Investigative reporting that often falls short — welcome to the Los Angeles Times
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?
For whom the bell tolls, it tolls for thee – King/Harbor Hospital
By now the closure of King/Harbor Hospital’s Emergency Room after the failed “make or break” CMS inspection has made the rounds of the newspapers, radio talk shows and various news outlets. I was one of the many King/Drew Medical Center supporters who both fought for and knew that the hospital could be “fixed” if the correct steps were taken. However, as the months passed and endless reports were issued I quickly concluded that under the current “save the hospital” plan being implemented that failure was the only possible scenario.
My knowledge and expertise was based on over 35 years as a nurse at the bedside, in nursing/hospital management and as a nursing educator. The County hired two different consulting firms, one that was billed as a consulting firm (The Camden Group) with nursing expertise and the other (Navigant) billed as being skilled at hospital turn-arounds. A little due diligence and research on my part provided me with information that contradicted the PR being spewed by Dr. Garthwaite, (head of Department of Health Services at the time). However, the Board didn’t have to rely on my word or even my proof, they only had to read the reports from the CMS and even the local paper to discern that the so-called nursing consultants were not making the grade. Under Camden’s watch we had the stunning failure of surgical instruments not being counted at the end of surgeries. Not long afterwards CMS issued their now infamous memo, which forced the County to enter into an agreement to pay for a management firm to oversee the day-to-day hospital operations. This MOU gave us Navigant Consulting and their 1000+ problems of KDMC report. It was about this same time that Garthwaite made his recommendation to close the trauma center, explaining that this would help “decompress” the hospital’s other service areas and thereby assuring a greater chance to pass the much needed CMS inspection. No one should forget that the Los Angeles County District Attorney found that the Board of Supervisors had violated the Brown Act by holding a closed-door session prior to announcing the decision to close the Trauma Center; however he never released the tapes of that session and I believe that this is still being litigated.
Navigant took over the day-to-day operations with a guarantee of a full time staff and promises that they were the “right” folks to do the job. And it was long afterward that we discovered that full time attention meant something more like Tuesday through Thursday; and forget have a Chief Nursing Officer (CNO) on 24 hour call since their CNO flew back to spend her weekends in her home in one of the Carolinas. She was later replaced with a CNO who lived much closer only requiring her to travel to New Mexico for her weekends. After at least one contract extension and a couple of financial augmentations Navigant finally concluded their overhaul of King/Drew with the placement of Ms. Antoinette Epps-Smith as the hospital’s Chief Executive Officer. There was a small opportunity for the County to rid itself of Navigant and replace them with another firm. Supervisor Antonovich managed to get the Board to consider FTI Cambio, unfortunately Ms. Epps sang the praises of Navigant (I wonder why) and we continued on with a firm that had been with us through several failed JCAHO and CMS inspections.
When CMS came for its next inspection the failure was so great as to caused the County to promise to down size and reorganize the hospital, placing it under the “umbrella”
of its sister hospital Harbor-UCLA. In the real world Ms. Epps would have tender her resignation or the DHS would have asked for her resignation, but of course this is Los Angeles County where people get promotions, praises, and raises when they fail. So Ms. Epps received a standing ovation from the community she failed and praises from the Board of Supervisors. It was about this point in time when Chernof and Epps became successful in clamping an almost complete lockdown on information about all things King/Harbor. Employees (nurses, physicians and staff alike) seemed fearful of sharing any information with anyone – but that didn’t stop the failures from occurring.
The most notable was the death of Ms. Rodriguez, a woman who had sought help from the hospital instead found an unresponsive and uncaring staff. Even after being left to writhe on the ER floor for 45 minutes, and it has been reported that numerous staff, including at least one RN, ignored her cries of pain that is until the hospital safety police came to arrest her, her boyfriend agreed when an officer informed him that she would get care at the County USC jail ward – imagine his desperation that allowing her to be arrested on the promise that it could possibly get her the medical care that King/Harbor personnel were unwilling or unable to give her. Unfortunately this intervention came too late. As she was being wheeled out to the patrol car she collapsed and all attempts to rescuitate her failed.
Shortly afterwards the State of California Department of Health and Human Services issued a notice that the state planned to revoke the hospital’s license. And this was followed by the failure of King/Harbor to pass the last critical CMS inspection and the loss of 200 million dollars in crucial federal dollars. The County immediately closed the ER and is in the process of closing the hospital leaving an urgent care clinic in the footprint of this once 200+-bed hospital.
Do the citizens of South Central need a hospital with an Emergency Room, without a doubt! Do I believe King/Drew Medical Center could have been brought up to minimum national standards, you betcha! There are those who blame the Board and indeed they deserve their share of blame for the failure – these failures occurred at several critical junctures and in my opinion they were:
1. Not firing the Camden Group when it was apparent they were being unsuccessful and once they “completed the job” and it was discovered that the work product appeared less than exemplar the County never sought legal remedy.
2. Not firing Dr. Garthwaite for his gross misunderstanding of the problem, which led to the mandated MOU agreement with CMS, which of course saddled us with Navigant.
3. Not replacing Navigant with Cambio or another firm when the opportunity presented itself.
4. The hiring of Ms. Epps, who was advertised as having presented an excellent resume did not appear to have ever been solely responsible for such a momentous task.
5. Not firing Ms. Epps when King/Drew failed its first “make or break” CMS inspection, which then caused for the drastic downsizing and reorganization of King/Drew and it being renamed King/Harbor.
You may wonder why such measures, because the failures that we saw at King/Harbor were never new ones but the repetition of many of the same ones that caused the original jeopardy. The consultants and DHS staff alleged that much of the King/Harbor staff appeared unwilling to accept change and there were even vague allegations of “sabotage” such as employees being given new policy to adhere to only to pretend that they had never received such policies. But most importantly the incident involving Ms. Rodriguez illustrates a staff so demoralized and demotivated that they were unable to respond to someone writhing in pain on the floor right before their eyes. When a staff reaches this point there is little that can be done to reinvigorate it and often the only remedy is closure.
So what does the future hold for beleaguered King/Harbor Hospital? Well, if we are to believe the Board of Supervisors they plan to find a private firm that will assume the operations of the hospital. It won’t be an easy task to find a private firm to assume the operations of this hospital, if we are fortunate enough to find such a firm then, I believe, to ensure the greatest possibility of success the County will, no must, relinquish a great deal of authority thus allowing the private firm a wide latitude of autonomy to make the necessary changes that will not only restore the hospital’s federal funding, but also stave off the loss of the hospital’s licensure to the State. And it’s not just the County that has to be willing to give up some control, all stakeholders are going to have to give up some of their “interests” (something that never really happened the last time around) and allow the firm to do what must be done. This of course is all dependent on the premise that the private firm is competent in its function and that they have a strong commitment to providing service to the community of South Central and by extension all of Los Angeles.
Just for added background on August 2, 2004 I submitted a civilian complaint to the Los Angeles County Civil Grand Jury, vis a vis the board of Supervisors lack of appropriate knowledge to oversee the health care of Los Angeles County and ask that they recommend a health care authority. The civil grand jury investigated and recommended the creation of a health authority. It would appear that, as usual, the Supervisors decided to let things be as is and now we know where that course has led. See grand civil 2004 findings and recommendations.
And for those who believe that CMS was overly harsh in its critique or evaluation of King/Harbor I encourage you to read the complete CMS report, which can be found at http://bos.co.la.ca.us/Categories/Agenda/cms1_071137.htm and select CMS Report, or you can download the report directly at http://lacounty.info/bos/sop/supdocs/34095.pdf. Read the report and then draw you own conclusions . . .
How to “Tear-Down” a Hospital in Ten Easy Steps
Back in 2004 I wrote an article on an outside observer’s look at the past eleven months at King/Drew Medical Center. In light of the recent developments (follow this link to the coverage in the Los Angeles Times http://www.latimes.com/news/local/la-me-king23jun23,0,1531420.story?coll=la-headlines-california); I thought it was time to publish this article to my blog.
How to “Tear-Down” a Hospital in Ten Easy Steps
Step One: Take an already troubled, but viable, hospital and put it under the microscope.
Step Two: Fire or encourage “to retire” some of the not so-competent hospital and nursing administration staff and replace them with equally or even less competent hospital and nursing administration staff.
Step Three: Close critical units, paying special attention to those units that have a full complement of nursing staff, particularly, if that unit can generate some much needed revenue.
Step Four: Bring in busloads of traveling nurses, especially if they are from a registry specializing in staffing strikes and it is even better if the traveling nurses are from states other than California.
Step Five: If the staff nurses aren’t yet ready to quit, be sure to promote some of those traveling nurses into assistant nurse managers positions (even if the position doesn’t exist within that hospital’s system) to oversee the remaining staff nurses.
Step Six: When the nurses and physicians begin to speak out, especially to their elected officials, be sure to remind them that they must follow the chain of command – and forget all that nonsense they were taught about being the patient’s advocate and the Hippocratic oath.
Step Seven: Give a huge sole-vendor contract to a consulting firm of your choice so you can control the consultants and the flow of information.
Step Eight: Make promises to the union power structure so they “stay way below the radar,” leaving the nurses and physicians to face the critics and media attacks alone.
Step Nine: Leave the public in the dark about what is happening, and when they ask questions about the work being done with their taxpayer dollars, tell them that the consultants are much too busy working to do reports.
Step Ten: Meet in two closed-sessions (meetings where the public is not invited) and decide to close the Trauma Center, the heart of the hospital and the pride of the community - -and then tell the public that you really didn’t mean to say close the Trauma Center, because of course there has to be the public hearings first, and then you’ll close it down. Of course the hospital will follow suit shortly thereafter.
The saga of King-Drew Medical Center, now renamed King-Harbor continues.
The Los Angeles Times is an interesting paper, getting a letter to the editor published is nearly impossible, unless of course you are one of the “chosen” that seems to get a letter in nearly every time. However, for us plebeians, we are relegated to rules of word length and a standard of no letter published without at least a 90-days wait, months or even years.
Not to be thwarted, when I read the latest article “Tale of last 90 minutes of woman's life” I was compelled to respond with little expectation that the LA Times would run my letter. Of course no surprise when they didn’t, but that’s why I maintain my blog “The World As I See It”. So below you will find my most recent letter to the editor on the happenings at King-Harbor.
May 20, 2007
Letters to the Editor
Los Angeles Times
202 W. 1st Street
Los Angeles, CA 90012
Re: “Tale of last 90 minutes of woman's life”
Dear Editor:
As a Registered Nurse I am appalled at the nurse’s lack of action, compassion and basic humanity as it has been reported, but contrary to Mr. Janssen’s comments what has been reported by the LA Times is indeed a “systemic failure”.
What the Supervisors, Dr. Chernoff and Janssen continually ignore is that in order to truly change the milieu at King-Harbor the change had be to start at the top. However, the hospital’s top administration, which continues to fall short, remains in effect the same. Dr. Peeks and Ms. Epps have both been in charge when King-Harbor suffered the big failures. Even Navigant was championed by Janssen to remain in place even in light of their failures. So why, should the hospital staff take change to heart when those who are in authority continue to fail and are rewarded with the retention of their positions; or as in the case of Dr. Chernoff a promotion?
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.
“A Mounting Tab to Fix King/Drew”
March 21, 2005
Editor
Los Angeles Times
Times Mirror Square
Los Angeles, CA
Dear Editor,
So Navigant has requested a “change-order” for the sum of $3.4 million, and Ms. Robertson states that the increase reflects, “additional costs that had been anticipated when the contract was signed last fall.” Then why was their bid $3.4 million shy; why not state that the job would take $16.6 million instead of $13.2 million? Why did Navigant submit an underbid for the contract? Of course these are questions that the Board will never ask, why because they had been warned and chose to ignore the warnings of individuals such as others and myself.
I also find it rather amazing that Ms. Robertson is now saying “even simple, basic operational systems were broken.” None of this should be a surprised to supposed experts in the field. All one had to do was read the numerous new reports, review DHS documents that were provided to the Board, etc to understand the depth of the problem, especially in Nursing. And let’s not forget that for almost one year DHS had their own handpicked team of experts managing KDMC so they should have been able to provide Navigant with the unvarnished truth. So there should have been no surprises as to the state of KDMC.
The only questions that the Board needs to ask are why did Navigant underbid the contract? Did anyone from DHS management encourage them to underbid in order to receive the contract? How many more change orders can the people of LA County expect? Of course the Board could also cancel the contract, since it would appear that the contracting process was violated by the underbidding of a contractor or of course Navigant could do what other contractors do when they underbid and that is assume the costs themselves for their error in judgment.
Sincerely,
Geneviève M. Clavreul, RN. Ph.D
“King/Drew Stripped of Accredited Standing”
February 2, 2005
Editor
Los Angeles Times
Times Mirror Square
Los Angeles, CA
Dear Editor,
Management is and has always been at the heart of the problems at King/Drew Medical Center. It’s weak, poor, and bad management that allowed for many of the lapses and failings identified by JCAHO. Though the problems identified are long-term, let’s not forget that Dr. Garthwaite has been the head of DHS for three years, and for the last year his team and he had direct and personal control of KDMC – so it is appropriate to blame him for these recent failures! Why? Because that year saw an escalation of errors, lies, mistakes and finally institutional collapse.
Contrary to Dr. Garthwaite’s assertions a competent and knowledgeable leader could’ve and would’ve made substantial and positive changes in one year’s time. Instead we were and still are saddled by a DHS director that has yet to admit that he played any part in this debacle. So long as he is allowed to remain in charge and the Supervisors reward him as they did recently with a raise then the message that is sent throughout the chain of command is that incompetence is not only acceptable, it is expected and it is rewarded! No amount of money or expertise can be expected to foster long-term changes so long as those involved in this debacle aren’t given their marching orders starting with Dr. Garthwaite.
Sincerely,
Geneviève M. Clavreul, RN. Ph.D.
Garthwaite no guru – 01/27/05 – Published Pasadena Star News
January 15, 2005
Editor
Pasadena Star News
911 Colorado Blvd.
Pasadena, CA 91109
Re: “Oversight overdoes”
Dear Editor,
I would have to agree that if the Board of Supervisors does not cede their control to the independent body then that body would become just another layer in the already bloated County bureaucracy. However, you are wrong to think that Dr. Garthwaite needs more freedom to do what he needs to do to get the job done. When it comes to the issue of King/Drew Medical Center, for once the Board actually gave up control. For more then one year Dr. Garthwaite, his hand-picked team of experts (his words not mine) and two separate consulting firms (of which one was awarded a sole-source contract) had free rein to make all necessary changes as it applied to King/Drew. In that year we saw a bad situation get progressively worse and left on the brink of collapse. Now, because of Garthwaite’s inability to make changes the County had to sign a memorandum of understanding with the Feds (CMS) to hire an independent hospital management turn around team, Navigant, at the cost of 13.2 million+.
If Garthwaite was the health guru your editorial makes him out to be we would not have the results we have today, and the Navigant team might not have come to the conclusions that one of the problems was that at times DHS (that would be Garthwaite et al) failed to give the Board the appropriate information to make sounds decisions. Does the Board deserve blame for this current debacle, of course; but do not attempt to paint Garthwaite as helpless and blameless in this matter. If he was a true health guru he would have stood up to the Board, instead he was too busy playing politics and being a good sycophant.
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.
Re: “Why supervisors let deadly problems slide”
September 20, 2004
Editor
Los Angeles Times
Times Mirror Square
Los Angeles, CA
Dear Editor,
Management is and has always been at the heart of the problems at King/Drew Medical Center. It is weak, poor, and bad management that allowed for many of the lapses and failings identified in your series. The people who failed the hospital, and more importantly the community, were nursing and hospital management, Dr. Garthwaite and Mr. Leaf in their position as Chief Medical Officer and Chief Operating Officer, respectively, and all five Supervisors.
Though the problems identified are long-term, the Supervisors gave Dr. Garthwaite and Mr. Leaf full day-to-day authority over KDMC for a year; with the help of 3 teams of so-called experts, a DHS management team, The Camden Group and LinBar & Associates at the cost of close to two million dollars. That year saw an escalation of errors, lies, mistakes and finally an institutional collapse.
The Board should and must take all necessary steps to correct this matter, and one of those steps is to terminate Dr. Garthwaite and Mr. Leaf for their failures. And the final steps rest with us, the citizens of LA County. It’s time to break the Board’s monopoly and back an expansion of the Board of Supervisors, now!
King/Drew and how the County of Los Angeles has failed
Here is my most recent letter to the LA Times regarding their recent article “King/Drew Treatment Errors Cited” and the comments made by LA County Officials:
August 5, 2004
Editor
Los Angeles Times
Times Mirror Square
Los Angeles, CA
Re: “King/Drew Treatment Errors Cited”
Dear Editor,
It would appear from Dr. Garthwaite’s comments that he fails to comprehend the seriousness of the nature of the 3 areas of deficiencies that were identified by the Federal inspectors. What’s worse, it would appear that he is trying to minimize the seriousness of the findings. All three areas identified are critical areas of hospital performance!
Nursing, and patient rights (which is actually a responsibility of nursing) are two areas where the County has hired a sole source vendor for the sum of over $600,000 to provide direct management. To attempt to shift blame by saying that the nurses were “travel nurses”, doesn’t exonerate the failed management of the nursing management company or the nursing management team. In a hospital the Chief Nursing Officer (CNO) is ultimately responsible for the nursing care provided by his/her nurses. The same for patient rights and advocacy – it is the function of the nurse to advocate for his/her patient. As to the physical plant, Dr. Garthwaite and his team are directly responsible for this area and for the failure.
Contrary to the assertions of Dr. Garthwaite and county officials the problems are not different from those found at the last inspections – they are in fact still the same. Medications errors continue. It doesn’t matter if the medication errors occurred on the inpatient wards or in the ER, it is a failure of the pharmacy and nursing. The same goes for the nursing errors, it doesn’t matter if these errors were made by temporary (travel) nurses or staff nurses. The CNO and the nursing management team are responsible and the patients suffer the consequences. Once again the Department of Health Services and Dr. Garthwaite appear unwilling to take ownership for their failures.
It is now up to the Board of Supervisors to take ownership for the failures of their management team. The remedy, however, is quite simple; the Supervisors can fire the head of DHS on any given Tuesday with a vote of three. I highly recommend that they take that step and show us some leadership!
Sincerely,
Geneviève M. Clavreul, RN, Ph.D.