What was Dr. Ferrer thinking when she made the decision to change from testing 100% of nursing home residents and staff to only about a third? Over the past many months we’ve been fed a message on how the elderly, especially those in long-term care and nursing homes, and by extension the staff are at greatest risk. Now it appears as though Ferrer and her Public Health team have changed their minds. I seem to recall that the original statistic cited by Ferrer was that 1 infected person could potentially infect 5 others. If this is the case it makes complete sense to test all nursing home residents and their staff, because even one person infected in this environment could set off a mini-epidemic.

Keeping in mind that there’s an estimated 14-day window then even more people outside the nursing home could be infected by an infected visitor or staff person (and let’s not forget that often these same staff people work in multiple facilities). It would appear to me that 100% testing would in the long run be money well spent. After all 10 million LA county residents haven’t suspended their lives, businesses, and education to prevent a second wave of the Coronavirus for no reason. Ferrer’s new ruling could easily miss an infected individual who was one of the 90% not tested rendering these sacrifices moot.

Click here to read the original article.

RE: Most counties may reopen in-store retail, hairdressers within weeks, Newsom says

Well isn’t the photograph at the top of your article a fine example of our governor being a hypocrite. We’ve been told that we can shop retail only via curb-side service because for some reason we’re not allowed to enter said shop – except of course if you’re Newsom posing for a photo-op. Also, whatever happened to social distancing because it would appear in that same photograph the two individuals (one of whom is Newsom) aren’t standing the requisite 6 feet apart? Yet another shining example of a politician preaching “Do as I say, not as I do”.

Click here to read the original news article

Here’s my letter to the editor that didn’t make it into the Star News (the link to the article can be found at the end of my letter)

I applaud Vice Mayor Hampton for sounding the alarm on our city’s public health department as it relates to our city’s handling of our numerous nursing homes. When nearly 7 out of 10 COVID-19 deaths are directly tied to nursing homes, it’s appropriate to be both outraged and concerned and too demand accountability – something Mayor Tornek appears to want to avoid. As a nursing professional who has performed numerous on-site inspections of hospitals, I can attest that a “virtual” inspection using the very staff whose facility is being inspected is far from optimal.

Pasadena has always prided itself for having its own stand-alone public health department and personally this has always concerned me. Now in light of the recent developments with the COVID-19 Pandemic perhaps I think it may be time to rethink this strategy, especially since the lions share of funding is provided by LA County. Maybe once we have COVID-19 behind us we should look at merging our city’s public health department with LA County Department of Health.

Clink here to read the original news article

As a RN with decades of experience at various nursing disciplines; I find myself conflicted as I watch my fellow health professionals, in particular nurses, protesting outside their respective hospitals. I fully support nurses who advocate for the patients and for themselves. It’s enshrined in our Nurse Practice Act – we, the nurse, are the patient’s advocate and we can’t cede that responsibility to another “agency”.

During this healthcare crisis our nurses claim to find that they’re lacking the appropriate protection to safeguard their patients, their families, and most importantly themselves. In order to bring light on these issues nurses have taken to the streets to protest with their state goal being to bring pressure to bear on hospital administrators to provide the appropriate safety materials, such as N95 masks, face shields, and other PPE. In turn, many of these same hospital administrators have claimed that these materials have been made available – so why the disconnect?

My experience has taught me that all too often when nurses claim that their concerns are being ignored that it happens for two reasons. The first, administration is either not listening to the nurses or ignoring the nurses’ concerns. The second, the nurses are failing to use their chain of command and thus there’s an appearance that administration isn’t being responsive to the nurses’ concerns. The first garners a great deal of press on behalf of the “beleaguered” nurse, and the second just reinforces the failure of the nursing staff to appropriately use their chain of command – which leads to the same sad result – a feeling that administration isn’t listening. One of my favorite things to do whenever I go to a hospital either to work as a nurse, consultant, or patient is to ask the nurses around me to tell me the name of their Chief Nursing Officer (CNO) and you’d be surprised how many can’t tell me that individual’s name.

COVID-19 has shown us the many weak points in our healthcare network. It’s also shown us that our healthcare community is willing to answer the call to serve in many cases putting aside their own needs.   However, I’d like to recommend that the next time nurses chose to protest the failure of their hospital administration to provide appropriate PPE that those same nurses aren’t photographed failing to practice social distancing or not wearing face masks while outside – this somewhat undercuts their claim that requests for safety protocols are being ignored when they can’t practice basic safety protocols during their protest.

Last week our local paper “Pasadena Star News” ran an article outlining the ongoing conflict between our mayor and assistant city manager and some other city council people regarding holding additional city council and commission meetings during our current coronavirus crisis and the state “stay at home” order.  The article can be found by following this link – https://www.pasadenastarnews.com/2020/04/26/pasadena-councilmen-go-rogue-demand-more-city-meetings/

My letter to the editor can be found below:

Your article reports that Mayor Tornek or other city employees describes, “it’s too difficult to hold regular meetings right now because it’s too much time and energy to prepare and facilitate the now-digital government meetings”. This surprises me because isn’t Pasadena the home of both Caltech and JPL, not to mention other cutting edge technology companies. Couldn’t our city staffers have reached out to them for help with the technology needed to run a city meeting, after all JPL has found a way to communicate with the Mars rover.

As an open meeting advocate I think that their excuse is a cop out. I’m please that Gordo and other councilmembers have requested additional meetings, because during these most uncertain times our elected officials should be meeting at least once a week both to provide Pasadena citizens with information/updates as well listening to their constituents’ concerns.

I’m also rather shocked when Assistant City Manager, Nicholas Rodriguez, states that the technology isn’t in place. Just last year the Broome County DA and others were able to participate live via videoconference in a murder trial held in Nicaragua. So apparently the technology does exist if one only looks for it. Or maybe Mr. Rodriguez’s over quarter million dollar salary wasn’t enough incentive for him to go the extra mile for the citizens of our fair city.

Shortly after my prior post regarding the LA County Board of Supervisors and their apparent lack of social distancing I received an email from Ms. Vega (who works for Supervisor Kathryn Barger). In her email she made a point to inform me that the photo referred to in the post was actually taken on March 16^th not March 23^rd, even though the photograph has no “date taken” attached to it or the post that it was attached to which went live on March 23^rd. However, I think even though the photograph was taken on March 16^th and the “Safer at Home” order wasn’t in place until March 19^th we already knew that social distancing was an important component to beating the Coronavirus and such a large gathering still put people at risk.

Now on to today’s newest development, Supervisor Janice Hahn who’s been very active getting masks, food, and other essentials out to our frontline workers and others in need posed for a picture taken today April 30^th at approximately 3:00PM (as per her post below). And while its wonderful that her office and she came out and brought lunch to these hard working healthcare workers. I ask you this where’s the social distancing, or do photo ops not apply?

I guess if you’re a member of the LA County Board of Supervisors, a LA County employee, Mayor Garcetti or a member of the press social distancing doesn’t apply to you!

Since the March 19^th “Stay at Home” order and Gov. Newsom suspension of many of the Brown Act and Open Meeting rules our LA County Board of Supervisors have not only halted all public meetings they gone so far as to change how often the Board meets from every Tuesday to every other Tuesday. The rationale is that they can’t have large groups of people congregate – but the picture above which was taken on 04/23/2020 seems to contradict the concern of large groups of people convening in the Board room. So how come they can meet for their press conference, but We the People aren’t allowed to meet there to address the Board, because if you’ve been in this room since the room redesign you’ll see that the public is even further separated from the Board then in the past.

So here’s the conundrum that this picture illustrates for the LA County residents. If as scientists have projected one in five people will have the Coronavirus and can possibly be asymptomatic is correct then let’s do the math. In the above photograph there are at least 22 people that we can see, so its quite possible that out of these 22 people four could be “carriers”, who in turn can spread the Coronavirus to others in the same room, as well as take their infection back to their place of work, where they shop, or even home to their loved ones. Even more confounding is that both Sheriff Villanova and Fire Chief Espy are pictured without masks or practicing social distancing and their departments has recorded numerous employees either ill or testing positive for the Coronavirus.

Yet one more example of our “leaders” saying “do what I say, not what I do.” Then there’s Mayor Garcetti whose office sets up a snitch line so folks can report non-essential business that aren’t adhering to the Safer at Home order. Where do we report officials that chose not to obey the wear a mask and social distancing orders?

As our elected officials and representatives they should be setting the example because if they don’t obey the edict of “social distancing and wear of masks” why should any of us.

Apparently it takes almost 63 days or nine weeks! That’s right!

Several weeks ago, I made an unannounced visit to the Harbor/UCLA Medical Center HUB. As usual there was quite a bit of traffic so I arrived after 6 in the evening and in the dark. I followed the directions provided by the LA County Department Health Services (DHS) to a bungalow identified on the website as “N26”. Imagine my surprised to find the bungalow dark and locked up tight, but wait there’s a paper note on the door detailing that the HUB has been relocated to the “Professional Building” in Torrance.

The note provides an address and with a little help from Google Maps I found the “Professional Building” just behind the hospital. I parked my car and walked up the steps to the building, which of course was closed because – it is after all a professional building, not a clinic or hospital. However, I found myself in luck as a county employee kindly lets me in and escorts me to the HUB, which is closed without a soul in sight because it is after all 6:15 pm and the HUB closes at 6:00 pm.

I chatted with the employee who shares what she knows about the building and the HUB, which she estimates, has been there for about six weeks now. So for at least nine weeks no change has been made to the Harbor/UCLA Medical Center website. The week following my visit, I informed the Board of Supervisors during the weekly meeting, I even provided photographs to illustrate the issue – still no change is made. It takes nearly another two weeks for the people at DHS to make the change, at least now providing the correct address. Unfortunately, the link to the campus map that is provided on the HUBs website takes you to; if you guessed it’s a map showing the HUB is located at N26, and not at the “Professional Building” you would be correct.

These HUBs provide a critical function when there is suspected child abuse. It’s bad enough that the HUBs aren’t opened on the weekends or late in the evening, but DHS Head, Dr. Christina Ghaly seems to only think that children are at risk only during business hours Monday through Friday; even after Ms. Hamai with permission from the Board of Supervisors has allocated additional financial resources to expand services, hire staff and what not. Not to mention that the Grand Jury made the recommendation that the HUBS should be opened 24/7 including weekends and holidays.

It angers me to see Dr. Ghaly spending taxpayer resources to allow a DHS employee to commute from Orange County to LA County using an Uber-like services, and to remodel an office including the purchase of new furnishings for said office. All the while Dr. Ghaly gives short shrift to our County HUBS and LA County children who are at the greatest risk, many of whom are children of color. I wonder how many more children must die before Dr. Ghaly’s failure to expand the HUBs is addressed by the LA County Board of Supervisors?

Now to answer my original question, not only did it take almost nine weeks, and numerous telephone calls from the folks at Hahn Hall of Administration to DHS to fix the problem. But after all of that: what the folks at DHS did in response was to remove the mismarked campus map – I guess correcting the mismarked campus map was beyond their ability, so they just took the map out.

On March 14^th, I sent a letter to Secretary of Health Azar (you can read it here – March 14, 2019).  In my letter I expressed my concerns with how our current PACHA Board was formed, as well as complained about the interaction I had with Kaye Hayes (Executive Director of PACHA).

I finally received a response, or should I say non-response, this past April 10^th.  This letter while addressed to me was not from Secretary Azar, but from Kay Hayes – the very person that I complained about – she even went so far as to explain that Secretary Azar asked her to respond.  Personally I hope that Secretary Azar had not asked her to do that. Because only a bureaucrat would think it logical to ask another bureaucrat (the subject of the complaint) to respond!  You can read Ms. Hayes non-response here – Azar Response 4-10-19.

Earlier this week I submitted the “op-ed” below to the Los Angeles Times for consideration, the response I got back was “I don’t think we can run this as an op-ed…” I called to find out why and Robin (Editor, Op-ed) went on to explain that my op-ed was too personal. Well, I’m sorry to say that to this LA County resident, health activist, and RN the health of our county’s health department is well – personal. Just ask the residents of South Los Angeles if the loss of King/Drew wasn’t personal and the eight (8) years they waited for it to be rebuilt, personal. Ask the allied healthcare workers, nurses, and physicians of our four (4) County hospitals if the health and well-being of these hospitals and assorted urgent cares and clinics aren’t personal.

Robin asked my permission to share my email with one of the LA Times reporter, but I’ve crossed paths with this reporter in the past so I won’t hold my breath waiting for her to call me back. In the meantime below is my letter to the Los Angeles Times, more to come…

Los Angeles County Supervisors “fiddle” while the Department of Health Services “burns”.

The LA County Department of Health Services has seen a turnover of directors over the years, and filling that vacant position has often required a tedious and time-consuming search process. So, its understandable that the LA County Board of Supervisors would choose to appoint an internal candidate, Dr. Christina Ghaly, as the new DHS director rather than undergo yet another long search. However, choosing expediency over an actual job search process means our County is now paying the price.

Prior to Ghaly’s appointment as our new director of DHS she was appointed to head County LAC+USC. During her tenure, she managed to lower LAC+USC’s Leapfrog score from a B to a D. As if it wasn’t enough that Ghaly’s management style lead to a two grade drop in one County-run hospital we had to see if she could do it again, so she was later appointed to run Olive View. True to Ghaly’s management style it wasn’t long before she drove Olive View from a B to a D grade.

After leaving Olive View, Ghaly was made the Chief Operating Officer for DHS before she was made Interim and then permanent Director. She’s therefore really been “in charge” of DHS for 2.5 years now. Only in LA County would this track record be rewarded with being offered the position of Director of the Department of Health Services. If Ghaly’s past management failures weren’t enough to give the Supervisors reason to rethink their hiring decision, you’d think the recently revealed 2018 Patient Safety Culture Survey-DHS Aggregate by Press Ganey would. That survey, completed by more than 12,000 DHS employees, showed DHS hospitals scored lower than the National Average and National Safety Net Hospital Average on all 24 of 24 questions asked. These results are a damning summary of Ghaly’s leadership, as they reflect the perceptions of DHS employees regarding how DHS treats both its patients and staff. The results of this survey were only revealed to the Supervisors after I handed copies of the one page aggregate to each of them, something Ghaly, herself should’ve done – but considering the dismal scores it’s not surprising that she was too ashamed to provide the information herself”.

Later, Ghaly would produce a 10-page report (2018 Patient Safety Survey Summary) where she tried to explain away why our County hospitals ranked so poorly. Ghaly even went so far as to try to rationalize that our County RNs and other advanced practice providers were using the survey as a negotiating tactic (a nursing strike loomed on the horizon), by writing the following: “In sub-group analysis, the negative trend was in large part driven by the responses of RN and Advanced Practice Providers within DHS. DHS will conduct a series of focus groups and perform other focused data analyses to determine why this change may have occurred, the extent to which it may have been related to ongoing labor negotiations that were occurring at the time of the survey, and how to address and improve perceptions among our nursing staff about the climate of safety across DHS.”

The DHS system is in trouble. The academic environment at Harbor-UCLA has been collapsing for some time. Harbor-UCLA hasn’t been able to recruit a new Chair of the Department of Medicine after 5 years and 3 failed national searches. Indeed they seem unable to recruit leaders generally; their Chairs of Surgery, Pediatrics, OB-Gyn, and Anesthesia are all internal promotions. After Ghaly left LAC+USC as Interim CEO, their Leapfrog scores began to recover from the D back up to a B. But since she took over as DHS COO and then Director, their scores have tanked back to a D. This may have something to do with the fact that in a period of little more than a year, Ghaly has turned over leadership at the hospital an absurd amount of times—4 CEOs, 3 COOs, 3 CFOs, and 3 CQOs in such a short period of time. Meanwhile, the medical staff at Olive View has been in revolt, forcing out their CMO, and complaining about DHS leadership. There are fires burning all across DHS, and people are being hurt as a result.

Not to mention the enormous amount of money DHS has wasted under Ghaly in what can only be described as incompetence in modern data analytics. The availability of data is the lifeblood of a quality improvement program—as I know well, having run QA at Cedars Sinai Medical Center in my past. After spending years and tens of millions of dollars attempting to build an internal data repository known as CEDAR, DHS recently hired an expensive consulting firm, Gartner, to assess their data readiness. I’m told that at a recent report-out downtown, Gartner assessed DHS as having the lowest possible data readiness, despite years and millions of dollars spent.

Meanwhile, I started receiving calls and e-mails from many County employees, including physicians, complaining about Ghaly. Many explained that she rules through fear and intimidation, and that she doesn’t listen to anyone, including many people who have far more experience than she does. Many also said that she brags that she only answers to the Board of Supervisors.

I’ve also heard that she seems to prefer to hire “yes people” who ask no questions and never challenge her, rather than hiring the quality of people to ensure the highest quality of service to staff and patients in the Health System. I’m not sure how true this is, but I can tell you that after Mr. James Brady was hired over Ms. Pam Griffith the DHS Dashboard has been riddled with a computer glitch that yields “N/A” which provides no information on some key and critical data points. A glitch that Mr. Brady hasn’t been able to resolve which might’ve something to do with that fact that his experience is with two small hospitals in the self-developed Kaiser system rather than Cerner/Orchid (which the County uses) which Ms. Griffith fully understood and was proficient in.

Not all that long ago our Board of Supervisors failed to recognize that King/Drew Medical Center was in critical condition and by the time they did; all the corrective action taken wasn’t enough to stop King/Drew Medical Center from losing its accreditation and closing. It’d take nearly 8 years to re-open the Martin Luther King, Jr. Community Hospital, a much smaller hospital with a smaller footprint and mission. I hope that the current red flags being revealed in various safety surveys and key indicators aren’t a warning that the Supervisors will choose to ignore. It’s often hard to acknowledge that as a group you made a bad choice, but as the evidence continues to mount the Supervisor’s need to rethink their original decision. Raising all the money in the world shouldn’t offset the fact that Ghaly appears to be hiding critical performance and safety issues from the Supervisors and that’s called dereliction of duty.

The Supervisors should remember that Ghaly is an “at-will-employee” and can on any given Tuesday by a vote of three be sent packing. This LA County health activist and RN wonders how many more of our at-risk children need to die or how much lower in quality of care must the hospitals that so many of our most vulnerable residents rely on for their care must fall before the Supervisors take that vote of three?