Behavior has consequences
On September 30, 2011, the San Francisco Chronicle ran an op-ed penned by two California Nurses Association (C.N.A. and affiliated with the AFL-CIO) members. They were identified as Genel Morgan and Rita LaBarge, RNs at Mills-Peninsula Hospital and Alta Bates Summit Medical Center respectfully. They wrote this op-ed in response to what they viewed as a growing black lash against their public theatre held in the name of Judith Ming, a patient that died due to a nursing error that occurred at Alta Bates Summit Medical Center in the early morning hours after the C.N.A. organized one-day strike.
They begin their op-ed, entitled “C.N.A. members: Nurses protect patients”, with the following statement “To suggest that nurses who fight to provide safe care every minute of every day are using the death of one of our patients for our own gain is genuinely disturbing. One only has to view the video of the candlelight vigil held honoring Judith Ming to recognize the palpable grief in all our faces as we honored the life of a patient caught in the crosshairs of a system gone awry.”
This statement just about says it all when it comes to why so many nurses like myself and the public-at-large haven’t exactly been singing the C.N.A. praises about their behavior during the one-day strike and subsequent four-day lock out. A patient, a human being, died a tragic death and the C.N.A. nurses and their leadership
- First, call for an investigation via a press release,
- Second, hold a candlelight vigil in the name of the patient, announcing this “exhibition” of sorrow through yet another press release and then for good measure videotape and post it for all the world to see, and
- Third, begin a campaign to vilify the nurse that made the nursing error because we all know that “replacement” nurses aren’t real nurses just like substitute teachers aren’t real teachers, and doctors covering another doctor’s shift aren’t real doctors and so on.
Stay at the bedside long enough, and I have a couple of decades under my belt, and you see your share of nursing and medical mistakes. I’ve even stopped similar mistakes as the one reported to have occurred at Alta Bates Summit Medical Center. My readers may also recall the heparin overdoes that occurred in a number of pediatric patients not that long ago at Cedars-Sinai Medical Center. Then there was the nursing error at St. Mary’s Hospital in Madison, WI that lead to the death of a 16-year old mother who was at the hospital to deliver her child. In this case Nurse Thao, an experienced Labor & Delivery nurse, gave the mother an epidural anesthetic via IV causing the mother the have seizures and eventually die. Our nursing literature is rife with cautionary tales of nursing errors narrowly avoided or of those not caught that ended in tragic outcomes. Which is why, I found the C.N.A.’s crocodile tears about this tragic event so repugnant, because just when you think they can’t stoop any lower, they do. One must ask oneself have they no shame – apparently not!
Like falling dominos, the C.N.A. and their members set in motion a series of events when they walked away from their assignments to hold their one-day strike. They did so fully informed that should they hold their one-day strike those that didn’t report to work would face an additional four-day lockout so the hospital could meet its commitment to the 500 nurses that had been hired to cover the shifts of the striking nurses. Neither party was engage in any thing nefarious. The nurses, aggrieved with the state of the contract negotiations issued an intent to strike and when strides weren’t made (in their opinion) they held their strike – all legal and above board. Alta Bates Summit Medical Center in turn, unlike a grocery store or office couldn’t just close up shop and send the patients home for a day. Their only option was to hire registry/travel nurses to cover the one-day strike. However it’s not realistic that the hospital bring 500 nurses from across California and the country just for one-day so they did what most hospitals in the same situation would do, they gave these nurses a five-day contract. In turn they informed the nurses that walked away from their assigned shifts that they wouldn’t be allowed to return for an additional four-days, this rule didn’t apply to nurses that weren’t scheduled to work the day of the strike -- all legal and above board.
Whether what happened at Alta Bates Summit Medical Center was a case of catheter confusion, some other nursing oversight, human error, or negligence we’ll have to wait for the conclusions of the various investigations that are ongoing. The C.N.A. instead of vilifying the hospital or offending nurse should be actually asking how they can help ensure that nursing errors such as the one that occurred never happen again. Instead they chose to publish op-eds about their anguish, or issue quotes about “if only I had been allowed to return to work my shift the day after the walk-out, and posting videos of candlelight vigils to the web, giving lip service to patient advocacy. I think it’s important to note that this is the same group that has reportedly held 100 strikes over the past three years. Which makes it all the more important to remind the C.N.A. and their nurse members that behavior has consequences.
What’s going on at Henry Mayo Newhall Memorial Hospital?
It would appear that the California Nurses Association (C.N.A.) has set its “sights” on Henry Mayo Newhall Memorial Hospital. Now by setting their “sights” on Henry Mayo Newhall, I don’t mean that they’re planning to try and unionize the hospital, because the C.N.A. already represents the RNs at Henry Mayo Newhall. What I mean is that I think they’re laying the groundwork for some serious arm-twisting in advance of the next contract negations. What? Pray tell would lead me to think such a thing. Simply put, an article that I believe the C.N.A. had planted in The Signal, the area’s local paper this past March.
The article was entitled “Nurses challenge staffing” laid out for all to read that the C.N.A.-represented nurses were accusing the hospital for failing to meet our state mandate nurse-patient ratio and this action as reported in the paper “poses a danger to patients”. Oh my! I find it interesting that nursing unions always seem to be quick to cry “poses a danger to patients” whenever they want to get in the paper or on TV and this cry makes sense because everyone’s ears perks up when they hear that something or someone “poses a danger to patients”.
As I read the paper I began to suspect a more choreographed press release rather than an article for several reasons.
- The first being that the reporter incorrectly reported that RN’s receive a college degree in Registered Nursing, and when I reported this error to the paper’s editor there appeared no attempt to correct the error, didn’t publish my letter to the editor dealing with the error and the reporter (for whom I left several messages) never responded to my phone call.
- The second, and perhaps most interesting, was the statement that the RNs came to The Signal to discuss what they “saw as the dangers of team nursing” on the condition on anonymity but brought along their C.N.A. representative to vouch for their credentials. Why did they need the C.N.A. representative to vouch for their credentials, since all they needed to produce was their valid California RN license and their Henry Mayo Newhall identification, and if necessary proof they were C.N.A. members. I think that the C.N.A. representative was there to ensure that the nurses stuck to the script, and The Signal fell for it hook, line, and sinker.
All in all, the article painted a grim picture of brave and overworked nurses struggling to do their job and provide appropriate care for their patients. However as a nurse with almost four decades of experience under my belt I found it hard to buy some of their “poor me” stories. Such as the one “Helen” tells of “I don’t know any of the meds my patient got today. Because all the thousands of medications we give to patients each day.” Really? Thousands of medications each day – how many patients does she have each day? 100? I’m a NICU/PCIU nurse and in some cases I’ve had to deliver complicated medication regimes and in my entire career I’ve never had to administer thousands of medications to my patients every day – come on! And even if a nurse did have to deliver thousands of medications to their patients every day no one would expect them to remember, but they would be expected to be able to report from the patient’s medical records what had been administered during their shift. This is why we record our actions in the patient’s medical chart, and in some of the more technologically up to date hospitals we simply scan the medication barcode and the patient’s id barcode and the computer updates the record.
In all likelihood there are underlying nursing management issues at Henry Mayo Newhall, especially when I learned that Mr. Larry Kidd, RN was the Chief Nursing Officer (CNO) and Vice-President for Patient Care Services. He was brought in by the Camden Group as their CNO in their failed attempt to help the Los Angeles County Department of Health Services to turn around and save King/Drew Medical Center (KDMC) – and we all know how that story ended. So I wouldn’t be surprised if competent and experienced nurses had issues with his management of the nursing department. Even I had issues with his management of the nursing department during the failed turn-around of KDMC, so no surprise there. I can also empathize with their dislike of team nursing, because I’ve never been a fan of team nursing. I’ve always found that team-nursing without clear lines of communication and strong management often devolved into chaos with no nurse stepping up to take leadership responsibility and everyone pointing to the other with the explanation that I thought it was their job?
You can find a copy of The Signal article and my response LTE TS Henry Mayo
Sarah Palin an example of a self-actualized person?
Unless you’ve been living under a rock these past several years you’ve probably heard the name Sarah Palin. Palin burst onto the national scene and into our national consciousness as John McCain’s choice as a running mate in his bid for office of the president in the 2010 Presidential election. Almost immediately people seemed to either like her or dislike her, with few expression of a neutral opinion about this polarizing figure.
During the 2010 Presidential election pundits, commentators, reporters, opinion makers, actors, pretty much everyone under the sun had an opinion on or about Palin. The more vociferous or negative opinions were sought out and giving leave to voice these opinions on any network or print media outlet that would have them. The same was done for those who held a positive viewpoint, but their opinions and voice seemed drowned out by the negative cacophony being broadcasted.
One would have thought that with President Obama’s election victory “Palin-haters” would have moved on to other “tastier” targets, but that was not the case. Nearly a day doesn’t go by that Palin’s name isn’t mentioned in print or over the airwaves. Negativity, which seems to have reached a crescendo this summer when Palin launched her “One Nation Tour” and with the subsequent release of more than 24,000 pages of her emails during her time as Governor of Alaska.
As I sat, read, and listen to the pundits chatter about Palin, insulting her intelligence, knowledge and even her child-rearing techniques I began to ponder where the roots of this almost pathological hatred emanated from? As a student of sociology it struck me that so much of the anger seemed – well visceral. People that I asked to explain the rationale for such a dislike often seemed at a loss for a substantial rationalization for their dislike of Palin, instead choosing to fall back on such reasons as she has no real world experience, she went to multiple colleges, and one of my favorites “she was a beauty pageant contestant after all” and so forth. But these were but shallow excuses used to describe a “je ne c’est quoi”. However, I think I may have finally begun to put my finger, sort of to speak, on the real issue why so many feel this undefined and unreasonable hate or love for Sarah Palin. In short, I think she evokes such passion and dispassion because Sarah Palin has reached the pinnacle of Maslow Hierarchy of Needs and has become what so many of us hope to but rarely attain – becoming fully self-actualized.
Maslow described self-actualization as "what a man can be, he must be. This need we may call self-actualization…It refers to the desire for self-fulfillment, namely, to the tendency for him to become actualized in what he is potentially. This tendency might be phrased as the desire to become more and more what one is, to become everything that one is capable of becoming." He went on to identify what he believed to be some key characteristics of the self-actualized individual. They are:
- Acceptance and Realism: Self-actualized people have realistic perceptions of themselves, others and the world around them.
- Problem-centering: Self-actualized individuals are concerned with solving problems outside of themselves, including helping others and finding solutions to problems in the external world. These people are often motivated by a sense of personal responsibility and ethics.
- Spontaneity: Self-actualized people are spontaneous in their internal thoughts and outward behavior. While they can conform to rules and social expectations, they also tend to be open and unconventional.
- Autonomy and Solitude: Another characteristics of self-actualized people is the need for independence and privacy. While they enjoy the company of others, these individuals need time to focus on developing their own individual potential.
- Continued Freshness of Appreciation: Self-actualized people tend to view the world with a continual sense of appreciation, wonder and awe. Even simple experiences continue to be a source of inspiration and pleasure.
- Peak Experiences: Individuals who are self-actualized often have what Maslow termed peak experiences, or moments of intense joy, wonder, awe and ecstasy. After these experiences, people feel inspired, strengthened, renewed or transformed.
I think that it’s this perception that Palin is self-actualized and thus not subject to the capricious whims of public opinion that evokes such unrestrained anger from her detractors and passion from her supporters. The public recognizes this self-actualization at an unconscious level and responds to it. Her supporters respond with unrestrained enthusiasm, while her detractors stew over how someone so plebeian can evoke such passion. Self-actualization is not conferred on an individual through the education as our wonderful country is filled with many well-educated individuals that have yet to attain self-actualization. Self-actualization is not the sole domain of the intelligent; one need not be a member of Mensa to be self-actualized. And as the saying goes money can’t buy you self-actualization either, because it shows no particular preference for rich or poor, beauty queen or not.
In an average person’s lifetime they may be lucky to encounter a handful of individuals that have reached the pinnacle of Maslow Hierarchy of Needs, these self-actualized individuals indeed make an impact on our lives. One need only look at Palin to see what emotions and passions a fully self-actualized person can evoke in others. All the slings and arrows her detractors may throw at Palin will do little to disabuse her passions and goals because a self-actualized person doesn’t seek nor need approval from external forces. Hopefully, her more rabid detractors will simply be seen as individuals on some self-fueled vendetta, harpies screeching from their perches at a force they cannot possible comprehend because they’ve yet to attain full self-actualization themselves.
Did C.N.A.’s Demonstration at Whitman Home Result in a Federal Offense?
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.
Worst U.S. Senate Office – EVER!
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”
The California Democratic Party (CDP) and sour grapes.
June 8th 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!
Health Care Reform – The Panacea to what ails America’s Health Care System? Maybe, No, Yes?
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
“Qui vole un oeuf, vole un boeuf”
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 24th 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!
What happens when the candidate is married to a practicing Democrat … you get a “Poizenegger”.
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!
Poor-sport Poizner
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.