. 

 If EMMC continues to pursue this $10,000,000 sale, and dialysis patients are harmed by Davita, EMMC becomes complicit in any resulting harm and sickness that our local dialysis patients my encounter.

 Keep the control and funds for dialysis services in Bangor, ME.  Use any revenue to address perceived defects  in our local clinics. Keep the dialysis business-related revenue in the local pharmacies, laboratories,  and supportive services.  Keep the  safety of Maine patients in Mainer’s hands.  Davita cannot do one single thing better than EMMC except make money and pay stockholders.

My third display poster for the hearing , showed photos of the CEO of Davita in a Three Musketeer Costume and quotes from him  saying “It is not about the patients, it is about the teammates”.  These photos, quotes and articles are available to anyone online.   This poster should have made it perfectly clear that money intended for high quality dialysis care is siphoed off by Davita and goes to glitzy rich booze soaked  parties, huge new $100,000,000 Denver, CO headquarters, a $22,000,000 annually compensated CEO,  and most importantly to them,  into stockholders hands.  Davita is even banking on boomers!  I posted that article on this board as well.

Mainers, demand that the control of our local dialysis clinics stay in local hands.  Cheapened care, cookie cutter treatments, and Walmartesque  services from Davita will not benefit Maine dialysis patients.

 The State of Vermont rejected Fresenius (Davita’s biggest competitor) because citizens declared that For profit dialysis services were not for the public good of Vermonters.

 Davita services are not for the public good of Mainers.

 

Kathy Day RN Patient Safety Activist

Dialysis Patients are Wall Street Commodities

May 27th, 2012 4 comments

I pray to God that I never go into End Stage Renal Disease.

When I read in the Bangor Daily News that Eastern Maine Medical Center was going to sell their Dialysis services (patients at average $70,000 annually each in 2008) to DaVita Dialysis Corporation, I was shocked. http://bangordailynews.com/2012/04/24/health/eastern-maine-medical-center-to-sell-dialysis-clinics-to-national-chain/  It is my understanding that EMMC offers a fine service already, just as they have promised their charitable donors they would.  Charitable donors have given money toward a beautiful 4 year old facility on the West Side of Bangor, ME, and I have never heard anyone complain about their treatment.  Information about bad care often trickles down to me because I am a patient safety activist and advocate.

The BDN news article went on to describe 3 concurrent investigations into Davita  by regulatory agencies.  One is for fraud in overcharging for a common medication given to dialysis patients, Epogen.  These investigations were fluffed over by EMMC  and we, the BDN readership were assured that these investigations are no big deal…..really?  Apparently the investigations are not as big a deal as a check for over $10.000,000 for the purchase of EMMC dialysis.   A fellow activist from California contacted me about  Davita.  She warned that Northern Maine does not want or need them here.  She in turn connected me with Arlene Mullin Tinker.  Arlene and her team of legal advisors  have advocated for thousands of harmed dialysis patients.  Many of them have been Davita patients.  Her experience is that Davita is #1 for dismissals. During my 42 years as an RN,  I had never heard of dismissing dialysis patients.  Wouldn’t that be a death sentence??  A death sentence usually involves a judge and a  jury of our peers.  Not so for dialysis patients.

As it turns out, Davita clinics nationwide have repeatedly dismissed dialysis patients without cause or notice.  These patients have generally been patients who were vocal. They complained about unsafe care, complications of their care, poorly trained staff or poor infection prevention techniques.  All of these complaints sound reasonable to me.  I would certainly complain if I was on the receiving end of poor care.  Dialysis patients are captive to  their illness and to the treatment for it, dialysis.  Without regular high quality  treatments, they will die.  So, even if their care is substandard, they generally have no choice about where to get their treatments.  Their only option is to continue care, often times  from the same people who may have harmed them.  My research revealed that the only reason to “dismiss” or fire a dialysis patient is violence.

At EMMC Dialysis services, the hierarchy beyond the director of the clinic, is EMMC management, and then Eastern Maine Health Services management, and finally we have 2 local Boards of Directors.  Managers and Board members are Bangor  and EMMC service area residents.  They live, shop, go to church and social  functions  in the same places that the patients do.  Our local Hospital hierarchy coexists in the same community as the patients and they are accountable to them.

Davita, now that is a different story. They are a Fortune 500, for profit company headquartered in Colorado.  They are buying up Dialysis clinics all over the World.   Davita people  ”from away” came to Bangor on May 25 to do a slick sales pitch at a State of Maine DHHS Certificate of Need hearing.   They presented  an almost religious mission and presentation.  They explained their trilogy of care. 1. We care for the World 2. We care for each other.  Last and finally,  3. We care for patients.   I immediately figured it out.  Patients are last on the list.  But, the money that patients bring in, mostly from taxpayers  in the form of Medicare/Medicaid dollars, is really #1.  The “world” is their stockholders.  ”Each other” are the so called citizens of the Governors community(will explain in a moment).  And finally at the bottom of the pit are the patients…..who get the dribs and drabs of whatever  remains of the healthcare dollars after the coffers are filled.   I looked into Davita leadership. Their CEO, Kent Thiry is quite a guy.  He likes to be called “Governor”, which seems  kind of egomaniacal.   Employees are called “citizens” of his community.  He runs RAH RAH rallies for his cult like “followers’ and dresses up like a Muskateer.  He leads loud Nazi like rants/chants.  He does somersaults on the stage.  He hired a bull for a ritzy Las Vegas meeting to prove that he can ride one.  What does any of this have to do with Patient Safety and high quality of care.  Dialysis funding (through Medicare patients)  pays for all of these Davita variety shows! http://www.youtube.com/watch?v=JowmBdx4nFw

Davita is a perfect example of everything that is wrong with Healthcare today.  Taxpayers pay into Medicare and Medicaid services.  Coverage for dialysis treatment in guaranteed to every US citizen regardless of income. Around $70,000 to $100,000 is paid annually  for every medicare dialysis patient.  EMMC was offered over $10,000,000 by Davita for their dialysis services.  Kent Thiry ‘s 6 year average yearly compensation was over $22,000,000, http://www.forbes.com/lists/2012/12/ceo-compensation-12_Kent-J-Thiry_IPFN.html,  more than all of the  dialysis services of EMMC is worth.  All of these  figures prove that there is HUGE money in corporate dialysis services.   My concern is …How much is spent on safe, high quality dialysis care?  If the profits in this for profit  ”business”  are any indication, not much actually goes to patient care.

The slick sales people at this CON meeting also bragged about Walmart-like “one stop shopping” for patients.  They are proud that they offer their own  mail order pharmaceuticals for their patients.  Most dialysis patients are on at least 8 prescription drugs.  Staff are trained to be sales people and to encourage their patients to purchase their medications through Davita mail order services.  Then they will deliver them directly to the patient, at the bedside.  WOW, it’s a miracle. Bill Miller of Miller Drug on State St in Bangor has been doing that for free for years…same day, home delivery for free.  And Bill’s profits stay in Bangor, and help the local economy. Bills neighbors and friends can also borrow certain medical equipment for free. I borrowed a wheelchair from Bill a few years back to help my father get around at the American Folk Festival….no charge!  What does Davita do for free?   What else will Davita sell their patients?  They are starting to buy up employee health clinics, nursing homes and other practices.   This is a company with outside policies and controls, and with inside sales.  This is a company that will profit off our local dialysis patients, and bring nothing to our local or State economy.  The money will go to the corporation/stockholders.  Living, breathing, suffering and captive Patients become cash cows for Wall Street Commodities.

Where do patients fit into the Davita scheme?  Good question.  If they are harmed or have issues with their care or safety, the complaint process is complex, and my understanding is that complaints often go into a black hole.    The End Stage Renal Disease Network fields these complaints.  Davita has representation on that network, so complaints essentially go to the people who are being complained about.  If a complaint somehow reaches a state health department, they might do an investigation, but generally the investigators are nursing home inspectors, and they do not know the specialty of dialysis.  If CMS (Centers for Medicare Services)  is brought in and they make recommendations, Davita may or may not comply.  Since there are no sanctions, there is no accountability and no incentive for Davita to fix problems. Then if a Davita clinic does not like the patient, because they have asserted themselves about substandard care or complications, Davita may just dismiss them. Some  patients that have been both harmed and dismissed by Davita clinics were also blackballed from other dialysis services.  Since Davita will purchase 3 dialysis clinics business, in Bangor, Ellsworth and Lincoln, ME, all inpatient EMMC services and home dialysis services, this leaves local dismissed pateints out on a limb….facing either death or horrible long commutes to distant clinics.    None of this bodes well for patients.

Davita answers to their stock holders, not to their patients and as importantly, not to our community or service area.  It is very clear what this company’s priorities are.  Patients bring money to the company, and by cheapening dialysis care, they make their stockholders happy.   Ask Warren Buffett.

Maine does not need Davita. They are exactly what is wrong with Healthcare today. Davita is a prime example of why healthcare is bankrupting this country and our States.    The fact that EMMC service area patients may recieve cheaper and lower quality care is reason enough to escort them out of State. We need to tell them “Thanks anyway, but we value our citizens too much to invite you in.”   Maine welcomes business..there is a sign near the New Hampshire border saying “Maine is open for Business”.  If that business has potential to harm our citizens or suck money out of our economy, we do not welcome them.  I look forward to seeing the back side of Davita going over the NH border….headed back to Colorado.

Addendum  http://bangordailynews.com/2012/05/27/business/who-makes-the-most-50-highest-paid-ceos/

check out who is #46 on the list of the highest paid CEOs in the US…all made on some of the sickest patients in our country, and on Taxpayer dollars to care for them.

Holiday Greeting to My Healthcare Team

December 27th, 2011 7 comments

On December 23, just 4 days ago, I had Robotic surgery to remove my Uterus, Fallopian tubes, Ovaries and lymph nodes because of endometrial cancer.  After surgery, I got encouraging news that  most likely I will not need further treatment for cancer. I will get further information on this at my recheck appointment on January 11.  I am forever grateful to my surgeon, and my entire Maine Medical Center healthcare team for exemplary care and a good healthcare outcome.  My great outcome didn’t come  by accident.  It was becasue of  my Healthcare Team’s  attention to detail and careful, safe care.

Just a few weeks before my surgery I sent the following Holiday greeting to my Healthcare team, through an assistant Chief Medical Officer at Maine Medical Center.  My hope was that this letter would be widely distributed. With a few changes, this letter could have come from any empowered patient.  Empowerment is essential in patient safety, but it does not remove the fears that all patients face.  Being frightned is human nature and is experienced by everyone when facing surgery or other medical endeavors.  My intention in writing this letter was not just to get “special treatment” for myself.  I expect special treatment for every patient.  I also wanted to point out the vulnerability that all patients experience and how we put our complete trust in our Healthcare team. 

This letter was distributed and widely read at MMC.  I had visits from nursing and department leadership and staff members and they thanked me for this letter and asked for me to come back to address some of their groups.   Iwill do this gladly and proudly.  I am forever grateful for the safe and excellent care that I recieved at MMC. I believe this was accomplished by hard work, experience,  dedication and partnership with me throughout my healthcare experience.   

Here is my Holday Greeting to my Healthcare team……

 

Happy Holidays to my Hospital Healthcare Team                             December 23, 2011

 

I haven’t met any of you except my GYN/oncologist before I came here today to have surgery, and yet, I trust you, as my healthcare team, with my life.  I am one of you and I am one of “them”.  Today I am a patient (them), but I worked at MMC in 1970 for a few months as a freshly minted RN.  Your ER and your Hospital have grown so much that they are no longer recognizable to me.

 

Today my dedicated husband Mike is with me and will stay by my side and be my advocate.  I am his wife, and I am also a mother, grandmother, daughter, sister, aunt, niece, cousin and friend to many.  Before becoming a trusting but vulnerable patient today, I have been the “strong” one for my family, friends and many thousands of patients during my 41 years as an RN. 

 

Your work is more important to me than you know.  I have had a tragic personal experience with Hospital care. In 2009, my own father died of Hospital Acquired MRSA Pneumonia that he contracted in a small Maine Hospital.  It was an earth shattering experience for me and my family.  So, since then, it has become my quest to make healthcare safer for everyone by working as a patient safety activist.  My work has taken me to the State and Federal DHHS, and the Federal CDC. I affiliate with the Consumers Union Safe Patient Project.  I volunteer my time to make healthcare, and particularly Hospital care, safer for everybody.

 

The work that you do is challenging even on your best days. I know that it seems downright chaotic and impossible some days.   Keeping me safe isn’t easy; it will take a lot of work, skill, coordination, collaboration, communication and care.  Care is the key word.  In current political discussions on Healthcare…the true meaning of care seems to get lost.

 

So, here I am, meeting you all, for the first time today.  This visit wasn’t an option.   I came to MMC to get rid of cancer. Admittedly, I am frightened.  Certainly in that respect, I am exactly like all of your patients.  I chose your hospital and doctors after a great deal of research and comparison to others.  I trust you to keep me safe.  I need your expert care. So, please………  Take the important “time out” before surgery and complete that check list. Give me the appropriate pre op antibiotic and give it at the right time. Keep me warm and clip, don’t shave my hair.  Tell me your name and I will tell you mine, on every contact.  Do it even if I scowl after a half dozen times.  Be patient with my questions, because I don’t know the answers if I ask. Listen to my concerns and my husband’s.  Remember that although he is not medically trained, after 40 years of marriage, he knows me a whole lot better than any of you do. Once I am in my room, please don’t ask him, my lifeline, to leave my side.   He will take a load off your nursing staff and help keep me safe.    Wash your hands every single time you touch me, my stuff or my immediate environment.  Please, help to keep me and my room clean thereby protecting me from infection.  Pain Control is very important to me. Use the 5 Rights for every medicine you give me. Remove my urinary catheter as soon as possible. Involve me in all discussions about my healthcare plan and even if something has gone wrong.  Secrecy erodes trust.  This is a short list of steps that can keep me safe and sustain my trust. .   Push me hard to walk, cough, deep breath, and take fluids. I plan to cooperate with this plan, but I may whine a little.   I want to be out of here as soon as possible, hopefully in just one day.   It’s not that I don’t appreciate the hospitality and your tremendous efforts, it’s because I know it is the best thing for me and my health.

 

I am giving you my trust, gratitude and sincere admiration for the incredible work that you all do.

 

In return, you are giving me the best possible Christmas gift today.  You are giving me the safe, clean and expert healthcare that I need, so I can get back to my family for Christmas and begin my recovery from cancer and surgery.  I plan to be the “strong” one again in no time.

Thank you and Happy Holidays to all of you and your wonderful families. 

Sincerely, Your Patient, Kathy Day RN, Patient Safety activist and advocate

What I have learned so far on my personal Healthcare journey

November 1st, 2011 1 comment

I have learned that although I am a smartie pants patient safety activist, and I know all the correct questions to ask and who to ask, the answers are hard to come by.  The most transparent places I called were Maine Medical Center and Eastern Maine Medical Center.  The hospital I called in Boston had attitude.  I asked their infection control nurse what the infection rate was for robotic assisted hysterectomies, and all hysterectomies and I was told “well, I know they are below the National average”.   Exactly what does that mean?  I have no clue.  She also said that they are not required to report those numbers to the public, but in a year, they would be doing that.  I told her I have cancer now and I need surgery, so that report in a year would do me no good.  Then she went on to tell me she did not have the authority to give me that information.  When Iasked for someone who did have the authority, she said I would have to wait until Tuesday(this was the previous Thursday) and call back, but she was not certain I could get that information.  I did not call back.  I was completely turned off by their lack of transparency.

Both of the Maine Hospitals I called gave me the information they had on infection rates for hysterectomies, and EMMC even had it broken down for robotic assisted hysterectomies.   Both were concerned compassionate and friendly.  It might be because I know both of them from my MRSA work.  Even so, I appreciated their honesty and candor.   The only problem I had was finding out about other complications of their robotic assisted surgery cases.   I think if I had persued it further, I could have found out, but sometimes there is such a thing as TMI….too much information.  TMI can be kind of frightening.

So, although the original plan was to go to Boston and engage the doctor who did the first robotic assisted hysterectomy in New England, I have changed my mind.  That is the perogative of patients/healthcare consumers.  I did my homework.  I also asked my personal local doctor her opinion.  She was  very candid.  Her own husband died of melanoma this past June.  She basically said that given the choice of going to Boston or Portland (she and her husband went to both places), she would choose Portland.  Her comments were that the Boston teaching hospitals are world class but they love having you come there to learn ‘on’ you.   She went on to say that Maine Hosptials have the focus of Patient Safety.   This was reassuring to me.  She is a wise doctor.

So, after all my struggles and conflicts with Maine Hospitals and the Maine Hospital Association over MRSA, I will put my trust in Maine Medical Center and a GYN/oncologist there to take care of me. I am hoping that my activism has made Maine Hospitals safer places.   I have the expectation of a very safe, infection free experience.  I am scared enough about the risks of anesthesia, complications, post op pain,  recovery and beyond…..I really don’t want the added concern of preventable harm.  Eastern Maine Medical Center would have been an option if they had a GYN/oncologist, but they do not.  MMC does and that is where I will go.

I encourage all potential patients to call the hosptials they are considering and ask about their infection and complication rates.  Look the Hospitals and Doctors up on Healthgrades.com, or Why Not the Best. com websites to see their ‘grades’.  Ask around, talk to your doctor.  Ask him or her “if this was you or your mother, with exactly the same risk factors, where would you go for care?”    No question is a stupid question and all the answers (or lack of answers) are important in making your best healthcare choices.

So, my first lesson in my personal Healthcare journey  has been that although one can know the right questions, we can’t expect to get all the answers…and in some cases we can’t expect any answers at all!  But, the answers we do get and the way they are delivered can have a huge impact on your decision.

Centers for Medicare Study, 1 in 7 injured while hospitalized

November 16th, 2010 1 comment

patientinbedThe study results released today by the Office of the Inspector General of the DHHS about Medicare patients is very disturbing.  ONE IN SEVEN medicare hospital inpatients suffered harm because of medical error/or infection.  This is huge. It is unacceptable and it is a big secret from most unsuspecting patients being admitted to the hospital.  Although half of our States have mandated reporting for medical error, not even all of those accurately report medical errors/hospital acquired infections.

How do we change this?  First of all we make them report it.  Mandatory public reporting of medical error and hospital acquired infections is a must.  Without transparency and accountability, there will be no change.   Mistakes and deadly infections will continue to be swept under that dirty rug and paltry investments in prevention will continue.  Second, we support improved staffing at our local facilities.  Safe staffing equals safer patients.  Third, we pressure our legislators to support any and all Safe Patient legislation, including prevention legislation,reporting legislation, patients rights legislation and informed consent legislation.

At the  recent Consumers Union Safe Project summit,  ad campaigns to educate people who are entering the hospital were discussed.  Having blind trust in our hospitals and doctors and other caregivers is a very naive way to conduct one’s self when hospitalized.  Educate yourself about your condition and help others who cannot do that for themselves. Ask if the surgery/treatment/medications are necessary and if there are alternatives.  Get second opinions.  Check out your Doctor’s history and experience.  Ask for your hospitals record on medical error and infections.  Finally take a patient advocate with you.  If you will be impaired physically and/or mentally because of your surgery or medical condition, ask a trusted loved one or friend to be your advocate. Don’t sign your consent for treatment or surgical procedure until you are perfectly clear on all the risks, including infections. Carry a journal for yourself or your advocate to use to document who visited you in the hospital and for what reason, list your medications, etc.  And make sure all of your caregivers, and visitors are washing their hands before touching you.

Don’t count on your hospital to do it all for you….as much as you would like that.  Take a stand for yourself or your loved one. Be prepared and educated.  You will be safer because of it.

http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf

Healthcare Reform, finally

March 23rd, 2010 No comments

Admittedly, I have not read the entire Healthcare Reform bill.  But, I am aware of several inclusions regarding patient safety and hospital acquired infections.  Unless these things were excised from the bill that passed the House on Sunday, they are still in there.

The Healthcare bill’s approaches to infection prevention and patient safety  included many approaches.  One approach was that the lowest performing hospitals will get their medicare reimbursement dropped by 2%.  And why not?  Actually that percentage would most likely be higher if Medicare just refused to reimburse for any hospital acquired infections.  If hospitals are unable to care for people, particularly the elderly, without infecting them, Medicare  (and other rinsurers)  should not pay and neither should the patients.

I am so happy for the millions of citizens who now will be empowered and able to get healthcare insurance.  I attended a meeting with the Maine Insurance Commissioner a few weeks back.  She was hearing stories from Maine citizens about their private Anthem insurance policies.  Anthem was greedily pursuing a hefty 23% increase in premiums from these already hard hit customers.  Some had policies that cost them over $10,000 a year and they had over $10,000 deductibles to meet.  That is not healthcare insurance, that is homeowners insurance.  It is the only way those people cold protect their homes and other belongings if they got sick.  And some of them already were sick.  Anthem had lawyers in the hearings so they could protest or object to what these hard hit customers were saying. It was despicable when they objected.

Finally, the Anthems of the country will be forced into fairness, and competition.  Medicare for all would have been my choice for Heathcare reform, but the HC bill that passed on Sunday will suffice, for now.  Now we can get on with the business of actually providing good, safe, affordable Health Care.

Maine Quality Forum Decision, LETS DO A STUDY

September 18th, 2009 2 comments

When my bill passed into law last spring,  there was a stipulation that the Maine Quality Forum would “define” what populations were at high risk for MRSA in Maine, for the purposes of screening.  This task was assigned to us by the Maine Health and Human Services Committee.   I attended meetings for 5 months and I worked diligently between meetings researching this subject.  I presented a solid list of known populations at risk for MRSA.  I gathered  this information from the CDC information and hundreds of other sources.  I never attended a meeting uninformed or unprepared.

I withstood stonewalling, dishonesty, reluctance and downright hostility in these meetings.  I took verbal beating repeatedly and with grace.   Without the refereeing of our leader and my  dedicated Maine State Nurses Association collegue, my pursuit of safer hospitals in Maine would have been much more difficult.  There is no doubt in my mind that they were trying their best to wear me down.  They thought “she will go away afer a while”.  Wow, they do not know me. 

The Maine Hospital Association and their associates, APIC (infection control professionals), and the MQF DO NOT WANT TO DO HIGH RISK SCREENING FOR THEIR PATIENTS.  They will tell you they are already doing it, or it is too expensive, or it is too cumbersome, or there is no need because they are improving handwashing,….my goodness, I can’t begin to complete the list of excuses I have heard.  The fact is that the MHA and APIC have lobbyists and money and they are fighting this effective approach to MRSA prevention tooth and nail. These associations and the MQF are the very people who should be making our hospitals safer.

What this all really boils down to is that Hospitals and doctors  do not want to be told what to do.  Another thing they don’t want is to be liable for an excellent MRSA Prevention program.  If patients have an increased expectation of hospitals and Active Detection and Isolation becomes standard practice in Maine, they will be held to it!  This means increased litigation for MRSA victims if the hospital fails to meet the standards.  Well, hells bells, why not?  Maine Hospitals are responsible if patients become infected on their watch.  They either improve safety or they are liable and there will be lawsuits!

 Maine hospitals  think they are doing a bang up job with MRSA prevention.  While I do recognize that some efforts are being made to stop MRSA, it is not nearly enough.  Why just last week I talked with a woman who had over 100,000 dollars in medical bills after her hospital discharge . She got MRSA, C Diff, and pseudomonas during an over 100 day stay at the local hospital.  She is still paying her bills off and she still suffers ill effects from those infections, but fortunately, she survived.   Another person  asked my son for my contact information because her father died 2 weeks ago with MRSA, same hospital.  So, although they are doing SOME things to improve prevention, they are not stopping the infections.

One  reason for this is that their screening protocol is not wide enough, and that is likely the same problem in all the hospitals in Maine who are still seeing new infections regularly.

Another reason is that they continue to room infected or colonized patients with uninfected pateints. I brought this up at the last MQF meeting and I got jumped on by 3 or 4 nurses all with similar excuses, including one that basically said that CDC says it is ok.   This  a recipe for disaster.  Your local infection control nurse will tell you that “patients do not spread MRSA, hands do”.  Yes, I agree, this is so.  But contaminated  instruments, uniforms, bathroom facilities  and other environmental contamination also spreads disease, with the help of hands.  And do not ever feel safe about the air you breath.  MRSA can be coughed 3 to 4 feet when a patient has MRSA pneumonia.  I have also read articles that air ventilation systems have tested positive for MRSA.  So, without effective air filtration, MRSA can spread that way too.

Another reason MRSA spreads is because doctors are rationing out treatment to interrupt colonization.  They get to pick and choose the patients who will get this simple treatment before invasive procedures.  The arguments for rationing is that there is some  antibiotic resistance, or that MRSA can come back or any number of other excuses.  The reality is that they are playing God in deciding who will have the advantage of simple decolonization ….if it will be you, or your neighbor or someone esle…. according to what procedure you are having.  This seems unethical to me.  If I am having a gut surgery and I have MRSA colonization, I want the treatment.  I will take my chances at resistance or that it might come back after I heal.  LET ME DECIDE my own fate.  This witholding of effective treatment to prevent active infection smacks of the “Sarah Palin” death panel referrence.  Not that I ever believed anything that Sarah Palin said.  My guess is that if any of the doctors who participated in our MQF work group had MRSA colonization and needed surgery, they would be pushing the antibiotic ointment up their noses and scrubbing their bodies with Phisohex frantically and frequently before anybody touched them!

There are many reasons that Maine hospitals are not stopping MRSA.  These are just a few and they are the ones I have addressed in my legislative proposal. 

I would love to see an ambitious investigative writer start calling all of our hospitals.  Their first question could be “how many patients in your hospital have MRSA now?”  Second question, “how many of those patients came into the hospital with those infections?”  Third question, “what is the prognosis for those patients?”   How long will those patients suffer from these infections?   “Is every MRSA colonized and infected patients isolated from other patients?”  “How high is your handwashing compliance?”  “Have your MRSA infections rate dropped or gone up in the past 10 years?”   “Are you aware of the Veterans Administration MRSA screening program and it’s success in dropping MRSA Infections?”   I want to do this investigation myself, but I have observed how close to the chest ANY MRSA information is guarded within these facilities.   I sat in meetings with representatives from hospitals all over the State and I don’t know any of the answers to any of these questions.  THIS IS THE BIGGEST DIRTIEST SECRET OF ALL IN MAINE HOSPITALS.  And the secret is closely guarded.  Each hospital’s representative in those meetings should have very proud CEOs.  They didn’t spill the beans on any useful numbers for the MQF group.

Two days ago, a unilateral and sudden decision was made by our MQF leader to do a “study”.  This decision was made with no plan, no deadline, no consultant, and no requirements.  After 5 months of pounding out a good solid list of high risk populations for screening, our work group’s direction changed.  It was announced, not suggested.  So, all of a sudden the MQF became a dictatorship, not a work group.  While all of the logistics and details of this “study” are being worked out and the study done and the analysis made and resulting recommendations are decided, Maine patients at high risk for MRSA will continue to be admitted to our hospitals without screening.  The expense of this test could be spent on a new effective screening program for all of our hospitals It is bogus and it is nothing but a stall tactic.  The hospitals believe they have won a battle of some sort.  If I thought for one minute that battle was against MRSA, I would not be writing this blog entry.  It is a power battle they think they have won.  MRSA prevention has little to do with it.

MRSA screening saves lives and stops suffering.  It is the first step in preventing MRSA infections.  Patients with undetected MRSA will continue to be admitted to Maine hospitals, and be roomed with uninfected patients.  Infections that can be prevented with simple decolonization treatment will continue to happen.    Rates will not drop.  And after a hospital allows this to happen to you, you will get the bill for the damages.  You will be billed for care rendered as a result of a preventable infection.

This study is a delay tactic.  This allows Maine hospitals to stall the inevitability of effective high risk MRSA screening.  This allows hospitals to continue doing exactly what they are doing now and that is not enough.  I hold the MQF , the Maine Hospital association and Maine hospitals responsible for every single new MRSA infection that occurs in Maine hospitals  while they are messing about with a study.    This is not what was expected of us in our work group…….we need to start screening now…and without further delay.

I will never give up this fight.  It is much to important to everybody.  My motivation comes from my grief and I will continue to grieve a long time for my special father who was infected by his trusted hospital and died as a result.