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Florida dumps surgical standards after failing hospital donates to GOP

26 Jan

By Mathew Keller RN JD, Regulatory and Policy Nursing Specialist

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In a decision that has shocked pediatric surgeons across the state, Florida recently repealed a 38 year-old rule establishing state standards for pediatric cardiac surgery. The decision comes on the heels of a scathing investigative report by CNN, which found that St. Mary’s Medical Center in West Palm Beach had an abysmal record in performing pediatric cardiac surgeries—including a death rate three times the national average.  St. Mary’s was also failing to meet the state’s quality standards, which include proficiency in performing the surgeries as well as a mechanism for outside physicians to conduct an expert panel review of such surgical programs. The rule also established standards and criteria for staffing, minimum physician and facility volumes, and data reporting for hospitals that perform pediatric cardiology surgery.

Florida doctors and medical experts were strongly against the repeal. Louis St. Petery, a pediatric cardiologist in Tallahassee and former executive vice president of the Florida chapter of the American Academy of Pediatrics, told CNN that “The whole situation is outrageous. It’s just outrageous.” William Blanchard, a pediatric cardiologist and former medical director of the Nemours Children’s Clinic in Pensacola, stated at a hearing on the standards that getting rid of them is “both poor public policy and poor politics.” Jeffrey Jacobs, a professor of surgery at Johns Hopkins, further argued that the standards “are necessary to protect the vulnerable children with heart disease.”

For those who wonder why Florida repealed its standards despite the strong opposition of the medical community, look no further than the contributions of St. Mary’s parent company, Tenet Healthcare, to Florida governor Rick Scott and the legislative majority GOP party. In fact, Tenet has donated more than $200,000 to Governor Scott and the GOP over the last several years. David Nykanen, a pediatric cardiologist and member of the state’s Cardiac Technical Advisory Panel, pointed out to CNN that Scott has been in office since 2011 and his administration never objected to the standards until a Tenet hospital was found publicly not to meet them. “The coincidence is just a little too much,” said Nykanen, co-director of the Heart Center at Arnold Palmer Hospital for Children in Orlando. “It’s just a little hard to swallow.” In fact, the standards have been in place since 1977, and many physicians pointed out that they served as an example for other states such as Pennsylvania, which has similar standards for pediatric cardiac surgery.

So what does this mean for us Minnesotans? For one, it’s a warning. If you think something like this could never happen in Minnesota, you are wrong. Big corporate healthcare is alive and well in our state, and as corporations like Fairview, Allina, Mayo, Sanford, Essentia and others swallow up their competition, they become bigger and bigger players on the political scene, wielding outsized influence at the capital with their brand and their political contributions. We have seen big corporate healthcare advance its aims more and more through the legislative process, not necessarily in the interest of what’s good for Minnesotans, but rather what’s good for their bottom lines.

Community EMT, the nurse compact, telehealth, and so on.  It’s not Minnesotans advancing these issues, it’s big corporate healthcare. When Minnesotans hear that a bill is being pushed by Mayo, or any of the other large corporate healthcare players, we tend to automatically assume that it is good for us and in our best interest, but we need to dig deeper and uncover who big corporate healthcare is actually looking out for. We as citizens must remain vigilant, because what happened in Florida could happen to us.

1 May

Legislative Update May 1, 2015

House HHS Omnibus Bill
Tuesday night, the House passed its Health and Human Services omnibus bill (HF 1638). The bill includes many of MNA’s issues in various forms:

MinnesotaCare is dropped all together. This is the insurance program for about 90,000 Minnesotans who make too much money for Medicaid but not enough to buy insurance through an exchange (approximately 134-200% of the Federal Poverty Level or about $40,000 for a family of four). Another bill, HF 848, includes tax credits for those dropped from MinnesotaCare to get coverage through the private market or MNsure.  Unfortunately, the proposed credits aren’t nearly enough to provide an equal level of care.  As a result, MinnesotaCare recipients could face high deductibles and co-pays, which could cause them to forego even routine care or just go broke trying to pay for care when they really need it.

CEMT is in the House version, which contains some but not all the language MNA fought for that would prevent Community Emergency Medical Technicians from practicing nursing skills. This bill allows CEMTs to check on and help newly discharged patients.  Because there is a provision in the bill that requires a workgroup to make recommendations to the Legislature on what services will be eligible for reimbursement, MNA will continue to advocate in that workgroup that these services not infringe on the nursing scope of practice.

Temporary license suspension is also in the House HHS Omnibus bill.  This language raises the level of threat a nurse or healthcare worker must pose to patients before that license holder can be suspended without a hearing.

Senate HHS Omnibus bill
Last week, the Senate passed its all-encompassing HHS bill, which includes these MNA issues:

Workplace Violence Prevention Bill
The bill, which would require all Minnesota hospitals to have a workplace violence prevention plan and provide training to workers on an annual basis. Despite a push from nurses and legislators, the data on incidents will only be accessible to collective bargaining representatives and law enforcement.

Healthcare Task Force
This bill echoes the Governor’s proposal to create a task force that will look at other ways to pay for healthcare in Minnesota. This analysis will look at many options.  We hope it will include a study on the savings that could be brought by a Single Payer system. MNA will work to ensure this proposal is in the final budget and to see that nurses are well represented on the task force.

MinnesotaCare
The program continues to operate in this version of the bill, but will face intense pressure and scrutiny as the conference committee decides its fate

Biennial Budget
Two and a half weeks to go in this Legislative Session, and the time to create a budget is growing short. The GOP-led House passed its tax bill Wednesday with a vote along straight party lines. The GOP budget cuts taxes for big business, including eliminating the corporate property tax all together. Those cuts are being marketed as a middle tax class cut, even though a single, $75,000 a year filer would only get $70 back.

To pay for this, the GOP budget underfunds education, and Greater Minnesota doesn’t get broadband, schools, or train safety. In addition, various services offered through HHS would be cut by $1.1 billion.  At a time when we have a $2 billion surplus that could help to move Minnesota forward, their proposed shifts and gimmicks could return us to the deficit days that forced Minnesota to borrow from schools again and again. Stay tuned on the response from the DFL-led Senate and the Governor’s office. It appears this budget won’t be settled until the final hours on May 17.

MNA nurses joined TakeAction Minnesota and many other groups to oppose the elimination of MinnesotaCare in the House HHS budget at a press conference on Tuesday. MNA Executive Director Rose Roach explained the impact of the cuts on Minnesota’s patients.

See clips from the conference hereScreen Shot 2015-04-30 at 12.24.42 PM

Rape Kit Inventory
Law enforcement agencies are sitting on hundreds of untested rape kits that could be used to bring suspects to justice. The bill that would look into the status of untested rape kits passed the Senate floor by a unanimous vote.  The bill also passed the House on Tuesday with the same language in the Public Safety Committee’s omnibus bill. There are concerns that some gun-related issues are riding on the omnibus bill, which could tie up this bill as well. The Governor will have trouble signing it with those riders. If that happens, there will be a push to hear the Rape Kit Inventory as a stand-alone bill.

Voter Pre-Registration
The bill that would allow 16-year-old to register to vote before they turn 18 has made it into the Senate Elections omnibus bill but not the House version.
 

Sen Hoffman
Wednesdays at the Capitol

This week, nurses from Children’s Hospitals in St. Paul and Minneapolis teamed up to talk to legislators, and they got a great response from their state representatives and senators. Every Wednesday, we bring small groups of nurses to the Capitol to meet with legislators about our priority bills. All MNA members are welcome.

Nurses in attendance will meet at the MNA office in the morning for a briefing and quick training on how to talk to legislators.  They then carpool to the Capitol to talk to elected officials about the need for Safe Patient Standard and Workplace Violence Prevention legislation. At around 1 p.m., the group returns to the MNA office for lunch and a debrief of the day.  Please contact Geri Katz geri.katz@mnnurses.org or Eileen Gavin eileen.gavin@mnnurses.org for more information or to sign up.

Video

Video: Minnesota Nurses Hold Informational Picket at North Memorial Hospital

25 Jun

 

 

Minnesota Nurses fighting for safe staffing levels for patients held an informational picket on Tuesday, June 24, 2014.  Legislative leaders from the area joined them to echo their concerns that patient safety is a concern.

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NNU launches “Insist on an RN” campaign with radio ads

13 May

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Sweeping changes underway in the nation’s health care delivery system that expose hundreds of thousands of patients to severe risk of harm are the focus of a major new national campaign by the nation’s largest organization of nurses announced today.

An unchecked proliferation of unproven medical technology and sharp erosion of care standards are rapidly spreading through the health care system, far outside the media spotlight but frighteningly apparent to nurses and patients, says National Nurses United.

In response, NNU has launched a major campaign featuring radio ads from coast to coast, video, social media, legislation, rallies, and a call to the public to act, with a simple theme – “when it matters most, insist on a registered nurse.”  The ads were created by North Woods Advertising and produced by Fortaleza Films/Los Angeles.

To watch the new videos and hear the radio ads visit www.insistonanRN.org

Or click below:

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Key features of the new threat to patient safety include:

Digitalized care – experimental, unproven medical technology put patients at risk

Hospitals and other healthcare industry giants are spending billions of dollars on medical technology sold to the public as the cure for everything from medical errors to cutting costs. But the reality is proving to be far different, warns NNU.

Bedside computers that diagnose and dictate treatment for patients, based on generic population trends not the health status or care needs of that individual patient, increasingly supplant the professional assessment and judgment of experienced nurses and doctors exposing patients to misdiagnosis, mistreatment, and life-threatening mistakes.

Computerized electronic health records systems too often fail, leaving doctors and nurses in the dark without access to medical histories or medical orders. The Office of the Inspector General for the Health and Human Services Department has reported widespread flaws in the heavily promoted systems. Telemedicine and robotics marketed as improved care deprive patients of individualized care so essential to the therapeutic process central to healing.

The face of future health care – a world without hospital care

Cutting costs is now seen as the prime directive in health care. Unwilling to reduce their profits or limit excessive pricing practices, the means to limiting expenses in the healthcare industry is by restricting or rationing care.

Insurance companies do that by denying claims or setting out-of-pocket costs so high Americans lead the developed world in skipping care when they need it because of the price. Hospitals, especially those that are also insurance companies, like Kaiser Permanente, or linking up with insurers through the new Accountable Care Organizations, restrict care by cutting patient services, limiting hospital admissions, or discharging still very ill patients to clinics, nursing facilities, or home, all settings that have fewer staff and regulations. Hospitals overall, have profit margins of 35 percent for elective outpatient services, compared to just 2 percent for inpatient care.

Nurses every day see patients denied admission who need hospital care, held on hallway gurneys in emergency departments, or parked in “observation” units. Observation is the latest fad in large part because Medicare reimbursement penalties for patients re-admitted within 30 days for the same illness do not apply if the patient was discharged from an observation unit.

The ascendance of profits while reducing access to professional nursing care

Hospital industry profits are at a record high – some $64.4 billion in 2012, according to American Hospital Association data.  Kaiser Permanente, which is the model for many of the industry trends, just reported first-quarter profits of $1.1 billion, up nearly 44 percent from a year ago.

Yet, as one of the new NNU radio ads notes, many of those hospitals are spending their profits and patients’ health care dollars “on everything but quality patient care” – on technology, Wall Street investments, buying up other hospitals, while cutting the staff of bedside registered nurses, “the health professionals most critical to your care and safety.”

Inadequate, unsafe staffing is proliferating through the nation’s hospitals, even as hospitals shift care to other settings leaving the patients able to get in, and stay in hospitals, facing often perilous care standards. Just one example of many, in a report released May 12,  Washington, DC nurses cited 215 incidents of severe understaffing, including life-threatening events, in District hospitals the past 15 months. RNs in DC and several states are pursuing safe staffing legislation.

‘Behind every statistic a patient exposed to unnecessary suffering’

“The American health care system already lags behind other industrialized nations in a wide array of essential health barometers from infant mortality to life expectancy. These changing trends in health care threaten to make it worse,” said NNU Co-President Jean Ross, RN. “Behind every statistic is a patient, and their family, who are exposed to unnecessary suffering and risk as a result of the focus on profits rather than what is best for individual patient need.”

“What we are advising every patient, every American to do is stand up and be heard,” said Ross. “When it matters most, insist on a registered nurse.”

Nurse Power at Caucus Night Feb. 4

3 Feb

Caucus-inviteAn Invitation from MNA President Linda Hamilton

2014 is an  important election year for nurses and the communities we care for and live in. The entire Minnesota House of Representatives is up for re-election, as well as the Governor, U.S. Senator Franken, all eight members of Congress and countless local races.

These elected officials make decisions about nursing and health care that affect our profession, our patients and our families. We must speak up for nursing values of caring, compassion and community. If we don’t advocate for our patients and our profession, no one will.

Start out by attending your party’s Caucus Night, Feb. 4.  View this video to learn more.

Resolutions to present:

Nurses React to 2013 Adverse Event Report

24 Jan

2013-Adverse-EventNurses of the Minnesota Nurses Association are pleased to see reductions in adverse events as reported in the 2013 Adverse Event Report by the Minnesota Department of Health but caution patients that the annual report of preventable errors in hospitals doesn’t tell the whole story of patient safety. They say no patient should suffer a fatal fall if they receive the proper nursing care.  Read More of MNA’s Statement

Read the full report

What if patients determined an adverse event?

31 Jul

NurseERNext fall, patients will be able to report adverse events in a limited time.  They’ll be able to initiate an investigation with the Agency for Healthcare Research and Quality if they feel they were given the wrong medication or suffered a negative patient outcome.  The report will then go to the RAND Corporation and the ECRI Institute, which investigates medical errors.

While originally supportive of the idea, the American Hospital Association touted the empowerment of patients when the idea was originally proposed last year.  Original story is here.

Now that the program is about to begin comes the warning that patients don’t have the background to assess what’s an adverse event and may merely complain when they’re not satisfied.  Another objection is the time it would add to facilities and physicians to answer questions by investigators about these reports.  The agency says it would only add 28 hours in administrative time.  Response is here and here.

In Minnesota, there is no such avenue for consumer complaints, but healthcare professionals can report an adverse event after it’s happened to the Office of Health Facilities.  This office however, while tasked with protecting vulnerable patients, is limited in its power.  It can’t, for example, investigate incidents where a lack of nurse staffing resulted in a “near-miss” or a fear of an adverse event.

As hospitals continue to cite industry studies that cite excellence in healthcare, there are few places to create a more realistic view of the quality of care patients receive.  Consumers need to join nurses at the Minnesota legislature and on-line forums to detail cases where they or their loved ones received poor quality care.

Patients’ voices should be heard.  Patients should join the chorus of nurses who cry for minimum standards of care to ensure that nurses have the time to provide safe care to patients.  Nurses have been clamoring for safe staffing levels for decades, but they’ve nearly always been rebuffed by administrators who cry out for lower costs instead.

MNA NewsScan, July 10, 2013: Hospital scam puts patients at risk; ACA intensifies debate on patient safety standards

10 Jul

HEALTH CARE NEWS

How the American Health Care System Killed My Father    Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate.

Hospital Exposes Patients to Needless Radiation For The Money   Cardiologists and the Infirmary Health System in Mobile, Ala., are accused of needlessly exposing patients to radiation in a nine-year-running kickback scheme tainting an estimated $522 million in Medicare, Medicaid and Tricare reimbursements since 2004.

2013 a Banner Year for Minnesota Children’s Mental Health    In-reach services were added so that care could be provided when a child leaves the hospital or emergency room to help reduce readmissions and ensure a smooth transition.

Reorganization Underway at North Memorial   “The employer, North Memorial has told nurses that some are being laid off due to unit closure and merger.”

How Oregon is Getting “Frequent Flyers” Out of the ER   Oregon’s health care experiment allows Pearlstein to help Seals and other Medicaid patients much like a family member might. She helped him schedule doctor appointments, and went with him to make sure he understood what he had to do. She also helped him get dialysis and take his medications correctly.

NOTES ON NURSING

ACA Intensifies Hospital RN Staffing Debate     The Affordable Care Act, which is expected to boost hospital admissions, has intensified a decades-old battle over the number of nurses who should be available to patients at all times.

Shift Workers Face Higher Miscarriage Risk; Subfertility    Women who work irregular shifts suffer more disrupted menstrual cycles, miscarriages and reduced fertility, according to an analysis of data from previous studies presented at a scientific meeting in London.

LABOR UPDATES

State Workers to Vote on New Contracts   The proposals include 3 percent raises for each of the next two years and would require state employees to pay more for their health insurance.