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A JULY 4th MOMENT of REFLECTION on HUMANE TREATMENT
Jul 4, 2006
A Happy 4th of July to all my Friends “Across the Pond”
 
 I love my doggie 
  

                           If this was your Puppy 
"Would you leave this, obviously well cared for, Puppy from our Care2 community cooped up in a room for a full 12 hours without any Food  or even a Drink of Water, but expect the poor animal not to pee on the floor?"

No!    Exactly,
   because that would be Cruel and Inhumane.

So why is it OK when Medical Professionals are expected to perform stressful work assignments in Surgery under the same inhumane circumstances, without Food or Water for 12 straight hours?
“Breaks are at the Discretion of the Employer!"  
                                                     
The unconscious Patient undergoing Surgery is vulnerable and defenseless.  However, as Medical Professionals we are duty bound to advocate for their safe treatment while they are in our care in the OR.  
         Please Help us Adhere to this Important Duty.


Does no one ever anticipate that a member of the OR Team might make a mistake during extended periods stranded in Surgery without relief? 
“Breaking Scrub,” to leave the OR before an assigned Scrub relief takes over, risks being charged with: 
        “Patient Abandonment!”     
Wetting the Floor is Unthinkable! 


  The OR at the Detainee Hospital, Camp Delta, Guantanamo Bay, Cuba – DoD photo Staff Sgt. Steven Lewald US Arm (Releases)
All members of the OR Surgical Team Must Remain Alert to Perform their Critical Tasks with the Utmost Regard for Patient Safely.  
If your family member was unconscious on the OR Table would you want members of the sterile Surgical team trying to concentrate on the meticulous demands of an operation while feeling sick, dizzy and faint after 10-12hours of extreme deprivation and fatigue due to the thoughtless abandonment of deliberate negligent under-staffing?

Do you need to Eat, Drink or Urinate more frequently than once every 12 Hours?
This deprivation is not permissible for the treatment of working P.O.W.s under the Geneva Convention!
         So, why is it acceptable for Hospital Staff in America?  
     
HUMANS DESERVE HUMANE TREATMENT TOO!

On America’s Birthday:   Make a commitment to demand Humane treatment for Medical Staff that Protects the Safety of vulnerable Surgical Patients in the OR and defends those who courageously advocate on behalf of Patient Safety;
                          GO TO:   
 http://www.thepetitionsite.com/takeaction/938995258 
                      ADD YOUR COMMENTS TO THE PETITION
    I REALLY NEED YOUR HELP!        
 With a 3000 Signature Goal, there is still a very long way to go 

  A BIG        FROM:  Kim Sanders-Fisher
                   Medic Integrity & T.E.A.M. 
TRANSPARENCY for EQUAL ACCOUNTABILITY in MEDICINE
                           Visit the new "Blogspot;" 
GO TO:  http://medicintegrity-team.blogspot.com/    
To read more about the Patient Safety issue that precipitated my dismissal: how deliberate negligent under-staffing leaves OR team members stranded in Surgery for unsafe periods without relief.
Also read my letter of appeal regarding enlisting the support of influential Doctors empowered to introduce regulatory changes to hopefully bring an end to such dangerous occurrences;  
 GO TO:   http://www.care2.com/c2c/share/detail/91853 
Alternatively, please explore the numerous informative Links in this Petition or visit discussion threads that I have either started or contributed to on the  allnurses.com   Website,  
 GO TO:   http://allnurses.com/forums/members/105717.html   
Read my comments posted under the name:   Tsunami Kim. 

PS.:  The Husky looked so like "Drew," the gorgeous puppy I rescued when I was working as a Medical Volunteer after Hurricane Andrew, I have taken the huge liberty of borrowing the picture from another Care2 member.  Well cared for and doted over I am sure by new member Marcie Webb; 
                                                       My Thanks to Marcie.
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Posted: Jul 4, 2006 6:48am
PATIENT SAFETY; IMPORTANT HEALTHCARE PETITION
Jun 21, 2006
Focus: Health
Action Request: Petition
Location: United States
ATTN.:  ALL PATIENT SAFETY ACTIVISTS & FRIENDS,
              Please sign this especially important Patient Safety Petition & then forward it to as many activist friends as possible; GO TO: 

 http://www.thepetitionsite.com/takeaction/938995258 

      I REALLY NEED YOUR HELP!         
 With a 3000 Signature Goal, there is still a very long way to go 

                                                                   
                  Many thanks to all who have signed & forwarded the Petition; Please keep forwarding this on to conscientious friends!   Once again,  Many Thanks for your support,     Kim Sanders-Fisher.

                   Medic Integrity & T.E.A.M. 
TRANSPARENCY for EQUAL ACCOUNTABILITY in MEDICINE
                           Visit the new "Blogspot;" 

To read more about the Patient Safety issue that precipitated my dismissal: how deliberate negligent under-staffing leaves OR team members stranded in Surgery for unsafe periods without relief, 
 GO TO:   http://www.care2.com/c2c/share/detail/99894   
Also read my letter of appeal regarding enlisting the support of influential Doctors empowered to introduce regulatory changes to hopefully bring an end to such dangerous occurrences;  
 GO TO:   http://www.care2.com/c2c/share/detail/91853 
Alternatively, please explore the numerous informative Links in this Petition or visit discussion threads that I have either started or contributed to on the  allnurses.com   Website,  
  GO TO:   http://allnurses.com/forums/members/105717.html   
Read my comments posted under the name:   Tsunami Kim. 
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Posted: Jun 21, 2006 2:08am
JOHNS HOPKINS HOSPITAL & THE CENTER FOR INNOVATION IN QUALITY PATIENT CARE: Petitioner Appeals for Urgent Patient Safety Action
May 24, 2006
Focus: Health
Action Request: Petition
Location: United States
PLEASE SIGN THE PETITION; GO TO:  http://www.thepetitionsite.com/takeaction/938995258
How Long is Too Long for a Vital Member of the Sterile OR Team to Remain Continuously Scrubbed into Surgery Without a Break?        
         Although the general public might not understand that medical professionals, including the Surgeon, must leave the OR briefly during a lengthy Surgery, most conscientious practitioners realize that this is a normal safety measure necessary to combat fatigue. I am still trying to get a consensus of feedback, from those who must routinely face this dilemma in the OR, as to what time frame is universally accepted as the maximum period that any member of the sterile team should ever be expected to safely function while scrubbed into Surgery without a break?  

         Protocol refinements are urgently needed to prevent OR personnel being left stranded in Surgery for dangerously long periods without any relief.  In signing this Petition, please join me in my quest to convince Johns Hopkins Hospital and the Center for Innovation in Quality Patient Care that this important patient safety priority requires their most immediate action.

         I am now enrolled in the National Institute of First Assists, “NIFA,” training program to become a First Surgical Assistant, but even as a Surgical Technologist, performing the “Scrub” role, I had to concentrate on anticipating the Surgeons needs during a case.  After how long would you consider that Scrub role jeopardized by fatigue to the point where I might have lost concentration and focus on the operation? Is 6hours of metilulous attention to the demands of a Surgeon and maintaining the sterile field still within the bounds of safe patient care?  But, after 8hours of continuous duty standing in Surgery has this demanding OR task become a torturous and dangerously unacceptable ordeal? 

         Can we really afford to take such risks and blithely talk of the increased incidence of medical errors as if these issues were completely unrelated?

         While a Surgeon can, and should, demand that the person assisting them in Surgery is relieved briefly during a lengthy case, Nurses and Surgical Technicians fall under the control of OR Management.  This leaves them vulnerable to the vagaries of inappropriate OR coverage as determined by the Hospital. As a consequence of Hospital “downsizing” to cut costs, "redundancy of personnel" has been severely limited. This has reached the point where during the off-shifts, especially at night and on weekends, there are no free staff to break people out of Surgery for even a quick run to the bathroom!  

         At an inner city Level One Trauma Center these off-peak time periods are covered by a minimal compliment of essential, highly experienced medical staff, who must frequently deal with critical trauma cases, emergency returns to the OR and major Transplant Surgery.  This was my regular OR shift assignment at my former Hospital for the last 2years of my 5year tenure. With just one Nurse and two OR Techs on duty after 11:30 PM on a Saturday night, this challenging shift already required knowledgeable, highly adaptable and versatile staff. However, inhumane levels of endurance plus the ability to tolerate severe deprivation should not represent an essential component of any normal job assignment!  
                                     
         The real question is, can critical OR personnel fully maintain concentration during complex cases under such radical extremes as 12hours continuously scrubbed into Surgery?  The current lack of redundancy among Nursing personnel is harmfully impacting ICU’s and other critical care units of many US Hospitals, but the physical limitations are severest in the OR. To determine if a similar problem exists in NHS Hospitals in the UK should the British also now consider reviewing their "Operating Theatre" regulations and protocols?
  
         Calling in call team people just to provide OR relief breaks is considered an unnecessary expense, despite the fact that there is a clearly established link between staff fatigue and medical errors.  The sterile team scrubbed into Surgery must remain trapped without food or water until they are relieved which, after 8hours, represents an unacceptable deprivation strain on the body. For those who are unaware, no food or beverage is allowed into an OR, although it's extremely difficult to consume anything during Surgery, totally "hands free” while wearing a surgical mask! The inability to urinate when necessary is very unhealthy too and may predispose repeatedly abandoned staff to a UTI or other significant medical problem.

         To simply “break scrub” and leave the OR without handing over to an assigned relief Scrub and completing the necessary “counts” is considered "patient abandonment."    However, there are currently no real safeguards within the existing US employment laws or OCHA standards to insure that critical Hospital workers, including those in the OR, are not left for hours of continuous, and dangerous, practice without a break.   Under employment laws in most US States:
“breaks are at the discretion of the employer.”  

         I was left stranded at the field without relief for 8, 10 and on the worst occasion 12 hours straight during a Liver Transplant case while my patient was on bypass!    I regularly covered all their irrefutably least desirable off-shifts in the OR of a busy downtown Hospital famous for its active transplant program. We saw more penetrating Trauma than any other facility in Baltimore, a city with a homicide rate that averaged well over 300 a year.

         These unsafe abandonment situations impacted my ability to concentrate as my blood sugar plummeted.   Each time I reported becoming sick, dizzy and faint, to the point of nearly passing out. My Nurse Manager wanted me evaluated for a “sugar problem,” and I was asked, “who needs to eat at night anyway?”  When I dared to complain that my condition in response to this hardship presented a danger to my Surgical patients I was targeted for removal, forced to take unpaid leave and then fired. 

         Incidents where any member of the OR team is forced to remain on task for that long should be documented in an “Incident Report,” as an extreme of this magnitude presents an unacceptable, and in most cases unnecessary,  danger to the patient.  How many normal human beings are expected to go for 12 hours without water, food or urination? The Geneva Convention strictly prohibits such inhumane treatment of working POWs!  Why is this acceptable for critical Hospital staff?  

         I offered this mandatory Incident Report requirement suggestion to my former Hospital via their Compliance Line, only to be ignored as a terminated and vilified unreliable informant. I then presented the same information a suggested remedy to the Maryland Board of Nursing only to face a similar incomprehensible rejection. Healthcare facilities know all too well that the most effective way to deal with legitimate patient safety concerns and negligent under-staffing complaints like this to just: “shoot the messenger!” 

         Compliance Lines were established in the late 1990s to allow employees to report negligence, fraud and abuse without any fear of retaliation. But, have these Hospital appointed Compliance officers now become another valuable layer of defense from rigid external scrutiny?  No current legislation exists to fully protect Healthcare Whistleblowers. Clearly Hospital Compliance Lines cannot always be trusted with rigorous, impartial, internal investigations when their own facility comes under fire. Knowing there is no potential possibility of independent oversight why should they bother to investigate?

         The campaign of silencing a dissenter goes on long after they have been ousted in disgrace.  I contacted JACHO and several other Accreditation Agencies besides the Maryland Board of Nursing, but my dire warnings were easily discredited by my untimely, deliberatly conspicious, removal from my job.  

         A minor protocol change must be enacted immediately to prevent future incidents like this from becoming even more commonplace exposing OR patients to potential harm through preventable negligent under-staffing.  Despite the still unproven transgressions that supposedly put my own professional credibility into question, I cannot understand why so many US Government agencies have remained so complacent in adamantly refusing to review this under-staffing situation rationally and in the best interests of public safety.

         There is a lot of talk about medical errors right now, but far less mention of the current toxic work environment that is increasingly encouraging mistakes.  This situation is getting steadily worse.   While “At Will” employment laws silence those who dare to speak out, mandated overtime and lack of a humane break policy condones driving Hospital staff until they drop. 

         Is it such a big shock that fatal or debilitating medical errors and “sentinel events” are on the increase?   Is it any wonder that a sponge or an instrument is inadvertently left inside the patient when the Scrub is almost comatose after a stressful 12hour ordeal in Surgery?  All the rigorous cross checks and elaborate safeguards are completely irrelevant if the Hospital staff are trying to function while they are so severely fatigued, hypovolemic or hypoglycemic that they are at the point of either falling asleep or passing out.  Even a genuinely delinquent OR Tech. could attest to this painfully obvious fact.  

         When will the Nursing Boards and the various Patient Safety Advocacy Groups in the US finally address this very real problem and insist on proper protective legislation?  There have been advances recently with limiting the Residents working hours and trying to stop mandated overtime for Nurses.  But, much more emphasis must be placed on eliminating unnecessary fatigue among all of our Medical staff.  

         Unit Managers must be held responsible for providing adequate personnel to cover all of their shifts, including a safe redundancy of staff to relieve OR teams during Surgery and in other critical areas.    
If a Manager’s failure to provide relief was documented on a routine basis this shameful practice would no longer be an acceptable form of staffing coverage!   Such incidents would become the rare exception, confined as they should be, to genuine emergency situations where there is absolutely no other alternative. 

“No one is more important than the patient unconscious on the OR table.”      
         This was the statement that I gave to Hospital Lawyers at an Arbitration Hearing to determine my reinstatement.  For this well respected Maryland Hospital the “Nursing Shortage” was a very convenient excuse to justify unconscionable Managerial abuse that seriously endangered my patient in the OR. They claimed that the ER was busy and I had not asked for a break! The ER is an unrelated clinical area and just try begging for relief on a phone you cannot even touch!   Doctors, Nurses, Technicians and other Medical personnel face severe discipline when mistakes occur, but why isn’t an abusive Manager, implementing a negligent Hospital policy that condones drastic staffing cut backs ever recognized as the real culprit?  

         In some cases misguided administration policies even offer financial bonuses to further encourage self-serving Managers to implement grossly inadequate staff coverage: greed works!  Then, after clear indications demonstrate that deliberate under-staffing is continually putting patients at serious risk, they fail to hold repeatedly abusive Managers accountable as they drive dedicated staff until they drop.  

         This dangerous Managerial policy is focused purely on drastically reducing vital staffing costs to save money at the expense of creating a safe patient care environment that saves lives.  We must put proper safeguards in place to curb this negligent profiteering strategy before more Surgical patients are put at unnecessary risk of serious harm.  Medical staff in other clinical care areas deserve equally humane treatment and consideration of their basic needs so that they can focus all of their valuable attention on providing safe patient care.

         Additionally, when any Healthcare employee is courageous enough to come forward and expose a pattern of ongoing negligent under-staffing practices, or other significant dangers to patient safety, they must be protected from retaliatory Managerial misconduct that threatens their job.   If a Hospital’s internal Compliance Hot Line fails in their crucial self-policing obligation by refusing to investigate negligence or provide protection from retaliation they must be held fully accountable for this refusal to cooperate.

         Whistleblowers should not face the third degree from our US Government Agencies who are all too easily fobbed off with fictitious excuses implying that an informant might be just some “disgruntled former employee intent on revenge.”   In reality, few will risk jail time to “seek revenge” by making sworn statements under oath to a States Attorney! 

         The primary duty of accreditation agencies is to protect public safety.  They cannot therefore, afford to ignore information or evidence based on self-serving opinions: all complaints and allegations must be taken seriously.   No medical institution, no matter how iconic, prestigious, or powerful should be immune from rigorous scrutiny, as this lack of oversight simply encourages bending of the rules, ignoring regulations and cost-cutting that is harmful to safe patient care.  

         Relentlessly abusive Managers are a remarkably valuable tool in generating increased revenue by facilitating staff downsizing without obvious layoffs. I call this the spineless approach to cost-cutting, but it makes our Hospital working environment extremely dangerous for the patients.  The current so called, “Nursing crisis” has come about through a deliberate and calculated policy of dangerous downsizing to target Nursing staff, but particularly the most experienced Nurses who are higher paid.  Minimally trained assistive personnel are plugging the gaps, working under the direction of overwhelmed new Nurse Graduates who are being forced to take on responsibility they are ill-prepared to face. 

         The creation of a toxic work environment is driving Nurses to leave their chosen profession in droves.  When these Nurses are powerless to change under-staffing, and then powerless to report negligent practices, the only way to refuse to participate or condone the dangerous policy of keep taking unnecessary risks with patient care is to leave: hence the Exodus.  

The US does not have a “Nursing Shortage” it has a “Nursing Exodus!”  

         The US healthcare industry is still consistently expecting all of our medical professionals to take bigger risks by making do with unsafe staffing practices. This vital patient safety issue desperately needs to be addressed immediately.

         Please join me in appealing to Johns Hopkins and the Center for Innovation in Quality Patient Care for their help.   The Dean/CEO of Johns Hopkins, Dr. Edward D. Miller, may be contacted at: (410)955-3180 or via e-mail: emiller@jhmi.edu and the Medical Director for the Center for Innovation in Quality Patient Care, Dr. Peter J. Pronovost may be contacted at: (410)955-8032 or ppronovo@jhmi.edu  (These are all publicly available contacts.)  In addition please draw their attention to this important issue by signing the Petition and posting your comments on this subject directly into the Petition itself.

TO ACCESS THE PETITION DIRECTLY FOR SIGNING AND COMMENTARY; GO TO:  http://www.thepetitionsite.com/takeaction/938995258

.        The author is still struggling to overcome the severe damage that wrongful termination as a Whistleblower has inflicted on her professional reputation.  She has recently returned from Tsunami ravaged Aceh Province, Indonesia where she worked as an unpaid NGO Medical Volunteer in Surgery at Cut Nyak Dhien Hospital in Meulaboh. Above, and on the Petition itself Kim is pictured wearing a flimsy ER cover gown over her scrubs in Surgery at this minimally equipped disaster zone Hospital. She is pictured with Indonesian Medical Volunteers, Dr Adityo, and Tre an NGO translator, calling home from  PACTEC at the UN Compound in Meulaboh in her recent Care2Share explanatory letter of appeal.  
To Access this, GO TO. http://www.care2.com/c2c/share/detail/91853 
         This conscientious and dedicated Medical professional is now urgently calling for your help in the hopes that her Petition will at last precipitate meaningful debate on important issue like Under-staffing, Compliance and Whistleblower protections for all US Healthcare employees; eventually becoming a catalyst for new legislation of vital regulatory safeguards.  While this will be gratifying, just to make a tangible difference, personal vindication might remove the remaining barriers that still prevent her from reestablishing a worthwhile career as an NGO Medical Volunteer overseas. The author is also in the process of writing a book called: “ICONIC IMMUNITY,” detailing her experiences and the lessons learned.   Please feel free to e-mail your comments to her at:               
Kim L. Sanders-Fisher    -  MedicIntegrity@Care2.com   
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Posted: May 24, 2006 4:50am

 
 
 
Content and comments expressed here are the opinions of Care2 users and not necessarily that of Care2.com or its affiliates.

Author

Kim Sanders-Fisher
female , divorced
Hastings, AA, United Kingdom
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