Sunday, April 18, 1999
Back to the trenches of mangled care
BY PETER BRONSON
The Cincinnati Enquirer
Terri says it took less than five minutes to end her 21-year hospital career. Staffing was stretched so thin she was assigned to watch two cardiac monitors in rooms 20 yards apart. She was in the wrong place at the wrong time. A patient died. So she was fired for negligence.
Now she's afraid that if she tells the family why their husband and father died, she will be tangled in a lawsuit. “I feel rotten enough about that man,” she said. “If you go in a hospital, just beware.”
Carol Ann couldn't take the long hours, short staffing and poor patient care anymore, so she left nursing and enrolled in law school. “I figured when I went to court in a lawsuit because a baby died, I did not want to go as the defendant,” she writes. But then she fell ill with hepatitis C — almost certainly from a needle stick during one of her long nursing shifts. “I've lost my health and my career and may not even be able to finish law school, so I may have lost my dreams as well. I've lost my peace of mind regarding my children who may have been infected while I was pregnant.
“I hope there is a special hell for the hospital administrators and managed-care executives that are getting rich off of our human misery.”
Mark is a doctor who no longer blames the managed-care CEOs who “earn” millions. “They are just middlemen who do what their clients want them to do,” he says.
Now he blames the bosses of local businesses — the Cincinnati Business Committee crowd — who have used their clout to cut health care “until all the fat is carved out and now they are trying to decide what muscle we don't need.”
He thinks business leaders on the boards of local hospital alliances have a conflict: The increases hospitals desperately need to restore safe patient care and adequate staffing “may hurt their businesses,” he says.
So the cuts continue. Cincinnati is getting a reputation as the tightest town in the nation for health care. Cost-cutters call it efficiency. Patients have other words.
“My whole experience (in the hospital) was a nightmare,” writes John, who was forced out of his bed and into a chair immediately after surgery. “There I am, sitting in a recliner chair, in excruciating pain with my bare backside to that cold and uncovered chair. I was wondering whose bare butt was there before me and who would be sitting there after I had left my germs. I decided immediately to push past my pain and weakness and get out of that place.”
Letters, calls and e-mail keep coming. My columns about “mangled care,” as one nurse called it, have struck a major nerve.
The most acute pain is despair that nothing can be done. The insurance companies are too big. The corporations that make our health care decisions care only about costs. Patients are just a raw material in an industry that puts profits and shareholder dividends ahead of “outcomes.”
There may be a cure. But as they say before they stick in the needle, this could hurt a bit.
Gov. Bob Taft has an unexpected prescription from a Republican: A Patient's Bill of Rights that makes managed-care companies liable for malpractice.
That means top managed-care CEOs who average $5 million in compensation might have a few sleepless nights like Terri, wondering if any patients have died because of their decisions. HMOs are immune from malpractice on the preposterous theory that they don't make medical decisions.
“The managed care lobby is going crazy on this liability provision,” said Gov. Taft's chief policy adviser, Scott Borgemenke.
If that can tiptoe past the biggest lobbying grizzly in Columbus, maybe Dr. Taft can get Ohio to choke down a few other pills:
• Public annual reports of salaries and performance by managed care companies.
• Whistleblower protection for nurses, doctors and other health care workers who are afraid they will lose their jobs if they speak up about hazardous patient care.
• Name tags for hospital workers that identify their jobs and qualifications — so that “care extenders” with a few days or weeks of training are not mistaken for RNs.
Many insurance company executives already think they are qualified to play doctor. I'd add a rule requiring them to wear name tags when they check into the hospital, so nurses and doctors can give them the kind of care they deserve.
• And maybe some local business leaders belong in a hospital — for a tour of the health-care trenches where cost-cuts are measured in flesh and blood. In fact, maybe all of us should get the “recliner view” before we are too sick to fight back.
Think of it this way: Would you rather pay a little more now, or wind up clinging to life on a cardiac monitor that nobody is watching?
Peter Bronson is editorial page editor of The Enquirer. If you have questions or comments, call 768-8301, or write to 312 Elm Street, Cincinnati, Ohio 45202.
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