Inadequate staffing blamed in $2.7 million lawsuit

A Wichita, KS, hospital has agreed to a $2.7 million settlement in a suit filed on behalf of a woman whose family contends she suffered a paralyzing stroke because of inadequate nurse staffing levels.

In February 1998, 61-year-old Shirley Keck was rushed by her daughter Becky Hartman to Wesley Medical Center, where she was diagnosed with pneumonia. Hartman said Keck required constant supervision after going into respiratory distress but didn't receive it because there weren't enough available nurses on staff. So instead, she almost stopped breathing, slid into a coma and now suffers from brain damage and partial paralysis.

According to published reports, Wesley Chief Executive Carl Fitch won't comment on the suit but says that inadequate staffing levels at the hospital are the result of a nationwide nursing shortage.

But the Keck family and other expert witnesses who offered testimony disagreed, saying that Wesley did not attempt to hire temporary nurses as other Wichita hospitals have done to counter staffing problems. "They didn't want to hire nurses from a temporary staffing agency because of cost concerns," Hartman said.

The Keck case is unusual because it does not include a confidentiality clause. Without the clause, Keck's family and her lawyer are free to discuss the situation. Hartman, who notes that the money from the settlement will "barely cover" the around-the-clock nursing care her mother now requires, said she felt compelled to speak out about the situation to spare others from having to endure a similar ordeal.

"Nothing can undo what happened to my mother or what our family has been through," she said. "So, [going public with] what happened to her is all that's left. I was never aware of the nursing shortage before this happened ... but I know about it now."

Banning thermometers

The city council of Ann Arbor, MI, recently passed an ordinance banning the retail sale, importation and manufacture of mercury thermometers within the city limits.

The council members' action makes Ann Arbor the third city to ban mercury thermometers. So far, the city has collected more than 300 thermometers, exchanging them for free, non-mercury thermometers.

In 1998, poison control centers fielded 18,000 calls from people who had broken a mercury thermometer in their home. Some of those incidents caused serious health effects in those exposed. Mercury attacks the central nervous system and can cause tremors, impaired vision and hearing, and developmental deficits during fetal development, among other serious health problems, according to Health Care Without Harm (HCWH).

In that same year, the Environmental Protection Agency and the American Hospital Association signed a memorandum of understanding with the goal of eliminating mercury from health care.

Both ANA and the Michigan Nurses Association had a role in this local effort as members of HCWH, which has been promoting the use of non-mercury products at health care facilities nationwide.

Safe alternatives for thermometers and other mercury-containing health care supplies do exist.

For more information, go to http://www.noharm.org/.

Med errors back in the media

Medical errors were once again in the headlines in August when The Washington Post reported on a study that revealed that an estimated 350,000 medication errors occur in U.S. nursing homes each year. According to the study, more than half of those errors can be prevented.

The Washington Post reported that researchers at the University of Massachusetts Medical School and Brigham and Women's Hospital discovered 546 medication-related injuries at 18 Massachusetts nursing homes during a year-long study. The results included one death and 31 life-threatening injuries.

If the results are extrapolated to the 1.5 million U.S. nursing home residents, then at least 350,000 adverse drug events occur every year, according to the study. Researchers cited the wrong drug dose as the most common problem, but noted that some drug categories that appear to cause more problems than others. For example, the study identified 188 potential adverse drug events in which 80 percent of the "near misses" were associated with the use of the blood thinner, warfarin.

UAN continues with labor victories

United American Nurses continued its successful labor work when the Illinois Nurses Association's (INA) state-wide local bargaining unit of 1,400 state-employed registered nurses negotiated an exceptional contract and the North Carolina Nurses Association (NCNA) defeated a raid at one of its Veterans Administration (VA) facilities.

The INA nurses won significant victories in the areas of restrictions on mandatory overtime, public health, longevity and holiday pay, tuition reimbursement, pension and salary increases. The new contract includes general wage increases of 15 percent over the life of the agreement and a total compensation package of 21 percent. This package is substantially richer than a similar agreement for non-RN personnel negotiated by the largest public employee union in the state.

"We not only got [management's] respect, we also got their money," stated one INA negotiating committee nurse.

The agreement marked INA's second major victory in recent weeks. Registered nurses in this same bargaining unit also resoundingly defeated an attempted raid by the Teamsters Union and the American Federation of State, County and Municipal Employees, with INA winning more than 70 percent of the votes.

NCNA scored a similar victory by defeating the American Federation of Government Employees' raid at the Durham Veterans Administration facility in late July. The vote was nearly two to one in favor of the NCNA.

For more information on United American Nurses, go to http://nursingworld.org/uan/.

Nurses win unfair labor practice

Nurses represented by the Michigan Nurses Association (MNA) scored a victory July 31 when the National Labor Relations Board (NLRB) issued a formal complaint against McLaren Home Care d/b/a Ingham Visiting Nurse Home Care and Hospice. The NLRB found that McLaren Home Care failed to bargain in good faith with MNA and ordered it to do so, and to cease and desist from "interfering, restraining or coercing" registered nurses in the union.

The MNA filed unfair labor practice charges after McLaren declared an impasse in negotiations and indicated its intention to implement changes in how RNs delivered care to patients.

"Proper health care is more than dollars and cents. Care for patients should be first. The Michigan Nurses Association is committed to working with McLaren to reach an agreement that is in the best interest of both the nurses and their patients," says MNA Labor Representative Flo Baerren.

Blow struck against domestic violence victims

Advocates for victims of domestic violence and rape were disappointed earlier this year when the U.S. Supreme Court ruled that the civil rights remedy in the Violence Against Women Act (VAWA) of 1994 was unconstitutional. U.S. versus Morrison concerned Congress' power to enact the VAWA's civil rights remedy, which would have allowed women (and men) to sue their attackers in court for damages resulting from injuries from gender-based violence. The petitioner was allegedly gang-raped by two college football players, who she subsequently sued in federal court under the VAWA's civil rights remedy.

The alleged rapists challenged the law's constitutionality in the first such case to reach the Supreme Court. The justices rejected arguments from the plaintiff's attorney and the Clinton Administration that the law is needed because states aren't doing enough to protect rape victims and because gender-based violence restricts women's choices in jobs and travel.

The ruling was not on the entire VAWA, only on the civil rights remedy. Advocates for rights for victims of domestic violence are urging Congress to consider adopting an amendment that would reinstate the civil rights remedy when the legislative body votes on reauthorizing VAWA this year for five years at full funding levels.

Mandatory overtime update

New Jersey Governor Christine Todd Whitman issued a conditional veto on Sept. 21 of the mandatory overtime legislation passed by state legislators in late June. According to the New Jersey State Nurses Association, the conditional veto authorizes the Department of Health in consultation with the Department of Labor to conduct hearings to set forth regulations for mandatory overtime and voluntary overtime.

In California, health workers who have voted to work 12-hour shifts cannot be forced to work overtime except in an emergency, according to a report in the July 17 California edition of Nurseweek.

A June 30 decision by the state's Industrial Welfare Commission means that nonunion California health care workers can no longer be forced to work overtime at management's discretion, and that those who must work overtime in a health care emergency cannot be required to work more than four additional hours. Workers who want to volunteer for overtime still would be permitted to do so.

More hospitals close, others post profit

A new government report shows an increase in the number of hospitals that shut their doors in 1998 and blames the Balanced Budget Act of 1997 (BBA) as a factor Ð but not the sole factor Ð in the closings, according to a story in the Aug. 7 Modern Healthcare. At the same time, HCA - The Healthcare Company and Tenet Healthcare Corporation posted profits of $223 million and $302 million respectively.

In 1998, the first year that the BBA went into effect, 43 of the 4,785 acute-care hospitals in the United States closed. However, in the same year, 14 hospitals either reopened or opened, according to the report by the Health and Human Services' inspector general.

Health care professionals, including nurses, previously had sounded the alarm on the effects that the BBA was having on their hospitals. ANA and other organizations have repeatedly urged lawmakers to rethink the BBA and its Medicaid and Medicare restraints with some success. (See The American Nurse, Nov/Dec 1999)

Modern Healthcare reported that of the 43 hospitals that closed, 15 were in rural areas and 28 were in urban areas. The total 1998 number represents an increase of five hospital closures over the previous year.

On a related issue, the Medicare hospital outpatient prospective payment system (PPS) went into effect Aug. 1. Hospital analysts are not saying how the new system will impact their health care facilities, maintaining that it's too early to tell, according to the Aug.7 Modern Healthcare.

On the profit side, HCA - The Healthcare Company, formerly known as Columbia-HCA, beat Wall Street estimates with its second quarter earnings. Excluding its $498 million charge related to the tentative partial settlement of its civil Medicare fraud case with the federal government (see The American Nurse, July/August 2000), a $6 million restructuring charge and a $9 million gain on sales of facilities, the nation's largest for-profit hospital chain reported a profit of $223 million or 40 cents per share, up from $182 million or 31 cents per share, in the 1999 quarter.

Tenet Healthcare Corp., the nation's second largest hospital chain, reported a 21 percent increase in net income for its fiscal year ending May 31, 2000. Tenet posted profits of $302 million or 96 cents per share, up from $249 million or 79 cents per share in the previous year.

Michigan nurses report pervasive change

Nurses in Grand Rapids, MI, have witnessed pervasive change in their workplaces, with 81 percent reporting that their facilities have gone through a merger or affiliation in the past few years, according to the Michigan Nurses Association (MNA) 2000 Health Care Survey Report for Grand Rapids.

Further, 85.1 percent of nurses surveyed anticipate more changes on the horizon. The study specifically studied changes in the area's health care system and how those changes are affecting patient care and nurses.

The majority of nurses surveyed work full time and in hospitals, with more than one-third of the respondents having more than 20 years in the field.

"Nurses, already in short supply, are going home at the end of their shifts exhausted, discouraged and saddened by what they could not provide their patients," said MNA President Marylee Pakieser, MSN, RN, CS.

The survey also found:

* Three-quarters of the nurses report that the acuity of their patients has increased, leading RNs to conclude that their working conditions are taking a toll on them and the quality of patient care in Grand Rapids.

* Nearly 40 percent of nurses say they are "frightened for their patients," and almost 60 percent report staffing as "inadequate."

* Almost 65 percent have felt increased pressure to accomplish their work, 42.8 percent have needed to work overtime, sometimes involuntary, and 1 in 10 have suffered a personal injury on the job.

Responding nurses also offered ways to address their workplace concerns in the survey with three-quarters supporting the passage of legislation that ensures safe staffing and quality care. About two-thirds identified union representation as a solution; 26.1 percent, whistleblower protection; and, 35 percent, workplace committees.

Dropping seniors

The Clinton Administration is saying that more than 900,000 elderly and disabled persons will be dropped by health maintenance organizations (HMOs) pulling out of the Medicare program, The New York Times reported this summer.

The number, according to The Times, is substantially lower than estimates provided by the HMO industry, and represents nearly one-sixth of the 6.2 million Medicare recipients in HMOs.

Senior citizens who have been dropped can join another Medicare HMO, if one is available in their area. Or, they can return to the traditional Medicare plan, which means they will not have prescription drug coverage as a benefit unless they purchase a separate supplemental policy, according to the Consumers Union. Many seniors citizens can't afford supplemental policies.

Rewarding safety

Health care professionals nationwide are being asked to share innovative ideas to improve sharps safety in their work environment through a new national campaign.

The campaign, "Sharps Safety Best Ideas Awards Initiative," will award monetary prizes totaling $10,000 for sharps practices judged most effective and will publish a compendium of the winning and other national entries that will be distributed industry-wide.

All health care employees who deal with sharps are invited to enter the competition by submitting a description of how they improved sharps safety in their work environment through efforts such as safety system implementation, workplace controls and training and development.

A panel from the Association for Professionals in Infection Control and Epidemiology will judge the entries.

For an entry kit, contact SIMS Portex Inc., a medical device manufacturer and founder of the campaign, at (800) 258-5361, ext. 332.

Managing pain within managed care

The American Pain Society (APS) has outlined ways the nation's managed care providers can improve the extent and quality of the pain management services they provide for their patients.

In its position statement, "Pain Assessment and Treatment in the Managed Care Environment," APS recommends that managed care organizations devote more attention to educating primary care physicians about pain management, assessing patients with acute and chronic pain, and determining when to refer such patients to pain specialists.

Managed Care and Pain, an APS book edited by Stephen Lande, PhD, and Ronald Kulich, PhD, covers a broad spectrum of managed care issues, including basic concepts, legislative initiatives, contracting strategies and managed care pain treatment guidelines. It is designed to help pain specialists and managed care decision-makers with the complex task of developing quality pain programs and providing cost-effective pain care within a managed care environment.

For more information on either document, contact APS at (847) 375-4715.

Tackling tobacco use

Health care professionals have a new tool to help patients quit using tobacco, according to a report issued this summer by the U.S. Public Health Service (PHS).

The guideline, "Treating Tobacco Use and Dependence: A Clinical Practice Guideline," contains evidence-based information about first-line pharmacological therapies, such as nicotine gum and patches, and second-line therapies, such as clonidine. It also highlights new evidence about how telephone counseling can help patients dependent on tobacco.

Studies have shown that more than 25 percent of U.S. adults smoke and that 70 percent of them would like to quit. Yet data show that only half of the smokers who see a doctor have ever been urged to quit.

The guideline urges health care insurers and purchasers to include, as a covered benefit, the counseling and pharmacotherapeutic treatments identified as effective in the guideline and to pay clinicians for providing tobacco dependence treatment, just as they do for treating other chronic conditions.

For a copy of the guideline or a consumer guide called "You Can Quit Smoking," call (800) 358-9295, or go to www.surgeongeneral.gov/tobacco/default.htm.

Admitting through the ER

More than a third of all hospital patients, including four of every 10 pediatric patients and half of very elderly patients, are admitted through the emergency department, according to a new U.S. Agency for Healthcare Research and Quality (AHRQ) report.

The report also shows that the leading causes of hospital admissions through the ER included pneumonia, heart disease, stroke, chronic obstructive lung disease, asthma and septicemia.

Further more than half of all patients -- regardless of how they were admitted -- had at least one other illness upon admission, with the most common being high blood pressure. Alcohol abuse was a leading co-morbidity in patients 18 to 64 years old.

The report is based on 1997 data from AHRQ's "Nationwide Inpatient Sample."

For a free copy of Hospitalization in the United States, 1997, HCUP Fact Book No. 1 (AHRQ Publication No. 00-0031), call (800) 358-9295.

Is that aspirin you're taking?

Earlier this year, The American Nurse reported that aspirin is being underused by Americans with heart disease to prevent a recurrent heart attack, based on a study in Circulation: Journal of the American Heart Association. Now, another study reports a more troubling trend: as many as 2.7 million Americans may be incorrectly using such common over-the-counter (OTC) pain relievers as ibuprofen and acetaminophen to prevent or treat cardiovascular disease (CVD) instead of aspirin or in combination with aspirin.

According to the study's authors, this means that nearly one in four Americans who should be taking an aspirin a day to help prevent a second heart attack are mis-medicating by taking a non-aspirin analgesic, leaving them at unnecessarily higher risk for a second heart attack, stroke or even death.

Conducted at Harvard Medical School, the peer-reviewed study, "Mis-medication and Under-utilization of Aspirin in the Prevention and Treatment of Cardiovascular Disease," looked at 23,158 people aged 40 and older with no prior CVD and 3,818 with prior CVD. The study found that among users of analgesics, 11 percent incorrectly took the non-aspirin products to prevent CVD, and another 10 percent erroneously took them in combination with aspirin. Among analgesic users with prior CVD, 11 percent incorrectly took only non-aspirin products and another 14 percent used a combination of non-aspirin and aspirin products.

According to the Food and Drug Administration (FDA), aspirin is the only analgesic that has been medically proven to be safe and effective in the treatment of a wide range of patients with prior occlusive events, including heart attacks. To help raise awareness of the benefits of aspirin therapy, the FDA enacted new treatment guidelines last year and stated that aspirin therapy should only be administered under the supervision of a health professional.

In light of the Harvard study results, the FDA has informed several health care organizations that it will be launching a campaign in the near future to help educate the public on the misuse of analgesic OTC drugs.