Monday, September 26, 2011

Hospital plays labor hardball, locks out nurses, and patient dies

Nurses called a one-day strike, but the hospital locked them out for days.

Thousands of nurses return to work at Alta Bates

By Angela Woodall
Oakland Tribune

Thousands of nurses returned to work Tuesday after a five-day labor dispute that turned deadly for one cancer patient.

The cloud of Judith Ming's death hung heavily over the returning staff at the Alta Bates Summit Medical Center in Oakland, where the 66-year-old died Saturday morning after a dietary supplement apparently was introduced into her intravenous line.

The Alameda County Coroner's Office has not yet completed the autopsy on Ming, who suffered from ovarian cancer. The fill-in nurse who police said made the error was questioned and released Saturday. She is 23 years old and from Louisiana.

One Alta Bates Summit veteran nurse said she and her colleagues did not think highly of the 500 replacements provided by Alabama-based Advanced Clinical Employment Staffing, which the medical center relied on for five days when it locked out the regular nurses, who had declared a one-day strike Thursday.

The Alta Bates Summit nurse, who asked not to use her name because her husband works for a public agency, said her colleagues are concerned that the staffing firm sent inexperienced nurses. "It's such a sad situation," the nurse said. "I feel really bad for her."

The nurse said the replacements could not have had adequate training before taking on their responsibilities at the hospital because there was "no one here to train them" on the sophisticated equipment and computer programs now used in medical care, or show them where equipment,
medications and other items are kept.

In addition, the replacement nurses had to work 12-hour shifts five days in a row. Usually, nurses are not required to work more than two to three 12-hour shifts at a time.

Standing outside the entrance to Alta Bates Summit in Oakland, hospital spokeswoman Carolyn Kemp said Tuesday that 40 percent of Alta Bates Summit's 1,800 staff nurses stayed on duty during the strike and worked side by side with the replacements. The fill-ins had experience in the area they were assigned and received an orientation the day before being deployed and again the day they began, according to Kemp.

"Everybody is a professional," she said.

The medical error is so basic that it has baffled nurses because the dietary supplement, Glucera, is labeled, should be taken orally or through a feeding tube and looks nothing like IV fluids. Ming may have had an abdominal feeding tube, but the two pieces of equipment do not fit with each other and look completely different.

An Advanced Staffing employee reached by telephone said the company plans to issue a statement soon but otherwise did not comment.

Advanced Staffing and Summit Medical Center were named as defendants in a 2006 lawsuit brought by the family of an 80-year-old woman who died because, according to the family, she did not receive oxygen. Advanced Staffing denied all allegations at the time but had provided the traveling nurse named in the suit. The lawsuit was settled in 2009. The nurses's license in California expired in January 2010, according to the California Board of Registered Nursing.

Advanced Clinical Employment Staffing, the employee said, required the hospital to sign a five-day contract. Only 500 of the 1,500 referred by Advanced Staffing were accepted, she added.

Kaiser Permanente, one of 30 hospitals affected by the strike, signed a one-day contract with American Mobile Healthcare and RNRx Medical Staffing Inc., according to the California Nurses Association. In all, 23,000 nurses in 30 hospitals went on strike.

Alta Bates Summit, like other California hospitals, routinely calls on replacement nurses to fill in for personnel on leave or on strike. They help bridge California's strict patient-to-nurse ratio requirement, the only one in the nation, which varies depending on illness, severity and complexity of required treatment.

Death of Oakland woman killed by nursing mistake prompts controversy, investigations
By Sean Maher and Jeanine Benca

OAKLAND — The 66-year-old woman who died at a hospital after receiving care from a temporary replacement nurse was identified by the coroner's office Sunday as Oakland resident Judith Ming.

Ming's death reverberated both inside Alta Bates Summit Medical Center and out Sunday. Nursing union leaders painted her as the victim of a staff lockout that prompted the hospital to cut corners by hiring replacement nurses who weren't up to par. Hospital administrators, on the other hand, said the death was an "extraordinarily rare" but extremely serious tragedy, promising cooperation with multiple investigations and asking that the death not be used for political means in the two parties' ongoing contract battle.

The hospital had temporarily hired 500 replacement nurses to continue service when the California Nurses Association staged a one-day strike Thursday, but had signed them to a five-day contract, sending staff nurses who'd gone on strike home when they arrived for work Friday.

A cancer patient at the Alta Bates Summit Medical Center since July, Ming died early Saturday morning a few hours after investigators say one of the replacement nurses, who'd come from Louisiana, administered a "nonprescribed dosage of medication."

"If I was taking care of that patient, it would not have happened at all," said Alicia Torres, an oncology nurse with 27 years of experience and one of those
who went on strike Thursday. She said she works in the same unit where Ming died and that replacement nurses "are not familiar with the policies and procedures, or with the equipment, because equipment will vary from hospital to hospital. So they're thrown in there without the proper training."

Dr. Steve O'Brien, the hospital's chief medical officer, said the death was the most serious possible tragedy, but that the policy of using replacement nurses was not clearly to blame.

"One hundred percent of every aspect of the situation, we're looking at," he said. "This is a tragedy, a significant medial error. There is nothing more serious."

Asked if he was concerned about the legal ramifications of an apology the hospital issued Saturday, O'Brien said, "There are people who will later look at the legal issues. I'm glad that's not my job. My job is to make sure our patients get the safety and medical care they deserve."

As for using replacement nurses: "Everybody working in this facility is qualified to work here," O'Brien said. He said the hospital uses replacement nurses every day, and all of them meet or exceed California's professional standards, which he described as especially rigorous.

Bruce Fagel, a longtime California medical malpractice attorney who is also a licensed medical doctor, said having replacement or temporary nurses working in hospitals for extended periods increases the risk of medical mistakes that harm patients.

Since 2007, California hospitals have been required to inform the state Department of Public Health within 24 hours of so-called "never events" -- 28 medical errors deemed inexcusable by the National Quality Forum. The health department must then immediately launch an investigation, and if wrongdoing is determined, the hospital can be slapped with tens of thousands of dollars worth of fines.

Since the law was passed, the California Department of Public Health has collected $4.6 million in fines from hospitals for incidents resulting in patient death or very serious injury, said Fagel, a 30-year veteran malpractice attorney. Still, with no real means of enforcing hospitals to disclose incidents, many cases go unreported, he added.

Of the 50 or so malpractice cases resulting in death or catastrophic injury that his firm handles annually, Fagel estimates 10 percent involve errors made by a traveling, or temporary nurse.

"Traveling nurses get into trouble more frequently because they don't understand the system, who to access in terms of the chain-of-command," Fagel said. "When you have replacement nurses, especially in large numbers, nobody is there to supervise them, and these are people who don't work together regularly ... it's a setup for these types of problems where a medical error can lead to a patient's death."

Because there is no way for hospitals to screen every fill-in, they often rely on the registry to perform the screenings for them. The registries also arrange for the fill-in nurses to get licensed in whatever state they will be working.

At Alta Bates, backups work alongside staff nurses to make sure they get up to speed, O'Brien said.

He declined to name the firm with which the hospital contracts, but union leaders said they believe it to be Alabama-based Advanced Clinical Employment Staffing. Nobody answered the phone there Sunday, but the outgoing voice message said, "We are working on ... going to the California strike beginning Sept. 22..."

September 25, 2011
Patient died during Calif. nurse labor dispute
The Associated Press

...The nurses union planned a candlelight vigil at the hospital, with nurses calling on Sutter Health, the operator of Alta Bates, to end the lockout and for the state to investigate what union officials called "safety violations" in the patient's death.

About 23,000 nurses across California walked off the job Thursday in a one-day strike at 33 not-for-profit hospitals run by Kaiser Permanente, Sutter Health and the independent Children's Hospital Oakland. They had planned to go back to work Friday, but were locked out when they tried to return to work at Sutter hospitals, according to union officials.

Sutter officials said they entered into contracts with replacement nurses that required they pay the replacement nurses for a minimum number of days.

"Once a strike is called, it would be financially irresponsible for hospitals to pay double to compensate both permanent staff and replacement workers," Sutter Health said earlier in the week.

The lockout was scheduled to end Tuesday.

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