In this nurse’s opinion the California Nurses Association (C.N.A.) membership hit an all time low this afternoon in Atherton, California.  You may wonder what could be worse than threatening opposition nurses, their children, and pets, or stalking opposition nurses, showing up at their relatives homes and calling family members at all hours of the night and day under the pretext of “convincing” the recalcitrant nurse that the C.N.A. is a great organization to join is low  — you weren’t in Atherton.  Today, low behavior was when hundreds of C.N.A. members and supporters descended on this quiet neighborhood so they could hold a demonstration at the private residence of California gubernatorial candidate, Meg Whitman.

Of course this demonstration was accompanied by all the usual hyperbole and misrepresentations that are part of the C.N.A.’s usual arsenal.  But to come to a person’s private home is truly above the pale. I’m sure Ms. DeMoro, Nurse Burger and company wouldn’t appreciate say the S.E.I.U. coming to their private homes and demonstrating to illustrate how the C.N.A. has engaged in raiding their nursing unions.  But common decency, and socially appropriate behavior seems to be lacking in the C.N.A. leadership DNA.

But what this nurse liked best was that in the C.N.A.’s attempt to garner media attention a nurse delivered a letter to Ms. Whitman by placing said letter in Whitman’s residential mailbox. In doing so this nurse may have engaged in a federal offense.  What federal offense, why the law that states only authorized letter carriers may insert mail into a residential mailbox.  Oh my!  The rule making and rule toting C.N.A. broke a rule themselves – color me surprised! …. More to come.

A little while back some of you may remember a little things called the Health care reform discussions, and if you don’t it might be time that you moved out of that cave you’ve been living in.  Anyway after a hiatus of many years from my ever now and then legislative visits to our Nation’s Capitol I was well enough to endure a flight out to DC, and thanks to my electric scooter (for which my daughter had to personally shell out nearly $2,000 to buy so I might have a modicum of freedom – thank you Adventist Health) I was able to scurry around the halls of our Nation’s Capitol and meet with various legislators and their aides and provide them with this nurse’s point of view on the health care discussions that were ongoing at that time.

Since I’m a California resident I always make a point to visit my representative who translates into Senators Boxer and Feinstein and Congressman Schiff, but since health care reform isn’t an issue limited to California, or just to Democrats or Republicans I also made a point to visit other Senators and Congressmen/women.   Over the years I found that even though Senator Feinstein is a Democrat, she and by extension her staff make a concerted effort to at least provide the appearance of listening to the opinions of the non-Democrats that comprise our fine State, the same unfortunately cannot be said for Senator Boxer or her staff.  There has been an ugly trend in her office for her staff to present an attitude of condescension to those who are of a different political persuasion then their boss.  This was never more apparent than my visit to her Hart Office.

I arrived on my scooter to follow-up on the appointment request that I had faxed several weeks early to her DC office.  The receptionist declared that no such request had been received, but when I presented her a copy of the request (received receipt an all) she amended her statement of denial to include that it had been received by the wrong fax machine in their office to which I responded and no one had the ability to put it in the correct person’s inbox?  Shamed by my assertion and at her obvious dereliction of duty she finally acquiesced to my request that I speak with someone from the Senator’s health care team, she hastily picked up the phone, called someone and shortly afterwards a young woman came out to meet with me in the reception area.  I introduced myself and asked the young woman to take a seat on the couch so I wouldn’t have to crane my neck upward to speak with her, but lacking all understanding of socially appropriate behavior she insisted on standing, thus towering above me and forcing me to look up for the duration of our conversation.  She paid little attention to what I had to say and after she interrupted for a second time to demand that I simply give her a one-line statement on my position since of course she was a very busy person.  I took a breath, gathered my thoughts and politely told her that as a RN and a healthcare expert I would not boil it down to “one-liner” for her, but since it was apparent that she didn’t give a damn I would end the conversation.  She tried to collect herself and continue the discussion, but for me there was no reason to continue why should I waste my time and energy on a person who had such obvious disdain for a constituent who held a differing opinion from her “illustrious” leader, Boxer.

So off we went to meet with other Congresspeople, including Senator Feinstein, whose office at least attempted to present to their constituents that they cared about their opinions even if those opinions diverged from their own.

Thus after spending several days wandering the halls, thanks to my electric scooter, and meeting with numerous elected representatives I concluded that Boxer’s office staff by far was the rudest and least hospitable to people and they win the award for “the worse office on the HILL”

June 8^th was our California Primary, both major parties had of course put up their candidates from which voters of their respective parties could vote for; except in the case of Governor and US Senate where Democrat Brown who had all but scared off any possible contenders and Senator Boxer being an incumbent didn’t have any real competition which left the Republicans with some very interesting races.  Which brings me to why I think the CDP and their operatives are exhibiting nothing more than sour grapes.  I can understand members, supporters, operatives and so forth of either party going full throttle after the other side’s candidate of choice, once that choice is clear, but in recent years party machinations have tried to influence the outcomes of primary elections, and in the case of the Republicans this usually translates into an unelectable candidate to face off against the Democratic hopeful.  However many Republicans decided that this year would be different and we’d let Republicans decide the outcomes of our own primary election.

Of course the CDP couldn’t help itself launching early and nasty attacks against both Meg Whitman (Republican Gubernatorial candidate hopeful) and Carly Fiorina (Republican Senatorial candidate hopeful).  So for the first time in recent memory the Republican party faithful seemed to successfully tune out the CDP propaganda and hit pieces, went to the polls and picked their candidates.  Which brings me to the evening of the 8th, when CDP operatives were aggressively handing out little pink half sheets “slamming” Carly.  I’m the last one that would attempt to censor someone, but I thought how tacky and how desperate the CDP was to pass out such misleading information during our day to celebrate.  Leave it to the CDP to try and rain on our parade, and why couldn’t they wait until the next morning to launch their first salvo in the General Election.  They just couldn’t help themselves so they tried to use the celebration at our venue to pass out their sorry attempt to smear our candidate – tacky — tacky — tacky.

So as my daughter drove me home I contemplated the motive of these “tiny” people and concluded that the only reason they chose to try and rain on our “parade” was fear!  You see they wanted deVore to get the Republican nomination and they did their best to nudge him into the winners slot, because by their calculations he didn’t stand a snowball’s chance in the general election; but Carly, well she’s an impressive leader who has proven she can and will make the tough decisions and could unseat Boxer, and for the CDP and Friends of Boxer this is a very scary thought!

On Tuesday, March 23, 2010 President Obama signed H.R. 3590, the Patient Protection and Affordable Care Act (PPACA) into law, and a collective sigh of relief could be heard, or was that a cry of despair that swept across the land?  Well it really does depend on which side you were championing, but it’s this columnist humble opinion that the real impact, value, benefits and whatnot of H.R. 3590 is far in the future and many of us may not be around to see how this scheme plays out; but let’s try to do a little crystal ball gazing.

Many of my readers may recall my two-part article “The Grass is Always Greener” that ran in the January 2008 and February 2008 issues of Working Nurse.  I believe that I made it quite clear in this two-part series that I wasn’t in favor of the so-called healthcare overhaul, and after watching and participating in last year’s discussions, town halls, real or manufactured, and debates too numerous to name I can firmly state that I’m still not in support of the overhaul especially not the one that has been saddled upon our citizenry and several future generations of citizens of our nation.  Gasp!  How can I a 30+year veteran of the nursing profession not be in support of this gracious gift bestowed upon us by our much wiser and worldly elected members of Congress?  You may think that I was oblivious to the pronunciations of such illustrious membership organizations such as the American Medical Association (AMA) and the American Nurses Association (ANA) which threw their full weight behind the President’s plan, but the reality is that neither organization represents a majority of their respective professions; and I was well aware of the Democratic-controlled Congress’ monumental plan to create out of whole cloth a Health Care bill that would become the law of the land.  Well, I know I’m not the only nurse that doesn’t see the ANA as a significant other in my career as a nurse and strongly oppose their choice to advertise that they “represent the interests of nearly 3 million nurses”, when the fact cannot be further from the truth with their actual membership being around 11% of America’s 3 million nurses; the AMA is not much better with a membership around 17% and yet choosing to present a “face” to the American people that they “speak for” the majority of physicians when they too fall far short of this grandiose promise.

Such examples “hyperbole” weren’t the sole domain of the proponents, but the opponents of what would later become known as the Patient Protection and Affordable Care Act (PPACA) as well.  Newspapers, Radio talk shows, daily newscasts and bloggers weighed in and their reports were replete with news stories and opinion of all types about the good, the bad and the ugly that was being discussed as the bill was being drafted and debated.  Many held out great hopes that the bill, when it finally reached the President’s desk for his signature would usher in Health Care nirvana for all (well at least all legal US residents, that is).  As I watched and listened to the various pundits – those from the left, the right, the far left and far right – I quickly concluded that this bill would be the proverbial elephant as described by a trio of blind men and H.R. 3590 did not disappoint.

I think that pretty much everyone I know and even strangers that I spoke with seemed to unanimously agree in the need for some kind of health care/health care insurance reform, but these same individuals were rarely of the same voice as to “the what” that change should be and I think the theatre that was health care reform discussion put on by Congress this past year was a mirror of that very same elusive “what”.  Ironically, the most ardent supporters of health care reform, such as President Obama, Speaker Pelosi, Majority Leader Reid, and others quickly dubbed the Republicans as the Party of NO when it came to the health care reform-taking place in Congress.  One only had to do the math, so to speak, to realize that Pelosi and Reid didn’t need a single Republican vote (up until Massachusetts sent their first Republican to the Senate in who knows how many decades) to pass their respective bills.  In the House the holdouts that were putting a crimp in Pelosi’s scheme were the “Blue Dog” Democrats who were the real members of the Party of NO, which is one of the reasons the Public were treated to such a circus throughout the health care reform discussions.  Most Americans were unaccustomed to the deal making, arm twisting, and at times heated language that our “Honorable” legislators can and do engage in when dealing with legislation making, and this time was no exception; except that the American people had been promised transparency, being able to view the debates and discussion on CSPAN, five days to review any bill on line before it was signed into law and so forth by the President and Party they swept into power in the last Presidential election.  I also think the American people were not prepared to be pilloried, insulted, and demonized by their very own members of Congress when they confronted these members at the August Town Hall meetings, in their Congress people’s offices or during protests, at one point a clear majority of American’s opposed the proposed legislation and yet many of our elected officials pontificated that “those folks just don’t what’s good for them, and that it rested on Congress to make things right”.  French history has a similar episode – It is said that Marie-Antoinette upon learning that her subjects had no bread to eat is said to have responded with the now notorious quote “Qu’ils mangent de la brioche” (better known as “let them eat cake”).

Indeed the summer of 2009 could be characterized as the summer of discontent, with many Congressman and women shying away from holding any formal meetings to help educate, answer questions and provide an open and free dialogue.  Senator Specter at one such town hall, which was televised, made a comment that shocked me when I heard it, what was his comment, you may wonder?  In response to an audience member about another meeting the Senator was to attend, the Specter responded in the vein of “he didn’t have to be there or go there” to which the audience erupted with comments of “that’s what he was elected to do, it was his job, etc.”  My own Congressman held, to my knowledge, only one town hall in Alhambra in an outdoor venue, that was originally suppose to be indoors, and hundreds of people stood in the sweltering August heat, under the blistering sun for hours before the meeting began in hopes of a town hall meeting.  In the end it was revealed that Schiff had organized a panel of proponents of healthcare reform, and the almost one hundred seats that were available had been reserved for the handicapped.  The very same seats which would later be filled by mostly bussed in supporters of the bill under discussion.  Such machinations marked many a town hall meeting, which only inflamed the public even more, convincing many that there was “evil” afoot, and the sociologist in me would have to agree.  Town Halls historically are small gatherings of citizens to discuss issues concerning the citizenry; these meetings are not usually orchestrated with individuals being required to show proof that they are constituents (we were told to be prepared to show proof that we were indeed constituents at my town hall), nor is there usually panel convened to “educate” the citizenry, or limits to the number of questions asked, holding telephone town halls instead of “live” meetings and so forth.  However there were Congress people that did brave both the ire and support of their constituents, and where this respect was shown these meetings seemed to have a more positive outcome with people agreeing that it was okay to disagree without having to be disagreeable.  One could almost judge the position of the Congressperson on the Health care reform bill by simply observing the attitude that Congressperson had towards the participants in the meeting.  Thus it was no surprise to me when the lines were drawn that those who supported Health Care reform were the enlightened and those opposed were described as “Brown Shirts” or “Astro-turf”.  These pejoratives did little to foster an open dialogue, and soon it appeared as though Health Care Reform was D.O.A.

Flash forward to March of this year and voila health care reform is the law of the land, and though HR 3590 and the companion reconciliation bill were signed into law there are still many unanswered questions and of course legal challenges.  Now that the bill has been signed into law, nurses, physicians and other frontline healthcare providers are going to bare the brunt of these changes, both good and bad.  This nation has had a chronic nursing shortage, and the last decade has seen a growing physician shortage (specifically General Practitioner/Primary Care physicians) these shortages will only be exacerbated by the passage of the PPACA.  There is talk that the roles of nurse practitioners (NP), physician’s assistant (PA) and even Naturopathic Doctors (ND) will need to be expanded in order to meet the needs of a nearly estimated 34 million people that will be added to the rolls of the insured, and many state legislatures are taking the expansion of the role of NP and PA’s under consideration.  This expansion of the roles of the above care providers will no doubt be met with resistance from the medical and nursing communities; one only needs to attend a local chapter meeting of the California Association Nurse Practitioners (CANP) to become educated on the frustrations and roadblocks that CANP has often faced when trying to make “simple” changes, including trying to codify a nurse practitioners scope of practice separate from our state’s current nurse practice act which has faced defeat at every turn to date.  At present Congress seems to think they can wave a magic wand and legislate wholesale changes to state’s regulation of both medical and nursing practice, which may prove more difficult then the passage of the PPACA, since we have no national physician or nurse practice acts, as these have been the purview of the states.  Additionally, though one can offer huge sums of federally funded grants and dollars to increase the physician and nursing educational pipeline, it still takes time to “backfill” and then reach the saturation point where we are educating and graduating enough nurses and physicians to meet growing demand as well as keeping pace with those leaving the field.  Add to the mix that at least twenty states (California is not one of them) have signaled that they may opt out of the high-risk pools that were meant to allow individuals with pre-existing medical conditions and chronic disease to buy health insurance, as well as the fourteen states (again California is not one of these states) that have filed suit claiming that the law is unconstitutional which may make the implementation of the PPACA long and laborious.  During the numerous legal battles that will doubtless continue to arise in response to the passage of PPACA nurses can and must continue to act as advocates for not only the patient but for the profession.

As a French native I’m not eager to see us adopt a French-style system, nor am I blind to the weaknesses of our health care delivery model.  In this debate, I’m what would’ve been described as an incrementalist, thus I didn’t support the sweeping changes pushed by one side nor doing nothing as others argued.  In many of my early writings I often used the following example, when a gardener finds himself or herself confronted by an ailing rose bush does he: a.) Pull out the entire bush and replace it with a new rose bush; or b.) Prune back the bad branches thus allowing the stronger, healthy branches to grow.  If instead of all the partisan bickering, ones-up-manship and spinmeistering that seemed to consume Congress this past year, the American people would have been better served if Congress had spent their energies on incremental change that would’ve delivered more bang for their bucks.  Just think what impact Congress could’ve made if they’d simply chosen to legislate that all insurance forms be delivered in a standardized format, imagine the trees we could save if they made electronic medical records the law of the land (France is one nation that’s been way ahead of this curve with all its citizen having the medical information available on a secure electronic card for longer than I can remember), or that all hospitals, clinics, labs etc., use a cost system similar to the DRG where doctors and patients alike would actually have a real grasp of the cost of treatment, or even allowing health insurance to be truly portable and purchased across state lines.  These four changes appear small, but have a much larger impact, unfortunately Congress was looking for the “grand gesture” and thus PPACA was born, a bill that far too many of our Congressmen and women have yet to read in full and who can blame them the bill is well over two-thousand pages.  Perhaps if they had read their bill they might have discovered for example that neurologists had been left out of the key categories that would qualify for reimbursement.  Opps!   No worries we’ll go back later and fix that little glitch, sounds just like what every homeowner faces when they remodel their home it never seems to come in on time or on budget, which is one of the primary concerns of so many Americans – cost and deliverables.

So lets take a quick and “dirty” look at some of the deliverables of PPACA:

Changes to take place this year – 2010

Perhaps the most notable change is that children and adults previously denied coverage due to pre-existing conditions would be able to access healthcare insurance, this would be accomplished by the establishment of high-risk pools.  These high-risk pools are to be Federally subsidized, but the “how” and “when” is yet to be established,

Lifetime maximums are now a thing of the past,

Insurance can no longer drop an individual if they become ill,

No more annual limits, which benefits those with catastrophic illness,

Children up to the age of 26 can stay on their parent’s plan,

Small business offering insurance can apply for a 35% tax credit from the premiums paid,

New plans written during this time period would have to offer preventive care with no co-pays or deductibles,

Medicare D participants will receive a $250 credit to help with the “donut hole”, and

Retirees aged 55-64will be offered access to a re-insurance program.

Next year (2011)

Medicare must provide plans with preventive care with no co-pays or deductibles

Medicare Part D participants will receive 50% off drugs falling in the “donut hole”, and

Health insurance companies will have to justify any premium increase or risk the possibility of being taken out of the state’s insurance exchange pool.

What happens in 2014

AN IRS penalty of $750 per individual or 2% of income (whichever is greater) will occur for those who choose not to purchase health insurance,

No one can be denied access to insurance for pre-existing conditions,

The temporary/state high-risk pools are gone as states will be required to have their insurance exchanges in place, and

Annual caps on benefits are now banned completely.

What happens in 2018

All plans must offer preventive care with no co-pays or deductibles,

Expect ongoing and possibly very contentious discussions regarding what PPACA does and does not “do”, as so often happens with legislation much of the legislative language can be “spun” to bolster or weaken one side or the other’s argument.  As nurses we can’t and shouldn’t dismiss the impact that this bill will have on our profession, the patients we care for or the institutions we work in because it’s far from a panacea for what ails our nation’s health system.  We have a crippling nursing shortage, a growing physician shortage, many hospitals and clinic are closed or closing and I see few provisions in the PPACA that are meant to address these issues.  Don’t expect to see our Emergency Departments (ED) “decompress”, because I doubt the average patient is willing to wait days or weeks to see their Primary Care Physician.  Remember when HMO’s were billed as being the great salvation to ending the crush of patients that used the ED as their source of primary care and this hypothesis was been proven flawed.  Recently, the New York Times reported the following with this ominous headline – “Health Care Cost Increase Is Projected for New Law”.  The chief Medicare actuary, Richard S. Foster, was quoted in the NY Times article to have said “Overall national health expenditures under the health reform act would increase by a total of $311 billion,” compared with the amounts that would have otherwise been spent from 2010 to 2019, which contradicts President Obama’s statement that it would “bring down health care costs for families and business and governments” which was made at the bill signing last month.  Foster went on to state that though 34 million uninsured people will gain coverage under the law 23 million (including 5 million illegal immigrants) will still remain uninsured in 2019.   Most telling was the following statement from Foster, “these savings assume that the law will be carried out as written, and that may be an unrealistic assumption.  The cuts could become unsustainable because they may drive some hospitals and nursing homes into the red, possibly jeopardizing access to care for beneficiaries”.  The full New York Times article can be accessed here.

As of this moment everyone, including nurses, will have to play a strange game of hurry up and wait, though the law has passed it’s becoming apparent that many of the promises and threats of our elected officials are both real and not to be believed all at the same time.  Recently, when several large companies such as AT&T reported, as required by law, that they would see a loss of profits due to the changes in the law, Congressman Waxman and others held numerous press conferences denouncing these “scare tactics” by several of these large companies, demanding and even scheduling hearings for the representatives to come before Congress and explain themselves only to cancel said meetings later when it was learned that the companies were not engaging in fear-mongering as some in Congress had accused them of but simply complying with the law.  Thus it is apparent that much in this new law still needs to be fully vetted, there is a report available from the Congressional Budget Office (CBO), that can be accessed as a PDF  here.  This report  provides the CBO’s opinion in a letter to Speaker Pelosi dated March 18, 2010 on both the PPACA and the companion reconciliation bill and yet concludes “Although the CBO completed a preliminary review of legislative language prior to its release, the agency has not thoroughly examined the reconciliation proposal to verify its consistency with the previous draft. This estimate is therefore preliminary, pending a review of the language of the reconciliation proposal, as well as further review and refinement of the budgetary projections.”

So whether PPACA remains whole or suffers from changes and amendments due to successful legal challenges or is found to be unconstitutional on its face by the Supreme Court the actions that brought PPACA may have changed our political and healthcare landscape for generations to come.  As nurses we will find ourselves, as so many others who deliver healthcare, in the heart of the mix, and thus can best serve our patients and ourselves by educating ourselves on what PPACA entails.  There is a real need to look beyond the rhetoric and opinion and learn to separate the “hard” facts from the “soft” facts, and the fact from the fiction our patients deserves this and we need this in order to be the best possible healthcare advocates that we can.  As nurses we should continue to monitor all media venues to gather and sift through all the data so we can comprehend the impact of PPACA, attend meetings that will surely sprout up to help “explain” PPACA, and think about setting aside some time during the next few weeks, draw yourself a bubble bath or brew a big pot of coffee and read the 2,000+page law that is the PPACA and educate yourself on this law that has already sent ripples through our healthcare system – our patients and our profession deserves

You may’ve read that this past Saturday a bunch of folks showed up in Searchlight, NV.  Some news sources (CNN, for example) reported that hundreds came out while others (LA Times, Fox News and so forth) reported closer to ten thousand turned out for the event.  My daughters and I didn’t do a head count but the line of cars extended for miles on both sides of the Highway 93 heading into Searchlight.

There were signs aplenty, mostly hand made, being carried into the event by the long lines of people, some who hiked many miles, to attend the rally.  We arrived at about 12:30, just in time to hear Gov. Palin’s speech.  The place was crowded with a jovial air in the crowd.  Since the event was being held in a large open lot riding my electric scooter was a bit of a challenge but there were plenty of gentlemen who stopped to help me each time my scooter got stuck in the dirt.

I spoke to people who came from around the local area, and many from California, including a gentleman from San Francisco also Palin’s supporters from Alaska.  And though the Tea Party movement has been characterized as “malcontents”, “astroturfers”, “uniformed”; just pick the pejorative word of your choice, I found most to be good, honest, civic-minded folk out to participate in a little old fashion peaceful demonstration.  This was my first Tea Party event and you could’ve easily confused it for a large 4^th of July party instead of a political rally – everyone was just having fun out in the beautiful desert with the wind blowing the numerous flags.

There are those who seem to fear the Tea Party movement or have attempted to marginalize those who participate in Tea Party events.  The sociologist in me says that the more people marginalize the Tea Partiers the stronger the likelihood that that strategy will “bite” those marginalizing the movement in the proverbial derrière.  As I pursued various comments made about the recent Searchlight Rally many commenter’s seemed to take issue that there were not the usually quota of identifiable groups, comments such as nothing but a bunch of angry white people was a common thread throughout.  I think this is what mystifies those who oppose the Tea Party movement the most, namely that no one seems to go out of their way to ensure that there are quota of people to represent interest groups.  All who wish to participate in a peaceful manner and believe in limited (smaller) government are welcomed; there are also those who wish to show their displeasure with the Obama administration — the broken promises, the lack of transparency and of course the coup de grace  which was the health care bill being pushed down our throats using misinformation and the apparent quid pro quo that it took to get enough votes to pass it.

I was with ACT-UP at its nascent beginnings in Los Angeles and I see many parallels between these two movements.  The first is that they both have a very real grassroots and organic feel to them, and second like ACT-UP the Tea Party movement needs to evolve from its loosely knit organization to one that has a better defined “command” structure.  To make this transition doesn’t mean that the Tea Party movement must lose its identity, but it can only have “fly by its seat of the pants” leadership for so long before the group will begin to disintegrate.  Showdown at Searchlight was one such event that though marked by an air of peaceful enjoyment there was also a undercurrent of disorganization that if not addressed can lead to bitterness and frustration – this needs to be avoided.  Examples of this are 38 “Andy Gumps” for an estimated crowd of thousands, and though many who attended came in campers folks who came in their cars had to in some cases walk 2 or more miles to find the nearest restroom.  The Searchlight merchants handled this with great aplomb, but after awhile everyone gets a bit annoyed when creature comfort is lacking.  And finally, how they handled the press.  The press doesn’t need to have the red carpet treatment, but members of the press generally have an expectation that they can easily identify and find the event press contact – before, during and after the event.  Tea Party movement organizers should keep this in mind.

What seems to frustrate many of those who have chosen to ignore, marginalize, deny, etc., the Tea Party is that they can’t seem to understand what draws people to the movement.  After all so much of their media lap dogs have been good at demonizing the movement, and yet still people seem to flock to the events.  The mainstream media has done its best to fail to exercise journalist integrity and fairness by purposefully underreporting the numbers of people that have turned out at some of these events.  Imagine my surprise when I learned that CNN had used the phrase hundreds turn out at Searchlight, hundreds?  The aerial photographs as well as eyes on the ground know full well and good that if there were well more than hundreds.  I think the movement is growing in part as push back to the elitist attitude of politicians who want to “pooh-pooh” the movement (remember Pelosi’s astroturf comment) and the mainstream media rabid attempts to paint the Tea Party as some come of aberrant, un-American activity only seems to ignite even more passion for the Tea Party movement.

So in the meantime enjoy the photographs of Showdown in Searchlight.

I’ve had the chance to snap numerous photos, a few of which are attached to this post.  I’ve also added several aerial shots (courtesy of Hack Wilson’s blog – http://hackwilson.blogspot.com/2010/03/pictures-from-showdown-in-searchlight.html).

This is the season of endorsements, and I hear Assemblyman DeVore is expecting to receive the endorsement of the Tea Party Express when it holds it’s big rally in Searchlight, NV this weekend.  This endorsement is said to be the first of its kind for the November 2010 elections season.  I’m not a member of any Tea Party group, but as a former member of ACT-UP Los Angeles I applaud and commend their activism and willingness to stand up for their beliefs.  That said, their endorsement of Assemblyman DeVore will not and does not convince me to give my money, support or vote for him.  Why you may ask, simple I’m just sick and tired of politicians that run for a new political office simultaneously while still in their duly elected post.  So why pick on DeVore, because he’s the last straw – especially when his purportedly running on a platform of being a conservative and of bring change to D.C.

A recent article in the Orange County Register (March 24^th article Should legislative staffers be allowed to volunteer for their bosses’ political campaigns? ) highlights what appears to be an all too frequent practice of some of our elected officials’ staff in Sacramento of pulling double duty.  That is “by day” they work in one of the elected officials’ offices and “by night” they work on said elected officials’ campaign.  I can only describe this as an ethically challenged mindset that is apparently endemic in our state capitol.  The article details several officials, including Assemblyman DeVore, use of office staff as campaign staff.  Albeit they claim that they do so only under the strictest adherence to the law, but is California with an estimated 12% (some say 18%) unemployment rate that devoid of qualified help that our State Senators and Assemblymen/women must “double-dip” with their staff.  Assemblyman DeVore is not alone in what many voters’ would describe as questionable behavior, however the following as reported in the OC Register is what should cast doubt in any voters’ mind about whether Assemblyman DeVore is any better than Senator Boxer (whom he and two other Republicans are competing against for the Republican nomination).

Trevino left DeVore’s Assembly office the next month, but returned in March 2009 as a “senior consultant” earning $5,000 a month on a 60 percent schedule. At the same time, Trevino wrote on his Facebook page that he joined the DeVore for Senate campaign in March 2009.

According to campaign finance records, Trevino, who also runs a firm called Trevino Strategies and Media, Inc., was paid $1,500 by DeVore’s Senate campaign in 2009.

In August, Trevino sent out an e-mail explaining his relationship with DeVore.

It has become clear to me that I need to be explicit about my involvement with the Chuck DeVore for U.S. Senate campaign out here in California. You’ve heard a lot about him from me, and you will probably continue to — at minimum through June 2010, and hopefully through January 2017. Don’t worry, the time will fly.

Here’s the deal:

1)      Yep, I work for the campaign: as a volunteer. Everything campaign-related that I do is 100% unpaid.
2)      HOWEVER, I also put in 20 hours a week at DeVore’s Sacramento office. A few points on that:
a)      It’s the minimum allowed by CA Assembly Rules.
b)      It’s so I can get face time with Chuck. (Of course, I also serve invaluable office- and Assembly-related functions….)
c)      It doesn’t pay the bills. (You former staffers know what I’m talking about.)
d)      No campaign work whatsoever goes on there. It’s illegal, and Chuck is scrupulously conscientious about it.

So:
— Is Chuck DeVore and/or his campaign a client of Trevino Strategies and Media, Inc.? No.
— Do I work for the Chuck DeVore for U.S. Senate campaign? Yes, as a volunteer.
— Do I work for the Office of Assemblyman Chuck DeVore? Yes.

Bottom line is that I’m not making meaningful money off DeVore — especially not compared to what I’d make with a similar commitment to a TSM client. I do what I do because I sincerely believe in him and his chances.

The Freudian slip that is 2b in Mr. Trevino’s email shows me that Mr. Trevino and Assemblyman DeVore themselves have blurred the proverbial “Chinese Wall”.  Mr. Trevino states that he works 20 hours a week in the Assemblyman’s Sacramento office and that this is so he can get “face time with Chuck”, he then adds in parenthesis that “Off course, I also serve invaluable office-and Assembly-related functions…” I would argue that Trevino’s invaluable office and Assembly-related functions should provide him with ample face time and for him to separate the two would lead me to believe that some of that face time in the Sacramento office may indeed be related to campaign business otherwise there would be no reason to construct 2b the way he did.

This is Sacramento and Congress’ dirty little secret and when we as endorsers and voters give a candidate a pass on this then we can expect to continue seeing business as usual in both our State house and in the halls of Congress.

If Assemblyman DeVore was truly the Conservative he portrays himself to be then, one he shouldn’t be seeking another elective office while holding a current elective office, especially in light of the fact there are at least two other people (Carly Fiorina and Tom Campbell) who have thrown their hat into the ring, and two he would quickly end the practice of office/campaign staff.  I thought the Tea Party movement was all about bringing change to Congress and various State houses, but Assemblyman DeVore is no different than so many of those the electorate is disillusioned in and disappointed with these days.

The saying goes, be the change you want to see.  Assemblyman DeVore, in this voter’s opinion, has fallen far short of this goal; and if “We the People” are ever going to get these career politicians to change we need to hold their feet to the fire on these key issues.  For it’s these are core ethical principals that separate the career politician from the citizen legislators that our Country was founded upon.  The French have a saying that describes such ethical lapses “qui vole un oeuf, vole un boeuf” which translates, “if one can steal an egg, one can steal a cow” I know is sounds better in French.   People, politicians included, are far from perfect but there should be some things that are non-negotiable, one of them should be that no current office holder (expect perhaps in the case where no one steps up to volunteer) should leapfrog from elected office to elected office during their term, and if the candidate claims that they are there to bring change then they shouldn’t be engaged in the very behavior or activity that they are promising to change.

Now is the time to choose a candidate that can go to Washington and really be a change agent bringing back the business acumen and someone who actually can make a difference.  You may have surmised that I’m not a DeVore supporter, you’d be correct.  I’m a Carly Fiorina supporter and I make no bones about it.

But in the end — Actions speak louder than words!

I took a little trip down to Buena Park this weekend to attend the California Republican Assembly (CRA), the reason for my trip was to listen to the Gubernatorial and Senatorial candidates speak and present their reasons for seeking these elective offices.  The candidates and their teams were out in force canvassing the conference on a mission to seek endorsements, sign-up supporters, and when possible recruit converts to their campaign and cause.

Granted, the CRA is known for being more conservative, and candidates had come seeking the endorsement of this politically powerful group; but their endorsement is no guarantee that California Republicans will fall in lock step behind a CRA endorsed candidate.  I had the opportunity to catch Whitman’s speech at noon, and found that she didn’t stray far from the candidate she has presented herself as at prior events and speaking engagements.  Whereas Poizner seemed to have move even further right, which I think is an attempt to garner support from the more conservative arm of the party.  I can understand a candidate wanting to craft their message to “suit” their audience, as a lecturer I’ve done this frequently; however there’s is crafting your message and there’s turning in a whole new message – which it what Poizner appears to have done just that to curry favor with the CRA delegates.

So desperate to curry favor that he ratchet up his negative campaign against his opponent, Whitman, to an almost frenetic level reminiscent of the now infamous Howard Dean yell.  The attacks against Whitman began with Michael Shroeder’s introduction of Poizner and Poizner continued those attacks with repeated charges that Whitman had good things to say about Van Jones, accusations of Whitman giving donations to Democratic candidates and so forth – charges that have already been answered by Whitman.  Yet Poizner meet the criticism of the disclosure that he had also donated personal monies to at least one Democratic candidate with “my wife the Democrat did that.”  Poizner’s marionette-like performance at the CRA left me with little doubt that he would receive the CRA’s endorsement.  While the CRA endorsement may be significant to some Republican voters, but for a voter such as myself an endorsement from a group such as Howard Jarvis Taxpayers Association PAC holds much more significance.

I recall reading, probably from one of the many Poizner for Governor propaganda pieces that continually fill my email inbox, that the CRA did not endorse Arnold Schwarzenegger for Governor and how that turned out; I’d counter with that’s what you get for electing a Governor whose wife’s a practicing Democrat!

Just the other day I received a nearly two-page letter, from Poizner, announcing his petition “California Republicans Deserve a Debate”.  The goal of this petition is to “force” Whitman to agree to a debate at the upcoming California GOP Convention.  This missive rambles on with many of the same and tired complaints Poizner has been lobbing at Whitman at each and every speaking engagement he attends and, well, at pretty much any opportunity that he can – and now he’s jut beginning to sound desperate and a mite peevish to this grassroots activist and voter.

He seems to forget that Whitman and he agreed to a debate; unfortunately it wasn’t at the California GOP Convention (I don’t think that the convention organizers had even thought to extend such an invitation).  As a grassroots activist, having cut my teeth on such activism as changing a state law to allow resident aliens to get their LVN license in one state, then getting a corrupt and unscrupulous Southern judge removed from the bench in another state, and later in the fight against HIV/AIDS, my involvement in ACT-UP LA and most recently on all things healthcare related – I know what grass-roots activism looks like and unfortunately I don’t think the California GOP convention qualifies.  I’ve come to this conclusion after attending quite a number of these conventions, and though I keep hoping the next one will be more grass-roots than the previous one, at the end of the day I usually go home disappointed.  This is not to say that grass-roots Republicans don’t attend, they do but the convention focus is generally not on growing the grass-roots. Maybe this one will be different.

But I digress, Poizner’s email attempts to paint Whitman as a woman on the “run” (I guess he read Dan Walter’s column in the SacBee), or someone who’s too afraid of him to agree on a debate, which of course is not true, since there is a debate scheduled – it’s just not at the convention and now he has buyer’s remorse for agreeing to debate at a venue other then the convention.  Poizner’s email is riddle with innuendoes and prevarications, which are unseemly in a man that aspires to our Governor’s office.  His email makes a point to rehash old stories, such as Whitman endorsed Boxer (not accurate but as so many CEO of large corporations she attended and donated to fundraising events for both Republican and Democrats alike).  I wonder if Poziner ever attended a fundraiser for one of our duly-elected Democratic representative; but we do know that he gave a sizable donation to “the other-side”, oh that’s right he blamed his wife saying that it was her donation written on a joint account, which of course makes it alright in his book.  Then he reminds everyone that Whitman spoke in glowing terms about now disgraced Obama appointee, Van Jones, for which she has admitted, was a mistake, stating that she had made such statements after a initial meeting in which he had left a strong impression.  She has also made it clear that she took this as a lesson learned and will not speak of an individual that she meets for the first time in such glowing terms until she has had an opportunity to do some research on that individual; and until she repeats the above mistake I’ll take Whitman on her word because I think she’s that smart.

He concludes his appeal with accusing Whitman of “wanting our party’s nomination for Governor without giving you a voice.”  I thought that’s what we did when we cast our vote at the primary and then later during the general election?  Perhaps instead of trying to browbeat Whitman into a debate at the convention he should make good on the previous agreement and have faith that Californians will make a sound and wise choice for Governor – but then again maybe that’s what he’s afraid will happen.

After reading this post, one might think that I have a bone to pick with the editors, and some reporters of the Los Times – and you’d be right!

For years, it has been my opinion that when it comes to nurses, nursing unions and the nursing profession the LA Times has been inconsistent and at times down right off in left field when it comes to nurses.  My disagreement with the LA Times on this topic goes back many years, and started with an article they ran on nursing which reported, incorrectly, that the American Nurses Association (ANA), was some how representative of all California.  When I read this article I quickly responded with a letter to the editor and provided them with data from the ANA itself showing that less then 11% of all active RNs were members of the organization nation wide . Did they run this letter, of course not, but they did run a very small correction in the Home section of the paper much later.  The correction was so small it barely served as a correction at all since it was so small it was all but insignificant and surely hardly worth the ink that was used to print it.  This episode would mark my first, but far from my last, run in with the LA Times Reader Advocate, Ms. Gold.

Over the years, I’ve been vigilant and responsive to articles that have run in the newspaper especially when those articles shed a bad light on nursing that was not deserved, or glossed over what were gross nursing mistakes because those nurses worked in some venerated institution.  For far too long all forms of media have relied upon groups such as the ANA, California Nurses Association (C.N.A.) and other such ilk to provide them with data and information on all things nursing.  I’ve nothing against the media citing these and other organizations as sources of information, they are after all groups that represent nurses and thus have some expertise in the nursing arena.  What’s wrong is when the media blindly cite suspect facts from these organizations with little effort to fact check the organization’s statements.  Such as when the ANA purports to represent the interests of the almost 3 million RNs; or when the C.N.A. labels itself the voice of the California RN – when neither of these facts are accurate, let alone true.  When individuals such as myself take the time to educate the media and provide them with the correct statistics and facts the response is often the proverbial paternalistic pat on the head, as if we’re somehow ignorant but well-intentioned children.

Equally frustrating is when the media soft peddles the mistakes or bad deeds of an organization or institution they consider venerable.  Not that long ago the LA Times and various other media outlets barraged us with the numerous medical and nursing misdeeds of the now defunct King-Drew Medical Center (KDMC).  Now granted there were many serious medical/nursing and even management errors occurring in this institution, and the press would have been remiss if they failed to report the story aggressively.  However, when two nurses at Cedars-Sinai nearly offed a handful of infants, including the Quaid twins, little was really covered.  Oh yes, there was front-page article about the initial incident, then there was at least one or two “follow-up” articles.  What I found striking about the handling of the nursing errors at both hospital was the way the articles were spun.  Granted KDMC’s problem were nearly endemic, but the heparin incident at Cedars was also on a grand scale, but the article spun this serious nursing error and breech of nursing protocol as well there have been other heparin incidents and these are primarily due to the labels not being different enough between the adult and children dosages and the fault was much more a “labeling” issue and not really the fault of Cedars-employed nurses.  As a RN I took issue with this redirection of blame, because as someone who had administered more than once dose of Heparin to infants during my career I knew precisely where the blame for this error lay, and it wasn’t with the labeling – it was squarely on the shoulder of the two nurses who failed to not only read the label, but to also implement the time honored and basic nurse practice of double checking of certain drugs (heparin being one of them).  What is this double-checking I speak of, simple the first nurse checks the order, checks the medication, draws the ordered amount, then another nurse checks the order, inspects the bottle the medication was drawn from and then verifies that the appropriate amount has been drawn, as well as verifying that the correct patient is receiving the medication at the correct time and by the appropriate route all the while placing their initials at the appropriate stages and places (this describes a general overview of the procedure, some hospitals have even more detailed safety protocols in place).  But why come down so hard, nurses are only human, and this was just a mistake.  Perhaps, but Cedars is also a so-called Magnet hospital which is supposed to designate that they have a higher standard for nurses, and such a failure of basic nursing safety protocols is indicative of a hospital that is not worthy of claiming that its nurses are a “cut above”, since the heparin incident is not a “ordinary” nursing error, because as it turned out apparently the mistake happened not once but twice.

Which brings me to the ongoing LA Times investigative report about the California BRN and the handling of nurse licensure.  In its December 27, 2009 – Inept nurses free to work in new locales (http://www.latimes.com/news/local/la-me-nurses27-2009dec27,0,2090185.story) the article took a detailed look at the licensing failures that occur because there’s no real national clearing house, i.e. national nurse license agency which can lead to nurses gaming the system and securing licenses in additional states when they have a suspended or revoked license in another state.  This is a very real problem, since every state is solely responsible for the verification of a nurse who is applying for or renewing their license in that state.  Some states have a better verification system then others, catching a nurse with an out-of-state suspended or revoked license then others (California falls into the not so successful verification system).  As part of their research the LA Times reported interviewed the National Council of State Boards of Nursing (NCBSN), regarding this issue.  The quote from NCSBN that really caught my attention was this one “Officials at the National Council of State Boards of Nursing said they don’t tell nursing boards how often to consult their database.”  But wait a minute the NCBSN is comprised of representatives (most of the Executive Director) from each of our Nation’s state board of nursing!  So what does this quasi-governmental agency really do; I call it quasi-governmental and not non-profit since it appears that its board is comprised entirely of representatives of governmental agencies.  In my opinion very little is done to truly protect the nursing profession and the patients we care for, since when the Philippine test stealing scandal broke in 2006 the NCBSN stayed relatively silent on the matter (I wonder if this had anything to do with the fact that the NCBSN was in the process of opening an NCLEX testing center in that country?), if not for the local Philippine Nursing Association, the Association of Nurse Executives and a handful of nurse activist such as myself very little would have been done to force a retest of the suspect exam period.  The NCBSN finally took a stand after the fact, so much for serving as a watchdog.

Though I think that its important that the LA Times reveals failures of our system of checks and balances, I think it’s equally important that they aggressively investigate agencies such as the NCBSN, that our BRN pays fees to and on which the BRN executive director (in this case the interim executive director) is a member of – if it cannot aid its board members to be better advocates for the profession then does it serve a purpose.  Or perhaps the purpose it serves is to continue to charge fees for tests once administered and collected by the individual states thus consolidating power and wealth in the quasi-governmental agency that presents itself as a non-profit?

I think a candidate for governor, especially in this state, needs to have a strong backbone, and possessed of the ability not to turn tail when they think they have done something to incur someone displeasure.  Several years ago I had the opportunity to speak with Poizner on several occasions about the issue of Workers Compensation reform, he was after all the Insurance Commissioner, and it seemed to me that Workers Compensation Insurance was under his department, or at least under his purview; and as someone who was currently going through the labyrinth that is our state’s Workers Compensation system I thought it appropriate to share with him my personal experiences and frustrations.

I gave him a brief synopsis of the problem and he asked that I forward to him a letter providing greater details and he’d have someone from his staff see how his department could aid me in getting answers to my questions and perhaps assistance in resolving some outstanding issues; nothing special but using our government resources as they are meant to when a citizen encounters roadblocks when navigating the “government services” that are meant to help, but all too often impede us.  Weeks passed and then months and still no one from his office responded to my citizen’s request for assistance.  Later I’d meet Poizner at another event and I mentioned to him how my letter had remained unanswered.  He expressed concern and asked me to resend my correspondence and assured me that someone would respond.  And true to his word a response followed in the form of a “form letter” that was non-responsive to my query and concerns; but that wasn’t all because this form letter also explained that Workers Compensation Insurance was not in the purview of the Department of Insurance – silly me and here I thought that our Department of Insurance had some influence over all things insurance.  Needless to say I shared this with Poizner at the next event that we both attended, and also in my “take no prisoner style” that I’ve become famous for, told him quite bluntly that I was surprised that Workers Compensation wasn’t under his purview and that I truly thought his department, and he personally might want to do some additional work on Workers Compensation reform; and that his excuse left me greatly disappointed.

Since that day, Poizner has done his best to avoid me.  Whenever we’re attending the same meeting he makes sure to cut a wide swath from where I’m at just to make sure he doesn’t have to make eye contact or say hello.  At two recent meetings, one of which was a candidate forum he still couldn’t meet my gaze, leaving me to conclude that he may lack the “intestinal fortitude” to be an effective governor.  Why?  You may ask.  Well ask yourself this if he can hardly stand to make eye contact with a little old lady from Pasadena who has to use crutches or an electric scooter to move around just because he felt his answer displeased or disappointed her; than how can he stand up to our fractious, recalcitrant, often hostile State Legislature.  We’re already constrained by a governor so concerned with being liked that he almost always wilts when the legislature pushes back, and I don’t think we need another milk toast in our Governor’s Office.