Let’s talk about pain

A while back I published several articles on pain and opioid use.  I wrote these article to shed light on the other side of the pain and opioid use debate that seemed to me to be very one-sided.  And while opioid abuse has undoubtedly destroyed many lives, what concerned me most was the focus on opioid abuse without equal time being given to the estimate 25.3 million Americans suffering from chronic pain (8/11/15 NIH press release).

That said you can find my articles on the issue here

Nov. 2011 – Working Nurse Magazine – Chronic Pain: What nurses don’t know about pain management WNM Chronic Pain1 copy

Sept. 2012 – Working Nurse Magazine – The Great Opioid Debate: Balancing the need for pain management with the potential for abuse — WNM The Great Opioid Debate1 copy

May – Apr. 2014 – Working Nurse Magazine — The Opioid “Epidemic”: Why we need to dial back the sensationalism and find common-sense solutions — WNM Opioid Epidemic1 copy

Enough is enough

Since April of last year there has been the constant drone from the California Nurses’ Association (CNA) and their supporters of “just let the Huntington Memorial Hospital (HMH) nurses vote”. Elected officials such as Congresswoman Judy Chu, Pasadena City Councilpersons, Gordo and Tornek, former Pasadena City Councilperson Robinson, various “community leaders” and others have picketed the hospital, held rallies, written letters to the editor and what not echoing this simple plea. However, when the vote which was held in April 2015 showed that a majority of HMH nurses voted no to having union representation these same individuals who claimed they were only interested in the HMH nurses getting to vote suddenly had a change of heart and cried foul, demanding that the vote be stricken and a new vote taken even though well over 90% of eligible HMH RNs came out to cast their vote.

As expected both the CNA and HMH leadership filed charges with the National Labor Relations Board (NLRB), each claiming that the other side had made one type of violation or another. The NLRB rendered numerous decisions, some in upholding the CNA claims and dismissing others. In the meantime the campaign to disparage the care at HMH continued unabated. Even after the CNA and HMH agreed to set aside the vote and hold a new election there were those CNA supporters who seemed unable to control themselves and continued their attempts to vilify HMH and its leadership.

One such person is an individual named John Grula, PhD who writes a column for the Pasadena Weekly. He’s most recent diatribe against HMH can be found here – http://www.pasadenaweekly.com/cms/story/detail/outbreak_of_truth/16130/.

He makes many claims in his article, which on their face sound absolutely outrageous. Claims such as CNA-affiliated RNs provide the best patient care in our state. To bolster this claim he brings up the Olympus scope and how the failure to properly clean them lead to bad consequences for many patients. He goes into great detail about these incidents that occurred at HMH, but failed to mention that there were at least two other LA-area hospitals that had similar outbreaks and breeches in reporting such outbreaks. One such hospital was UCLA Ronald Reagan Medical Center, which ironically he cites as having CNA-affiliated RNs that provide the best care in our state.

At the beginning of Grula’s article he cites a June 1, 2016 LA Times article which if you don’t read beyond the first paragraph paints a dim picture about how HMH handled the drug-resistant Pseudomonas aeruginosa. However, if you read the full article, which you can find here — http://www.latimes.com/business/la-fi-huntington-hospital-scopes-20160601-snap-story.html, a slightly different picture emerges. The article lays out the problem was not just at HMH, but at hospitals across our nation, it also lays out the steps HMH took to correct the matter.

His article goes on to mention the firing of two HMH nurses, which the CNA and their supporters claimed was in response to the nurses’ pro-union stance and unionizing activities. He then writes that the NLRB agreement rescinded their termination, removing any mention of termination from their employment record, that they received back pay and that one nurse had returned to HMH. While some of his statement is correct, he fails to mention that while any mention of their termination was removed from their employment files notating instead that they had voluntarily resigned. Grula goes on to claim that one of these nurses chose to return, but my research shows that the nurse he claims returned to work at HMH, hasn’t. The reason for this appears to be related to the NLRB agreement, which bars both nurses from ever working at or having any business with HMH now or in the future. Not to mention that I know that at least one complaint has been filed with the California Board of Registered Nursing (BRN) about the nurses and the possible violation of our nurse practice act. Several weeks ago, I learned that several HMH nurses have admitted to being questioned by the BRN. Now whether this goes anywhere remains to be seen.

In the end, I find it ironic that the CNA and their supporters continue to rant and rave about giving the HMH RNs a voice, but seem to ignore that their “victory” at having the HMH vote overturn effectively gaged the voice of the 539 HMH RNs that voted no to union representation. Throughout this entire contested voting period the CNA and their supporters seem to only advocate for the 445 HMH RNs that voted for union representation and minimize the fact that a majority voted not to unionize.

Where are the CNA and their supporters speaking out in support of these nurses? Nowhere I guess, because it would appear to me that the CNA and many of their supporters appear ethically and morally challenged to acknowledging that these RNs might actually feel that they don’t need a nursing union to speak for them.

You may recall that back in September of last year I blogged about at least one complaint being filed against Nurse Allysha Almada and Vicki Lin with our Board of Nursing (BRN). It’s come to my attention that BRN investigators  have interviewed several Huntington Memorial Hospital (HMH) nurses regarding the Almada/Lin affair.

At this point I have no idea what these nurses told the BRN investigators or what questions that the BRN investigators had for the nurses. However, as I learn more I’ll be sure to share the information on The Nurse Unchained. Of course the BRN investigators may conclude that there wasn’t a violation of our nurse practice act in which case the allegation can be closed with or without merit. However if its decided that the allegation is substantiated then the allegation can be refer to the Attorney General for formal disciplinary action or refer to cite and fine. This is call an accusation and if a nurse has an accusation filed against him/her it will show up on a license search.

You can learn more about the complaint process by pointing your browser here

Also point you browser here for my article on the California BRN WNM California BRN1

Here we go again, at the begin of June, just 4 days shy of the scheduled NLRB hearing regarding Huntington Memorial Hospital (HMH) and the California Nurses Association (CNA); the news broke that HMH and the CNA had come to an agreement. The papers spun it as if it was a victory for the CNA and the two nurses that had been fired, over the “evil” HMH and its management.  HMH reportedly terminated Alysha Almada and Vicki Lin for violating hospital policy, however Almada, Lin, their supporters and the CNA argued that they had instead been fired for their activity in trying to unionize the HMH registered nurses. An attempt that failed with 539 HMH nurses voting NO to 445 HMH nurses voting YES (with 171 additional votes being challenged by one side or the other).

Our local media herald the “rehiring” of Almada and Lin, even going so far as quoting Almada that she had “decided to decline returning to work at HMH because for the past six months I’ve been working at Keck USC, a hospital where RNs enjoy a CNA contract”. However I received an email (which you can find attached at the end of this post) that tells a slightly different tale. Yes, Almada and Lin’s termination was rescinded, but this termination was replaced with voluntary resignations. However what struck me as odd was that part of the agreement assured that neither Almada nor Lin would never be permitted to obtain employment or have any other business relationship with HMH; a caveat that I found very interesting.

Still unresolved through all this is what is happening with the complaint (at least one that I know for a fact was filed, and another that has been filed which I cannot confirm) about Almada and Lin’s action that were filed with the California Board of Nursing (BRN). I’m not sure if the BRN is moving forward with the complaint, but if they do and if the BRN does decide that their action was indeed a violation of our nurse practice act then an accusation will in all likelihood follow. I wonder if that indeed happens will our media report on this or just ignore it? Only time will tell.

Meanwhile, various newpapers, including the Pasadena Star News, Pasadena Weekly and Pasadena Independent spun the agreement as some sort of victory for the HMH nurses, but never once interviewing a single one of the 539 nurses who voted no to CNA representation. Not a single reporter asked them what they thought about their votes being thrown out at the request of, ironically enough, the very nurses union that Almada and Lin argued were all about giving nurses a voice. I guess the only nurses deserving a voice in their opinion are those that favor a nurses’ union and the rest be damned.

As promised below is a copy of the email that nurses forwarded to me, and though I have confirmed that it wasn’t a confidential internal memo, I’ve redacted private and contact information to protect my sources.

eMail HMH v CNA Settlement

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).

So for those who may or may not have read Mr. Grula’s latest attempt to convince the Pasadena Weekly reader’s that the California Nurses’ Association (CNA) should be given free reign at Huntington Memorial Hospital (HMH), by “just let the nurses vote” – what a disingenuous piece of tripe.

He begins by heralding that the LA region of the National Labor Relations Board (NLRB) has found “probable cause to believe the HMH has engaged in unfair labor practices against the nurses wanting to form a union”. That might be the case, but let me remind my readers that this is the same regional board of the NLRB that found that the threats made from the offices of the CNA against two Cedars’s nurses that opposed the union weren’t threats at all. However the DC NLRB (and final say on the matter) decided that threats made to one nurses children and another’s nurse’s pets were indeed threats and thus were enough to invalidate the vote – and to this day Cedar nurses remain union-free. In short, just because the regional branch feels there’s probably (i.e. a reasonable belief) cause it doesn’t mean that in the end it will be substantiated.

But what really galls me is this attempt by Grula to somehow equate union representation with the recently released “Leapfrog scores” published in a recent LA Times article — http://graphics.latimes.com/california-hospital-scores/. Granted HMH gets a rank of “C”, but so did 69 other hospitals, including such venerable institutions such as UCLA Medical Center, Loma Linda (which got a D believe it or not) and Stanford Hospital. Grula goes on, in his article to make it appear as though HMH is the only LA County hospital with such a low score – not true! He also goes on to pontificate that Kaiser (a CNA-represented hospital network) has a rank of “A”, which is true, but what he fails to disclose is many other CNA-represented hospitals that scored “C”, “D” and “F” grades– yes “F”.

So, Antelope Valley Hospital is the only LA County area hospital to receive a big fat F and is a CNA-represented hospital! California Hospital Medical Center, Citrus Valley Medical Center Inter-Community, Glendale Memorial Hospital, Good Samaritan Hospital, Henry Mayo Newhall Memorial, and UCLA Medical Center all receiving a C grade are all CNA-represented hospitals. So while HMH receiving a C-grade might provide fodder for Grula and the CNA to say that hospitals with unionized hospital staff get better grades from Leapfrog is a very weak assumption to make (I think they’re kind of leapfrogging to that assumption). It would appear that Grula is following in the footsteps of the CNA in not allowing the facts to get in his way.

The problem, in my opinion, lies with the CNA-campaign to gather enough valid RN signatures to call for a vote – and it would appear that they might be falling short of this goal. So now the CNA is trying to pressure HMH management into just giving the CNA the “keys to the kingdom” and allow a vote to go forward without showing via signed cards that a majority of HMH RNs want the union. The feedback that I’ve gotten from HMH nurses on the ground is that most have been rebuffing the CNA’s advances. So this will have to make the CNA representatives work all that much harder for the votes – oh boo hoo. The CNA likes to paint nurses that are pro-union as somehow being brave and self-determined all the while painting nurses that oppose the union as somehow misguided, naïve or shills for management. They accuse yours truly of interfering because I’m giving “aid and comfort” to those RNs standing up to the CNA union machine all the while the CNA applauds local politicians, church and community leaders who support the CNA. Their message if you support the CNA you are somehow brave and community minded, and if you don’t you’re weak minded and interfering; their logic boggles the mind.

The CNA tried this same tactic many years ago when they tried to get our state legislators to pass legislation that would bypass a vote entirely and simply allowing gathering enough signed cards to install a union. They testified that nurses were really too weak to “speak up for themselves” thus they needed this card check legislation. Union representatives even went so far as to tearfully testify that if only the nurses at that “Tenet hospital in Redding” had been unionized the RNs would have felt safe to come forward to blow the whistle on all the unnecessary cardiac surgery that was being performed. There was just one problem with that scenario. It was the nurses, themselves, that blew the whistle – the very non-unionized nurses that the union deemed to weak to speak for themselves. Meanwhile they never explained why the union represented nurses at UC Irvine never blew the whistle on the problems with the IVF program.

This is one of my fundamental issues with nursing unions, which is they all too often resort to mud slinging, fact mangling and sometimes out right lies to grow their ranks. Nursing is a profession and should be treated as such. All too often unions in their mad dash to unionize the RN workforce resort to tactics that leave a mark on our time honored profession. I say if they want to convince nurses to unionize do so with the facts, with well supported arguments and leave the bullying and threats out of it. And as I always say “if nurses are too weak and incapable to advocate for themselves (as the CNA purports) how can these same nurses advocate for their patient as they are require by The California Nursing Practice Act.

But back to the “C” grade awarded to HMH and many other hospitals. It’s important to keep in mind that there several different hospital safety “report cards” available. Leapfrog – www.hospitalsafetyscore.org- is but one of many that are recognized and used. You can also see how your local hospital stacks up by using the Joint Commission Quality Check – www.qualitycheck.org; CMS Hospital Compare – www.hospitalcompare.hhs.gov; and Consumer Reports Hospital Safety Ratings – www.consumerreports.org/health/doctors-hospitals/doctors-and-hospitals.htm to name a few.