BROKEN HEALTH CARE HITS HOME!

Our broken health "care" system has hit home. I am sad to say that my elderly mother, who will turn 86 in less than 3 weeks, has been diagnosed with terminal cancer. We are all saddened by this news and I, in particular, am extremely disappointed in, and angry about, the way her case was initially handled.

No, I am not accusing anyone of malpractice or trying to build a malpractice suit. And no, she has not been booted off her insurance policy or had Medicare slam the door on her - at least not yet. But I clearly believe she has been victimized by the dybamics of economics in our current, very broken system, which is definitely placing cost-saving measures well in front of patient needs and comforts.

My mother had a full hysterectomy done at the time she was diagnosed with uterine cancer back in 1988. Because the cancer had broken through the wall of her uterus, her surgeon wisely decided to follow up with radiation therapy and a brief cesium implant to kill any stray cancer cells which may have escaped the immediate area. His decision kept her alive and cancer-free for more than 20 more years. But he also warned that this radiation treatment would result in radiation proctitis, which is a kind of burning damage to nearby tissues which results in scar tissue. He further mentioned that this form of proctitis also results in colon cancer.

Long story short, this may or may not have brought on her current cancer, which is called adenocarcinoma. Rather than appearing or originating in her colon (large intestine), it appears that this cancer originated in either her stomach or in the glandular bile ducts in her pancreas. From its origin, it has migrated throughout her abdomen and resulted in a partial blockage of her small intestine, the aftereffects of which led us to hospitalize her.

For more than six months, my mother had been suffering from irregular bowel function: nauseous, sometimes constipated, sometimes having diarrhea. Her appetite fell off markedly in the new year, and she was vomiting with steady diarrhea in mid-February. We were concerned she was becoming dehydrated, and she was incredibly weak, so we brought her to the hospital on February 17. They put her on an IV and a liquid-only diet, and she was given a CAT Scan. The determination of ulcerative colitis was made (inflammation of the colon) and she was discharged to a rehab center (nursing home) a few days later, after she was able to hold down solid food again. She was advised to rest and eat several small meals each day rather than 2 or 3 large ones. She was sent home after a week or so there, and seemed to be doing better for a time. Her stomach and bowels seemed to be functioning better. But by the end of March, she was again feeling queasy and weak, and her appetite dwindled. By mid-April, she was again vomiting, with regular diarrhea, so we brought her back to the hospital. Here they again put her on a liquid diet and took an inconclusive x-ray of her abdomen, which was now becoming distended and hard to the touch. It was obvious something was radically wrong. And it was here that I became aware of a relatively new entity in health care: the "Hospitalist."

In the good old days of not-that-long ago, your own family physician, the doctor who knew you and your personal case best, would spend part of his or her day prowling the halls of nearby hospitals to check in on his or her patients who may have been admitted there. He or she would consult with staff doctors and other on-site medical personnel and prescribe a treatment and medicine regimen. Nowadays, though, in many hospitals, your personal physician no longer pays a visit and has been replaced instead by a "Hospitalist."

A Hospitalist is a doctor of internal medicine who has been hired by and works for the hospital directly, ostensibly to relieve the burden of and free up time for your primary care physician (family doctor). But, given the experience my mother had with her Hospitalist, I would suggest that his main task was to be a company man and boot patients out of the hospital as quickly as possible. This, of course, makes both insurance companies AND hospitals happier, as it reduces both of their costs and indirectly creates more profitability for them.

From the second day after her readmittance, until we finally requested he no longer be her Hospitalist, this son of a bitch was obviously repeatedly trying to get my mother discharged! Here was a frail, elderly woman who could not keep food or liquid down, had chronic diarrhea, who had just been in the very same hospital for the very same symptoms two months prior, and this cold, uncaring moron was telling her she couldn't stay there indefinitely, and that she had better soon choose a rehab center to go to! When she told him she didn't feel she was well enough to go elsewhere yet, and that she thought doing so would inevitably bring her right back to the Emergency Room for a third admittance, he cooly told her, "You know, I think you're just getting attached to this place." He still pressured her to agree to a discharge, even though she was still weak and unable to keep down solid food. UNBELIEVABLE!!!

We filed an immediate appeal with Medicare against this decision to discharge and she was granted an automatic 48 hour reprieve pending review. That night she again vomited and the next day a different Hospitalist ordered a CAT Scan. It revealed what appeared to be a partial obstruction in her small intestine. A surgeon was called in and he examined her and then decided that exploratory surgery would be the advisable option. Upon opening her up, he discovered the scattered nodules of adenocarcinoma and a larger tumor which was responsible for her blockage and its resultant nausea, vomitingm and diarrhea. He proceede to clamp off the diseased portion of bowel and created a bypass so her undigested food could again flow for whatever time she has left. Then he sewed her up and gave us the bad news.

I remain furious with that first Hospitalist, whose priorities were obviously in herding patients along like anonymously numbered calves from one pen to another, just because it seemed the most cost-efficient thing to do. In the process, I believe he made an incomplete and inaccurate diagnosis of my mother's condition. He represents our broken health care system personnified. He was effectively acting as a one-man "death panel" and proves how far off base Sarah Palin's lying misrepresentation of government-run health care was. He was acting on behalf of a private system, overly concerned with money and profit and under-concerned with patients' needs. This complete and utter nonsense must change!

AN INSIDER'S VIEW OF OUR BROKEN HEALTH CARE SYSTEM

I got a very nice email recently from a former classmate, now a nurse, who has followed my blog and its various posts on our pathetically profit-driven and chronically broken health care system. She provides some behind-the-scenes insights on the day-to-day frustrations and horror stories now being faced by many of our nurses and hospital workers in this increasingly greedy and corrupted system. My own comments follow her email in bold, at bottom below.
-----------------------------------------------------
Jack,

I still love your blog, it makes me think way too hard, so I have to always plan some time to read it. Your information and thoughts take time to read, consider, and always learn. You should join the bloggers that make an income blogging. Though finding sponsors may be a bit difficult with your views on caring for and improving the lives of the people of our country.

I was a little, well very worried about your April 1, 2010 blog until I got to the end. GREAT READ.

Here are some thoughts for you to think about:

As you may know the big hospital industry in Minneapolis is trying to negotiate the MNA (nurses union) contract. According to the Mpls Startribune the hospital CEO salaries in the metro run from $957,300 (David Cress at North Memorial) to $1,738,300 (Richard Petingill-Allina). The hospitals cite the need to make changes because of declining reimbursement, increased uninsured patients and anticipated changes of reimbursement due to the national health care program.

The hospitals have some "great" ideas of how to cut their costs by changing the way patients are cared for by delivering the care in a more efficient way. Efficiency includes redefining the care provided to each patient and taking away reimbursement to the nurse in terms of pension. Nurses do not have the luxury of profit sharing, stock options and bonuses given for meeting corporate cost saving quotas like many professionals.

Key issues during the MNA (Minnesota Nurses' Association, the nurses' union-Ed.) negotiations include nurse-to-patient staffing ratios and the hospitals’ desire to slash the nurses’ long-standing pension plan benefits. The hospitals also want the ability to change nurses' daily assignment to fill in at the site and unit most in need for that shift. I for one do not want to be called 90 minutes before a shift and told to go over to United and work in the OR. A patient or a surgeon does not want to see me show up at that site and pretend to know what I am doing.

As a nurse I can cite many daily examples of wasted time or resources. I can testify to the consequences of working short staff. As a mother of an uninsured 25 year old son I worry about any injury or illness he may have that requires medial care. Medical bills cause a large amount of bankruptcies and that is not good for society. I also have a child with a serious and persistent mental illness. The mentally ill are truly neglected by our society. Day to day living is a challenge at best for them. As an abandoned wife of a director at United Health Care, I see the huge corporate profits and the excessive compensation executives make by negotiating health care payment, determining what health-care procedures are going to be paid depending on the diagnoses and finding legal loopholes to continue to make excessive profits at the expense of the ill. As I watch my 47 year old brother die from cancer, I grieve for all the terminally ill people stuck in such system that seems more concerned about profit than patient care.

Is there a nursing shortage? Ask the RN graduates of 2010 or 2009 or 2008, how many recruiters are banging on their doors begging them to work at their health care corporation. I know a few 2010 graduates, and none of them have been recruited, they are are all aggressively looking for a job-any RN job. The nursing shortage? Yes. The average age of nurses is high and someday they will retire. Others will go into another career. My unit had 2 nurse managers return to staff positions. The important nurse manager job is left to a "rotating charge nurse" situation which is a band-aid for a shift but provides no one able to see the needs of the patient or the unit in a consistent manner. No one advocates for the patients or unit. Last week, we temporarily closed one of the small units because of vacancies, secondary to MDs being on vacation. Four to six staff were told to stay home each shift. Last summer almost every shift experienced the need to reduce staff, sometimes the staff voluntarily took the shift off and took a vacation day or no pay, sometimes they were mandated to stay home. Try to pay your bills when your vacation is all used up and you are mandated to take the shift off. Try to plan a vacation-we bid vacations in Feb but if all your vacation time is used up by leaves you do not get the vacation time.

Other shifts we are truly short a nurse. The number of patients on the unit require so many nurses and one calls in sick or there are admissions causing the number of nurses to be less than ideal. Admissions are always happening, causing nurses to take on more patients. The hospitals staff for the number of patients in the unit. The patient number determines the number of nurses. There are no accommodations made for acuity or anticipated admissions. Getting 4-5 admissions on a shift is a nightmare for the staff.

The schools offering nursing programs are doing well. They have several applicants for every open spot. They have a cash cow, expanding their nursing program staff to add more student spots and make more money. I have met many nontraditional students going into health care because of the perceived guarantee of a job. I question if the purpose of this career change is for financial gain or perceived job security. Some males want to be a director (of something) and going into a traditionally female profession gives men an advantage. Real nurses are nurturing healers who want to take care of those needing help or dying. Fortunately, the "old" traditional nurses are just that.

Health care is in crisis, but don't blame sick or mentally ill, handicapped, or nurses. In our society capitalism has created corporate greed. Health insurance companies divvying out health care treatment at the expense of the sick while making huge corporate profit. Politicians create laws which give incentives to hospitals and MDs provide only the minimum amt of care, or not offering some care or treatments, just to increase profits. If an insurance company pays a predetermined amount for a procedure or admission diagnoses, the hospital tries to "get the job done" for the least expense. My daughter broke her jaw and needed 2 surgeries. and the insurance company determined she did not need anesthesia. Where did the actuary or the writers of that plan get their MD degree? I had brain surgery, access to my brain was through nose and upper jaw. This killed my two upper front teeth, causing them to yellow and brown. The insurance company would not pay for the required reconstructive surgery. They explained to me breast reconstruction is required by law but they are not legally required to fix my teeth. Somehow the insurance company never got my 3 requests and my physician's explanation of the need for the surgery.

One MD on MPR reported that 1/4 (or some significant amount) of every health-care dollar does not go to health-care. Is this the time I am paid to triple document education and pathways? This takes time away form patient care. Then one of my managers audits charts to make sure all documentation is entered. Then insurance companies or Medicare audits the documentation. I understand that if all required documentation is not entered the claims may be not paid or medicare or the state or someone can fine the hospital. The outside auditors-medicare need to be paid I believe my taxes pay them. I would prefer my taxes go to caring for the sick or homeless, or working poor paying way too much for a small apartment for their families leaving little for food, a car and no health insurance.

I hope you and Nick Coleman pay attention to what is happening to our negotiations. Nurses are not the problem in the health-care crisis. I love being a nurse and cannot think of anything I would rather do except to be at home taking care of my high school age daughter and my grandchildren. Some shifts I actually get to spend quality time with one of my patients.

Take care.
P.

HERE IS THE TEXT OF THE MNA's MAR. 16 PRESS RELEASE:

ST. PAUL (March 16, 2010) – Saying their 12,000 members are committed to standing united in the coming months, Minnesota nurses formally began labor contract negotiations with six Twin Cities hospital systems on Tuesday.

“The safety and quality of care for our patients is on the line,” said Minnesota Nurses Association President Linda Hamilton, who works as a registered nurse in the Newborn Intensive Care Unit (NICU) at Children’s Hospital in Minneapolis. “Nurses always have and always will be an outspoken advocate for the men, women and children of Minnesota who are put under our care. These negotiations are all about the bottom line. For nurses, that bottom line remains the same – patients before profits.”

The current labor contract between 12,000 Minnesota Nurses and six Twin Cities hospital systems (North Memorial, HealthEast, Allina, Methodist, Children’s and Fairview) expires on May 31, 2010. After several weeks of bargaining, nurses will vote on May 19 to either ratify the new contract or authorize a strike. The last time there was a large-scale RN strike in Minnesota was 1984, when 6,000 nurses walked off the job for 35 days. It remains the largest RN strike in U.S. history.

At the forefront of 2010 talks are two issues – RN staffing levels and the nurses’ pension fund, which has been in place since 1962.

“More than 72,000 people in this country needlessly die every year because hospitals don’t have enough nurses on staff,” Hamilton said, referencing a 2005Medical Care Journal study. “The numbers don’t lie. If you don’t have enough nurses working, people are going to die when they don’t need to. So we’ll keep saying it until we’re blue in the face: Safe staffing saves lives.”

Pension bargaining between nurses and the hospital systems began during early March, and the hospitals have made it clear they want to cut the nurses’ pension funding by a third.

“First of all, our pension funding equals about one percent of these hospital systems’ annual revenue,” Hamilton said. “It’s a minimal expense. These hospitals aren’t going to be closing their doors in order to pay nurses the retirement benefits we’ve been earning for nearly five decades.”

The hospitals’ current proposal would put the nurses’ pension benefits back to 1968 levels, according to Hamilton.

“Gas cost 34 cents a gallon in 1968,” Hamilton said. “A new house cost around $15,000. To ask us to retire and support our families on a standard of living like that would require a time machine to pull off.

“Nurses are not greedy people. It’s not in our nature,” she continued. “We sign up to do what we do because we put the well-being of others ahead of ourselves. At the same time, we need to advocate for our families the same way we advocate for our patients. We need a livable pension plan to ensure that we can retire when we’re ready and that our spouses and children have the support they need from us.”

Minnesota nurses will hold a large rally for patient safety on March 27 at Hopkins High School as part of their united stance on the labor contract’s key issue.

“When it comes to the people of this great state, Minnesota nurses want everyone to know that we care,” Hamilton said. “We care for each and every patient we see. And we’ll keep fighting to ensure we’re allowed to do that to the very best of our ability and that your experience with us is as safe and comfortable as possible.”



------------------------------------------------------------------------

This attempt by Twin Cities hospitals to shake down their nurses is an outrage I'm sure a number of you were never aware of or ever thought about. It's the same old story, though: wealthy corporate CEOs are trying to further increase profits and line their pockets at the public's AND THEIR OWN WORKERS' EXPENSE! In this case, their greed is not only cheapening the "product" their institutions provide, but directly and negatively impacting the care sick and dying people will be receiving. "Free market" economy advocates: this is a perfect example of "free market" economiucs gone astray, and why there MUST be government oversight in the marketplace. If these greedy CEOs are to succeed in rolling back employee pensions and further cutting back staff, they will be the ONLY beneficiaries. The patients certainly won't benefit, nor will the nurses. Should a handful of self-centered individuals be empowered with the ability to negatively impact health care solely to protect and maintain their own already opulent lifestyles? I ask you, everybody: IS THIS NECESSARY? Why should hospital CEOs and directors receive exorbitant salaries when they are doing virtually nothing themselves to heal or comfort their customers, the patients? Why are they attempting to cut employee pensions at a time when the insolvency of Social Security is looming? Why are they, in effect, STEALING from their employees, the very people who ARE healing and comforting their customers? Shouldn't the priority here be the maximization of patient comfort and quality of care rather than the maximization of hospital profit and/or CEO and stockholder earnings and benefits?

This is not an isolated incident. Corporations all across this country have been chipping away at employee pay and benefits for far too long, and the time for a reversal of this is long overdue. It is my sincere hope that, if these purported actions against nurses are taken by Minneapolis-St. Paul hospitals, the Minnesota Nurses Association will respond more vigorously in their negotiations than they ever have before. Enough is enough. When the greed of a handful of piggish individuals begins to hurt patient health care, these piggish individuals have gone WAY too far! They will - if not directly, strongly, and successfully challenged - effectively be instituting their own PRIVATE "death panels" which will be REAL, unlike the fictitious government ones Sarah Palin has lied about. These CEOs are classic examples of how badly broken our existing for-maximum-profit health care system is, and they are walking billboards for a fully government-run, single-payer system like every other civilized country in the world has!