2015 CWC & Risk Conference – Day Two

Once again, the CWC & Risk Conference organizers, exhibitors and presenters made good on their promise to deliver a conference that was packed and stacked with information. The venue was the St. Regis in Dana Point and the meetings ran pretty much from 8:00 in the morning 17:00 in the evening every day for three days.

I attended as I have for the past several years to educate both my readers and myself on the workers compensation system and to keep abreast on changes that affect the injured worker and the employer. This year’s conference didn’t disappoint.

I arrived too late in the day on Wednesday for the wonderful breakfast, but in time to attend a session that I thought might prove interesting. The session entitled “MSA Cost Mitigation: Strategies to Reduce Future Medical Exposure” was eye opening and helped shed light on how the defense side of Workers Compensation “thinks” when it comes to providing treatment to and for the injured worker.

MSA or Medicare Set Asides need to be calculated in many Workers’ Compensation cases, especially in those cases where the injured worker is already a Medicare beneficiary or will become Medicare beneficiaries within 30 months or where the injured worker is eligible or receiving Social Security Disability Insurance benefits (SSDI). Since this can have an impact on yours truly, needless to say I listened with rapt interest.

The speaker provided us with many examples of how an employer could control medical costs, however as a nurse I thought that some of these cost-saving measures came at the expense of the injured worker. The speaker gave the example of Gabapentin versus Neurontin. Gabapentin as with generics cost much less than the brand name medication Neurontin. She explained that by switching to the generic the employer could save as much as 2,124.30 a year on a claim. She went on to explain that even more money can be saved depending on the number of pills ordered based on milligrams; for example if the physician ordered one 800 mg pill a day an even greater cost saving can be realized if the following combination was ordered two 300mg pills (at a cost of .03 cents/pill) and two 100mg pills (at a cost of .02 cents/pill). The cost then goes from $85.80 to $3.00 a month. Of course this means that the injured worker must take a total of four pills a day instead of one pill a day, but hey what a cost savings!

The speaker explained that to make such adjustments the client must be a willing participant and that other conditions such as generic must already be available on the marketplace and that the client must already be using the generic. She suggested that if the employer took the long view and was in a position to anticipate when the generic of a specific medication would become available on the marketplace then it might serve the employer well to delay the MSA until the generic was available so the cost of the generic could be included instead of the brand name, once again providing a cost saving to the employer.

And while I am very much in favor of saving, I think it’s critical that the injured worker be truly part of the decision making process. Though the speaker made a point of using the term willing participant to refer to the injured worker I think there’s a fine line between willing and coerced.

Our local paper recently published an article about two Huntington Memorial Hospitals with the claim made by the nurses that they were fired due to their union activity.  However there’s more to the story and below you’ll find both the link to the above mentioned article and my letter to the editor — that the Star News chose not to publish.  I think they were afraid to encourage their readers to think beyond the pablum the union was spoon feeding to both the paper and its readers.

Huntington Memorial terminated 2 nurses; both claim retaliation for efforts to unionize

Dear Editor:

Nurses Almada and Lin with the help of the California Nurses Association (CNA) held a rally to demand that Huntington reinstates the two nurses. The claim is that these two nurses were unfairly terminated due to their support of the recent failed unionization effort at Huntington Memorial. If what they claim is factual, then shame on Huntington Memorial.

However, as a nurse with more than 40 years of experience at all levels of the nursing ladder I’m somewhat hesitant to take their tale at blind faith. Why? Because the hospital is bound by confidentiality in all personnel matters and Almada, Lin, and the CNA know that and are counting on Huntington to adhere to this code. Meanwhile, they can sling all the mud that they want, which they’ve been doing over a year now with support from much of the local media and many local officials who enjoy union support.

I’d prefer to wait and see, because something tells me that there’s more to the tale of the firing of these two nurses than just their involvement in the failed unionization attempt. My nursing instinct tells me that these two nurses may have failed to adhere to our nurse practice act and if this were the case then firing them would’ve been the appropriate action. I also think it is interesting that they’ve made a big deal about going to the NLRB, but said nothing about filing a complaint with our state’s labor board. Not to mention it’d be an act of ultimate stupidity on the part of Huntington to fire any nurse at this time except for cause.

Once a year more than 2,000 people gather in Las Vegas to attend a five-day conference on all things pain related. The attendees aren’t just researchers, but all types of healthcare providers and patients as well. I started attending PainWeek nearly three years ago and each year I return with even greater knowledge about pain and more specifically the latest in treatment for my condition — Complex Regional Pain Syndrome; a condition I developed as a direct result of my work related injury.

This year’s conference had several session regarding workers’ compensation and I had the opportunity to attend Dr. Matthew P. Foster’s session on “Pain Management in Workers’ Compensation: Overview of Spend, Utilization, and Treatment Guidelines”. The room filled up quickly, leaving only a few empty seats.

Dr. Foster’s presentation moved quickly explaining how workers’ compensation treatment and drug prescription moved from whatever, without questions, that the doctor ordered for the injured worker to more and more states adopting guidelines that were either created by the state or that followed the Office of Disability Guidelines (ODG) or that followed the recommendations of the American College of Occupational & Environmental Medicine (ACOEM) or that followed some combination.

His presentation showed that by using treatment guidelines, most states had shown some “control” over the rising costs of workers’ compensation, with the exception of State of New York (which has created its own treatment guidelines). One area where treatment guidelines seem to have the greatest impact was in the approval of opioid treatment for injured workers suffering extreme and/or chronic pain. Many insurance companies and their adjusters have used these guidelines, not such as a guide but much more like something which to adhere to very strictly without wiggle room. Nowhere is this more apparent than with prescription opioids.

It was during the question and answer section of Foster’s presentation that members of the audience brought up very similar tales of adjusters using guidelines to basically “cut off” the injured worker from any opioid medication beyond what the “guidelines” suggest. A common thread was the following: the earliest the insurance company will allow a patient refill of their opioid prescription is 28 days (2 days before the patient’s current script ends), when the patient turns in a new script at the 28 days mark some insurance companies then ask for 7 to 10 days to authorize the new opioid script thus leaving the patient without opioid medication to cover for that time period placing the patient at risk for withdrawal, not to mention the emotional and psychological impact the fight every month to fill their physician order medication has on the injured worker. Meanwhile in California a great many of the utilization review physicians are from ER specialty a discipline that doesn’t prepare the physician to take care of patient for the long term, an observation that I shared with the audience and with which the audience agreed.

So in short when it comes to opioid prescriptions the injured worker is basically made powerless by the very program that’s been put in place to “help the injured worker return to pre-injury condition as quickly as possible”.

Thanks to several high profile news articles and news reports a heightened awareness of opioid pill mills and the doctors that run them came into the awareness of not only the American people, but various government agencies, as well. This was not such a bad thing, but what was never addressed by the news articles (many covered in the Los Angeles Times) were the thousands of patients living with chronic pain that were finding benefit from opioids and the conscientious doctors that made a point to monitor their patients for compliance.

The constant focus on those who die from opioid abuse and the doctors that prescribe opioids willy-nilly overlooks the reality that many more people have benefited from opioid use and do so without abusing the medication. The 2012 LA Times series on opioid abuse and deaths has been referenced in nearly all opioid cautionary articles since the series first ran with the factoid that between 2006 and 2011 there were 3,733 opioid-related deaths in four Southern California counties (Los Angeles, Orange, San Diego and Ventura). Though 3,733 is a staggering number of opioid-related deaths, the LA Times reporter failed to provide perspective; such as, during this same period of time there was a total population of 16.9 million people (as of June 2011) in the abovementioned counties and these opioid-related deaths though tragic represents .0002% of the population – my question then how does this make a raging epidemic?

Also missing in many of the reports of opioid abuse is how many individuals were not only addicted to opioids but to other drugs (both legal and illicit), and alcohol. Little effort was done on the part of the experts and reporters alike to deduce which came first the opioid abuse or the alcohol/illicit drug use. Actually in the LA Times series, it was noted that in many of the deaths that were reported as being opioid-related could only be assumed, since at the time of death the death wasn’t identified as an opioid-related death.

While the LA Times did a relatively good job at highlighting deaths related to opioid-abuse they did a disservice by not providing context and by failing to present stories from those living with chronic pain for which opioid use is the only treatment. Instead as a response to the LA Times and other similar articles various agencies and regulatory bodies began to discuss ways to “curb” the opioid epidemic. Meanwhile, few if anyone was talking about what could be done to provide support to those living with chronic pain for which opioid treatment was the only option or one very important part of their therapy to alleviate the constant, chronic pain– because that would be too easy! While the LA Times targeted California for its pill mill and opioid-related deaths (remember 3,733 people died), they failed to mention that California had the lowest person to opioid rate of all 50 states. They failed to address how insurance, in particular Workers’ Compensation, seemed reticent to provide alternative treatment for people living with chronic pain. For example, Workers’ Compensation puts a cap on the number of physical therapy (PT) sessions an injured worker can have, in total, over the course of an injury. This doesn’t mean that a Workers’ Compensation adjuster can’t approve more (PT), but far too many adhere to the strict guideline; even if PT is the recommended course of treatment for recovery from a particular procedure, so all too often doctors have to rely on opioid treatment in lieu of PT.

While it may seem as though states regulatory agencies have done little to curb opioid abuse a map/document produced by Progressive Medical outlined with some thoroughness state opioid rules by restriction, and though this document was published in 2013 it provides a good snapshot of these restrictions by state and can be found here – OpioidRulesByRestriction + MAP_10-15-13_FINAL.

So with so many people and agencies focused on the “problem of opioid-abuse” no one seems willing to advocate and address the needs of people living with chronic pain for which opioid treatment is the only option. There’ve been a few groups that have spoken out, but their voices are often muted by the screams of those who seem intent of removing opioids completely from all formularies. Prescription Drug Monitoring Programs (PDMP) such as California’s Controlled Substance Utilization Review and Evaluation System (CURES) programs have shown little effectiveness. Meanwhile, CURES has a very low utilization by California physicians and pharmacists. Meanwhile few states, including California’s CURES updates in real-time. Oklahoma is one of the few states whose program updates with very little lag-time which allows both prescribing physicians and pharmacists to access the Oklahoma PDMP in real time which helps weed out pill shoppers and helps in the identification of possible pill mills.

Draconian measures will not solve the challenge of opioid-related deaths or abuse or those running pill mills. What’s needed is a balance and sane approach. Doctors need to be well educated on when opioid use is optimum, how to detect possible doctor shopping, non-compliance and so forth. In turn patients and their families need to be educated on appropriate opioid use and provided tools to be both compliant with treatment protocol and to be aware of possible signs of opioid dependency. For example patients who are in extreme pain may not be cognizant that they just took their Vicodin because when a patient is in a state of extreme pain they experience time differently. I should know I had to endure an Ilizarov external fixator for a time and if not for a note that I kept at my bedside where I would document each time I took the Vicodin that had been prescribed to me there would’ve been times when I could’ve sworn that two hours had already passed since my last dose. I can’t recall one occasion where physician, nurse practitioner or nurse ever recommended a method to track when medication, especially opioids, that had been taken.

On the upside conferences such as PainWeek offer caregivers, practitioners and patients alike an opportunity to learn about the various manifestations of pain and the different modalities to treat pain. I’ve truly enjoyed attending PainWeek these past two years and I am looking forward to more networking this year.

On Monday, August 24, 2015, the California Nurses Association (CNA) held yet one more of their dog and pony shows. This time the subject of their display was the firing of two Huntington Memorial Hospital RN’s.   The nurses, Allysha Almada (CA RN License #802190) and Vicki Lin (RN License #832090), claim that they were fired by Huntington administration for being vocal about their support for a nursing union, a union that if the nurses voted in favor of (which they didn’t) would have been represented by the CNA. Want to check an RN’s license all you have to do is go to the California Board of Registered Nursing (BRN) website here – http://www.rn.ca.gov/online_services/perm-verif.shtml and click the big grey button marked “click to verify a license” and you can check not only if a RN is licensed but pretty much any health/medical profession that is licensed in our state.

Depending on which newspaper you read somewhere between two dozen to 50 nurses/people came out in support of the reinstatement of Almada and Lin. However, if my many years of experience (all up and down the nursing career ladder) has taught me anything, its that sometimes there’s more to the story than what meets the eye – and that would appear to be the case with Almada and Lin.

I’ve learned that at least one complaint has been filed against Almada and Lin. The complaint has been sent to the BRN, the licensing body in our state that has oversight of nearly 400,000 licensed RNs and is responsible for investigating allegations of misdeeds, accusations, etc., lodged against a California RN. So, what pray tell could the complaint be – well it’s not about Almada and Lin’s support of a nursing union for darn sure!

The complaint alleges the following:

  • Nurse Almada provided her username and password to Nurse Lin
  • Nurse Almada provided this in the form of a note, which was later found in a patient’s medical record, and perhaps the most serious of charges
  • Nurse Almada did this so that Nurse Lin could use Nurse Almada’s username and password to confirm as a second “signatory” that Nurse Almada had double-checked a medication that required two nurses to check-off, without Nurse Almada actually being present and having actually verified that she had indeed confirmed that the appropriate amount of medication had been titrated/drawn by Nurse Lin.

If indeed, Nurse Almada did as alleged and Nurse Lin “signed” as Nurse Almada as alleged in the complaint then it would appear to this nurse that they clearly violated our nurse practice act, not to mention potentially placing a patient in harms way – because the medication that was being administered could be deadly – which is why our nursing protocols call for the first nurse to draw the medication and check that the amount is appropriate and for a second nurse to come and verify that indeed the medication is the appropriate medication and that the appropriate amount is about to be administered. Remember the “rights” — the right patient, at the right time, and so forth.

What’s the big deal about requiring two or more nurses to verify that the appropriate medication is about to be administered to a patient, simple some of the medications that a nurse administers can KILL their patient and nurses are only human and can make a calculation error, inadvertently draw too much medication, misread an order and so forth, so nursing protocols require that certain medications such as insulin, heparin and others require a two nurse protocol. Because too much insulin can kill and too much heparin and your patient can bleed out of every orifice of their body. So the two-nurse protocol protects both patient and nurse and to circumvent this safety protocol is unconscionable.

The question that now begs to be asked is how come the CNA is demanding the reinstatement of two nurses that allegedly engaged in acts of what would appear to be not only the falsification of a medical record and the possibility that these two nurses engaged in an act of patient endangerment? I guess, when the rubber hits the road patient safety isn’t what concerns them as much as holding press conferences that continue to spread their propaganda and accuse Huntington Memorial Hospital of being a “bad” hospital that’s mean to its RNs on staff.

A lot’s been “said” in print about the recent vote to unionize/not-unionize the RNs at Huntington Memorial Hospital (HMH). If you’d listened to the California Nurses Association (CNA) and many of their vociferous supporters you’d think that it was HMH management that was trying to suppress the vote, but you’d be wrong. You may wonder how I came to this conclusion, simple by looking at the outcome of the NLRB-led and supervised April 15th – 16th election. The unofficial outcome of the vote was as follows – 539 No to 445 Yes with 176 Challenged ballots. There are 176 ballots left to be counted and were challenged by either HMH or the CNA, which is their prerogative. However, if you’re a “true believer” of the CNA party line you might assume that it’s HMH that has challenged the lion’s share of the 176 ballots, but you’d be wrong. It’s my understanding that HMH has challenged only five that’s right five of the 176 challenged ballots, leaving 171 votes challenged by the CNA, that’s right the CNA is the side that has chosen to challenge the largest number of ballots. On the bright side, it looks like pretty much every eligible RN who was entitled to vote did just that with only about 40 nurses abstaining. This, in my humble opinion, is proof that contrary to the heated rhetoric of the past several months show that the HMH RN’s felt free to vote! Now why would the CNA, the nursing union that kept spewing the “just let the nurses vote” mantra at every media source they could find and painting HMH as some kind of boogey man when it came to the nurses voting on the issue of whether or not to unionize, challenge so many ballots? Why, because they feared that the majority of these 171 ballots were not in favor of the union and thus their strategy was to challenge these ballots, thus hopefully swinging the outcome of the vote in their favor. However it would appear that this strategy might have backfired. We should know the final results on April 27th and if the NO votes win the day the CNA will of course respect the nurses will – NOT! They’ve already made it clear (just take a peek at their newest flyer handed out the very next day – CNA Flyer) that they plan to continue their campaign to unionize the RNs at HMH – so much for “just let the nurses vote”. Hypocrite, thy name is the CNA.

I would hope that Professor Dreier is a better fact checker of his instructional material than he is of his columns, because in his above entitled column he failed to fact check the statements about me provided to him in all likelihood by the California Nurses Association (CAN).

Not only does he mangle the name of my company (it’s Solutions Outside the Box, not Outside the Box Solutions), he also falsely accuses me of having been hired by Huntington Memorial Hospital (HMH) to as he puts it “to harass and intimidate nurses and undermine their organizing efforts”. I’ve not received, been paid, promised, etc., a single red cent by Huntington Memorial Hospital. I’ve also not engaged in any way shape or form to harass or intimidate any HMH nurse. The CNA (whose leadership fears me as well as any nurse willing to stand up to their machinations) is always happy to spread lies and untruths – in short they know that I’m not being compensated but they are happy to say I am because more often then not the folks that support them (like Prof. Dreier) don’t bother to fact check the information that the CNA spoon feeds them.

Prof. Dreier goes on in his column to illustrate, as so often happens when ideologues from either side of the political spectrum get their “panties in a wad” to tell the tale of woe of their favorite side and ignore the experiences from the other side of the discussion. So, since Prof. Dreier’s fact checking is lacking let me set a few things straight.

First, I was contacted by several HMH nurses that wanted to learn what their options were to avoid a union. In that spirit, I met with a group who came on their own time and dime to learn what resources and recourses they had to provide a counter-point to the “let’s join a nursing union” advocates. They didn’t pay me a red cent. I did however secure the domain name of their group, IStandWithHuntington.com to ensure that it couldn’t be co-opted for other uses, but it’s the IStandWithHuntington nurses that run it and moderate it.

Second, I know that many of the “we don’t need or want to join the union” nurses have shared stories of being followed, tires being slashed, secure areas (key-card accessible only areas) doors of the hospital being propped opened with orange traffic cones bearing the name of hospitals other than HMH have been reported. One nurse who has vocally opposed the CNA returned to her station to find that someone had left feces on her chair. In case you think she imagined such a disgusting act, a third party observed a pro-union nurse committing the act. As for the incident that Prof. Dreier states occurred in the HMH cafeteria, I understand that there is a video of the event and from what has been described to me the pro-CNA nurses weren’t just sitting politely at a table, but instead were blocking egress to the cafeteria and one of their supporters went so far as to go over to the IStandWithHuntington group in a confrontational manner to verbal abuse the nurses for not coming along with the program. So it would appear that there might be bad actors on both sides, which is why such a campaign often leaves open wounds in its wake regardless of which side prevails.

Third, Prof. Dreier parrots the plea for “just let the nurses vote”, but what he fails to inform his readers is that the CNA doesn’t want to let all eligible nurses vote, they want to pick and chose which nurses can vote and they do this by challenging a particular nurses’ vote. When the NLRB called the election the first thing the CNA did was challenge the right of the Patient Flow Coordinators (PFC) to cast a ballot. The NLRB didn’t agree and said the PFC’s could vote but that their ballot would be a different color (a Scarlet letter so to speak), segregated from the other ballots and only counted if the vote was close. Then the CNA, not happy with this, made it clear they planned to “challenge” some of but not all of the PFC ballots – guess which one they didn’t want counted. Finally, the CNA declared that they didn’t want any PFC ballot counted, even though theses nurses if the CNA prevailed would fall under the CNA representation. So I guess when the CNA stomps their feet and shout “just let all the eligible nurses vote” what they really meant to say was “Just let the ones we say have the right to vote, cast a ballot”.

Back in the day when I was a professor of Nursing the need to fact check our information was considered paramount. Perhaps the same exacting standards aren’t required for Prof. Dreier’s department of Urban & Environmental Policy or Occidental College – one would hope not.

You can read Dreier’s column here – http://www.huffingtonpost.com/peter-dreier/huntington-hospital-nurses-defy-union-busting-campaign_b_7051072.html

Tornek for Mayor!

It takes a strong person to admit a mistake.

Yeah, I know – didn’t I blog all that long ago to not vote for Terry Tornek for Mayor, and you’d be right. Except, two things happened since then. The first being that my candidate of choice back then was Dan Morgan and after the general election he came in third leaving only the top two vote getters to move to the April 21st run-off. And second of the two remaining candidates, Terry Tornek and Jacque Robinson, Tornek in my opinion is the better candidate.

During the run-off period I and several other individuals had the opportunity to met with both candidates, on different days of course. The reason for the meetings was an item of concern to us as a group, and Tornek when asked agreed immediately, emailing me by the next day with dates and times that worked for him, while Robinson appeared to take her time deciding whether or not she would grace us with her presence, but at the last moment emailed a day and time that she could meet with less than a 24-hour window in which to let everyone else know. The topic of our discussion would be the concerns of the nurses from the other side of the whether or not to form a nursing union at our local hospital, Huntington Memorial.

The CNA had played their usual dirty PR game, demonizing the hospital management, accusing the hospital of providing poor care and of course getting local elected officials, religious leaders and community members to come out to these “demonstrations” and calling for “fair elections” and “just let the nurses vote”. Of course both Robinson and Tornek came out to one or more of these demonstrations, so for the nurses coming to the meetings with Robinson and Tornek it was very significant because until that time no nurse who didn’t want a union had had the opportunity to speak to either Tornek or Robinson so they were anxious to have their voices and concerns heard.

As luck would have it we met with Robinson first, the meeting was brief and it was apparent from her body posture that the meeting was pro-forma. Robinson listened but parroted the “just let the nurses vote” line, ignoring that the vote was already tainted with all the demonstrations and that the CNA had already challenged the right of some of the nurses to vote – so much for a fair election and letting the nurses vote. In short she might have appeared to listen to our concerns but most of our group came away with the impression that her side was picked and her decision well made, and we shouldn’t burden her with new information. After one of her patented just let them vote,” I finally told her that she was being flippant. I told her that as an elected official her duty is to represent union as well as non-union constituents. So strong was this vibe that a couple folks from our group said it wasn’t even worth their time to meet with Tornek.

Our meeting with Tornek followed many days later and where Robinson seemed stiff and distant, Tornek appeared relaxed and engaged. He gave us nearly an hour of his time and seemed to be taking great interest in our concerns – this didn’t necessarily mean that he supported our point of view, but it didn’t leave us with the feeling that we were beating our heads against a brick wall.

At a recent debate Robinson kept telling the audience that she was willing to have difficult conversations, but when asked by one of the panelist how she could (and let me paraphrase) on the one hand be endorsed and supported by the police union when it had sued to block the release of the independent review of the police shooting of McDade an unarmed teenager from our community. She never did answer the panelist’s question – I guess this was one difficult discussion she wasn’t willing to have.

I like to think that I’m capable of integrating new information and adjusting my conclusions based on that information which is why tonight my daughters and I are going to complete our mail in ballots – selecting Tornek for Mayor of Pasadena. I hope that all my Pasadena friends that are registered to vote will do the same as well, because we need an individual who can and is willing to represent all Pasadena residents!

Hard Facts? Whose Facts?

Once again John Grula has published yet another attack (“Hard Facts” – http://www.pasadenaweekly.com/cms/story/detail/hard_facts/14291/) against Huntington Memorial Hospital (HMH), and argues that somehow a nursing union (in this case the California Nurses Association – CNA) is the panacea for all the ills that he lays at the doors of HMH. His source for his damning accusations of poor quality of care is the September 2013 issue of Consumer Reports article – “Your safer-surgery survival guide.” which in his article he cites as “the gold standard when it comes to providing trustworthy evaluations of consumer products and services.” Such reports might serve you well for a dishwasher, vacuum cleaner, car and so on, but maybe not so much for a hospital. Perhaps he and others may believe that Consumer Reports is the “gold standard”, but this nurse and health care professional prefers to rely on reports from sources such as the Joint Commission – www.qualitycheck.org and the Centers for Medicare and Medicaid Services (CMS) – www.hospitalcompare.hhs.gov, State and County Department of Health Services ratings when it comes to accessing the overall “quality” of a hospital.

I also had a good laugh at his reference to the recent Leapfrog scores where HMH received a grade of “C”. He made a great deal out of HMH’s C-grade while extolling Kaiser (a unionized hospital chain), but fails to point out that UCLA Medical Center (a unionized hospital) also received a “C” from Leapfrog. Grula also goes on to rave about how of the four hospitals designated by the CDC to provide care for Ebola patients were all in Northern California – oh and unionized. However, Grula should be well aware that in all likelihood these hospitals were selected more for meeting specific qualities and criteria that the CDC setup more than anything else. But then again Grula’s facts seem somewhat weak on this issue, because in his article he makes the following claim “A hospital really has to have its act together to be designated an Ebola treatment center by the CDC, and in the case of California, the four hospitals that achieved this mark of excellence are all in the northern part of the state.   Those four hospitals are:  Kaiser Oakland Medical Center, Kaiser South Sacramento Medical Center, the UC Davis Medical Center and the UC San Francisco Medical Center. No hospital in Southern California, including HMH, made the grade with the CDC.” However, a quick glance at this CDC page – http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/current-treatment-centers.html, and you’ll see all 55 hospitals with Ebola treatment centers including the four Southern California area hospitals overlooked by Grula that hold this designation. I guess Grula and the Pasadena Weekly editors need to be more thorough with their fact checking – but perhaps the facts don’t matter for Grula and the Pasadena Weekly when it comes to their campaign to denigrate HMH. And for the curious among you this CDC link details the process for being designated an Ebola treatment center – http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/treatment-centers.html.

Grula, even went so far as to pull a quote from one of my blog posts “Myth of the Magnet Hospital”, but was unable to even correctly spell my name or include my credentials, where I state that I believe the Magnet designation is a dubious one. I stand by this statement primarily because unlike receiving Joint Commission accreditation that can be pulled by the Joint Commission. A “Magnet” hospital rarely if ever stands to loose its Magnet designation when their nursing staff truly fails. A Magnet hospital might not be able to renew their status, but to my knowledge UC Davis (it has since regained its Magnet designation) is the only Magnet hospital to lose its Magnet status ironically due to all the nursing conflict created by their nursing union. No other Magnet hospital has had it Magnet designation, not even Cedars lost their Magnet designation when their NICU nurses nearly killed several infants due to heparin overdosing due to nurses failing to read the vial and to follow the procedure to double-check the medication. So my philosophy is that the Magnet designation can serve a purpose to help distinguish excellence in nursing, but only if the organization behind that designation is willing to remove or place a hospital in a probationary status when the nursing team makes an egregious error. Just as the Joint Commission will come back to re-inspect a hospital when problems arise and if necessary remove their seal of approval until corrections are made, so too should the ANCC for the Magnet designation.

Grula is so enamored with Leapfrog and his conclusion that unionized hospitals provide the best of care he still hasn’t explained why Antelope Valley (a CNA-represented hospital) was the only hospital in LA County to receive a F from Leapfrog. Could he be engaging in the practice of ignoring information that might unfavorably skew his results? Just asking?

It would appear his love for Kaiser knows no bounds, because as he extolls Kaiser’s virtues he fails to acknowledge the recent 28 million, that’s right 28 million, dollar judgment against Kaiser for their failure to promptly MRI a patient, costing that patient the loss of her leg, and fines imposed against Kaiser for their failure to provide appropriate mental health services to their patients, this is the second year where they still have deficiencies and not made all the corrections required. This is a common willful blindness problem on the part of the rabid pro-union advocates. They pick apart organizations and individuals that they perceive as opposing their unions and views at the expense of some obvious truths. Many years ago the CNA tried to get the California legislature to pass a card-check law for nurses. If passed this law would simply require a union gather enough qualified signatures from nurses at a particular hospital and that hospital’s nursing staff would automatically be represented by a union, no election, no opportunity to present any other side of the discussion. I attended one of the hearings in Sacramento where unionized nurses presented their tale of woe to the committee. They argued that without a nursing union nurses couldn’t stand up to hospital administrators and appropriately advocate for the patient. Their tales were vivid and pulled at your heartstrings they even invoked the example of a Tenet hospital in Redding, CA that was accused, at that time, of excessive cardiac surgery. Their claim was simple, if only those nurses had been in a union they would’ve felt safe to speak up; the only problem with their argument was that it was the nurses, the non-union nurses that blew the whistle on this practice. As I listened to their rationale, I wondered where were all the union nurses blowing the whistle on the IVF scandal at UC Irvine so many years ago? And because I had my ducks in a row and all the evidence, I like to think it was this last minute effort by a handful of nurses and myself that helped get the bill pulled by its sponsor and it eventually died. If there’s one-thing legislators don’t like, its being lied to and made a fool.

And while we’re at it if unions are so great for nurses why are the CNA and another nursing union, UNAC/AFSCME embroiled in a fight at Kaiser – Los Angeles Medical Center to hold an election so the nurses can leave UNAC for the CNA. Ironically, the CNA has also accused UNAC and Kaiser of engaging in practices that are blocking the nurses from this vote. Here’s a copy of an Open Letter to UNAC members_Sigs2 sent to UNAC members sent by CNA-supporting nurses regarding this very matter. In their letter they plead that people should call “UNAC at 800-762-5874 and tell them to withdraw all blocking charges, charges that are preventing your nurse colleagues at LAMC from a fair and democratic election that will finally allow us to choose our union”. Sounds familiar doesn’t it, I guess “evil” hospitals aren’t the only ones that seem to cause the CNA problems, unionized nurses cause the CNA problems as well – how ironic!

So Grula I call your September 2013 issue of Consumer Reports article and raise you my 2014- 2015 US News & World Report Best Regional Hospitals (http://health.usnews.com/best-hospitals/area/ca/huntington-memorial-hospital-6932350).

Terry Tornek for Mayor — NOT!

Not that long ago the Pasadena Star News announced that it endorsed Councilman Terry Tornek for mayor. In their editorial they characterized his running as mayor, as being brave. They came to this conclusion that he was brave by throwing his hat in the ring, before Mayor Boggard (our current mayor) had announced whether or not he’d seek another term. I don’t know about you but I would hardly call what Tornek did as brave, especially since he didn’t resign his council seat – that’s right. He’s currently an elected member of our city council, so if he loses his bid for mayor he can finish out his term. In my book that’s not called being brave, it’s called hedging your bets. At least, Jacque Robinson resigned her council seat to run for mayor – not that’s definitely showing more courage that Tornek – but still not enough to earn my vote.

At first, I was supportive of Robinson in her run for mayor, but as time would reveal she, like her fellow councilmember Tornek, were way too beholding to their union cronies. I was able to come to this conclusion because these two, like Victor Gordo and Judy Chu were only open to listening to the handful of pro-California Nurses Association (CNA) nurses from Huntington Hospital and chose to ignore the requests of the we-don’t-need the CNA nurses from Huntington Hospital (they call themselves IStandWithHuntington). It took 30 or so IStandWithHuntington nurses swarming the CNA sponsored press conference before Robinson, Tornek, et al to even acknowledge that there nurses that had a differing opinion on the issue of whether or not to unionize.

So when I took in account both Tornek and Robinson’s lack of fairness to the IStandWithHuntington nurses and that these two individuals were also sitting councilmembers during at least part of the time a city employee was able to embezzle an estimated 6.4 million of Pasadena taxpayer money – I made the decision that it was time to support a different candidate. So from among the remaining four candidates, I decided that I’d support and vote for Don Morgan.

Your can read my letter here – (LTE PSN Tonrek for Mayor2a) that I sent to the Pasadena Star News, which they have failed, refused — call it what you may. I hope you’ll consider voting for Don Morgan. I think he would be a welcomed change.