September 25th, 2009 by Happy Hospitalist in Better Health Network, Humor, Opinion
No Comments »
Over the last several weeks I have received numerous emails dictating the enforcement of work place rules regarding eating and drinking in nursing areas and other areas with patient charts. It seems everyone, from the Chief of Staff to the CEO to the Head Nurse In Charge has been making it very clear that drinking in work areas won’t be tolerated. I have at times been confronted by dutiful staff doing their jobs with a robust sense of confidence to enforce this potentially dangerous patient safety issue.
Or so I thought. Whilst speaking with one of Happy’s friendly colleagues, I learned that the issue of food and drink in the work place has nothing to do with patient safety. Like my colleague stated so eloquently, if there is data that can be presented to me that shows my action of drinking coffee at the work stations would some how harm my patient, I will gladly stop immediately. Discussion finished.
But as I learned from my colleague, the issue of food and drink at the nurse’s station or anywhere near patient charts has nothing to do with patient safety. In fact, the regulations are in place to protect ME from myself.
That’s right, the coffee Nazis are cruising the halls with reckless abandonment searching for violators of the hospital wide coffee ban on rounds not because patients could be harmed, but because I could harm myself.
You see, it turns out my distinguished colleague was told these regulations were not CMS or JCAHO regulations, but rather OSHA regulations.
So I looked it up
“OSHA does not have a general prohibition against the consumption of beverages at hospital nursing stations. However, OSHA’s bloodborne pathogens standard prohibits the consumption of food and drink in areas in which work involving exposure or potential exposure to blood or other potentially infectious material takes place, or where the potential for contamination of work surfaces exists 29 CFR 1910.1030(d)(2)(ix). Also, under 29 CFR 1910.141(g)(2), employees shall not be allowed to consume food or beverages in any area exposed to a toxic material. While you state that beverages at the nursing station might have a lid or cover, the container may also become contaminated, resulting in unsuspected contamination of the hands.
Here are the actual OSHA regulations
1910.1030(d)(2)(ix)
Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.
1910.141(g)(2)
Eating and drinking areas. No employee shall be allowed to consume food or beverages in a toilet room nor in any area exposed to a toxic material.
In other words this is not a patient safety issue, but rather an employee safety issue. The Joint Commission has no specific standard on the issue other than for hospitals to comply with OSHA regulations.
So with that in mind, I have two comments regarding the issue:
- As a private practice physician who is not employed by the hospital, I would suggest that these OSHA rules do not apply to me and therefore the hospital risks no retribution for noncompliance from the accreditation arm of the Joint Commission, which is why I suspect the issue comes center stage for hospitals everywhere. If necessary, I will gladly sign a waiver to relinquish my rights to compensation should I ever contract a blood born pathogen or other communicable disease from drinking my coffee.
- If the hospital believes this is a patient safety issue and wishes to make their regulations stronger than those of OSHA and apply them to ALL people in areas with patient pathogens, I will gladly relinquish my daily fluids when I am shown the data regarding patient harm AND the hospital also bans all patient guests from bringing food or drink into the patient’s room. If this is a patient safety issue, it must apply to everyone should they wish to make their rules stronger than OSHA guidelines.
Until this is resolved with rational thought, perhaps over a round of coffee, I’m going to carry one of these around:
It always seems to work for patients.
*This blog post was originally published at A Happy Hospitalist*
September 24th, 2009 by Dr. Val Jones in Audio, News
No Comments »
Rudy Tanzi, Joe Perry, Francis Collins
I know. I was just as surprised as you are. Dr. Francis Collins, former director of the Human Genome Project, author of The Language Of God, and new director of the National Institutes of Health performed live in front of a group of Washington locals at the Capitol building today. He actually jammed with Aerosmith’s Joe Perry in an “unplugged” performance of Bob Dylan’s, “The Times They Are A Changin’.” This is not the kind of thing one expects in the hallowed halls of the Capitol building. But maybe it’s time to expect the unexpected?
I happened to have my reporter’s microphone with me in the audience so I recorded the song. The vocalist is Dr. Collins, Joe Perry does a guitar solo near the end, and Dr. Rudy Tanzi is on harmonica. The sound quality is… well… it’s what you’d expect from a hand-held microphone. But it’s worth a listen, just to get to know our new NIH director a little better!
[Audio:https://www.getbetterhealth.com/wp-content/uploads/2009/09/francis-collins.mp3]
Delta Goodrem
Australian pop star and cancer survivor Delta Goodrem followed Dr. Collins with this acapella beauty (again, forgive the sound quality):
[Audio:https://www.getbetterhealth.com/wp-content/uploads/2009/09/delta-goodrem.mp3]
A few things struck me about the event. First of all, Francis Collins is more of a “firecracker” than I expected. I read and reviewed his book recently, and his vivacious personality did not come through in its pages as well as it did on the stage with Joe Perry. He’s a fun-loving guy, a serious scientist, and very committed to advancing research and encouraging young people to rekindle their interest in discovery. That’s all very good news for America.
Secondly, I was touched by Joe Perry’s story about wanting to be a marine biologist when he grew up. Apparently he had a learning disability of some sort that was not addressed in school. For that reason, his test scores suffered and he looked for ways to excel outside of the classroom. His bright mind discovered an immediate affinity for music, and he poured himself into a career as a rocker. He still yearns for the ocean, though, and is a certified diver. As I looked at Joe, I kept thinking – my gosh, he might have been the next Jacques Cousteau if he had more help in school. But brilliance finds its own way to flourish – and Aerosmith became his outlet instead.
Thirdly, I realized that there are in fact a few congressmen with their heads screwed on straight when it comes to science. I had almost lost hope after watching video footage of Tom Harkin instructing scientists to validate his opinions rather than test whether or not certain things were true. Yikes. But the three co-chairs of the congressional biomedical research caucus, Reps Brian Bilbray, Mike Castle, and Rush Holt, seemed to truly understand some of the issues facing the advancement of medical research – and are determined to move America forward.
And finally, I noted that there wasn’t a single female or minority “rock star scientist” in the program. That made me a little bit sad. Are we really that rare? I guess we still have a long way to go on that front… And since Dr. Collins mentioned that only 15% of US students are enrolled in science or engineering bachelors’ programs (compare that to 50% in China or 75% in India) we are soon going to be playing catch up with the rest of the world in terms of scientific discovery.
So we’ve got our work cut out for us folks – with our youth’s waning interest in science education, the excessive red tape that is slowing down the process of producing cures, and the public getting their medical advice from the likes of Jenny McCarthy, there has never been a more important time to restore science to its rightful place.
Maybe Francis Collins is going to “bring sexy back” to science?
Whatever works!
***
More info on the Rock Stars Of Science program.
September 24th, 2009 by KevinMD in Better Health Network, Opinion
No Comments »
Over at Slate, Christopher Beam takes a balanced look at the issue. He acknowledges that, yes, American physicians get paid proportionally more than the average employee when compared to other countries.
But that should always come with the caveat that other countries, like Great Britain and France, heavily subsidize medical education, while the average American medical student graduates with debt in excess of $150,000. Furthermore, the cost of medical malpractice insurance is significantly more fiscally burdensome for doctors Stateside.
Listen to Princeton’s Uwe Reinhardt, a favorite economist of health reformers, who says, “doctors’ take-home pay (that is, income minus expenses) amounts to only about 1 percent of overall health care spending, or about $26 billion. That’s a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors’ offices, and advertising for drug companies. The real savings in health care will come from these expenses.”
Indeed.
By the way, thanks to Mr. Beam for including a quote and link from yours truly.
*This blog post was originally published at KevinMD.com*
September 24th, 2009 by RamonaBatesMD in Better Health Network, Medical Art
No Comments »
The surgical dressings section of the old surgery text, A Text-Book of Minor Surgery by Edward Milton Foote, MD, I first mentioned on Monday is very interesting.
Cotton
Cotton in its raw state has very little absorbent power because of the oil and gum with which its fibers are covered. When the cotton has been bleaches by chemicals, and the oil extracted, its absorbent power is very great. This fact, together with its cheapness and lightness, the toughness of its fiber, and its ready sterilization by steam or dry heat make it almost the ideal material for surgical dressings.
Unbleached Cotton
This is cotton in its natural state, freed from dirt, combed, and put up in pound rolls. It is non-absorbent and has a greater elasticity than the absorbent cotton. It is therefore preferable as a padding for splints, and to diffuse the pressure of a non-elastic bandage….It costs about thirty five cents a pound…..
Absorbent Cotton
as supplied by the manufactures of surgical dressings, is freed from dirt, gum, and oil, combed and sterilized, and so wrapped in tissue-paper that with a little care it remains aseptic until it is all used. It is furnished in packages of various sizes, from a half ounce to one pound, costing thirty-five cents a pound in pound packages. On account of its lack of elasticity, it is inferior to unbleached cotton as a padding for splints, etc.
Dry cotton is not a suitable material to bring into contact with a wound either during operation or afterward. In the former case its fibers are likely to stick to the wound, and also to the fingers of the operator. In the latter case, if the discharge is small, it is likely to evaporate and seal the cotton to the wound or to the surrounding skin with a scab which is difficult of removal. If cotton is used for sponging, during an operation, balls of suitable size should first be saturated with saline or some antiseptic solution, and then squeezed dry.
Substitutes for Cotton
Lamb’s Wool
Lamb’s wool has great elasticity, does not become soggy when exposed to moisture, and absorbs readily oily substances and glycerids. When cleaned and sterilized it is therefore an excellent material for vaginal tampons.
[So very different from today!]
Gauze
Bleached absorbent gauze is the most important item in surgical dressings. The firmness of the material varies according to the number of threads to the inch. The quality should be selected according to the purpose for which it is desired. Thus a gauze which has 24 X 32 threads to the square inch is suitable for sponges or for dressings, but has not sufficient firmness to make a good bandage. On the other hand, a gauze with 40 X 44 threads to the square inch, used for bandages, is unnecessarily expensive when used for sponges or dressings. It is, however, an unwise economy to select for sponges and dressings a gauze with too large a mesh. Such a gauze absorbs so little that an additional quantity is required in every case, so that the total expense is very likely increased.
Gauze suitable for sponges and dressings, have 26 X 32 threads to the four to five cents a yard, by the piece of 100 yards. This price is increased to eight or even ten cents a yard when the gauze is purchased in small pieces, previously sterilized and hermetically sealed.
Unbleached Muslin Read more »
*This blog post was originally published at Suture for a Living*
September 24th, 2009 by David H. Gorski, M.D., Ph.D. in News, Quackery Exposed
3 Comments »
Although I have criticized state medical boards for not doing enough to protect patients from physicians who practice pseudoscientific medicine and quackery, they do nonetheless serve a purpose. Moreover, critical to medical boards doing even the limited amount of enforcement that they do is the ability of health care providers or other citizens to submit anonymous complaints against physicians who are not practicing up to the standard of care or who may be in other ways taking advantage of patients.
Unfortunately, the other day I found out about a very disturbing case in Kermit, Texas. Two nurses who were dismayed and disturbed by a physician peddling all manner of herbal supplements reported him to the authorities. Now, they are facing jail:
In a stunning display of good ol’ boy idiocy and abuse of prosecutorial discretion, two West Texas nurses have been fired from their jobs and indicted with a third-degree felony carrying potential penalties of two-to-ten years’ imprisonment and a maximum fine of $10,000. Why? Because they exercised a basic tenet of the nurse’s Code of Ethics — the duty to advocate for the health and safety of their patients.
The nurses, in their 50s and both members of the American Nurses Association/Texas Nurses Association, reported concerns about a doctor practicing at Winkler County Memorial Hospital in Kermit. They were unamused by his improperly encouraging patients in the hospital emergency department and in the rural health clinic to buy his own herbal “medicines,” and they thought it improper for him to take hospital supplies to perform a procedure at a patient’s home rather than in the hospital. (The doctor did not succeed, as reportedly he was stopped by the hospital chief of staff.)
How can this be? This is how:
The nurses Vicki Galle, RN, and Anne Mitchell, RN, say they were just trying to protect patients when they anonymously reported their concerns April 7 to the Texas Medical Board (TMB). The RNs believed a physician wasn’t living up to ethical practice standards at the 15-bed county hospital where they worked.
The report indicated Rolando Arafiles, MD, one of three physicians on contract with the hospital, improperly encouraged patients at the Winkler County Memorial Hospital emergency department and the county’s rural health clinic to buy herbal supplements from him.
However, because the two nurses worked for a county hospital – and included medical record numbers of the patients in their letter to the TMB in April – the county attorney’s office indicted them on “misuse of official information” – a third-degree felony that carries potential penalties of 2-10 years’ imprisonment and a maximum fine of $10,000. Additionally, the prosecution asserts the nurses used patient records as part of the evidence they offered to the TMB to “harass or annoy” Arafiles.
Part of what’s so disturbing about this is that complaints to the medical board are supposed to be confidential. Indeed, this sort of retaliation is exactly why such complaints are confidential. Why do I say “retaliation”? Well, certainly there is the suspicious timing of how they were arrested:
Mitchell and Galle, both long-time nurses at the facility, were fired from their positions and were subsequently arrested June 12, just 5 days past the 60-day window that could have been part of the defense to prove retaliation. The two nurses are free on bond of $5,000 each.
Gee, you don’t think that timing was intentional, do you? If that’s not enough, take a look at this account:
The nurses went up their chain of command with their complaints. They got nowhere with their 25-bed rural hospital. So they anonymously turned the doctor into the Texas Medical Board using six medical record numbers of the involved hospital patients .
When the medical board notified the physician that he was under investigation for mistreatment and poor quality of care, he filed a harassment complaint with the Winkler County Sheriff’s Department.
To find out who made the anonymous complaint, the sheriff left no stone unturned. He interviewed all of the patients whose medical record case numbers were listed in the report and asked the hospital to identify who would have had access to the patient records in question.
At some point, the sheriff obtained a copy of the anonymous complaint and used the description of a “female over 50″ to narrow the potential complainants to the two nurses. He then got a search warrant to seize their work computers and found a copy of the letter to the medical board on one of them.
So let’s get this straight. Two nurses, alarmed that a physician was inappropriately peddling herbal remedies that he sells to patients in the emergency room of a small rural hospital in the middle of Nowhere, Texas, try to report him through the chain of command. From here on out, I’m going to try to read between the lines a bit, but I bet my speculation is not too far from the truth. My guess is that Dr. Arafiles is probably either popular or desperately needed in Kermit–or both–and that he’s well-connected in the town. Well, actually, that last part is almost certainly true, as apparently Dr. Arafiles is buddies with the Sheriff (Robert Roberts) and–who knows?–probably Winkler County Attorney Scott Tidwell as well for all we know. The Sheriff, tipped off by his buddy that someone at the hospital was complaining about his questionable choice of venue to peddle his herbal woo, went after Mitchell and Galle as though they had gone on a four county shooting spree and and then, after he figured out who they were, threw the book at them, even though they had no justification in doing so:
The Texas Medical Board sent a letter to the attorneys stating that it is improper to criminally prosecute people for raising complaints with the board; that the complaints were confidential and not subject to subpoena; that the board is exempt from federal HIPAA law; and that, on the contrary, the board depends on reporting from health care professionals to carry out its duty of protecting the public from improper practitioners.
Excerpts from this letter include:
- Information provided by an individual to the board… is information used by the Board in its governmental capacity as a state agency…Information provided triggering a complaint or furthering and investigation by the Board is information provided for a governmental purpose – the regulation of the practice of medicine.
- …under federal law, the TMB is exempt from the [HIPAA] requirements; therefore, the provision of medical documentation with patient names on them to the Board is not a violation of [HIPAA].
And it’s true. In order to encourage whistleblowing and minimize the chances of retaliation, HIPAA rules don’t apply to complaints to state medical boards. Regardless of the merit of Mitchell and Galle’s complaint, they were well within their rights to report Dr Arafiles to the Texas Medical Board. It doesn’t matter whether they had first gone through the chain of command or not, regardless of what hospital flunkies or apologists for the sheriff say.
This case is bad. Real bad. Nurses and other health care professionals are reluctant enough as it is to report a bad doctor or a doctor peddling dubious therapies as it is. What makes this case particularly outrageous is not only because it appears to be a horrible abuse of power by Sheriff Roberts, but, even worse, it sends the clear and unmistakable message to nurses in Texas: Don’t get out of line or the medical powers that bewill make you pay. They will find out who you are, no matter what it takes to do so, and then they will do everything in their power to retaliate. They’ll even try to throw you in jail if they can figure out a rationale to do so, legal or not. It’s hard enough to go against a doctor as it is, particularly in small towns, where doctors are often considered pillars of the community, making it hard enough to risk the disapproval that would be likely to be directed at any whistleblower. Without legal protections against prosecution for reporting a doctor to the board, confidentiality means nothing if there is someone in a position of power who is determined enough to shred the confidentiality of the complaint (like a county sheriff) and apparently ready to abuse his power to retaliate against the nurses making the complaints.
Even though I’m a bit late to the game, it disgusted me to read about this case. If we are to protect the public from physician misconduct, be it quackery, breaches of ethics, inappropriate sexual behavior, fraud, or whatever, there must be protections for the complainants against retaliation by hospitals or whomever. Quite correctly, the Texas Nurse’s Association is fully backing Mitchell and Galle, and Mitchell and Galle are also filing a civil lawsuit in federal court against the hospital (Winkler County Memorial Hospital), the county attorney, and the sheriff. The complaint alleges:
Specifically, Winkler County had a policy to prohibit any adverse report without first getting the approval of the Board of Control of Winkler County Memorial Hospital and the Medical Staff. This discouraged employees from publicly reporting matters of public concern regarding patient safety and patients’ health and welfare as to how they were being treated that would cast Winkler County or Winkler County Memorial Hospital or Rolando G. Arafiles, Jr. in a negative light.
This sort of miscarriage of justice should not be allowed to stand. TheTexas Nurses Association has set up a legal defense fund for these nurses (a link is on the TNA home page), and I urger SBM readers to contribute. I have. I also encourage SBM readers to write polite letters of protest to the Winkler County District Attorney’s Office. It is a travesty that this retaliation against nurses just trying to do their duty for their patients has been allowed to continue this long and this far. We should do whatever we can to make sure that this pure power play to put a couple of uppity nurses back in their place does not stand.
It always seems to work for patients.
