Monday, December 21, 2009 3:12 AM
By Suzanne Hoholik
THE COLUMBUS DISPATCH
While you watch parades and football games on New Year's Day, you can fire up your computers and compare Ohio hospitals.
A state law passed nearly four years ago requires hospitals to provide extensive quality and pricing information to the Ohio Department of Health. A consumer-friendly Web site with this information goes live Jan. 1.
Hospitals already report some of this information, but it's difficult for consumers to compare hospitals.
"A lot of that information was out there but was never in a user-friendly format for everyday users of health care," said Jim Raussen, the former state legislator who sponsored the legislation.
"It has to be transparent for the average citizen so they can feel comfort that the information they're getting makes sense to them and is accurate," Raussen said.
The site is called Ohio Hospital Compare and will feature more than 100 quality measures, including mortality and infection rates and how often specific medical procedures are performed at a hospital. There is even information about whether a hospital has a hand-washing program for its health workers.
On the main page, consumers will be able to pick hospitals to compare on quality measures.
Consumers need access to this kind of information, said Cathy Levine, executive director of the Universal Health Care Action Network of Ohio.
"Hospitals need to be reporting publicly their quality measures such as hospital-acquired infections and preventable complications, so they feel public pressure to improve patient quality and safety," she said.
The Web site also will link to lists of hospital charges, but they won't be in an easy-to-use format until the end of 2010, said Sara Morman, a Health Department spokeswoman.
At that time, consumers will be able to compare charges such as for private and semiprivate rooms, the 30 most-common X-rays, and services in emergency, operating and delivery rooms.
Hospitals caution that these charges aren't what the 88 percent of insured Ohioans will pay. Private and government insurance pay lower, negotiated rates.
"Each one of our health plans has a negotiated rate that's substantially less than those charges," said John Stone, chief financial officer at Ohio State University Medical Center. "We don't have two like payments from any one payer."
Even so, knowing what hospitals charge for the same thing will be helpful, said Kelly McGivern, president of the Ohio Association of Health Plans.
"It's a good barometer just for educating consumers on what these services actually cost," she said. "They need to know it's not going to cost them $10 to have a baby, that it actually costs more than that."
On Jan. 1, consumers will be able to compare hospitals by going to http://www.odh.ohio.gov/ and clicking on Ohio Hospital Compare.
Monday, December 21, 2009
Tuesday, November 10, 2009
Sebelius Announces Release of Recovery Act Funding to Improve Care in Nation’s Ambulatory Surgical Centers
To reduce healthcare-associated infections (HAIs) in stand-alone or same-day surgical centers, the HHS Secretary Kathleen Sebelius today announced the availability of up to $9 million in funding from the American Recovery and Reinvestment Act (ARRA) to state survey agencies in 43 states. HAIs are infections some patients acquire when they are in a health care setting such as a hospital or outpatient clinic.
“Because of the Recovery Act, millions of patients who go to stand-alone surgical centers will have greater assurance that they won’t come home with a new infection,” said Health and Human Services’ Secretary Kathleen Sebelius. “Residents in these 43 states will continue to see the benefits from the Recovery Act not only by addressing health care associated infections, but by putting people to work to solve an important issue and improve the quality of life for Americans.”
“Healthcare-Associated Infections kill nearly 100,000 people and add an extra $30 billion in healthcare costs every year. But with a little bit of knowledge, and some extra effort, much of that can be prevented. I’m glad to see these funds going to help put people to work combating this tragedy around the country,” said Congressman Dave Obey (D-WI), the Chairman of the House Appropriations Committee, who was a lead author of the Recovery Act and has been an outspoken advocate for efforts to reduce HAIs.
Accredited facilities are surveyed by CMS-approved private accrediting organizations. As part of the new initiative, surveyors in the 43 states will survey approximately 1,300 ambulatory surgical centers (ASCs) across the nation, one-third of the more than 3,800 non-accredited ASCs across the country during the next 12 months. State surveyors will employ a new CMS survey process for ASCs that uses an infection control tool developed in conjunction with the Centers for Disease Control and Prevention (CDC).
Across the United States, health care services are being shifted to outpatient settings such as ambulatory care facilities, long term care facilities, and free-standing specialty care sites. The number of ASCs participating in Medicare grew from about 3600 in calendar year 2002 to 5200 in early 2009, a 44 percent increase. ASCs account for more than 43 percent of all same-day (ambulatory) surgery in the United States, amounting to about 15 million procedures every year. Typical surgical procedures conducted in ASCs include endoscopies and colonoscopies, orthopedic procedures, plastic/reconstructive surgeries, and eye, foot, and ear/nose/throat surgeries.
HAI outbreaks in outpatient settings continue to occur according to the CDC. In several ASC-related communicable disease outbreaks, failure to employ very basic infection control practices were implicated, leading CMS to identify this as an area for additional oversight.
In the last fiscal year, 12 states volunteered to get a head start on this nationwide effort to reduce healthcare-associated infections in stand-alone or same-day surgical centers by beginning to survey ASCs with funding of nearly $1 million provided through the Recovery Act.
In addition to the funds being made available for the inspection of ASCs, the CDC has also made $40 million available to state public health departments to create or expand state-based HAI prevention and surveillance efforts, and strengthen the public health workforce trained to prevent HAIs.
These funds support activities outlined in HHS’ 2009 Action Plan to Prevent Healthcare-Associated Infections. The plan also establishes national goals, prioritizes recommended clinical practices, and coordinates a national research agenda. Development of this national plan, available at http://www.hhs.gov/ophs/initiatives/hai, is coordinated by HHS’ Office of Public Health and Science, and involves participation from the Agency for Healthcare Research and Quality, CDC, CMS, the Food and Drug Administration, the Indian Health Service, the Health Resources and Services Administration, the National Institutes of Health, the Office of the National Coordinator for Health Information Technology, and other HHS offices, and the Department of Veterans Affairs.
“Because of the Recovery Act, millions of patients who go to stand-alone surgical centers will have greater assurance that they won’t come home with a new infection,” said Health and Human Services’ Secretary Kathleen Sebelius. “Residents in these 43 states will continue to see the benefits from the Recovery Act not only by addressing health care associated infections, but by putting people to work to solve an important issue and improve the quality of life for Americans.”
“Healthcare-Associated Infections kill nearly 100,000 people and add an extra $30 billion in healthcare costs every year. But with a little bit of knowledge, and some extra effort, much of that can be prevented. I’m glad to see these funds going to help put people to work combating this tragedy around the country,” said Congressman Dave Obey (D-WI), the Chairman of the House Appropriations Committee, who was a lead author of the Recovery Act and has been an outspoken advocate for efforts to reduce HAIs.
Accredited facilities are surveyed by CMS-approved private accrediting organizations. As part of the new initiative, surveyors in the 43 states will survey approximately 1,300 ambulatory surgical centers (ASCs) across the nation, one-third of the more than 3,800 non-accredited ASCs across the country during the next 12 months. State surveyors will employ a new CMS survey process for ASCs that uses an infection control tool developed in conjunction with the Centers for Disease Control and Prevention (CDC).
Across the United States, health care services are being shifted to outpatient settings such as ambulatory care facilities, long term care facilities, and free-standing specialty care sites. The number of ASCs participating in Medicare grew from about 3600 in calendar year 2002 to 5200 in early 2009, a 44 percent increase. ASCs account for more than 43 percent of all same-day (ambulatory) surgery in the United States, amounting to about 15 million procedures every year. Typical surgical procedures conducted in ASCs include endoscopies and colonoscopies, orthopedic procedures, plastic/reconstructive surgeries, and eye, foot, and ear/nose/throat surgeries.
HAI outbreaks in outpatient settings continue to occur according to the CDC. In several ASC-related communicable disease outbreaks, failure to employ very basic infection control practices were implicated, leading CMS to identify this as an area for additional oversight.
In the last fiscal year, 12 states volunteered to get a head start on this nationwide effort to reduce healthcare-associated infections in stand-alone or same-day surgical centers by beginning to survey ASCs with funding of nearly $1 million provided through the Recovery Act.
In addition to the funds being made available for the inspection of ASCs, the CDC has also made $40 million available to state public health departments to create or expand state-based HAI prevention and surveillance efforts, and strengthen the public health workforce trained to prevent HAIs.
These funds support activities outlined in HHS’ 2009 Action Plan to Prevent Healthcare-Associated Infections. The plan also establishes national goals, prioritizes recommended clinical practices, and coordinates a national research agenda. Development of this national plan, available at http://www.hhs.gov/ophs/initiatives/hai, is coordinated by HHS’ Office of Public Health and Science, and involves participation from the Agency for Healthcare Research and Quality, CDC, CMS, the Food and Drug Administration, the Indian Health Service, the Health Resources and Services Administration, the National Institutes of Health, the Office of the National Coordinator for Health Information Technology, and other HHS offices, and the Department of Veterans Affairs.
Tuesday, November 3, 2009
Where Are the Firing Offenses in Medicine?
Patrick Malone
Posted: October 29, 2009 04:04 PM
The recent news about the two Northwest Airlines pilots whose licenses were revoked, less than a week after they let their plane wander 150 miles off course, raises the question: Where are the firing offenses in medicine?
The pilots injured no passengers, and the event didn't even qualify as a "near miss." But because they egregiously violated safety rules by working on their flight schedules on a laptop in the cockpit, the aviation authorities did not hesitate to pull their licenses.
In the medical industry, by contrast, it is well known that a doctor will lose his or her license for only flagrant patterns of drug or alcohol abuse or other criminal behavior, with a trail of dead and injured patients usually lasting years before the practitioner is finally put out of business.
Medicine's big safety emphasis in recent years has been to create a "no blame" culture that encourages reporting of errors, injuries and "near-misses" by promises of confidentiality and non-punitive action. The idea has been to bring systemic problems out into the open so they can be corrected by implementing "systems" changes, such as checklists to make sure all appropriate steps are taken to prevent infections when inserting catheters into blood vessels.
But what about a doctor who repeatedly puts patients in jeopardy, in small or big ways, by ignoring the rules? Many don't wash their hands routinely when they enter a patient's hospital room, and deadly infections sometimes get spread from patient to patient. Others don't "sign out" their patients at the end of a shift by a person-to-person encounter with the provider taking over.
Some surgeons still won't follow the now routine practice of "signing the site" to prevent wrong-site surgery. If the surgeon is a prominent "feeder" of patients to the hospital, such transgressions can easily be overlooked by administrators who don't want to lose the business. That helps explain why an estimated 4,000 wrong-site surgeries still are performed every year in the United States, more than a decade after the "sign your site" campaign by orthopedic and other surgical specialties.
The good news is that medical safety leaders are starting to call for accountability for rules violations. Dr. Robert Wachter of UC-San Francisco and Dr. Peter Pronovost of Johns Hopkins recently wrote about this in the New England Journal of Medicine. Comparing medicine to aviation (the article was published before the Northwest Airlines incident), they noted: "Every safe industry has transgressions that are firing offenses."
They proposed a short list of offenses in the hospital that should call for suspension of the doctor's practice for one or two weeks: failing to perform hand hygiene, skipping the sign-over to a new provider at the end of a shift, not marking the surgical site, and failing to use a checklist at the start of surgery to make sure everyone in the operating room knows the special needs of the patient. These penalties, they suggested, should only apply after the doctor has failed to respond to an initial warning and counseling.
These modest, tentative steps forward are proposed by the authors to their colleagues as a way of fending off intrusive government regulation. But they also say: "The main reason to find the right balance between 'no blame' and individual accountability is that doing so will save lives."
Amen to that.
Patrick Malone
Attorney and Author of "The Life You Save"
Posted: October 29, 2009 04:04 PM
The recent news about the two Northwest Airlines pilots whose licenses were revoked, less than a week after they let their plane wander 150 miles off course, raises the question: Where are the firing offenses in medicine?
The pilots injured no passengers, and the event didn't even qualify as a "near miss." But because they egregiously violated safety rules by working on their flight schedules on a laptop in the cockpit, the aviation authorities did not hesitate to pull their licenses.
In the medical industry, by contrast, it is well known that a doctor will lose his or her license for only flagrant patterns of drug or alcohol abuse or other criminal behavior, with a trail of dead and injured patients usually lasting years before the practitioner is finally put out of business.
Medicine's big safety emphasis in recent years has been to create a "no blame" culture that encourages reporting of errors, injuries and "near-misses" by promises of confidentiality and non-punitive action. The idea has been to bring systemic problems out into the open so they can be corrected by implementing "systems" changes, such as checklists to make sure all appropriate steps are taken to prevent infections when inserting catheters into blood vessels.
But what about a doctor who repeatedly puts patients in jeopardy, in small or big ways, by ignoring the rules? Many don't wash their hands routinely when they enter a patient's hospital room, and deadly infections sometimes get spread from patient to patient. Others don't "sign out" their patients at the end of a shift by a person-to-person encounter with the provider taking over.
Some surgeons still won't follow the now routine practice of "signing the site" to prevent wrong-site surgery. If the surgeon is a prominent "feeder" of patients to the hospital, such transgressions can easily be overlooked by administrators who don't want to lose the business. That helps explain why an estimated 4,000 wrong-site surgeries still are performed every year in the United States, more than a decade after the "sign your site" campaign by orthopedic and other surgical specialties.
The good news is that medical safety leaders are starting to call for accountability for rules violations. Dr. Robert Wachter of UC-San Francisco and Dr. Peter Pronovost of Johns Hopkins recently wrote about this in the New England Journal of Medicine. Comparing medicine to aviation (the article was published before the Northwest Airlines incident), they noted: "Every safe industry has transgressions that are firing offenses."
They proposed a short list of offenses in the hospital that should call for suspension of the doctor's practice for one or two weeks: failing to perform hand hygiene, skipping the sign-over to a new provider at the end of a shift, not marking the surgical site, and failing to use a checklist at the start of surgery to make sure everyone in the operating room knows the special needs of the patient. These penalties, they suggested, should only apply after the doctor has failed to respond to an initial warning and counseling.
These modest, tentative steps forward are proposed by the authors to their colleagues as a way of fending off intrusive government regulation. But they also say: "The main reason to find the right balance between 'no blame' and individual accountability is that doing so will save lives."
Amen to that.
Patrick Malone
Attorney and Author of "The Life You Save"
Tuesday, October 6, 2009
Safety Gurus: Penalize Doctors Who Don’t Follow the Rules
October 1, 2009, 3:50 PM ETBy Laura Landro
Should hospitals start penalizing doctors and nurses who fail to follow patient safety rules?
That’s one solution proposed by Peter Pronovost of Johns Hopkins and Robert Wachter of the University of California at San Francisco. Writing in the New England Journal of Medicine, the doctors contend that the failure to hold clinicians accountable for patient safety is the main reason health care is still riddled with errors, adverse events, and just plain non-adherence to some of the most basic rules.
(Compliance with hand hygiene rules ranges from 30% to 70% at most hospitals, and few have sustained rates over 80%, the authors note, while there are about 4,000 wrong-site surgeries in the U.S. annually despite a universally accepted protocol for preventing them.)
In the decade since the Institute of Medicine’s landmark “ To Err is Human” report, which estimated that up to 98,000 people a year die of medical errors, many hospitals have embraced a “no blame” model: Instead of focusing on a single individual to blame for a mistake, they’ve tried to set up systems to prevent mistakes, catch them before they cause harm, or mitigate harm from errors that do reach patients. That’s all well and good if it works, but many hospitals are now finding that a blame-free culture creates its own safety risks, Pronovost and Wachter write.
Punishments such as revoking privileges for a chunk of time tend to be used for administrative infractions that cost the hospital money – things like failing to sign the discharge summaries that insurance companies require to pay the hospital bill. By contrast, hospital administrators may just shrug their shoulders when it comes to doctors who fail or refuse to follow rules like a “time out” before surgery to avoid operating on the wrong body part.
Docs and nurses who fail to follow rules about hand hygiene or patient handoffs should lose their privileges for a week, Pronovost and Wachter suggest. They recommend loss of privileges for two weeks for surgeons who who fail to perform a “time-out” before surgery or don’t mark the surgical site to prevent wrong-site surgery.
Pronovost — best known for his development of medical checklists designed to improve patient safety — tells the Health Blog that he still sees a tremendous amount of “pushback” when he speaks to doctors. Many still resist checklists and don’t feel bound by hand washing rules, even though they’ve been shown to prevent harm to patients.
“Some of these doctors just come to the meetings to throw spears at me,” he says. “We know how important these things are for patient safety, but there needs to be some accountability for infractions,” he adds. The suggested penalties “are an attempt at a practical way to hold people accountable.”
Sunday, July 26, 2009
Doctors Want to Roll Back Policies Curbing Gifts Between Doctors And Drug Company Reps
Perks policy for doctors challenged
Physician organization wants limits rolled back
By Liz Kowalczyk,
Boston Globe July 23, 2009
A growing number of hospitals, universities, and states are barring drug companies from buying physicians dinner, hiring them as speakers, and giving them even token gifts.
Now, a new organization of doctors - several from Boston - wants to roll back policies curbing interactions between doctors and drug company representatives, saying restrictive rules ultimately will hurt the patients they’re designed to protect.
The group, called the Association of Clinical Researchers and Educators, plans to hold its first conference today at Brigham and Women’s Hospital to promote “productive collaboration’’ between industry and physicians, which they say leads to better medicines and treatments. Dr. Jeffrey Flier, dean of Harvard Medical School, is one of 25 speakers and will give the welcoming remarks to about 200 attendees.
Flier, who is unaffiliated with the organization, will not endorse its views, said David Cameron, spokesman for the medical school, which is revising its conflict-of-interest policy. “He will welcome vigorous debate and analysis on the issue of academic collaborations with industry and encourage individuals with varied perspectives to participate in the discussion,’’ Cameron said in a written statement.
Dr. Thomas Stossel, an oncologist at the Brigham; Dr. Jeffrey Garber, chief of endocrinology at Harvard Vanguard Medical Associates; and Dr. Paul Richardson, an oncologist at Dana-Farber Cancer Institute, are among the founders of the group. Stossel said they want “to convey that there is a silent majority out there. And to restore some balance to the debate,’’ he said.
The group’s website says its long-term goals include reversing restrictive new conflict-of-interest policies and establishing chapters at universities and within medical specialty societies.
Massachusetts public health officials plan in two years to review the state’s new conflict-of-interest regulations, which went into effect July 1 and include a ban on gifts to doctors from drug and medical device companies, and Stossel said his group “wants to create an outcry against’’ the law. The law also requires drug and device companies to disclose publicly most payments made to doctors for consulting.
Partners HealthCare, which includes the Brigham and Massachusetts General Hospital, passed its own restrictions in April, which go further than the state law, banning all industry-paid gifts and meals and also forbidding doctors from traveling the country as paid members of company “speakers bureaus.’’
The association’s goals, which run contrary to the widespread movement in medicine to create more distance between doctors and pharmaceutical companies, have been widely discussed - and often derided - on healthcare blogs in the past several weeks.
Patient advocacy groups and lawmakers leading the charge for more restrictive policies say Stossel and his colleagues are misguided. Advocates of the restrictions believe drug companies, by giving doctors gifts and paying them to speak and consult, create bias in favor of their products, causing doctors to write more prescriptions for expensive new drugs even if patients don’t really need the medication or if an older, less expensive drug would work just as well.
Dr. Peter Slavin, president of Mass. General, has said that company-funded meals, gifts, and other practices don’t promote a positive image of doctors and increase healthcare costs.
“The rules benefit consumers by removing the conflicts that we know cloud judgment, and let doctors make decisions free from market pressures,’’ said Brian Rosman, research director for Health Care For All, a Boston-based patient advocacy group.
But Stossel and his colleagues said the new rules stifle invention. They believe the impact of small gifts and meals on doctors is negligible compared with the benefit of collaboration.
“I’ve been in medicine 40 years, and medicine is incomparably better than when I started out,’’ Stossel said. “I don’t think anyone can challenge the fact that it’s because of the tools we’ve gotten from industry.’’
Stossel is a former member of Cambridge-based Biogen Idec’s scientific advisory board. He said he now does occasional consulting to companies on conflict-of-interest policies. The conference is funded by attendees’ fees, though participants who work for drug and device companies are charged more, he said.
Physician organization wants limits rolled back
By Liz Kowalczyk,
Boston Globe July 23, 2009
A growing number of hospitals, universities, and states are barring drug companies from buying physicians dinner, hiring them as speakers, and giving them even token gifts.
Now, a new organization of doctors - several from Boston - wants to roll back policies curbing interactions between doctors and drug company representatives, saying restrictive rules ultimately will hurt the patients they’re designed to protect.
The group, called the Association of Clinical Researchers and Educators, plans to hold its first conference today at Brigham and Women’s Hospital to promote “productive collaboration’’ between industry and physicians, which they say leads to better medicines and treatments. Dr. Jeffrey Flier, dean of Harvard Medical School, is one of 25 speakers and will give the welcoming remarks to about 200 attendees.
Flier, who is unaffiliated with the organization, will not endorse its views, said David Cameron, spokesman for the medical school, which is revising its conflict-of-interest policy. “He will welcome vigorous debate and analysis on the issue of academic collaborations with industry and encourage individuals with varied perspectives to participate in the discussion,’’ Cameron said in a written statement.
Dr. Thomas Stossel, an oncologist at the Brigham; Dr. Jeffrey Garber, chief of endocrinology at Harvard Vanguard Medical Associates; and Dr. Paul Richardson, an oncologist at Dana-Farber Cancer Institute, are among the founders of the group. Stossel said they want “to convey that there is a silent majority out there. And to restore some balance to the debate,’’ he said.
The group’s website says its long-term goals include reversing restrictive new conflict-of-interest policies and establishing chapters at universities and within medical specialty societies.
Massachusetts public health officials plan in two years to review the state’s new conflict-of-interest regulations, which went into effect July 1 and include a ban on gifts to doctors from drug and medical device companies, and Stossel said his group “wants to create an outcry against’’ the law. The law also requires drug and device companies to disclose publicly most payments made to doctors for consulting.
Partners HealthCare, which includes the Brigham and Massachusetts General Hospital, passed its own restrictions in April, which go further than the state law, banning all industry-paid gifts and meals and also forbidding doctors from traveling the country as paid members of company “speakers bureaus.’’
The association’s goals, which run contrary to the widespread movement in medicine to create more distance between doctors and pharmaceutical companies, have been widely discussed - and often derided - on healthcare blogs in the past several weeks.
Patient advocacy groups and lawmakers leading the charge for more restrictive policies say Stossel and his colleagues are misguided. Advocates of the restrictions believe drug companies, by giving doctors gifts and paying them to speak and consult, create bias in favor of their products, causing doctors to write more prescriptions for expensive new drugs even if patients don’t really need the medication or if an older, less expensive drug would work just as well.
Dr. Peter Slavin, president of Mass. General, has said that company-funded meals, gifts, and other practices don’t promote a positive image of doctors and increase healthcare costs.
“The rules benefit consumers by removing the conflicts that we know cloud judgment, and let doctors make decisions free from market pressures,’’ said Brian Rosman, research director for Health Care For All, a Boston-based patient advocacy group.
But Stossel and his colleagues said the new rules stifle invention. They believe the impact of small gifts and meals on doctors is negligible compared with the benefit of collaboration.
“I’ve been in medicine 40 years, and medicine is incomparably better than when I started out,’’ Stossel said. “I don’t think anyone can challenge the fact that it’s because of the tools we’ve gotten from industry.’’
Stossel is a former member of Cambridge-based Biogen Idec’s scientific advisory board. He said he now does occasional consulting to companies on conflict-of-interest policies. The conference is funded by attendees’ fees, though participants who work for drug and device companies are charged more, he said.
Thursday, July 16, 2009
Schwarzenegger Replaces Most of State Nursing Board
by Tracy Weber - July 13, 2009 9:55 pm EDT
Tags: Arnold Schwarzenegger, California, California Board of Registered Nursing, Nurses
California Gov. Arnold Schwarzenegger (John Moore/Getty Images)California Gov. Arnold Schwarzenegger replaced nearly everyone on the Board of Registered Nursing late Monday, citing the unacceptable length of time it takes to discipline nurses accused of egregious misconduct.
Correction (July 14, 2009): This story incorrectly referred to former Board of Registered Nursing vice president Elizabeth O. Dietz as a professor of nursing at San Jose State. Although the board’s web site lists that as her current affiliation, the university said she retired in July 2008.
Update (July 14, 2009): Nursing Board Executive Officer Ruth Ann Terry Resigns [1]
Gov. Arnold Schwarzenegger replaced most members of the California Board of Registered Nursing on Monday, citing the unacceptable time it takes to discipline nurses accused of egregious misconduct.
He fired three of six sitting board members [2] – including President Susanne Phillips [3] – in two-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, the governor's administration released a list of replacements.
The shake-up came a day after the Los Angeles Times and ProPublica published an investigation [4] finding that it takes the board, which oversees 350,000 licensees, an average of three years and five months [5] to investigate and close complaints against nurses.
During that time, nurses accused of wrongdoing are free to practice – often with spotless records – and move from hospital to hospital. Potential employers are unaware of the risks, and patients have been harmed as a result.
Reporters found nurses who continued to work unrestricted for years despite documented histories of incompetence, violence, criminal convictions and drug theft or abuse. In dozens of cases, nurses maintained clean records in California even though they had been suspended or fired by employers, disciplined by another California licensing board or restricted from practice by other states.
"It is absolutely unacceptable that it takes years to investigate such outrageous allegations of misconduct against licensed health professionals whom the public rely on for their health and well-being," Schwarzenegger said in a written statement.
Board member Andrea Guillen Dutton, in a resignation letter Sunday [6], said she was leaving in frustration. "Certain ‘bad actors' are jeopardizing the reputation of the entire nursing profession," she wrote. "This deeply saddens me."
"I have fought to defend the integrity of patient care throughout the state by holding the negligent accountable," she wrote. "However, I have grown increasingly frustrated by the board's lack of ability to achieve its stated objectives in a timely and efficient manner."
Besides Phillips, the other fired board members were vice president Elizabeth O. Dietz, a former professor of nursing at San Jose State, and Janice Glaab, a public affairs consultant.
Schwarzenegger's action Monday fills two of three vacancies on the board [2] and replaces four of the board's sitting members – all of whom had been appointed by him.
The two remaining members are Nancy L. Beecham, appointed by the governor in 2006, and Dian Harrison, who was appointed last year by Assembly speaker Karen Bass.
Neither Beecham nor Harrison could be reached late Monday, nor could any of the departing board members.
Schwarzenegger's statement said his "administration is dedicated to protecting public health and safety, and the new board will act quickly and decisively to achieve that goal."
Fred Aguiar, secretary of the State and Consumer Services Agency, said in an interview that the new board would be asked immediately to come up with a plan to eliminate the case backlog. "This plan needs to include how many more investigators are needed, how much that will cost. … I want to know now."
California Board of Registered Nursing executive officer
Ruth Ann Terry (Liz O. Baylen/Los Angeles Times)
The governor's decision does not directly affect the standing of Ruth Ann Terry, who has been the board's executive officer for nearly 16 years and a staff member for 25. Only the board has the power to hire and fire the executive.
Terry, reached late Monday, hung up on a reporter, saying, "We don't have anything to say."
But Aguiar suggested Monday that Terry and other staffers could be vulnerable. The governor "supports the new board in its commitment to protecting patients – and if that means cleaning house, including board staff, so be it," he said. "The days of excuses and status quo are over. It's broken and we're going to fix it."
The Times and ProPublica
In an interview last week, Terry acknowledged that the system needed to be "streamlined" but blamed other parts of the state's bureaucracy for delays.
Early Monday, Terry and her assistant executive officer, Heidi Goodman,
"Ruth and I are aware of the grim picture painted by this article," they wrote, "however, the board members, managers and supervisors know that you work very hard to carry out the mission of the board to protect the healthcare consumers in California and we appreciate all that you do."
Presented with the investigation's findings Thursday, board President Phillips, a family nurse practitioner and associate clinical professor at UC Irvine, said she supported Terry "absolutely – without question."
"The issue of patient safety is of the utmost importance to this board," she said. "It's not that we are ignoring a situation where there are delays. We absolutely are not."
Questions about the board's leadership were first raised last fall
In addition to the governor's action, the state Senate Business and Professions Committee, which has jurisdiction over the board, plans to hold a hearing next month to address the issues raised in The Times' article.
The committee will look at introducing legislation that would appoint an "enforcement monitor" to evaluate the board's discipline process and make recommendations, said Bill Gage, the committee's chief consultant. Such a monitor was appointed at one time to work with the Medical Board of California, which regulates the state's doctors.
Consumer advocate Ken McEldowney said the board members need to do more than just fill seats.
"The leadership is key," said McEldowney, executive director of Consumer Action, a San Francisco-based national consumer advocacy and education membership organization.
"It just appears to me that they don't care."
The six new board members are: Ann Boynton, 47, of Sacramento, a former undersecretary for the Health and Human Services Agency; Judy Corless, 58, of Corona, a clinical nursing director at the Corona Outpatient Surgical
Center since April 2009; Jeannine Graves, 49, of Sacramento, a staff nurse for the Capitol Surgical Associates and the Mercy San Juan Medical Center; Richard Rice, 60, of Imperial Beach, a former chairman of the Unemployment Insurance Appeals Board; Catherine Todero, 57, of La Mesa, director of the school of nursing at San Diego State University and a professor there; and Kathrine Ware, 50, of Davis, a nurse practitioner for the Vascular Center Clinic at the University of California Davis.
These positions do not require Senate confirmation, and the compensation is $100 per working day.
[8] when The Times and ProPublica reported that nurses with serious or multiple criminal convictions kept their licenses for years before the board acted against them. As a result, the board now requires every nurse to submit fingerprints [9], which can be matched against arrest records. Renewing nurses must also disclose any convictions or discipline by other states.sent an e-mail to all board staff members encouraging them not to lose heart [7].found that the board relied heavily on Terry and her staff [4]. At five public meetings attended by reporters since November 2007, Terry never focused on the delays in disciplining errant nurses. Neither did board members, even though they must vet all disciplinary actions.
by Tracy Weber - July 13, 2009 9:55 pm EDT
Tags: Arnold Schwarzenegger, California, California Board of Registered Nursing, Nurses
California Gov. Arnold Schwarzenegger (John Moore/Getty Images)California Gov. Arnold Schwarzenegger replaced nearly everyone on the Board of Registered Nursing late Monday, citing the unacceptable length of time it takes to discipline nurses accused of egregious misconduct.
Correction (July 14, 2009): This story incorrectly referred to former Board of Registered Nursing vice president Elizabeth O. Dietz as a professor of nursing at San Jose State. Although the board’s web site lists that as her current affiliation, the university said she retired in July 2008.
Update (July 14, 2009): Nursing Board Executive Officer Ruth Ann Terry Resigns [1]
Gov. Arnold Schwarzenegger replaced most members of the California Board of Registered Nursing on Monday, citing the unacceptable time it takes to discipline nurses accused of egregious misconduct.
He fired three of six sitting board members [2] – including President Susanne Phillips [3] – in two-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, the governor's administration released a list of replacements.
The shake-up came a day after the Los Angeles Times and ProPublica published an investigation [4] finding that it takes the board, which oversees 350,000 licensees, an average of three years and five months [5] to investigate and close complaints against nurses.
During that time, nurses accused of wrongdoing are free to practice – often with spotless records – and move from hospital to hospital. Potential employers are unaware of the risks, and patients have been harmed as a result.
Reporters found nurses who continued to work unrestricted for years despite documented histories of incompetence, violence, criminal convictions and drug theft or abuse. In dozens of cases, nurses maintained clean records in California even though they had been suspended or fired by employers, disciplined by another California licensing board or restricted from practice by other states.
"It is absolutely unacceptable that it takes years to investigate such outrageous allegations of misconduct against licensed health professionals whom the public rely on for their health and well-being," Schwarzenegger said in a written statement.
Board member Andrea Guillen Dutton, in a resignation letter Sunday [6], said she was leaving in frustration. "Certain ‘bad actors' are jeopardizing the reputation of the entire nursing profession," she wrote. "This deeply saddens me."
"I have fought to defend the integrity of patient care throughout the state by holding the negligent accountable," she wrote. "However, I have grown increasingly frustrated by the board's lack of ability to achieve its stated objectives in a timely and efficient manner."
Besides Phillips, the other fired board members were vice president Elizabeth O. Dietz, a former professor of nursing at San Jose State, and Janice Glaab, a public affairs consultant.
Schwarzenegger's action Monday fills two of three vacancies on the board [2] and replaces four of the board's sitting members – all of whom had been appointed by him.
The two remaining members are Nancy L. Beecham, appointed by the governor in 2006, and Dian Harrison, who was appointed last year by Assembly speaker Karen Bass.
Neither Beecham nor Harrison could be reached late Monday, nor could any of the departing board members.
Schwarzenegger's statement said his "administration is dedicated to protecting public health and safety, and the new board will act quickly and decisively to achieve that goal."
Fred Aguiar, secretary of the State and Consumer Services Agency, said in an interview that the new board would be asked immediately to come up with a plan to eliminate the case backlog. "This plan needs to include how many more investigators are needed, how much that will cost. … I want to know now."
California Board of Registered Nursing executive officer
Ruth Ann Terry (Liz O. Baylen/Los Angeles Times)The governor's decision does not directly affect the standing of Ruth Ann Terry, who has been the board's executive officer for nearly 16 years and a staff member for 25. Only the board has the power to hire and fire the executive.
Terry, reached late Monday, hung up on a reporter, saying, "We don't have anything to say."
But Aguiar suggested Monday that Terry and other staffers could be vulnerable. The governor "supports the new board in its commitment to protecting patients – and if that means cleaning house, including board staff, so be it," he said. "The days of excuses and status quo are over. It's broken and we're going to fix it."
The Times and ProPublica
In an interview last week, Terry acknowledged that the system needed to be "streamlined" but blamed other parts of the state's bureaucracy for delays.
Early Monday, Terry and her assistant executive officer, Heidi Goodman,
"Ruth and I are aware of the grim picture painted by this article," they wrote, "however, the board members, managers and supervisors know that you work very hard to carry out the mission of the board to protect the healthcare consumers in California and we appreciate all that you do."
Presented with the investigation's findings Thursday, board President Phillips, a family nurse practitioner and associate clinical professor at UC Irvine, said she supported Terry "absolutely – without question."
"The issue of patient safety is of the utmost importance to this board," she said. "It's not that we are ignoring a situation where there are delays. We absolutely are not."
Questions about the board's leadership were first raised last fall
In addition to the governor's action, the state Senate Business and Professions Committee, which has jurisdiction over the board, plans to hold a hearing next month to address the issues raised in The Times' article.
The committee will look at introducing legislation that would appoint an "enforcement monitor" to evaluate the board's discipline process and make recommendations, said Bill Gage, the committee's chief consultant. Such a monitor was appointed at one time to work with the Medical Board of California, which regulates the state's doctors.
Consumer advocate Ken McEldowney said the board members need to do more than just fill seats.
"The leadership is key," said McEldowney, executive director of Consumer Action, a San Francisco-based national consumer advocacy and education membership organization.
"It just appears to me that they don't care."
The six new board members are: Ann Boynton, 47, of Sacramento, a former undersecretary for the Health and Human Services Agency; Judy Corless, 58, of Corona, a clinical nursing director at the Corona Outpatient Surgical
Center since April 2009; Jeannine Graves, 49, of Sacramento, a staff nurse for the Capitol Surgical Associates and the Mercy San Juan Medical Center; Richard Rice, 60, of Imperial Beach, a former chairman of the Unemployment Insurance Appeals Board; Catherine Todero, 57, of La Mesa, director of the school of nursing at San Diego State University and a professor there; and Kathrine Ware, 50, of Davis, a nurse practitioner for the Vascular Center Clinic at the University of California Davis.
These positions do not require Senate confirmation, and the compensation is $100 per working day.
[8] when The Times and ProPublica reported that nurses with serious or multiple criminal convictions kept their licenses for years before the board acted against them. As a result, the board now requires every nurse to submit fingerprints [9], which can be matched against arrest records. Renewing nurses must also disclose any convictions or discipline by other states.sent an e-mail to all board staff members encouraging them not to lose heart [7].found that the board relied heavily on Terry and her staff [4]. At five public meetings attended by reporters since November 2007, Terry never focused on the delays in disciplining errant nurses. Neither did board members, even though they must vet all disciplinary actions.
Saturday, July 4, 2009
Consumer Reports Profiles Survivor Alicia Cole
Reform should make it easy to get information on qualityAugust 2009
'I lay in my hospital bed watching my stomach turn black and purple and rot. It looked as if I had been snapped in half by a shark.'— Alicia Cole, 46, of Sherman Oaks, Calif.Photo by Melanie Eve Barocas
This article is the archived version of a report that appeared in the August 2009 Consumer Reports magazine.
When Alicia Cole learned she needed surgery for benign fibroids, she did her homework on the surgeon and the hospital. "I looked at HealthGrades, Leapfrog, Hospital Compare, and other Web sites," says Cole, a 46-year-old actress from Sherman Oaks, Calif. "But one thing I didn't check was the hospital's infection rate."
Even if she had tried to check, California hospitals didn't have to make such data public, and hers didn't. Cole had the operation there anyway. During her hospital stay, she came down with a post-surgical flesh-eating infection that turned her entire midsection into something worthy of a horror movie. After two months in the hospital and two years of painful rehabilitation, she still can't work. "The skin and scar tissue is so delicate that the least pressure will tear or scratch it," she says. Federal inspectors subsequently found unsterile conditions in the hospital's operating area.
Enraged by her experience, Cole joined the fight against hospital infections and helped persuade the California legislature to pass a law requiring public reporting; she now sits on the advisory board for the law. Did she ever learn the hospital's infection rate? Sadly, no. The law has not yet been implemented. "What we really need is a national law," Cole says, noting that hospital-acquired infections are a leading cause of death in this country. "It's the elephant in the room," she says.
CU recommends
Health reform should make it simple to get good information on health-care quality. You should be able to find data not only on infection rates, a reform we've backed for years, but also on doctors, drugs, treatments, and errors. Yet most states still allow doctors to shield a history of malpractice settlements. And infection rates, if reported at all, are often kept secret, which doesn't provide enough incentive for improvement.
What does work is disclosure. Pennsylvania, which passed the first statewide reporting law, remains the only state to require disclosure of all major types of hospital infections. And infections there have dropped 8 percent in the last two years.
Read about our latest reform efforts and our analysis of legislation as its being debated in Washington, D.C. in our Guide to Health-Care Reform.
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