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.
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.
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
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!)”
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.
Milstein Hospital Building at Columbia Presbyterian Medical Center, photo by Samat Jain via Flickr.
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.
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.
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.”
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.