Sunday, February 21, 1999
Nurses hurt but HMOs feel no pain
BY PETER BRONSON
The Cincinnati Enquirer
Harvard Medical School reports that 80,000 patients die in hospitals each year. Here's a finding that doesn't require a Harvard study: Not one of those patients wanted to die alone and afraid. But it happens. Too often.
“The patient is suffering. When someone is dying, they're scared, they want me there,” said Cheryl Townsend, a nurse in the cardiac care unit at University Hospital. “I want to be there, and I can't be there, because I have two other patients who will live if I'm with them. That's a terrible place for nurses to be, and that's why nurses are burning out.”
Ms. Townsend and nurse Annie Hamilton are a chronic pain to University Hospital administrators because they dare to say publicly what many nurses and some doctors say privately: overworked, understaffed nurses can't give patients the care they need. As HMOs bleed health care for savings, hospitals have cut where it hurts. Experienced nurses are quitting, or being replaced by poorly trained “care extenders” who can make fatal mistakes.
I first met Ms. Hamilton and Ms. Townsend in 1997, when they told me staff cuts were so severe they would not feel safe as patients in the hospital where they work.
I called them the other day to see how things have changed. The answer: Not much. In some ways, their jobs are worse.
They feel demoralized, tired of fighting the managed care system that is making nurses an endangered profession. “Nurses are afraid of being labeled troublemakers or the "B'-word,” Ms. Hamilton said. “They're just trying to get through the day.”
Constant turnover spreads chaos. “Almost on a daily basis you have to deal with a new face on your team,” Ms. Townsend said. “We're in a chronic state of teaching and training — you can't get the work done.”
Ms. Hamilton said the steady loss of experienced nurses is “devastating” to patient care.
“I would still certainly encourage anyone going into the hospital to have a family member who knows what's going on,” she said. “Is that diplomatic enough?”
Ms. Townsend was more blunt: “It costs $1,500 to spend a night in my place, and I have to look at family members and say, "Can you spend the night so your mother doesn't fall out of bed?' People are not getting what they are paying for.”
But insurance premiums keep going up. The HMOs are still twisting a tourniquet on spending. So somebody must be getting what we pay for. And I think I know who: The CEOs of HMOs.
Salary figures from the Ohio Department of Insurance could raise your blood pressure in a heartbeat. Numbers for the latest year available (1997):
• At Community Insurance Co. (Anthem Blue Cross-Blue Shield), the CEO was paid $596,575 — a 52 percent raise. Top officers were given raises of 117 percent, 63 percent, 27 percent and 98 percent.
• Prudential Health Care Plan paid its chairman $889,830.
• Humana (the local HMO is ChoiceCare-Humana) had a top salary of $921,000. Next were $580,000 and $538,000, with raises of 40 percent and 24 percent.
• CIGNA HealthCare of Ohio was a piker, paying top salaries of $218,148 and $126,685, with raises of only 18 percent and 23 percent.
• And then there was Aetna U.S. Healthcare Inc. Top salary was $1.6 million, including a $1 million bonus. The third-ranking officer of Aetna received a 23 percent raise, on top of a $1 million salary.
Most of these salaries are a few steps up the ladder from the local HMO. The numbers are old and the list is incomplete — because HMOs have been doing their best to hide such embarrassing jackpots.
Last year, state Rep. Robert Netzley sponsored a bill to require HMOs and hospitals to file annual public reports on compensation and other things consumers should know. But HMOs, one of the most powerful lobbies in Columbus, smothered it.
“There are a lot of heavy hitters in opposition to this thing,” Rep. Netzley said. “I may introduce it again to keep it going, but it probably has no chance.”
His conclusion: “Hospitals are the most cutthroat business except perhaps the illicit drug trade.”
With 25 years of nursing experience, including 16 at University Hospital, Ms. Townsend earns $45,000 a year, which she calls “not that good.”
“My salary is topped out. That's one reason nurses are leaving. They won't put up with this kind of salary and then watch patients suffer.”
My calculator says that the CEO of Aetna is worth 200 nurses like Ms. Townsend. But like those overpaid HMO bean counters, the calculator is wrong.
To someone scared, in agonizing pain or dying, one nurse is worth a million CEOs.
Peter Bronson is associate editor of the Cincinnati Enquirer. If you have questions or comments, e-mail to letters@enquirer.com/b>
BRONSON ARCHIVE