Nursing Homes are restarting the ‘don’t send the MAR’ game

For a primer, from 2007, here.

Another patient, another absent MAR (if you don’t know that acronym, you didn’t read the lead in article!). Usually they send when we call, but not recently. Here’s an amalgamation of some cases:

Calls are made by the nurses at my behest. The MAR Will Not be Sent.

Per nursing, whom I work with daily and trust implicitly, here are the objections proffered:

1) It’s illegal to send our signatures
Really? No, it’s not.

2) It’s our policy not to send MAR’s
Good luck with that policy. It’s going to get you in trouble.

3) You don’t need that.
As it’s a patient who has a) gotten meds from you and b) that timing is a question and c) we don’t know what the timing is, yeah, we and the patient you sent to us need that.

4) We sent you a med list
Yes, you did. That’s a List of Meds, but we don’t know what’s scheduled, PRN, given, held, parameters, etc. That’s a dodge.

Allow me to quote me:

This is outrageous. A chronically ill patient is sent to a higher level of care for an acute problem, and without a complete information base; but not just that, information crucial to the care of the patient that’s being intentionally withheld.

It is a situation that makes me, frankly, nuts. When did intentionally withholding critical patient care information become acceptable? Seriously, have these people not learned from history? The coverup is always, always worse than the crime, and is looked upon less favorably and punished more severely that any original offense. You could ask Nixon, but he’s dead.

Send me all the info you have, and our patient will live or die based on their problem(s); withhold information I need, and it’s on you, Nursing Home nurses.

– See more at: http://gruntdoc.com/2007/06/nursing-home-mars-sent-to-the-ed-with-all-times-removed-a-new-and-horrible-trend.html#sthash.k1mXnxiK.W4zJDG1c.dpuf

And if you’re from the Texas NH Regulatory agency that emailed me after the first posting, please recontact. I’m ready to send you some facility names going forward.

A wonderful Fisking

I’m neither terribly for nor against paramedics working as employees in the ED, but I love people ripping apart straw man arguments.

Texas ENA’s Unprofessional Attack on EMS

Author’s note: I generally avoid posting non-tech matters on my blog, but this unprofessional, unsubstantiated, fear-mongering attack of EMS in Texas has me boiling. I present to you something that doesn’t just affect Texas EMS, but EMS in the entirety of the United States of America. This has been fought in other states, and if it isn’t stopped now, will set a precedent and spill into many more states and regions. If you want to advance, you don’t do it by holding your siblings down in mediocrity and attacking their skills and intelligence. They seem to have taken a page out of the book, “How to Get Ahead in Life by Attacking Your Colleagues.” It is uncalled for.

Go, now, and enjoy.

 

Olivet Nazarene University ED Nursing graphic

Well done, and some good information:

nursegraphic2

 

via http://graduate.olivet.edu/

Thanks Emergency Nurses

via J&J



You Rock. Dunno if you know that…

Jury finds Roberts guilty | roberts, county, arguments – ROBERTS TRIAL VERDICT – Odessa American Online

Justice.

1:45 p.m. Jury finds Sheriff Robert Roberts guilty on two counts of misuse of official information, two counts of retaliation both third-degree felonies and two counts of official oppression Class A misdemeanor.

via Jury finds Roberts guilty | roberts, county, arguments – ROBERTS TRIAL VERDICT – Odessa American Online.

Jury deliberations just started.

The verdict, including lunch, took less than 2 hours.

I’ve been following the twitter feed of the Odessa American’s court reporter, @OAcourts. Good factual reportage.

More Winkler County Nurse news

Well, okay, one of these isn’t ‘news’, as it’s an article from March of this year, from the Texas Observer:

Four months after he started, Wiley hired Dr. Rolando Arafiles, a Filipino family-practice doctor he’d met at the hospital in Crane. Arafiles and his wife bought a house in Kermit. They threw themselves into the town’s social life. Arafiles played golf with the county sheriff. Wiley, who wanted his doctors to be part of the community, was thrilled—so much so that when the nurses started to question Arafiles’ treatment of patients, the administrator tried to quash their complaints. When Mitchell, Galle and Warren finally sent damning evidence to state regulators, Wiley and two of Winkler County’s leading citizens took decisive action: They launched an attack on the nurses.

It’s well written, and serves as the bulk of the material in a podcast from This American Life. You can play it from their page, and it features audio interviews of the Nurses. It’s good.

 

 

Winkler sheriff trial to begin Monday | trial, winkler, moore – Odessa American Online

Remember the Winkler County Nurse scandal? I do.

So does the Texas States’ Attorney.

June 06, 2011 6:30 AM

ODESSA AMERICAN

UPDATE 1 p.m. The court has taken a break until 2 p.m. for lunch in the trial of Winkler Sheriff Robert Roberts on charges of misuse of official information and retaliation.

The Midland County courtroom was packed with about 80 potential jurors in a trial now expected to last at least a week. Even after moving the trial from Kermit, the question of impartiality looms in an ongoing whistle-blowing nurses saga that has gotten national attention after the investigation and attempted criminal prosecution of the two Winkler County nurses who reported a doctor at their hospital violated proper medical procedure.

The doctor, Rolando Arafiles, asked his friend Sheriff Roberts to investigate the nurses, who were arrested.

via Winkler sheriff trial to begin Monday | trial, winkler, moore – Odessa American Online.

I’ll be very interested to see the outcome of this.

HT: Glen in the Big O.

Former Winkler County Hospital Administrator Pleads Guilty, Must Serve Jail Time

From Texas Attorney General Greg Abbott

ODESSA – Former Winkler County Memorial Hospital administrator Stan Wiley pleaded guilty today to abuse of official capacity. The defendant’s guilty plea stems from his decision to fire two nurses after they filed an anonymous complaint with the Texas Medical Board against one of the hospital’s physicians.
Visiting Judge Robert H. Moore III sentenced Wiley to 30 days in the Winkler County Jail for his improper conduct.

Today’s plea deal was reached after the defendant agreed to cooperate with the State’s prosecution of three remaining defendants in this case. The Texas Attorney General’s Office is handling the case as district attorney pro tem, as the Winkler County District Attorney recused himself from these proceedings.

Today’s guilty plea stems from the Office of the Attorney General’s investigation of official oppression, retaliatory conduct, and misuse of official information by four Winkler County officials: Wiley, Sheriff Robert Roberts, County Attorney Scott Tidwell, and former Winkler County Memorial Hospital physician Dr. Rolando Arafiles.

If the guy who made a deal gets 30 days, what is the Attorney General going to be looking for in those that go to trial?

I’ve written about the Winkler County nurses before, and I wonder if this gives them some solace. I doubt it.

More on the Kermit (Winkler County) Nurses

Two nurses in Kermit, Winkler County, Texas felt a Physician had done wrong, and did their duty (which is protected), under the law: they reported the doctor to the State Medical Board.

Then, things got bad, but not like any sane person would think. The nurses were eventually charged in Criminal Court for “Misuse of official information“, the flimsiest of pretexts to punish them for their whistleblowing, which the Texas Medical Board said was both good and correct.

This mattered not, and they were forced to go to trial to defend themselves from imprisonment; They were very quickly found not guilty, then came the civil suit, which catches us up for today’s addition to the story…

First, imagine keeping your job as Hospital Administrator after this kind of public derision. No, it doesn’t end as you’d expect:

Via CBS 7:

A week after it was posted at the Winkler County Courthouse that Winkler County Memorial Hospital Administrator, Stan Wiley, would announce his resignation, he changed his mind.

In what board member, John Walton, is calling “the shortest meeting in the board’s history”, Wiley did not resign.

The resignation was put before the board members as a motion.

John Walton seconded the motion to “accept Wiley’s resignation” but none of the other board members did so.

Wiley then acted as if this were a dramatic show of support and decided to not resign.

Quite the vote of confidence…

That was on August 10th, by the way, the same day, again from CBS 7:

After their original concerns about Dr. Rolando Arafiles were substantiated by a state fine levied against Winkler County Memorial Hospital and an official complaint lodged against the Dr., the “Winkler County Nurses” were “compensated” today for their damages.

The nurses will split a nearly $1,000,000 settlement but nurse Anne Mitchell says this case was never about any money.

Vickilyn Galle and Anne Mitchell believed their anonymous report to the state in 2008 would be just that: anonymous (as is prescribed by nurse reporting laws).

There’s no way they could have predicted that standing up for patients’ rights would get them arrested, then prosecuted, then vindicated and now, more than two years later, leave them hard pressed to find a nursing job.

The four Winkler County Commissioners voted unanimously Tuesday afternoon, to settle the civil suit filed against the county and numerous other defendants.

The move means they are agreeing to pay $750,000 dollars to nurses, Anne Mitchell and Vickilyn Galle.

The county only has to pay $150K, the rest is covered by a risk management pool, which appears to be how Texas Counties self-insure.

I’d like to have seen the trial on this. It’s not enough for two nurses who will have to move a long way to even possibly continue their careers, and the behavior of the Sheriff and Prosecutor in all this is bafflingly ugly.

The lesson? 1) Don’t live in Winkler County, their public decision-making seems atrocious on every level and 2) if you’re going to report someone anonymously, don’t do it from a County owned computer, lest it be ‘investigated’. (Feel free to add your lesson in the comments, but I’m not interested in getting sued, so let’s not libel anyone, shall we?).

HT to Glenn, my West Texas news connection.

How not to do the NG tube

I put a post up a few days ago about an NG tube that went poorly.

The post went just as badly as the tube (though with lesser consequences), and when I tried to fix it the new and improved WordPress rebelled. It refused to accept the change, and just got worse.

So, go read ImpactedNurse‘s post. And cringe.

Physician in Whistle-Blower Case Charged by Texas Medical Board

July 15, 2010 — The Texas Medical Board (TMB) has charged a family physician at the center of a nationally publicized whistle-blower case involving 2 nurses with poor medical judgment, nontherapeutic prescribing, failure to maintain adequate records, overbilling, witness intimidation, and other violations.

via Physician in Whistle-Blower Case Charged by Texas Medical Board.

Some follow-up / karma from the Kermit / Winkler County Nursing prosecution.

Thanks to CardioNP!

» Features » July 15th: Note 2 Nurse day.

Nurses. Sometimes we are our own worst enemy.

But on July 15th, you have the chance to thank a nurse you admire.

Buy a small card and take a moment to write a message acknowledging their awesomeness.

via » Features » July 15th: Note 2 Nurse day..

Impacted Nurse has a good idea here, a day to send some small token of appreciation to your nurses.

Put it on your calendar, and I’ll do the same.

More on the Winkler County Nurses

Beau BermanCBS 7 Newsbberman@cbs7.com

April 20, 2010

Kermit, Texas -Winkler County Memorial Hospital’s decision to fire two nurses in 2009 is going to cost them, in the form of a $15,850 fine assessed by the State Department of Health Services.

The nurses’ termination is listed as a violation in a state report obtained by CBS 7 News. Now, one board member is speaking out, claiming this fine could have been prevented.

via CBS 7 – Your Eye on West Texas.

I don’t have any clue as to what a usual state fine for such a ‘violation’, so I don’t know if this is a big or little number in those circumstances.

Read the article for the comments of one board member (who’s apparently swimming upstream on this board if he can’t get any seconds on his motions), it’s an interesting look inside hospital politics, small-town or not.

HT: reader Glen

Lesson Over a Latte // Emergiblog

Some of our patients are made, not born…

(The story you are about to read is true.)

The day was uncharacteristically warm.

via Lesson Over a Latte // Emergiblog.

Care does not include sex – Dutch nurses’ union – Yahoo! News

AMSTERDAM (Reuters) – A union representing Dutch nurses will launch a national campaign on Friday against demands for sexual services by patients who claim it should be part of their standard care.

The union, NU'91, is calling the campaign “I Draw The Line Here,” with an advert that features a young woman covering her face with crossed hands.

via Care does not include sex – Dutch nurses’ union – Yahoo! News.

Hmmm.  Their nursing curriculum must be quite different from ours…