Problem nurses move from state to state
Filed under: Health journalism, Hot Health Headline
ProPublica’s Charles Ornstein and Tracy Weber have, with the help of the Los Angeles Times‘ Maloy Moore, released the final installment in their nurses series (full series: ProPublica | LA Times), this one focusing on how “caregivers with troubled records can cross state lines and work without restriction.” They found that a large number of these cross-state issues could be prevented if state regulators took advantage of readily available information.
By simply typing a nurse’s name into a national database, state officials can often find out within seconds whether the nurse has been sanctioned anywhere in the country and why. But some states don’t check regularly or at all.
The failure to act quickly in such cases has grave implications: Hospitals and other healthcare employers depend on state nursing boards to vouch for nurses’ fitness to practice.
The reporters found an army of examples, from the disturbing anecdote they lead with to the 117 California nurses whose licenses had been revoked, suspended, denied or surrendered elsewhere or the 10 nurses who were disciplined in Rhode Island, yet operated with clear licenses in neighboring Massachusetts.
Most of these transgressions are recorded in a federal database, as well as in one operated by the National Council of State Boards of Nursing. Both are incomplete, even though states are required to update the federal database within 30 days of a disciplinary action. And the federal database, while more complete, is rarely used, probably because it costs money while the state boards’ database is free. Some states only check these databases when licensing a nurse the first time, others rely on the nurses themselves to disclose their own problems. A handful check their nurse list against the database regularly, but they appear to be in the minority.
Lopez finds glamour in LA’s marijuana community
Los Angeles Times columnist Steve Lopez has released his latest dispatch from medical marijuana’s front lines.
The Medical License page of Dr. Sona Patel’s site, Doc420.com. Patel specializes in medical marijuana recommendations.
This time, Lopez checks in with a physician who specializes in herbal medicine, worked as a model to help pay her bills to attend a Caribbean medical school, wears high heels and a lab coat in her ornate gold-and-maroon office, and writes about 15 medical marijuana recommendations a day.
“I guarantee a 100% refund if you do not qualify for a medical marijuana recommendation,” she announces on her Web site, Doc420.com. The really crazy part about Dr. Sona Patel? Unlike some of her peers, she spends about half an hour on each appointment and actually turns down some of her patients’ requests.
In two earlier columns, Lopez tells the story of how he got a recommendation to purchase medical marijuana after a brief visit to a gynecologist and how he then used that recommendation to join a cooperative and legally purchase marijuana.
Related
- Lopez, author of The Soloist, was the keynote speaker at AHCJ’s 2008 Urban Health Journalism Workshop.
- Covering Health: Feds issue guidance on medical marijuana
Lopez: Gynecologist gave me permit to buy weed
Los Angeles Times columnist Steve Lopez writes about his trip to a clinic specializing in herbal medicine (known for “writing recommendations that allow folks to buy medical marijuana”).
Photo by Troy Holden via Flickr.After explaining the back pain he’s suffered through for the past few decades, Lopez was issued a form announcing that “Steve Lopez was evaluated in my office for a medical condition, which in my professional opinion, may benefit from the use of medical marijuana.”
The doctor, who described himself as a gynecologist, billed Lopez $150 for the visit.
On Sunday, Lopez will publish a follow-up (his stories are archived here) about his marijuana dispensary shopping experience.
Related
- Lopez, author of The Soloist, was the keynote speaker at AHCJ’s 2008 Urban Health Journalism Workshop.
- Covering Health: Feds issue guidance on medical marijuana
Scans at LA hospital spewed 8x normal radiation
Filed under: Government, Hospitals, Hot Health Headline
On Oct. 8, the FDA issued an alert recommending hospitals review CT scan radiation levels after dangerous doses were detected at an unnamed hospital. The Los Angeles Times‘ Alan Zarembo took over from there, finding that serious radiation overdoses at Los Angeles’ Cedars-Sinai hospital had prompted the warning.
Zarembo followed up with a series of stories on the radiation and its aftermath:
Cedars-Sinai investigated for significant radiation overdoses of 206 patients
Zarembo leads with a summary of what exactly went down at Cedars-Sinai:
More than 200 patients at Cedars-Sinai Medical Center were inappropriately exposed to high doses of radiation from CT brain scans used to diagnose strokes, hospital officials told The Times on Friday.
About 40% of the patients lost patches of hair as a result of the overdoses, a hospital spokesman said.
Even so, the overdoses went undetected for 18 months as patients received eight times the dose normally delivered in the procedure, raising questions about why it took Cedars-Sinai so long to notice that something was wrong.
Class action filed for Cedars radiation patients
Zarembo checks with experts who say the class-action suit filed on behalf of victims has little chance of success because it’s difficult to prove damages, especially since they may not develop for years.
Cedars-Sinai head expresses regret for radiation overdoses
A quick-hit story in which the hospital details exactly what they’ve done to ensure it doesn’t happen again.
4 patients say Cedars-Sinai did not tell them they had received a radiation overdose
Zarembo tracked down patients who said that, while they were contacted by the hospital concerning hair loss, they weren’t informed of radiation overdose or potential cancer risk.
Hospital error leads to radiation overdoses
Zarembo writes that the problem has been traced to a CT scanner reset in early 2008.
Cedars-Sinai radiation overdoses went unseen at several points
In one of the most remarkable moments, Zarembo writes that, before every single scan, technicians were shown a screen indicating, among many other things, the unusually high radiation level. The error was in plain sight the entire time.
Beginning in February 2008, each time a patient at Cedars-Sinai Medical Center received a CT brain perfusion scan– a state-of-the-art procedure used to diagnose strokes – the dose displayed would have been eight times higher than normal. No standard medical imaging procedure would use so much radiation, which one expert said is on par with the levels used to blast tumors.
Somebody should have noticed. But nobody did – everybody trusted the machines.
Related
The New York Times‘ Walt Bogdanich added a broader perspective on the story, adding an additional case and subtly weaving it into the debate about the dangers of medical screening.
War injuries advance treatment of brain injuries
In a three-part package published this month, the Los Angeles Times‘ Melissa Healy explains recent advances in the diagnosis and treatment of traumatic brain injury, with special focus on the United States armed forces.
- Treating traumatic brain injuries: Anecdotes from an Army National Guard medic and an equipment officer show how much lives can be changed by traumatic brain injury, an ailment that doesn’t even show up on CT scans or MRIs, and how a simple accurate diagnosis can provide patients with hope and understanding.
- War injury leads to advances at home: Healy writes that while combat veterans with traumatic brain injury are receiving the lion’s share of the attention, they’re just the tip of the iceberg. The “silent epidemic” has hit about 2 percent of the civilian population as well, which totals up to about 11 million since the wars in Iraq and Afghanistan began.
- Treating brain injuries on the sports field and battlefield: Finally, after tackling diagnosis and prevalence, Healy moves on to treatment. She walks through every step, from prevention to diagnosis to treatment, examining the latest in medical science along the way. It’s the longest piece in the package, and the best to start with if you’re looking for a better technical understanding of traumatic brain injury.
Health journo goes it alone without insurance
Filed under: Conflicts of interest, Health care reform, Health journalism, Member news
Freelance health writer and AHCJ founding member Duncan Moore has gained national attention recently for his Los Angeles Times piece explaining his decision to go without health insurance at age 53. Moore quit his job and used a COBRA policy to tide him over until he found a new job. Then the economy tanked, newspapers retrenched, that new job never materialized, his 18 months of COBRA ran out and Moore was forced to ask some tough questions. The answer he found to his first question, “what insurance actually buys,” led him to rethink the entire system about which he’d been reporting for years.
After a quick self-assessment, Moore found he had a clean family history, good habits and almost no pre-existing conditions. That started him thinking.
So what does a guy like me need with health insurance? I’m the best risk in town, I thought to myself. Why shouldn’t I self-insure? In other words, why couldn’t I accept full responsibility for my own health expenses?
Moore writes that he’s ready to accept a certain amount of self-rationing when it comes to everyday care, and that, even if something catastrophic happens, he’ll likely be no worse off than he’d have been if he was insured, because “there are no guarantees that the insurance company would pay, that it wouldn’t try to weasel out of the obligation.”
Moore also made an appearance on Dr. Nancy Snyderman’s show on MSNBC on Tuesday to discuss his decision.
Calif. nurse rehab program full of holes
ProPublica’s Tracy Weber and Charles Ornstein follow up their investigation of California’s nursing oversight with a story about the failures of the state’s nurse rehab program (Los Angeles Times version; ProPublica version). The embattled California Board of Registered Nursing has touted the program as a safe haven where otherwise good nurses can free themselves of bad habits, but Weber and Ornstein have discovered that nurses often don’t complete the program, and sometimes continue bad behavior unabated despite the voluntary, confidential program’s required drug tests and treatment.
The team has reinforced its data-driven story with well-chosen anecdotes and observations. Program proponents argue that Weber and Ornstein are focusing on a few failures and ignoring the more numerous success stories, but the reporters show that the failures are due, at least in part, to flaws in the program. Even nurses designated as a “public risk” often aren’t investigated until more than year after earning that dubious distinction.
The reporters’ sum up the problem thus: “At the moment, the main person responsible for protecting the public from a drug-addicted nurse in California is the drug-addicted nurse. It’s a risky honor system.”
Schwarzenegger replaces nursing board members following ProPublica, LA Times investigation
Late Monday, Calif. Gov. Arnold Schwarzenegger replaced nearly everyone on the state’s Board of Registered Nursing, “citing the unacceptable length of time it takes to discipline nurses accused of egregious misconduct.” The move came a day after a ProPublica and Los Angeles Times investigation into the board’s activity was published.
He fired three of six sitting board members — including President Susanne Phillips — in one-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, his administration released a list of replacements.
Charles Ornstein and Tracy Weber of ProPublica and Maloy Moore of the Los Angeles Times joined forces to review every case between 2002 and 2008 in which a nurse faced disciplinary action — more than 2000 of them — and found that, on average, California’s Board of Registered Nursing took more than three years to take action on such cases. Many took far longer and have not yet been acted upon at all. In other large states, the reporters write, such cases are usually dealt with in less than a year.
The reporting team adds depth to their investigative work with a compelling series of anecdotes, told from the perspective of patients, administrators and even the wayward nurses themselves. They also dissect the system, finding few safeguards other than the tardy board review process, and work to discover all the factors contributing to the delays.
In reaction to the story, leaders of the California Board of Registered Nurses sent a note of encouragement to its staff on Monday that points to some recent accomplishments.
Over at Off the Charts, the American Journal of Nursing blog, AJN editor-in-chief emeritus Diana J. Mason, R.N., Ph.D., weighs in on the investigation and an earlier study of recidivism among disciplined nurses. Mason suggests that the National Council of State Boards for Nursing could “work with the state boards to publicly report on a state-by-state basis a quality metric of length of time between complaints and board action.”
Update
Calif. Nursing Board executive officer resigns: On Tuesday, the longtime executive officer of the embattled California Board of Registered Nursing resigned. Ornstein and Weber report that “Terry had been the appointed executive officer for nearly 16 years and had been on the staff of the board for 25.”
A painful picture of rare childhood mental illness
The Los Angeles Times’ Shari Roan tells the story of a 6-year-old girl suffering from a rare – perhaps even unique – case of early childhood schizophrenia. For months, even the most powerful medications her young body can handle don’t seem to phase her imaginary animal friends and almost-constant hallucinations. The mental illness is a serious threat to her health and that of those around her. In January she had to be moved from home to UCLA’s pysch ward. Roan uses the story, told with intense, wrenching detail and ending with a note of hope for the future, to illuminate the plight of America’s tiny population of mentally ill children.
About 1% of adults have schizophrenia; most become ill in their late teens or 20s. Approximately one in 10 will commit suicide.
Doctors and other mental health experts don’t fully understand the disease, which has no cure. Jani’s extreme early onset has left them almost helpless. The rate of onset in children 13 and under is about one in 30,000 to 50,000. In a national study of 110 children, only one was diagnosed as young as age 6.
“Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia,” says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children’s study, the largest such study in the world on the illness.
Calif. nonprofit’s conflicts of interest ‘inherent’
Los Angeles Times reporter Alan Zarembo found unusually high executive pay and a tangle of additional compensation (ranging from rent to legal fees) that make executives at Tarzana Treatment Center some of the best-paid nonprofit leaders around.
The $45-million-a-year business, which has aggressively pursued lucrative government contracts, paid out salaries as high as $428,057 for the chief operating officer, a number which does not take into account deferred compensation and other activities. Part of the property leased by the center is owned by four board members, in an arrangement which nets them $2.7 million in rental fees annually. The CEO earned $330,372 for 32 hours a work a week, not including his share of the rent or the $237,965 in legal fees he earned in 2007 as part of an ongoing contract.
Frances Hill, a professor at the University of Miami specializing in nonprofit tax law, said conflicts of interest were inherent at Tarzana because the chief executive wears so many other hats: chairman of the board, lawyer and landlord.
“My jaw is dropping over this,” she said.
All of this appears to be legal, though “anathema” to a nonprofit’s mission, Zaremba found. The IRS allows this sort of self-dealing as long as the nonprofit can show that it gets better rates than it would on the open market, and government caps on executive pay for its contractors don’t apply because much of the compensation comes from non-government revenues. The leader of a nonprofit watchdog group asks “If the executives weren’t paid so much, ‘how many more services could be provided to people who need them?’”
Numbers on the rehab center’s effectiveness remain elusive, as they do for many such organizations, but Zaremba quotes a patient praising its professionalism and a positive review from a local official.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
