ProPublica guides reporters to check local boards
Filed under: Government, Health data, Health journalism, Nursing, Public records, Tools
For those of you who have followed the ongoing investigation ProPublica’s Charles Ornstein and Tracy Weber have done into nurses and whether states are reporting disciplinary actions, you might have a chance to localize the story.
ProPublica has posted a guide, “Reporting Recipe: How You Can Investigate Your State’s Oversight of Its Nurses and Other Licensed Professionals,” to help reporters and the public check up on what’s happening in their states.
ProPublica editor-in-chief Paul Steiger and managing editor Stephen Engelberg, explain why they are providing the reporters’ techniques and insights:
We hope that others will use the techniques created by Ornstein and Weber to hold local officials accountable. Reporters who look into the local boards that oversee nurses or other health professionals will make new discoveries, some of which will undoubtedly go beyond what we have found. That, in turn, will help others push the story ahead. We hope statehouse reporters, beat reporters, general assignment reporters, bloggers, citizen journalists and others will use this road map.
Use the state-by-state guide prepared by Ornstein (also president of AHCJ’s board of directors) and Weber that shows what information is available to the public in each state and specific things to look for in the records.
They have used the data to identify some states that appear to be inconsistent in reporting disciplinary actions against medical professionals. If you are covering any of these states, you should probably be looking into the story yourself:
- Florida
- Georgia
- Illinios
- Indiana
- Kentucky
- Michigan
- Mississippi
- New Jersey
- Ohio
- Tennessee
- Wisconsin
- West Virginia
Nurses push to make up for physician shortages
Kaiser Health News’ Andrew Villegas reports that the nation’s 125,000-plus nurse practitioners (and physician assistants, certified nurse midwives and dental therapists) are stepping up to fill the void created by America’s shortage of primary care physicians.
The Association of American Medical Colleges projects that the shortage of primary care physicians will reach 46,000 by 2025 and it will only increase if health care reform efforts succeed and millions of Americans are added to the ranks of the insured, Villegas writes. Nurse practitioners typically handle basic services such as physical exams, common health issues and some drug prescriptions.
Debate over national health overhaul legislation has heightened the sense of urgency about primary care and given nurses ammunition for their argument. “The biggest group of clinicians that will be in shortage with universal (insurance) coverage will be those who provide primary care — and that’s what nurse practitioners are so extraordinarily good at,” says Mary Mundinger, dean of the Columbia University School of Nursing.
There is precedent: Massachusetts’ 2008 health insurance overhaul recognized the 5,600 nurse practitioners as primary care providers who would be reimbursed through private insurance and Medicaid at the same rates as doctors. The nurses, however, must work under written protocols that designate a physician who can provide medical direction.
Despite questions from the American Medical Association, proponents argue that practitioners, who are typically required to have a master’s degree in nursing and work under a doctor’s supervision, know their limits and have proven their competence and effectiveness over several decades.
Report details errors in waiting-room death
The Philadelphia Inquirer’s Tom Avril reports on how hospital errors led to the death of a 63-year-old north Philadelphia guidance counselor. Avril opens his story by painting a picture of hospital operations, one based on documents released after a state investigation.
Photo by exvertebrate via FlickrTwice, when an emergency-room nurse called out the name of Joaquin Rivera and he did not respond, she had no idea he’d already suffered a massive heart attack.
The reason: The nurse did not venture beyond the waiting-room doorway and simply did not see him where he sat, unattended, for nearly an hour.
Avril reported that the hospital has already taken steps to prevent a similar occurrence in the future, including:
- Increasing security by more than 30 percent
- Creating new training for registration staff, with an emphasis on communication with nurses
- Instituting a policy of calling patient names every 10 minutes if they don’t answer at first
- Identifying a location on the waiting-room floor from which all parts of the room can be seen and marking it with tape so that triage nurses know where to stand when calling out names
- Hiring an architectural firm to see if further improvements can be made
Temp agencies a haven for problem nurses
Filed under: Hospitals, Hot Health Headline, Nursing
Calling it a “free-wheeling, $4-billion industry” fueled by the nation’s chronic nursing shortage, ProPublica reporters Tracy Weber and Charles Ornstein take on the firms that supply temporary nurses to American hospitals (Los Angeles Times version here). In the story, the reporters say they “found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.”
Although the healthcare system as a whole is increasingly regulated, the nurse staffing industry remains a Wild West. No one knows how many agencies exist nationwide; estimates range from 3,000 to 6,000.
Ornstein, AHCJ’s president, and Weber found plenty of cases to back up that ‘Wild West’ impression. In some cases, firms shift problem nurses from hospital to hospital as trouble arose and, even when a nurse was tossed from one temp firm, he or she usually had no problem finding work at another. Nurses were hired with criminal backgrounds and licenses that were revoked in other states. They often allow employees to prove their “competency” through online tests, and are sometimes fly-by-night operations run by people with no prior nursing experience.
In the end, the reporters found that while there is a clear divide between the best and worst temporary nurse staffing organizations, it’s not always easy or possible for hospitals to figure out which is which.
Nursing blog marks anniversary of landmark report
In a two-week series of posts, the INQRI blog – the blog of the Interdisciplinary Nursing Quality Research Initiative – is recognizing the 10th anniversary of “To Err is Human,” the groundbreaking report that found that as many as 98,000 people die each year from medical errors in hospitals.
A nurse vaccinates a child in this CDC photo.
The latest post, written by Barbara Olson of Florence dot com, looks at the building blocks of better health care. She says that ten years of studying how to make health care reliable has revealed that “things like speaking clearly, repeating words to be certain they have been understood; taking turns; using “inside” voices; and getting plenty of rest matter when individuals rely on complex processes to deliver intended outcomes. (Even “time-outs” have made a comeback!)”
Earlier posts include a Q&A with Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston; one that warns that we may not have made much progress in the area of patient safety; and a post about a nurse researcher who has found that a positive work environment helps nurses catch errors before they harm patients.
Slip of the needle brings fallout, tough decisions
Filed under: Hospitals, Hot Health Headline, Nursing
Writing for The New York Times, AHCJ member Sibyl Shalo Wilmont shares the chain of events that followed when she accidentally injected herself with a drop of a patient’s blood.
A quick test showed the patient was likely negative for HIV, but Wilmont still had to decide whether or not to undergo post-exposure prophylaxis, a grueling cycle of treatment that would continue for at least a month. Wilmont had covered post-exposure prophylaxis as a journalist and her knowledge for that helped guide her decision.
Feds take Columbia to task over decade-old study
Filed under: Conflicts of interest, Health data, Hospitals, Hot Health Headline, Nursing, Pharmaceuticals, Studies, Tools
The run of intriguing health journalism from the Huffington Post Investigative Fund continues this week, as Jeanne Lenzer and Shannon Brownlee look at the federal government’s entrance into an internal conflict at Columbia University’s medical center over the legality and morality of a heart-related study that took place from 1999 to 2001, one in which some experts say it was “virtually guaranteed” that some patients would suffer hemorrhaging.
Columbia has already conducted three internal investigations on the matter. Now, the federal government has asked for a full account of what happened to the study’s participants and ordered that Columbia write a letter to the study’s participants and disclose the “true nature” of what some contend was a deceptive study.
NOTE: In addition to the story itself, the reporters have posted a selection of key documents online.
Lenzer and Brownlee explain that the study went wrong when participants (some of whom were “Spanish-speaking patients who lived in low-income neighborhoods near the hospital”) “were not told that they could be given high doses of the fluids or that they faced a risk of serious bleeding.” Then, despite protests from hospital doctors that patients hadn’t been informed of what were serious possible health risks, the local Institutional Review Board allowed the study to continue. This was followed by years of internal fighting, and finally capped by the HHS’ Office of Human Research Protections entrance into the fray.
Access to list of disciplined health workers in limbo
Filed under: Government, Health data, Health journalism, Nursing, Public health, Public records, Tools
NPR’s Joseph Shapiro looked into the status of the Healthcare Integrity and Protection Data Bank, a database of nurses, nurse aides, pharmacists and pharmacy assistants who have been disciplined by state boards.
The 22-year-old database was supposed to be open to hospitals and nursing homes for background check purposes, but has been tied up in layers of bureaucracy. A policy for opening it up was written during the later years of the Bush administration, but the president decided to defer the decision to his successor.
Shapiro writes that the plan for opening the database is now under review by the Obama administration: “A spokeswoman for the Department of Health and Human Services says things are on track. And that maybe by early next year, the department will open the registry of disciplined nurses, aides and pharmacists.”
Related
Public Citizen has posted an open letter to HHS Secretary Kathleen Sebelius requesting that the proposals to open the database be put into effect “immediately.” The letter explains why the database is important, and details the consequences of keeping it under wraps.
Propofol abuse a concern in medical profession
Filed under: Hospitals, Hot Health Headline, Nursing
Alicia Mundy of The Wall Street Journal reports that abuse of the common anesthetic propofol has become a problem the medical profession, where the drug is plentiful and easy to access. The powerful, fast-acting drug enters the bloodstream quickly and makes the user unconscious.
Mundy does note that “The number of people with a propofol problem is small, and there is little data tracking addictions or death.”
The FDA is considering whether to classify propofol as a controlled substance, which professionals say might be problematic because the sedative, which is suspected to have contributed to Michael Jackson’s death, needs to be readily available during emergencies. If it were to become a controlled substance, hospitals would have to “track inventory, account for all vials, list users, and lock it up with narcotics.”
Mundy cites another concern: “Tighter regulation might impede doctors and nurses from seeking help for addiction, because abusing a DEA-controlled drug is more likely to cost them their licenses and lead to criminal charges.”
Collins unanimously confirmed as head of NIH
Francis S. Collins, M.D., Ph.D., has been unanimously confirmed as director of the National Institutes of Health, HHS Secretary Kathleen Sebelius announced today.
“Dr. Collins is one of our generation’s great scientific leaders. A physician and geneticist, Dr. Collins served as Director of the National Human Genome Research Institute, where he led the Human Genome Project to completion,” said Secretary Sebelius. “Dr. Collins will be an outstanding leader. Today is an exciting day for NIH and for science in this country.”
Francis S. Collins
Collins, a geneticist, had received some attention when he was nominated because of his religious beliefs. The evangelical Christian wrote a book, “The Language of God: A Scientist Presents Evidence for Belief.”
Jacob Molyneux, senior editor at the American Journal of Nursing, examined some of what was written about Francis at the time and looked at the then-nominee’s statements and records, including those about the use of embryonic stem cells for research. He concluded that “for Collins, science and the potential for alleviation of human suffering trump moral or religious absolutism and blind adherence to the sanctity of life issue.”
The Los Angeles Times ran a point-counterpoint piece about the topic, Newsweek’s religion editor weighed in, and The New York Times ran an op-ed by an author who is “uncomfortable” with Francis’ nomination. Eric Berger of the Houston Chronicle did a Q&A with Josh Rosenau from the National Center for Science Education, which defends the teaching of evolution in public schools.
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- Addressing the growing demand for kidneys
- Ethics in hard times: Panel for science and health journalists
- Compromised care: What reporters learned about felons in nursing homes
- Experts say tuberculosis poses a nearly silent threat
- Childhood obesity: Experts discuss strategies, solutions journalists should cover
- Mark your calendar now for Health Journalism 2010!
- Directory of freelance health journalists now available
- New resource: Easier-to-use Nursing Home Compare data
- Resources for covering H1N1 flu, pandemics and preparedness
- Online tools for creating multimedia: easy, accessible, and inexpensive
