Save The Company Time and Money

Family Medical Leave and Patient Safety

Betty needs to take a few days a month off from work to take her husband of 30 years to doctor’s appointments and for procedures following his stroke earlier this year.  Under the Family Medical Leave Act she is entitled to time away from work.   

Supportive of Betty, her boss gives her the time, no questions asked, but the company she works for  suffers when Betty is away.  What exactly is Betty doing for her husband when she takes him to the hospital for tests and procedures?  When I asked her, she says she drives him to the appointments and asks the doctor questions.

What Betty or her the supervisor at her job don’t realize, is that there are many things she can do to help ensure that her husband receives the best care possible and help speed up her time back to work – ultimately saving her from using sick time or losing pay and save her company money.

The Family Medical Leave Act (FMLA) entitles family members to take up to 12 weeks off from work to care for a sick family member.  But the family is not given the skills that can actually help produce better results speeding up recovery time and shorten lost work days.  Very often they are just the driver for the patient or what I call, the coat holder, doing nothing more than holding the coat for the patient, maybe ask a few questions, or write some notes.

If Betty took a brief training course in Family Centered Patient Advocacy, she would have some of the skills to make sure everyone who touched her husband washed their hands, cutting down the risk of infection.  She would learn to carry antibacterial wipes to clean door knobs and anything her husband, or others touched that may carry germs.

She would be confident to take all her husband’s medication, vitamins and herbs to the doctor or pharmacist for review to check for hidden side effects or interactions.

Betty may learn to ask about support groups for stroke patients who would help her, and him through the maze of paperwork increasing her chances to get back to work faster.

She would feel empowered to ask the doctor to repeat himself if she didn’t understand instructions avoiding a missed appointment, missed dose of medication or the improper use of equipment.

Betty would know to look for risks of falls so her husband would be safe from injury at home and in the hospital.  If he were to fall it could easily cause a delay in her return to work.  

Betty would learn to take notes when the doctor is speaking and ask the doctor to come back so they can think of more questions before they leave, possibly avoiding another day of missed work to visit the doctor or make phone calls for corrected information.

She would learn to ask for forms before she has to sign them so she can read them.

And finally, Betty would encourage a friend, family member, someone from her church, synagogue or a neighbor who doesn’t work to take the advocacy training too so Betty can go back to work and not be afraid that no one else could care for him.

Wouldn’t that be wonderful for her company?

Byron Garcia and Michael Bloomberg

Who is Byron Garcia and why is he important?

Byron Garcia is best known for his leadership of 1,500 prisoners dancing to Michael Jackson’s “Thriller”  following the death of Michael Jackson, prisoners wanted to pay tribute and practiced for many long hours stopping only when it rained, or to eat according to a CBS News report.

Garcia claims prisoners told him 'You have put my mind off revenge, foolishness, or thinking how to escape from jail, or joining a gang'," he said.

Byron Garcia, a businessman became the warden of the prison when his sister became governor and offered him the job.  With no experience with the prison system, Garcia transformed the prisoners from angry murderers, rapists and drug pushers to dancers who enjoyed entertaining and paying tribute to Michael Jackson through dance and rhythm teaching them cooperation and control.

Mayor Michael Bloomberg was a businessman until 2002 when he became New York Cities 108^th Mayor.

In September 2010, New York City claimed to be the safest large city in America

Under Bloomberg’s direction New York City is leading the nation in job growth.

So, what does this have to do with patient safety?  Imagine if patients ran the hospitals?  We may not know the business, but we may be the best at running the hospital.  Garcia knew people and he knew what they would be willing to do to.  He knew what they needed.  A tribute to Michael Jackson.

Mayor Michael Bloomberg was not a “politician” but a businessman and turned the city around.  Imagine if I were given a year to work with a hospital and improve patient care?  I know I could turn it around and make it safe.  Not because I know every detail about patient safety standards and policies but because I know people, how to make them strong and want practice safe, quality care.

I’m up for the challenge, anyone willing?

Health Information Technology

HIT

A phone call and e-mail invitation last week brought me to Philadelphia to be part of a small discussion group talking about health information technology (HIT) this week. This group was brought together by the US Department of Health and Human Services to explore the consumer’s perspective of healthcare technology.

Ironically, this has come at the same time a local RHIO or Regional Health Information Organization is focusing on learning the patient’s perspective through research trials. Over the years I have learned that Health Information Technology, opportunities to use the internet to correspond with your doctor’s office or share information between hospitals and doctor’s offices is actually potential life-saving technology.

It occurred to me that in my own son’s case so many years ago, as he was bleeding from a tonsillectomy and I brought him to 4 different doctors on 5 different occasions during that week to be examined, if they each knew I did that, they may have taken my concerns more seriously. Not knowing at that time that I went from doctor to doctor may have actually made them think they were the first visit. Not stressing that I made numerous visits with continued bleeding may have made them not aware of how much he was actually bleeding sending us home with the comforting words “don’t worry, he will be fine” each time.

Could health information technology saved my son’s life? That’s a question that will never be answered but knowing the full history of a patient is important to each doctor’s decisions of care and presently they are trusting us, the patient and family to share information appropriately and fully.

Hot Coffee

Hot Coffee; The Story of a Family's Fight Through Our Civil Justice

A young mom says to me “I could have sued my doctor, but my son turned out fine”.  I asked her why she would sue her doctor as we watched her son dancing to the music.  “Because they made so many mistakes”, she said.

I found myself explaining to her that a lawyer would probably not take the case if there was no pain and suffering, no loss of life and not even an injury.  I tried to tell her.  We don’t sue people because we don’t like them.  There isn’t a “winnings” or “jackpot” like the media likes to make it seem. That’s all for the media, it’s not real life.

I spoke with the daughter and son-in-

law of  Stella Liebeck who spilled

hotcoffee on herself and sued

McDonalds

I was telling her about “Hot Coffee” a movie that finally shares with the public the truth about the McDonalds hot coffee that spilled into the lap of the elderly woman many years ago.  Most people think she spilled her coffee and because of inconvenience, sued McDonalds for a large sum of money. 

That’s not the way it happened.  I saw the movie twice and knew the story because I followed it years ago when I started patient safety.  People make comments about lawsuits without knowing the facts. People just like to comment not thinking how hurtful or inaccurate their comments might be.

I saw the movie the first night at the premier in New York City.  I got to speak to the family of the woman who spilled the coffee.  “I’m a scientist, an educated man with a good paying job” the son-in-law told me.  “This was not about money”.  I believed him.  The next 90 minutes was a riveting movie about America’s civil justice system like you just don’t know it.   

Filming Surgery

Massachusetts bill would give patients the right to film surgery


Hospital officials say the measure would increase liability costs and present challenges to infection control. Physicians question the logistics of videographers in the OR.

http://www.ama-assn.org/amednews/2011/06/27/prsb0627.htm

I’m not sure I would support having my surgery filmed. If others want it on tape, so be it. I suppose the law is a good thing. But to have a video camera in the room, I would be afraid would be a terrible distraction. If I chose my doctor to do the surgery for all the right reasons, I’m not sure filming their behavior would be appropriate. And, for what reason? Assuming it would be for a lawsuit, the video would have to prove that there was malpractice. If they strayed away from policy and standards, was there damage done because of it? Infections surely can’t be videotaped and an item left inside doesn’t need a video. With the surgery itself be videotaped so the viewer(s) can see the accidental cut? So, now that it’s on video, does the patient heal faster? Or, will he doctor say it was because he/ she was distracted by the video?


I am in support of the legislation; I am just pretty sure I wouldn’t use it.

When they Don't Want to Hear Your Opinion

The Advocates Role

There are many different kinds of patient advocates. There are those who will keep a patient comfortable. There are those who will review medical records and help with billing, or help with placement and rides to and from appointments and there are those, like myself who are patient safety advocates and concentrate on the patient’s safety. It is often difficult to try to explain to the general public the difference.


I find much of my work is on the phone. I do go to the patient’s bedside to meet with the family on occasion, but when it’s not absolutely necessary I can just get in the way.

A family recently asked me to visit them, and their parent who was being treated at a Long Island hospital. I knew there was tension between one adult child and the attending physician. I interviewed the nurse before meeting with the family and she told me about some of the family heartache and confusion. I knew I would be working on communication issues mostly. The nurse asked me what my role was and what was I going to do.

I told her “I am going to repeat everything that you and the doctor say - but I am not representing the hospital”. In this case, the family does not want to hear how sick the patient is. They want to know what is going to be done to help the patient come home. Medical professionals often know that with a disease, infection or damage to certain parts of the body, patients won’t get better. This family wouldn’t hear any of it. As their advocate, it is important to listen to them, hear their needs and keep others opinions, including my own, out of it.

The Advocate's Responsibility

There is no magic to being a patient’s advocate. We cannot guarantee a perfect outcome. I just read a blog that was entitled “Be A Patient Safety Advocate. Help Stop Medical Malpractice”. I knew that it was from a lawyer because it used the term “malpractice” and we use the words error, injury or adverse event. It may often mean the same thing but malpractice is a legal term.

 In this case an advocate is a legal advocate, fighting for the family or patient after the injury or death. But, make no mistake there are never guarantees.

He used this scenario in his blog: "In a recent case, a man suffering from intestinal pains was admitted to the hospital where he was diagnosed with Diverticulitis. Blockage was detected the next day and surgery performed. During surgery, his intestines ruptured. Then he suffered a heart attack. The man died thirty days later from sepsis and gangrene. The family filed a wrongful death lawsuit alleging the ER physician misread the patient’s X-rays."

This is the sort of case an advocate would fear. Many patient advocates are hired by the patient or family and paid (usually very well) for their time. But what if an incident like this happens? What if the patient becomes infected even with an advocate? Is the patient / family entitled to a refund? Are advocates making patients believe they are safe because they are there or safer?

How can we count the lives we save? When a patient leaves the hospital healthy because I have been there for 10 or 12 hours or more, weren’t they supposed to leave healthy? What about the patient who contracted an infection, just days after I left her bedside after being there over 90 hours?

 I am confident that no one will ever guarantee a “good” outcome, but I wonder what people think of the role of an advocate when there is a "bad" outcome.

Patient Safety and the Disabled Patient

The Disabled Patient in the Hospital

When I received the call to visit a patient at a local, Long Island hospital, I was confident that this wasn’t going to be a simple visit. The patient I was going to see was someone who couldn’t use her arms or legs. Completely disabled, she was living in real time the stories I have been collecting about how people, with disabilities are treated and feel unsafe in the hospital.


She had her personal care assistant with her. In most cases Medicaid or insurance will not cover a home health aide once the patient is admitted into the hospital. The hospital is supposed to care for the patient. In this case the aide, caring for the patient for over 10 years, told me she is not leaving her - with or without payment. God bless her.

I gave her aide some much needed time off to get a bite to eat and sat with the patient to talk about why I was called. She started off telling me about being admitted. She had the symptoms of pneumonia. Because of her size and the lack of equipment to move her, she was not given a CAT scan that the doctor’s felt was needed. She did not want untrained people attempting to lift her. If she began to fall she could not stop herself, she could not protect herself. I could only just imagine the fear this would bring to someone with her sharp mind and to a woman who has knowledge of her needs.

On two occasions she told me, before her aide came to be with her, her food tray was left out of reach. She could not feed herself nor could she even turn her head to see where the tray was. All she knew is that it was nowhere in sight.

She was coughing up phlegm, exactly what is needed to break up pneumonia. But she told me no one was there to suction her. Her care, she felt was below standards. As she struggled to breathe the day before, she was unable to call for help. When someone finally checked in on her, they found her oxygen was not plugged in. The call bell, out of reach was something she couldn’t use anyways.

So what if she had no family to sit at her bedside? They have to work. What if she didn’t have such loyal caregivers – one who was there at night and another during the day “with or without pay”? Could she easily get bedsores that would be blamed on her lack of movement? Could she have choked to death on her phlegm? What if she fell out of bed trying to move or get up? Are nurses and other support staff supposed to continue with the same case load of patients and a disabled patient? I was told by a hospital administrator a year ago that they do tell their nurses to take special care of patients with disabilities. So, I asked him, are you giving those nurses less patients? He said they didn’t.

We need to think about how hospitals will start caring for people with disabilities. This experience is not unusual. I have been hearing similar stories for two years. The patient said to me that everyone was so “nice” but thank goodness she recognizes that nice does not mean safe.

Unfortunately, this can be any one of us someday.  There must be some system put in place to be sure these patients are kept safe, and keep their dignity.

Emergency Room Madness

How Busy is Too Busy?

Hospital cutbacks, not if I can help it! But what is one to do and where does the money go? I don’t work for a hospital and the short time I did, I felt like I was part of the problem. Now, when I go into a hospital I can look at it not from a paycheck standpoint but from a patient’s and safety view.


In the emergency room I had no problem finding the patient I was there to see. He was on a gurney next to the door leading to the outside where ambulance crews came in and out with stretchers filled with injured adults and children. The constant door opening and closing made for very little rest for this patient, and the others surrounding the door. I was told that earlier a patient was actually out in the vestibule because there was no place else to put him.

This was a hospital you wouldn’t think twice about going to on Long Island were you in need of care. But the emergency rooms of many hospitals are just too crowded and very busy which can lead to unsettling feelings of adequate care.

The staff constantly used the hand sanitizer, but there were families coming into the hospital who were not. I watched as staff used the hand sanitizer but still touched the bedrails, clip boards, blood pressure machines and then touched the patients. The gurneys so close that the feet of one patient was only inches from another patient’s head. I watched as a young woman’s belly was examined for pain in the hallway only inches from another patient.

How are patient’s sharing their medical history, personal information or asking questions in this situation? The hustle and professionalism of the staff was impressive. They stopped to answer questions when asked and they were calm but busy.

I didn’t know where to look. If I looked straight ahead there was a man with no shirt, handcuffed to the bed, to the right a young woman squirming in pain, no matter where my eyes brought me, there was a lack of privacy, breaches in standard safety practices, yet lives being saved with barely room to walk.

Nassau County and the Transgender Community

I spoke yesterday at the Nassau County Legislature on behalf of the Gender Clarification Law. This law is to clarify what the word “gender” means within the human rights law for the transgender community. The term gender can mean something as simple as the characteristics between male and / or female or it can be as detailed as the “actual or perceived sex and shall also include a person’s gender identity, self-image, appearance, behavior or expression, whether or not that gender identity, self-image, appearance, behavior, or expression is different from that traditionally associated with the legal sex assignment to that person at birth”, which is what is being requested by the transgender community.

I am aware that in Nassau County, Long Island there is no protection for the transgender person. A person can lose their apartment, lose their job or be harassed because they are transgender (a term meaning people whose gender identity differs from their assigned sex at birth). If the word transgender is not specific enough people can decide on their own what it means and people won’t be protected who may look different, dress differently or sound differently than what someone in society sees appropriate.

I witnessed a woman asked to pack and leave her rental home following her transition. She was tall blonde and beautiful and not someone anyone would consider a “freak”. But she had no protection. Someone else I know was pulled over by the police, had her car searched and was brought and left at a hospital because someone else, acting on their own prejudice, reported her having a weapon – of which there was none.

The Nassau County republican-party refuses to support this change in wording. My own republican legislator said to me “No, I won’t support it”. I’m not sure why- accept their own prejudices can be acted on in this powerful position. To give protection to a class of people who are now not legally protected is a slap in the face. Presently, New York City and Suffolk County have human-rights laws which clearly defines what gender means. Nassau Republicans refuse to define the word gender.

 Following is my testimony:

 "My name is Ilene Corina and I am a Patient Safety Advocate since 1997 and reside in Nassau County. I have been an advocate for the transgender community as part of my training with the American Hospital Association Patient Safety Leadership Training of which I received a full scholarship from the National Patient Safety Foundation. As a board member of The Joint Commission which accredits over 18,000 healthcare organizations, I am an advisor to the Joint Commission LGBT work group because of my work with this community. I am here because there is gender clarification law pending that has not been passed. Here are some of my thoughts and experiences:

 A young man hands a written prescription to the medical receptionist that he is in need of a vaginal sonogram. She questions him in front of a waiting room full of patients. Embarrassed he leaves, never to get the care he needs.

 A man in need of an EKG is told to remove his shirt. Because of his discomfort with his body given to him at birth he is embarrassed and confused. He has already avoided the gynecologist and mammography he so desperately needs in an attempt to avoid acknowledging his body and the possibility that there may be snickers.

 A 45 year old man is hospitalized following a hysterectomy and the doctor wants to put him on the postpartum floor filled with women who just gave birth.

 Bill wants to be called Jennifer but nowhere on the medical chart is there a place to have that information available.

 The first time I was asked to advocate at the bedside of someone who is transgender, I was determined to be sure the patient was kept safe from medical errors and treated with dignity and respect. But, an unauthorized hospital worker walked into the patient’s room who I was there to support and protect. Every hospital worker must introduce themselves upon entering a room and state their reason for being there. But he got past me – my first experience that the same people who are supposed to help and heal the patient, bring their own curiosity and even prejudices to work every day.


Every day transgender people avoid necessary medical treatment, dreading the inevitable and hurtful lack of sensitivity they may find in the medical community.

 Hospitals are not perfect places. Every day as many as 200 people die in Americas hospitals due to preventable medical errors. 98,000 a year.

 One hospital worker spent years caring for patients. When he began his transition, he was taunted and harassed but his colleagues who wouldn’t allow him simple dignity and privacy. These are the people who are treating your loved ones.

 Most hospital workers are the most caring people we will ever know. But some will go to work with unforeseen prejudices. There must be constant, mandatory, sensitivity training and this behavior will not be tolerated by law.. The place to start that is here, in this room with YOU – each and every one of you who are NOT willing to pass the gender clarification law to protect the rights of the growing number of transgender people who you can’t even count because you can’t find out who they are until they are protected.

 Today, we are in a remarkable position: To fix this disconnect between the curious and caring.

A young man has an asthma attack and fears going to the emergency room because he doesn’t want anyone to know he wears a binder. To reveal his body would be more tragic than the struggle to breathe. His life is on the line because there is no protection for him.

 No one can presume that they know how to treat someone with different needs if they have not taken the time to listen, hear and learn what those needs are. I suggest that this legislation is passed today and you stop hiding behind your own prejudices.

Thank you."