Tag Archives: la times

Lopez columns on ailing dad spark discussions about end-of-life decisions

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

From his friendship with a cellist to his adventures with medical marijuana, Los Angeles Times columnist Steve Lopez often draws on highly personal material in his work. His latest series, surrounding the end of his father’s life, mines that vein even more deeply.  Lopez has initiated a community-wide conversation about death and dying through his columns, his profiles of several people confronting life’s end, and reader contributions, which have snowballed since the series began this summer.

New journalists’ resource on aging debuts

Core Topics: Essential coverage areas for health journalists

AHCJ has rolled out another Core Curriculum topic on its website. “Aging” is the second in a series of core topic subject areas the organization believes today’s health journalists will need to master to cover the beat well.

Colorado-based writer Judith Graham is AHCJ’s topic leader on aging. She produces reporting guides, seeks out reliable resources, assigns stories and blogs regularly. She works with Pia Christensen, AHCJ’s managing editor/online services, to find the latest material, edit contributions and make the site as easy to navigate as possible.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Dec. 28: Open the discussion on dying
What I’ve learned along the way is that we have to get past the fears and cultural taboos that prevent us from discussing death with loved ones. We need to make our wishes known in advance healthcare directives, sparing friends and family the psychological trauma of impossibly difficult decisions. We need more information on end-of-life choices and broad reforms of Medicare, which gladly pays for the tools of slow suffering in terminal patients — feeding tubes, hip replacements, etc.— but is stingier about paying for palliative care despite lower costs and higher patient satisfaction.

Dec. 18: Wishing for the right to make that final exit
Since I began writing about these issues in July, when my father took ill, I’ve had readers argue that how and when we die is not for us to decide, but is in the hands of a higher authority. I respect that view, but I’ve heard from far more readers who make a humane argument for options to avoid lingering and painful deaths. Many say that once they reach the point where they are simply being kept alive – as opposed to living – they want to have the choice of ending their suffering.

Dec. 14: Having to think about the unthinkable
Most people don’t like to plan for dying, but in our state of denial, we leave ourselves vulnerable to conditions we would never want. Arrangements for the end of life are essential.

Dec. 11: A terrible choice to ponder
Medical advances now keep people like my father alive in severely debilitated states, at ever-soaring costs to the public. Is that a humane, compassionate approach?

One doctor told me that our fragmented healthcare system has a built-in incentive to give my dad a feeding tube. The surgeon and hospital would get paid, the nursing home would benefit because Medicare would cover 100 more days and my family would be spared that cost. The only losers would be taxpayers, and maybe even my father, who has already been cut open, probed and filled with buckets of medication, only to become sicker, angrier and more depressed.

Dec. 4: Not ready to die, but prepared
The cancer that started 11 years ago has now ravaged the body of Freddie Ramos. It attacked a kidney first, then a lung, and the 57-year-old family man knows that death waits in the near distance.

He’s not ready to go, he says, but he’s prepared.

Nov. 27: Geriatric doctor doesn’t shy from tough talk
Gene Dorio, an old-school practitioner in Santa Clarita, insists families – and physicians – have honest discussions about end-of-life issues with those in failing health. Too often the difficult conversations are put off for too long.

Nov. 11: When death is certain, but dignity is not
For a senior, those two dreaded words – “broken hip” – are often the beginning of the end. Doctors said that without surgery, my father would probably die within three months. But surgery itself could kill him, given his weak heart.

Because of the morphine and dementia, it wasn’t clear that my father understood his options.

Aug. 13: Waiting calmly to die
The email from a reader in Westwood was short, to the point and disturbing.

“My life has been very full,” wrote Polly Berger. “But now it is getting very bad, and I want to go to that other world.”

Berger also said she wished there were more Dr. Jack Kevorkians around. I responded immediately, worried it was a cry for help.

July 17: Waiting in the dark with Dad
And so it goes, the slow, inexorable march to the place we all must visit. Watching, I find myself wondering why we’re so ill-equipped to accommodate, accept and talk about the fate we all are guaranteed.

We’re not very good at dying, or even aging. We dye our hair unnatural colors, pin back our faces and pretend nobody knows. We’ve got an obsession with youth and a phobia about death.

Ongoing: Matters of life & death
As part of the series, the Times invited readers to share their own experiences. Many have.

Lopez, author of The Soloist, was the keynote speaker at AHCJ’s 2008 Urban Health Journalism Workshop.

Learning from Calif.’s mental health parity law

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

On the Los Angeles Times Booster Shots blog, Shari Roan writes about a recent scholarly review of California’s mental health parity law that illuminates lessons that will be key to the success of the upcoming national mental health parity law. The California law has been in place for five years.

Roan summarizes the most important of these lessons, including the accuracy of price estimates and the lack of public awareness about the program. The study considers the views of consumers, insurers and providers as well as the public at large.

The national mental health parity law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (HR 6983), is intended to prevent discrimination against patients seeking treatment for mental illness by prohibiting “insurers and group health plans from imposing treatment or financial limitations when they offer mental health benefits that are more restrictive from those applied to medical and surgical services.”

However, as MIWatch.org reports, the three federal agencies that are supposed to write the regulations to implement the act missed an Oct. 3 deadline. The law will go into effect in January.

Temp agencies a haven for problem nurses

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

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.”

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Photo by timsamoff via Flickr.

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.

Calif. adopts strict rehab rules for medical workers

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

ProPublica reporters Tracy Weber and Charles Ornstein have filed a report (Los Angeles Times version, ProPublica version) on the fallout from their work exposing failures in California’s nurse rehab program.

The state has adopted strict new rules governing drug abusers in the health care industry, requiring that those in the rehab program be tested more than 100 times in the first year, and pulling them from practice immediately should a relapse be detected.

In addition, public Web sites will now list any restrictions to their licenses, “easing the long-standing confidentiality protections that have shielded participants and kept their patients in the dark.”

Calif. nurse rehab program full of holes

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

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

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

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.”