OrbStandard

The Price of Freedom and Democracy our
Elected Officials are Willing to Pay
Sleep impaired RN’s, LPN’s, Technicians and Nurses Aides
BY Joseph A. Mungai, RN
December 13, 2005

In the Stanford University‘s “OVERVIEW OF THE FINDINGS OF THE NATIONAL COMMISSION ON SLEEP DISORDERS RESEARCH (1992)” (http://www.stanford.edu/~dement/overview-ncsdr.html) it is stated; “The lack of awareness throughout America about the nature and impact of sleep disorders and sleep deprivation is a national emergency. Witnesses asked repeatedly, "How many preventable deaths are going to occur this year?" "Why don't we do something right now?" "Why don't we save as many lives as possible now - not years or decades from now?" The Commission has concluded that the American public has been inappropriately denied the benefits of the research knowledge its tax dollars have supported. The Commission recommends that a major public awareness/education campaign about sleep and sleep disorders be undertaken immediately by the federal government”.

About a decade later the Agency for Healthcare Research and Quality (AHRQ) was assigned the lead federal agency for patient safety. “AHRQ established the Center for Quality Improvement and Safety, which has become the nation’s leading source for education, training, disseminating information, developing measures and facilitating the setting of standards for furthering patient safety efforts”. (http://www.hsph.harvard.edu/press/releases/press05172005.html)

There’s already a plethora of studies on sleep deprivation and other systemic problems causing errors in the public and private sector and in 2001 the AHRQ appropriated 50 million dollars to “examine how staffing, fatigue, stress, sleep deprivation, and other factors can lead to errors……..and other patient safety activities”. (http://www.ahrq.gov/news/press/pr2001/patsafpr.htm)

Dr. Lucian Leape of Harvard concluded in a 1991 study, “Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Practice Study” that “There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care” (http://qhc.bmjjournals.com/cgi/content/full/13/2/145).

Two-hundred-sixty-eight (268) in-hospital patients die each day due to medical errors per the 1999 IOM report, “To Err is Human”.

In the U.S.A. your chances of dying in a car accident is 142 times greater than being murdered in a terrorist attack per a study in the latest issue of “Injury Prevention” (http://www.medicalnewstoday.com/medicalnews.php?newsid=34352). In 2002 there were 117.8 automobile accident deaths per day, which equates to a 2.27 times greater risk of dying in a hospital. {43,005/365 = 117.8 and 268/117.8 = 2.27} (From the article, “Motor Vehicle Crashes as a Leading Cause of Death in the United States”: http://www.weitzlux.com/motorvehiclecrashes/leadingcauseofdeath_960.html)

Finally, a report came out in 2003 by the IOM (Institute Of Medicine), “Keeping Patients Safe; Transforming The Work Environment Of Nurses” costing nearly 1 million dollars to complete, paid in part by taxpayers. In this study it states, “To reduce error-producing fatigue, state regulatory bodies should prohibit nursing staff from providing patient care in any of the combination of scheduled shifts, mandatory overtime, or voluntary overtime in excess of 12 hours in any given 24-hour period and in excess of 60 hours per 7-day period”. (http://www.illinoisnurses.org/) Remember medical equipment is much more complicated in Med/Surg, ICU, CCU and Dialysis Units, etc., today.

The press release for this study from the National Academies states: “Long work hours pose one of the most serious threats to patient safety, because fatigue slows reaction time, decreases energy, diminishes attention to detail, and otherwise contributes to errors. While most nurses typically work eight- to 12-hour shifts, some work even longer hours. At the same time, patients admitted to hospitals typically are more acutely ill and require technologically more complicated than in the past. State regulatory bodies should prohibit nursing staff from working longer than 12 hours a day and more than 60 hours per week, the committee said”. (http://www4.nationalacademies.org/news.nsf/isbn/0309090679?OpenDocument)

Now review what your elected officials and some bargaining representatives have done to affect positive change. There are NO LAWS limiting the amount of hours an rn, lpn, technician or nurse’s aide can work in a week. They can work unlimited hours, which means 16 hour days between jobs for 80 or more hours in a week despite the prevalence of studies pleading for government, state regulatory agencies, hospital administrations, unions, and the publics’ attention.

Instead, as in Illinois, the government placed caps on jury awards should you be injured by “the result of substandard care” (Dr. Lucian Leape, 1991). Then, as reported in the Chicago Suntimes, “Hospital mistakes going public in 2008” released November 28, 2005, it states, “They're called "never events" -- inexcusable hospital foul-ups that should never occur but happen all too often -- say, a hospital operates on the wrong leg, or leaves behind a surgical sponge, uses the wrong blood type or kills a patient with a medication overdose.”

The article also informs the public that, “The never events law takes effect Jan. 1, 2008. After each event, the hospital must analyze the cause and take corrective action. The names of patients and health care workers will remain confidential. The information cannot be used in malpractice lawsuits. And the state will not take disciplinary action for any mistakes. Illinois is the fourth state to pass a never events law.”

Since 1991 there has been no significant, important and effective changes made as evidenced by “Med Err International Ltd., Winter of 2005 (http://www.mederr.com/?src=overture), which alerts us to the fact, “Six years have passed since the IOM Report “To Err is Human” (1999) and in spite of numerous products, targeting specific types of medical errors, the rate of error occurrences has not changed”.

Keep in mind that the government enacted laws to limit the amount of money you can be awarded for grotesque injuries, pain and suffering due to neglect, abuse and malpractice. To add insult to your injuries the “NEVER EVENTS LAW” concept conceals evidence of the abuse, neglect and malpractice you were subjected to as you can’t use these facts to defend and validate your pain and suffering.

Politicians claim they enacted these laws under the guise of reducing healthcare costs. A study clearly describing these fallacious allegations is highlighted in the article, “FALLING CLAIMS AND RISING PREMIUMS IN THE MEDICAL MALPRACTICE INSURANCE INDUSTRY” (http://www.centerjd.org/ANGOFFReport.pdf). It concludes:

“Over the last five years the amount the major medical malpractice insurers have collected in premiums has more than doubled, while their claims payouts have remained essentially flat.

Some malpractice insurers substantially increased their premiums while both their claims payments and their projected future claims payments were decreasing.

Malpractice insurers accumulated record amounts of surplus over the last three years.

Taken together, the malpractice carriers analyzed increased their net premiums by 120.2% during the period 2000-2004, although their net claims payments rose by only 5.7%. Thus, they increased their premiums by 21 times (120.2/5.7 = 21.09) the increase in their claims payments.

As a result of these two dramatically different trends, the ratio between these insurers’ claims payments and premiums fell by more than half between 2000 and 2004: it declined from 69.9% to 33.6% on a net basis, and from 68.8% to 32.1% on a gross basis.

Put another way, in 2004 the leading medical malpractice insurers took in approximately three times as much in premiums as they paid out in claims. Moreover, several insurers substantially increased their premiums even though their claims payments actually fell--and fell substantially.” (Also see the Public Citizen study released Jan. 16, 2003 at: http://www.citizen.org/pressroom/release.cfm?ID=1303)

In November of 2005 the media source “Reuters” published the article, “U.S. Leads Way in Medical Errors: Study”. It sums up the study conducted by the Commonwealth Fund by stating, “Patients in the United States reported higher rates of medical errors and more disorganized doctor visits and out-of-pocket costs than people in Canada, Britain and three other developed countries, according to a survey released on Thursday.

Thirty-four percent of U.S. patients received wrong medication, improper treatment or incorrect or delayed test results during the last two years, the Commonwealth Fund found.

Thirty percent of Canadian patients reported similar medical errors, followed by 27 percent of those in Australia, 25 percent in New Zealand, 23 percent in Germany and 22 percent in Britain, the health care foundation said.

"Driven up by relatively high medication and lab or test errors, at 34 percent, the spread between the United States and the countries with the lowest error rates was wide," Cathy Schoen, senior vice president of Commonwealth Fund, wrote in the journal Health Affairs, which published the study on its Web site.” (http://www.alertnet.org/thenews/newsdesk/N02241096.htm)

In pleasant conversation ASK YOUR HEALTHCARE STAFF HOW MANY PATIENTS ARE ASSIGNED PER RN? HOW MANY HOURS WILL THEY BE WORKING TODAY? HOW MANY HOURS A WEEK DO THEY WORK?

There are more than enough taxpayer funded studies to guide the healthcare system in the right direction. However, it still remains a blatant fact that many politicians prefer to err on the side of hospital administrations than on the side of patient safety. Where human life is concerned, money and politics shouldn’t be the driving force---Conscience, compassion, evidence based practice and common sense should be. It doesn’t make sense to pay for studies with our tax dollars and then ignore them while complaining spending is out of control.

The government surely retaliates against whistleblowers, just watch the 6 o’clock news or read the paper and you will see government sources listed as anonymous, “a White House source”, “a source close to the Vice President”, “inside sources” etc.

As one who was severely retaliated against for raising unsafe staffing issues when working for the government I can safely say you need to report the hazards in groups. When reporting to the media as a group you can request anonymity, it would be journalistic suicide if the media disclosed their sources.

Hospital managers and staff also retaliate against patients and employees. So what is the answer?

This is the moment to organize groups, affiliate with existing advocacy organizations, contact the media and watchdog groups, write letters to the editor and sign petitions.

Petition your congresspersons asking if they voted for legislation that limits monetary awards should you become injured, disabled, disfigured or die under the longstanding “substandard care” in our healthcare system. Ask them if they voted or intend to vote on a bill that effectively conceals the evidence of malpractice leading to injury and death of our fellow Americans.

Follow this with the question, Why haven‘t you passed legislation that limits hours worked in a day to 12, and hours worked in a week to 60? Certainly we don’t want air-traffic-controllers, airline pilots flying or nuclear-power-plant-operators working 16 hour days for weeks, months or years on end (remember 3-Mile Island). 268 patients die needlessly each day, that’s the equivalent of three fully loaded jumbo jets crashing every other day.

You may also want to politely ask why their leadership hasn’t produced the kind of results that has brought about a decrease in the number of “preventable deaths”, 268 each day. Remind them they had more than ample time to affect this kind of change before 9/11. And point out the fact that priorities need to be in favor of the public they serve---NOT solely corporate and campaign interests as reflected from the past.

Accentuate the reality that medicine in the United States is the leading cause of death. If our “leaders” are sleep impaired to the point of being unable to grasp the gravity and enormity of the crisis they need to let someone else read the studies and then make the decisions that affect the safety and well being of the “poor and huddled masses”. Anything less is incompetence, abuse of power and neglect of duty.

In conclusion, there are more than 1 million nurses working in hospitals in this country according to the CDC (http://www.cdc.gov/ncidod/EID/vol10no11/04-0253.htm). If there was just 1 million and only 5% of them worked 16 hour days that would be a total of 50,000 registered nurses engaging in this highly risky behavior at your expense. If only 10% of the 268 preventable deaths occurring each day were caused by these voluntarily sleep impaired nurses, it would amount to 26.8 lives annihilated per day. Since politicians are not living up to their moral obligations “we the people” must come forward and declare our intention---WE WILL NO LONGER ACCEPT BEING TREATED LIKE SOMETHING YOU STEPPED IN!! (S_ _ _ !)