9
Street roots
March 16, 2012
EPIDEM IC, fro m page 8
enough of them, and because we don’t take
enough time, (we’re) not killing germs.
There is a study in Britain that came out six
months ago that shows if you hire one extra
housekeeper, on a Monday-to-Friday shift,
you reduce the amount of hospital acquired
infections by 38 percent. I was in the
hospital taking care of a friend last week, at
Virginia Mason. On her ward, the (nurse-to-
patient-ratio seemed high). We’re supposed
to have a ratio bill in this state, but it’s not
being applied. (The Nurse Staffing Law,
passed by the state legislature in 2008,
requires hospitals to develop a nursing staff
plan for each unit and shift.)
The third systemic cause would be shift
work: health care workers working too many
hours. After a certain amount of hours you
lose your cognitive ability, your rational
thought. And on a shift in any health care
institution, you need your cognitive ability.
You need your rational thought. Yet we still
are working too many hours because we
don’t want to hire enough people to do the
job.
The fourth, health care working
conditions. Health care workers are working
under too much stress, under conditions
that are not ergonomically suitable. One out
of 10 health care workers applies for
workers’ compensation every year. And
when you injure a health care worker, you
have a downstream negative patient effect.
Bullying is huge.
R.R.: W/zew you say bullying, I think,
“Don’t bully people in school.”
W.C.: Well, one form is being dressed
down by your superior, being yelled at,
being ganged up on by your peers. It’s very
similar to bullying in the schoolyard. The
studies show that it lowers cognitive
capacity. Doctors dressing down nurses,
nursing supervisors dressing down nurses,
nurses dressing down licensed (practical)
nurses or orderlies. There’s a pecking order
in hospitals, a class system that’s very clear.
But each time a health care worker gets
bullied, they lose their ability to do their job.
We can’t get health care workers to wash
their hands when they come out of the
bathroom. Systems are not being
accountable through the basics of health
care delivery and infection control.
R.R.: But there are always those signs that
say, “Employees must wash hands. ”
W.C.: They don’t do it. There’s no peer
pressure. There was just an article in The
New York Times, where during operations,
doctors have their cell phones in the OR
(“As Doctors Use More Devices, Potential
for Distraction Grows,” NY Times, Dec. 14,
2011). And during an operation, they’re
making calls to their travel agents to book
vacations. Nurses were doing the same
thing. So there’s a lack of accountability.
R.R.: One of the hot topics a couple years
ago was MRSA (Methicillin-resistant
Staphylococcus aureus) How’s MRSA tied into
this?
W.C.: MRSA is a bacterium, and it
becomes a problem when health care
workers and hospitals aren’t diligent enough
to prevent transmission, either from a
patient or a surface in the hospital, which
has not been cleaned properly to eradicate
the MRSA. Then they touch another patient
who’s immuno-compromised. Most people
in the hospitals are immune compromised.
The germs, the bacteria, the viruses, the
pathogen will spread. And they’ll spread
because the basic infection control
paradigms are not being rigidly enforced. So
MRSA — Methicillin-resistant
Staphylococcus aureus - has been killing
patients for years now in hospitals.
These are not easy bugs to kill. You can, if
you clean properly. In America we don’t
know how to clean hospitals. We’re letting
the housekeeper in a room for 20 minutes
or 15 minutes or 10 minutes, and then they
gotta go to the next room. That’s not
enough time. They’re not using the right
kinds of products that actually kill them. We
don’t understand survival times of these
germs, these pathogens. We’re not cleaning
nursing stations where they can accumulate.
You know, about 100,000 people are dying
every year of hospital-acquired infections
and MRSA is one of them. Not the only one,
but certainly one.
numbers game because Europe may be
counting differently than the U.S. is
counting. And that’s one of the big problems
we have: In 27 states in the U.S. —
Washington is one of them — we have laws
that say they have to report medical errors.
Twenty-three states don’t have rules. But we
don’t know how they’re counting, we don’t
know what they’re calling a medical error or
what they’re not. There’s no standardization
of approach of epidemiology, which tells you
events that are supposed to be reported. We
don’t really have a mathematical way of
comparing the
numbers.
R.R.: This might sound a little naïve, but
hospitals are projected as this place where you
go to get better. But I know so many people
who are terrified to go into a hospital.
W.C.: Well, we have to keep in mind the
same hospital, theoretically.
W.C.: Well, in terms of social approach to
medicine, the U.S. is behind Brazil and a lot
of other third world countries, second world
countries, in how we apply the umbrella of
medicine. And certainly, people of color,
people of poverty, receive the lowest
amount of any type of intervention than
people who are more able to pay for
whatever intervention they are trying to
receive. And that’s true in medicine. If you
go into the same hospital and you’re black
and you have no
insurance, you’re
going to get a certain
quality of care. I
R.R.: Why did you
Somebody
has
to
radicalize
mean, they’ll deny
start researching this
this ’til they’re blue
the process, somebody's
data?
gotta get out there and shout in the face, but that’s
what the data shows:
W.C.: Well I
from the rooftops and the
that you will not get
became horrified
the same care as
when I saw the data. I treetops that this is
somebody who is
untenable» Änd patients,
got angry. I know so
fully insured. You
many people who, in
especially patients of color,
may get fewer tests,
my own life, have
poor
patients
—
we're
k
illin
g
you may get fewer
sustained a medical
134,000 Medicare patients a interventions, you
error, who will never
be the same. And the
year in this country through may get less personal
care. The metrics of
more I researched it,
medical error.
the care become
the more I realized
lower for people who
there was an
have less money or
epidemic. (Then) I
are people of color.
realized that the
people who are in charge of fixing it are also
R.R.: Earlier you mentioned someone needs
the people in charge of breaking it. And
to radicalize (health care). Let’s say you’re that
that’s a relationship that never works. It just
radical individual. What do you decide to do?
never works.
The Society for Actuaries, which is a
W.C.: One of the things I’ve decided to do
national society that actually counts money,
is publish this book. It’s a conversation
says — and this is a very low figure — we’re
changer, because we’re saying that (medical
spending $20 billion a year on medical
errors. So if you take the number of hospital errors are) the leading cause of death. And
nobody knows that. I mean, Americans are
beds we have in this country, which are
dumbed down in practically every category
about 1 million, and you divide those
numbers — $20 billion by 1 million — you get you can think of at this particular moment
d en o m in ato r. T h e n u m b e r of c a se s th e y
tr e a t a re in th e billions; n u m b e r of p eo p le
$ 2 0 ,0 0 0 p e r b e d th a t w e ’re sp e n d in g on
m ed ical e rro rs . E v en b efo re a p a tie n t is p u t
in h isto ry , w h ich is o n e of th e re a s o n s th e
e m p ire is declining. Some people see that
they harm are in the millions. They’re only
harming about maybe a third or more
patients, according to some studies. One out
of three has an adverse affect, according to
Health Science, which is a journal that’s
published. So you justify the epidemic in
terms of the good that they do to two-thirds
of the population that they don’t harm.
However, when you look at the number of
fatalities and the number of people they
hurt, but don’t kill, it’s really becomes an
epidemic of harm.
in the bed. And nobody’s taking
responsibility for that kind of cost. I mean,
we can’t afford to insure 50 million people
in this country, and there’s millions of
others who are under-insured, who are
making medical decisions because they can t
afford it. Somebody has to radicalize the
process, somebody’s got to get out there
and shout from the rooftops and the
treetops that this is untenable. And patients,
especially patients of color, poor patients -
we’re killing 134,000 Medicare patients a
year in this country through medical error.
as a good thing and some people don’t. But
in health care it’s never a good thing. So, we
want to change the conversation. We want
to change how we approach this.
The second thing is we’re gonna try and
create a North American alliance and social
movement around trying to create the
change. If every state had a law, every
hospital had to apply a ratios bill - like
Kaiser (Permanente), in California, which is
a big HMO. They’re doing it voluntarily,
their rates have really come down. They’re a
leader in this field. So we’re gonna
introduce legislation. And we’re gonna try to
get people angry. Because hospitals are
literally getting away with murder.
R.R.: Is there somewhere where the harm
isn’t as extreme?
W.C.: I think European hospitals tend to
have lower medical error rates. Scandinavian
hospitals have lower rates. That’s a guess on
my part. I’ve seen some comparable data.
But we don’t want to turn this into a
R.R.: So many statistics point to how people
of color, poor people, are adversely impacted in
law enforcement, educational opportunities,
unemployment. So how does it happen with
medical errors? How would it be any different,
if I were black or poor, that I might undergo
more medical errors? I mean, we’re in the
Rosette Royale is the assistant editor for Real
Change News, Street Roots sister paper in
Seattle, Wash. Reprinted from Real Change
News.
Non and Under Reporting: There are
27 states in the U.S. with reporting
regulations and none in Canada.
Accountability: Studies have shown
directly to medical errors, in 115 studies
included in a 2003 review, working
conditions affect patient safety, the rate of
even„
hands'"between patients or after leaving
medication errors and the rate of
recognition of such errors after they occur.
low compliance rates
bathrooms is not
Technology: Smart technologies in
health care are being designed to
intervene in administration errors. But
according to a recent study, 98,000
people end up in emergency rooms
every year (mostly elderly) due to
medication error.
dangerous shortcuts. Specifically, 84
percent of MDs and 62 percent of RNs
and other clinical care-providers had seen
coworkers taking shortcuts that could be
Cost-Benefit Analysis: The Society of
Actuaries has stated that medical errors
are costing $20 billion a year. Bedsores
||
P H O T O B Y R O BER T H A R W 1 G
alone account for a cost of $3.9 billion
annually. The cost per patient of medical
error can be as high as $20,000 per bed
(using the American Hospital
Association’s data of 1 million hospital
beds in the U.S.).