55 of Medtronic's Best Hospital Friends, Including HCA, Settle for $34 Million

The case of the over-marketing of Kyphon's kyphoplasty device (look <a href="http://hcrenewal.blogspot.com/2008/05/corporate-integrity-agreement-for.html">here</a>) just got more complicated, and now appears to have involved an amazing number of players.<br /><br /><b>The State of Play </b><br /><br /> As reported by the AP (<a href="http://www.washingtonpost.com/business/justice-department-55-hospitals-reach-34-million-settlement-over-medicare-fraud-claims/2013/07/02/3d3d2356-e34e-11e2-bffd-37a36ddab820_story.html">via</a> the Washington Post),<br /><br /><blockquote class="tr_bq"> <i>Fifty-five hospitals in 21 states have agreed to pay $34 million to the U.S. government to settle allegations that they used more expensive inpatient procedures rather than outpatient spinal surgeries to get bigger payments from Medicare,</i> the U.S. Justice Department said Tuesday.<br /><br />The settlement involves kyphoplasty procedures used to treat spinal fractures usually caused by osteoporosis. It can be done as an outpatient procedure, but he Justice Department said the hospitals performed the surgeries as inpatient procedures to increase Medicare billings.</blockquote><br />The current media reports provided little detail about the allegations, but did note that this case has been litigated for a while,<br /><br /><blockquote class="tr_bq"> A similar settlement was reached last year, when 14 hospitals agreed to pay a settlement of more than $12 million. And in 2008, the Justice Department agreed to a $75 million settlement with Medtronic Inc.’s spine business. The government was investigating allegations that Kyphon, a company that had been acquired by Medtronic Spine in 2007, advised hospitals to do inpatient kyphoplasties to bulk up their Medicare payments.</blockquote><br /><b>The Players</b><br /><br />Per the AP, there were quite a few<br /><br /><br /><blockquote class="tr_bq">In the latest settlement, the largest payments are being made by Atrium Medical Center of Middletown, Ohio, which will pay $4.2 million; Mount Sinai Medical Center in Miami, $1.8 million; Altru Health System of Grand Forks, N.D., $1.5 million; Cedars Sinai Medical Center in Los Angeles, $1.5 million; Wayne Memorial Hospital in Goldsboro, N.C., $1.3 million; Trover Health System of Madisonville, Ky., $1.2 million; The Queen’s Medical Center in Honolulu, $1.1 million; and Des Peres Hospital in suburban St. Louis, $900,000.<br /><br />Several multi-hospital organizations agreed to settlements, including:<br />—Twenty-three hospitals with <a href="http://hcrenewal.blogspot.com/search/label/HCA">HCA Inc</a>. of Nashville, Tenn., paying a total of $7.1 million.<br />—Six hospitals with Lifepoint Hospitals Inc. of Brentwood, Tenn., $2.5 million.<br />—Five hospitals with Trinity Health of Livonia, Mich., $3.9 million.<br />—Four hospitals with Morton Plant Mease BayCare Health System of Clearwater, Fla., $2.4 million.<br />—Three hospitals with Baptist Memorial Hospital-Golden Triangle of North Columbus, Miss., $1.8 million.<br />—Two hospitals with Bayhealth Medical Center of Newark, Del., $1.1 million.</blockquote><br /><br />A Modern Healthcare <a href="http://www.modernhealthcare.com/article/20130702/NEWS/307029967/55-more-hospitals-settle-in-kyphoplasty-overpayment-cases">report</a> noted that the leadership of HCA, the hospital system with the largest liability, made it out to all be a misunderstanding,<br /><br /><blockquote class="tr_bq">Hospital executives say the allegations are prompted by  <i>unclear Medicare rules on when spinal-surgery patients should be held overnight.</i> And they note that even though the whistle-blowers and the government are targeting hospitals, t<i>he decision to admit patients is usually dictated by the treating physician.</i><br /><br />'We are pleased to see new clarification of industry care standards, which help physicians make decisions regarding kyphoplasty patients,' HCA spokesman Ed Fishbough said in an e-mailed statement Tuesday. 'We are confident as a result that this issue has been resolved.'</blockquote><br />However, the case appears to be more complicated than that.<br /><br /><b>What Really Happened, and Who Benefited?</b><br /><br />In fact, we <a href="http://hcrenewal.blogspot.com/2008/05/corporate-integrity-agreement-for.html">discussed</a> the Medtronic settlement in 2008.  At that time, a New York Times <a href="http://www.nytimes.com/2008/05/23/business/23device.html">article</a> described the government's allegations about what went on this way,<br /><br /><blockquote class="tr_bq"><i>A unit of Medtronic defrauded Medicare of hundreds of millions of dollars</i>, according to a civil lawsuit that was unsealed Thursday and simultaneously settled with the Justice Department.<br /><br />Two insiders had said Kyphon, which Medtronic acquired in 2007, <i> improperly persuaded hospitals to keep people overnight for a simple outpatient procedure to repair small fissures of the spine. Medicare then reimbursed the hospitals much more generously than it otherwise would have </i>for the procedure, which was developed as a noninvasive approach that could usually be done in about an hour.<br /><br />By marketing its products this way, <i>Kyphon was able to artificially drive up demand among hospitals, bolstering its revenue and driving up its stock price. Medtronic subsequently bought the company, its competitor, for $3.9 billion, greatly enriching Kyphon’s senior executives. </i></blockquote><br />Furthermore,<br /><br /><blockquote class="tr_bq"> The scheme at Kyphon was <i>based on Medicare’s practice of reimbursing hospitals more for complex inpatient back surgery than for outpatient care.</i> The two whistle-blowers, Charles M. Bates and Craig Patrick, said Kyphon had <i>deliberately urged doctors to admit patients overnight, knowing the admissions were unnecessary.</i><br /><br /><i>Hospitals saw the overnight admissions as a way to raise revenue,</i> the two said, and <i>bought Kyphon’s products, even though they were expensive, starting at $3,500 to repair one spinal fissure.</i> The hospitals could recover the cost through the improper reimbursements for overnight stays.<br /><br />Kyphon sold so much equipment this way that at one point it <i>enjoyed a 90 percent profit margin,</i> according to the two insiders, both of whom worked in sales positions.<br /><br />The former employees said the <i>scheme began in 1999</i>, when Kyphon’s products first came to the market. Kyphon’s rapid sales growth and profitability eventually gave rise to a patent dispute with Medtronic, which was dropped when Medtronic acquired it. The acquisition richly rewarded Kyphon’s shareholders, particularly its top executives. <i>The company said its top 15 executives stood to receive about $145 million by cashing in their options and restricted stock.</i></blockquote><br />Note that at that time, Medtronic leadership, whose decision to purchase of Kyphon would end up so enriching Kyphon executives, seemingly had no worries,<br /><br /><blockquote class="tr_bq">A  spokeswoman for Medtronic, Marybeth Thorsgaard, said the company had <i>known Kyphon was under investigation</i> when it made the acquisition. She said it knew that Kyphon’s marketing strategy was being challenged, and took the risk of litigation into account. <i>'There were no surprises,'</i> she said.</blockquote><br />I can find no public record that any individual who authorized, directed, or implemented the arrangements above that lead to huge overcharges to Medicare, and huge revenues to Kyphon and the hospitals was subject to any negative consequences.  As noted above, it appears that the executives who lead Kyphon at the time it was acquired by Medtronic made substantial amounts of money apparently attributable to this scheme to allegedly "defraud Medicare of hundreds of millions of dollars" (as it was described above in the New York Times).  <br /><br />Using the public record available on the internet, I tried to see how the top three Kyphon executives are doing now.  It appears they are not doing badly, and remain influential in health care.  According to its <a href="http://www.sec.gov/Archives/edgar/data/1123313/000119312507096257/ddef14a.htm">2007 proxy statement</a>, just before Kyphon was bought out, its CEO was Richard W Mott.  As best as I can tell, <a href="http://people.equilar.com/bio/richard-mott-alfred-university/salary/525993#.UdRnh6zNrrI">per Equilar,</a> he currently runs a consulting firm (Walkabout Consulting LLC), and was previously chairman of <a href="http://www.linkedin.com/company/photothera">PhotoThera</a>, which just went out of business.  Kyphon's chief science officer was  Karen D Talmadge, PhD, who is now on the <a href="http://www.diabetes.org/about-us/board-of-directors/karen-d-talmadge.html">board of directors of the American Diabetes Association,</a> and is also "Chair of the Board of Directors of Gynesonics, and serves on the Boards of Directors of Amplyx Pharmaceuticals, Velocity Pharmaceutical Development and Venous Health Systems."  Kyphon's chief operating officer was Arthur T Taylor, who is now on the <a href="http://www.providencemt.com/board-directors">board of directors of Providence Medical Technology</a>.<br /><br />The CEO of Medtronic at the time it bought out Kyphon, and the CEO of HCA at the time the arrangements began appear not to be doing badly either.  The CEO of Medtronic at the time it acquired Kyphon was Arthur D Collins Jr, who is now on the boards of directors of Boeing, Alcoa, and US Bancorp, also, according to his <a href="http://www.boeing.com/boeing/corp_gov/board_directors.page?">Boeing biography,</a> he is a senior adviser to Oak Hill Capital Partners, and is on the Board of Overseers of the Wharton School.  The CEO of HCA at the time of its arrangement with Kyphon began was Dr Thomas Frist Jr, who is currently <a href="http://www.forbes.com/profile/thomas-frist-jr/">on the Forbes list of billionaires</a> at number 262 in the world, with a total worth estimated at $4.3 billion. <br /><br /><b>Summary</b><br /><br />In retrospect, this case allegedly involved arrangements between Kyphon, a device company, and multiple hospitals to increase the revenue of all parties by billing the US government for unnecessary hospitalizations occurring after the use of a device made by Kyphon.  The arrangements appeared to have been particularly lucrative for Kyphon's executives after a larger device company, Medtronic, chose to buy Kyphon. Medtronic ultimately paid a large fine and entered into a corporate integrity agreement nine years after the arrangements began.  Now fourteen years after the arrangements began, at least some of the hospitals involved have also paid fines.  The former Kyphon executives who benefited the most seemingly paid no penalties, nor seemingly did any managers of Medtronic or the hospitals who might have gotten larger compensation because of all the revenue that these arrangements generated.     <br /><br />So initially, the big losers from this complex dance were the US government, and ultimately US tax payers.  Some patients may have also paid out of pocket for unnecessary services and thus lost money too.  Whether some patients suffered due to adverse effects of unneeded procedures was not clear.  Much later, Medtronic and some of the hospitals involved did pay big fines and thus lost some money.  However, it does not appear that they paid anything like what they made from the original scheme, and their payments were delayed for years.  However, the insiders who personally made a lot of money never apparently paid anything later.  So, this case appears to be a vivid example of how such insiders can walk away with piles of money from the misbehavior of their own corporations, while others pay the price.<br /><br /><br />Many of those of us of a certain age were brought up on myths that ultimately the good guys win and the bad guys lose.  We would all like to believe that the "arc of the moral universe ... bends toward justice."  History and this recent example suggest that it may not do so without our active intervention.  <br /><br />In health care, as we have said many times (look <a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">here</a> for examples), when bad behavior occurs within a large health care organization, rarely are the insiders who authorized or directed it, and who had the most to gain from the behavior ever made to suffer any negative consequences.  As long as health care leaders have such impunity, expect them to continue to personally profit from unethical behavior.  As a result, expect health care costs to continue to rise as quality and access get worse and worse.<br /><br />True health care reform.needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.

55 of Medtronic's Best Hospital Friends, Including HCA, Settle for $34 Million

The case of the over-marketing of Kyphon's kyphoplasty device (look here ) just got more complicated, and now appears to have involved a...

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Is ONC's definition of "Significant EHR Risk" when body bags start to accumulate on the steps of the Capitol?

In a June 25, 2013 Bloomberg News article "<b><a href="http://www.bloomberg.com/news/2013-06-25/digital-health-records-risks-emerge-as-deaths-blamed-on-systems.html">Digital Health Records’ Risks Emerge as Deaths Blamed on Systems</a></b>" by technology reporter Jordan Robertson (<a href="http://go.bloomberg.com/tech-blog/author/jrobertson40/">http://go.bloomberg.com/tech-blog/author/jrobertson40/</a>), an EHR-harms case in which I am (unfortunately) intimately involved as substitute plaintiff is mentioned:<br /><br /><blockquote class="tr_bq">When Scot Silverstein’s 84-year-old mother, Betty, starting mixing up her words, he worried she was having a stroke. So he rushed her to Abington Memorial Hospital in Pennsylvania.<br /><br />After she was admitted, Silverstein, who is a doctor, looked at his mother’s electronic health records, which are designed to make medical care safer by providing more information on patients than paper files do. He saw that Sotalol, which controls rapid heartbeats, was correctly listed as one of her medications.<br /><br />Days later, when her heart condition flared up, he re-examined her records and was stunned to see that the drug was no longer listed, he said. His mom later suffered clotting, hemorrhaged and required emergency brain surgery. She died in 2011. Silverstein blames her death on problems with the hospital’s electronic medical records.<br /><br />“I had the indignity of watching them put her in a body bag and put her in a hearse in my driveway,” said Silverstein, who has filed a wrongful-death lawsuit. <b>“If paper records had been in place, unless someone had been using disappearing ink, this would not have happened.”</b></blockquote><br />How can I say that?  Because I trained in this hospital and worked as resident Admitting Officer in that very ED pre-computer.  The many personnel in 2010 who were given the meds history by my mother and myself directed it not to paper for others to see, but to /dev/null.<br /><br /><i>Why</i> can I say that?  Because the hospital's <i>Motion for Prior Restraint</i> (censorship) against me was denied outright by the presiding judge just days before the Bloomberg article was published (<a href="http://en.wikipedia.org/wiki/Prior_restraint">http://en.wikipedia.org/wiki/Prior_restraint</a>):<br /><br /><blockquote class="tr_bq"><b>Prior restraint</b> (also referred to as <b>prior censorship</b> or <b>pre-publication censorship</b>) is <a href="http://en.wikipedia.org/wiki/Censorship" title="Censorship">censorship</a> imposed, usually by a government, on expression before the expression actually takes place. An alternative to prior restraint is to allow the expression to take place and to take appropriate action afterward, if the expression is found to violate the law, regulations, or other rules.<br /><br />Prior restraint prevents the censored material from being heard or distributed at all; other measures provide sanctions only after the offending material has been communicated, such as suits for <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Slander" title="Slander">slander</a> or <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Libel" title="Libel">libel</a>. In some countries (e.g., <a href="http://en.wikipedia.org/wiki/Law_of_the_United_States" title="Law of the United States">United States</a>, <a href="http://en.wikipedia.org/wiki/Constitution_of_Argentina" title="Constitution of Argentina">Argentina</a>) prior restraint by the government is forbidden, subject to certain exceptions, by a <a href="http://en.wikipedia.org/wiki/Constitution" title="Constitution">constitution</a>.<br /><br />Prior restraint is often considered a particularly oppressive form of <a href="http://en.wikipedia.org/wiki/Censorship" title="Censorship">censorship</a> in Anglo-American jurisprudence because it prevents the restricted material from being heard or distributed at all. Other forms of restrictions on expression (such as actions for <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Libel" title="Libel">libel</a> or <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Slander_and_libel#Criminal_libel" title="Slander and libel">criminal libel</a>, <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Slander" title="Slander">slander</a>, <a href="http://en.wikipedia.org/wiki/Defamation" title="Defamation">defamation</a>, and <a href="http://en.wikipedia.org/wiki/Contempt_of_court" title="Contempt of court">contempt of court</a>) implement criminal or civil sanctions only after the offending material has been published. While such sanctions might lead to a <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Chilling_effect_%28term%29" title="Chilling effect (term)">chilling effect</a>, legal commentators argue that at least such actions do not <i>directly</i> impoverish the <a href="http://en.wikipedia.org/wiki/Marketplace_of_ideas" title="Marketplace of ideas">marketplace of ideas</a>. Prior restraint, on the other hand, takes an idea or material completely out of the marketplace. <b>Thus it is often considered to be the most extreme form of censorship.</b></blockquote><br />The First Amendment lives.<br /><br />(I wonder if it irks the hospital that they cannot perform <a href="http://www.aapsonline.org/index.php/article/sham_peer_review_resources_physicians/">sham peer review</a> upon me now that the censorship motion is denied.  Sham peer review is a common reaction by hospital executives to "disruptive" physicians, but I have not worked there since 1987 and I no longer practice medicine.)<br /><br />In the Bloomberg story Mr. Robertson wrote:<br /><br /><div style="margin-left: 40px;">... “<b>So far, the evidence we have doesn’t suggest that health information technology is a significant factor in safety events,” said Jodi Daniel (</b><a href="http://www.healthit.gov/newsroom/jodi-daniel-jd-mph">http://www.healthit.gov/newsroom/jodi-daniel-jd-mph</a><b>), director of ONC’s office of policy and planning.</b> “That said, we’re very interested in understanding where there may be a correlation and how to mitigate risks that do occur.”</div><br />In my opinion this statement represents gross negligence by a government official.  Ms. Daniel is unarguably working for a government agency pushing this technology.   She makes the claim that "so far the evidence we have doesn't suggest significant risk" while <i><u>surely being aware (or having the fiduciary responsibility to be aware) of the impediments to having such evidence</u>.</i><br /><br />From my March 2012 post <b>"Doctors and EHRs: Reframing the 'Modernists v. Luddites' Canard to The Accurate 'Ardent Technophiles vs. Pragmatists' Reality"</b> at <a href="http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html">http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html </a> (yes, this was more than a year ago):<br /><br /><blockquote class="tr_bq">... The Institute of Medicine of the National Academies noted this in their <a href="http://hcrenewal.blogspot.com/2011/11/iom-report-on-health-it-safety-nix-fda.html">late 2011 study on EHR safety</a>:<br /><br /><br /><blockquote>... While some studies suggest improvements in patient safety can be made, others have found no effect. Instances of health IT–associated harm have been reported. However, <b><u>little published evidence could be found </u></b><span style="font-weight: bold;"><u>quantifying the magnitude of the risk</u>. </span><br /><br />Several reasons health IT–related safety data are lacking include the <span style="font-weight: bold;">absence of measures and a central repository</span> (or<span style="font-weight: bold;"> linkages</span> among decentralized repositories) to collect, analyze, and act on information related to safety of this technology. Another impediment to gathering safety data is <span style="font-weight: bold;">contractual barriers (e.g., nondisclosure, confidentiality clauses)</span> that can prevent users from sharing information about health IT–related adverse events. These barriers limit users’ abilities to share knowledge of risk-prone user interfaces, for instance through screenshots and descriptions of potentially unsafe processes. In addition, some vendors include language in their sales contracts and escape responsibility for errors or defects in their software (i.e., “<span style="font-weight: bold;">hold harmless clauses</span>”). The committee believes these types of contractual restrictions <span style="font-weight: bold;">limit transparency, which significantly contributes to the gaps in knowledge of health IT–related patient safety risks. These barriers to generating evidence pose unacceptable risks to safety.</span><span style="font-style: italic;">[IOM (Institute of Medicine). 2012. <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/Patient%20Safety%20and%20Health%20IT%20prepub.pdf">Health IT and Patient Safety: Building Safer Systems for Better Care</a> (PDF). Washington, DC: The National Academies Press, pg. S-2.]</span><span style="font-weight: bold;"><br /></span></blockquote><br />Also in the IOM report:<br /><br /><blockquote class="tr_bq">… “For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use barcoding systems. But even in these instances, the<span style="font-weight: bold;"> ability to generalize the results across the health care system may be limited</span>. For other products— including electronic health records, which are being employed with more and more frequency— some studies find improvements in patient safety, while other studies find no effect.<br /><br /><b>More worrisome, some case reports suggest that poorly designed health IT can create new hazards</b> in the already complex delivery of care. <u><b>Although the magnitude of the risk associated with health IT is not known</b></u>, some examples illustrate the concerns. Dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human–computer interactions or loss of data have led to serious injury and death.”</blockquote></blockquote><br /><br />I also noted that the 'impediments to generating evidence' effectively rise to the level of <span style="font-weight: bold;">legalized censorship</span>, as observed by Koppel and Kreda regarding gag and hold-harmless clauses in their JAMA article "<a href="http://jama.ama-assn.org/content/301/12/1276.extract">Health Care Information Technology Vendors' Hold Harmless Clause: Implications for Patients and Clinicians</a>", JAMA 2009;301(12):1276-1278. doi: 10.1001/jama.2009.398.<br /><br />FDA had similar findings about impediments to knowledge of health IT risks, see my Aug. 2010 post <b>"Internal FDA memorandum of Feb. 23, 2010 to Jeffrey Shuren on HIT risks. Smoking gun?"</b> at <a href="http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html">http://hcrenewal.blogspot.com/2010/08/smoking-gun-internal-fda-memorandum-of.html</a>.<br /><br />I also note this from amednews.com's coverage of the ECRI Deep Dive Study (<a href="http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html" target="_blank">http://hcrenewal.blogspot.<wbr></wbr>com/2013/02/peering-<wbr></wbr>underneath-icebergs-water-<wbr></wbr>level.html</a>):<br /><br /><br /><div style="margin-left: 40px;">... In spring 2012, a surgeon tried to electronically access a patient’s radiology study in the operating room but the computer would show only a blue screen. The patient’s time under anesthesia was extended while OR staff struggled to get the display to function properly. That is just one example of 171 health information technology-related problems reported <b>[voluntarily]</b> <b>during a nine-week</b> period<b> [from 36 hospitals]</b> to the ECRI Institute PSO, a patient safety organization in Plymouth Meeting, Pa., that works with health systems and hospital associations in Kentucky, Michigan, Ohio, Tennessee and elsewhere to analyze and prevent adverse events.<b> Eight of the incidents reported involved patient harm, and three may have contributed to patient deaths, said the institute’s 48-page report, </b>first made privately available to the PSO’s members and partners in December 2012. The report, shared with American Medical News in February, highlights how the health IT systems meant to make care safer and more efficient can sometimes expose patients to harm.</div><br /><br />One wonders if Ms. Daniels' definition of "significant" is when body bags start to accumulate on the steps of the Capitol.<br /><br />I also note she is not a clinician but a JD/MPH.<br /><br />I am increasingly of the opinion that non-clinicians need to be removed from positions of health IT leadership at regional and national levels.<br /><br />In large part many just don't seem to have the experience, insights and perhaps ethics necessary to understand the implications of their decisions.<br /><br />At the very least, such people who never made it to medical school or nursing school need to be kept on a very short leash by those who did. <br /><br />-- SS

Is ONC's definition of "Significant EHR Risk" when body bags start to accumulate on the steps of the Capitol?

In a June 25, 2013 Bloomberg News article " Digital Health Records’ Risks Emerge as Deaths Blamed on Systems " by technology repor...

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Pfizer May No Longer be Able to Delay Paying Its Asbestos Claims of Nearly $1 Billion

Pfizer, which claims to be the "world's largest research-based pharmaceutical company," is one step closer to paying a nearly one billion dollar settlement of legal claims of harms due to the asbestos products it used to manufacture.<br /><br /><b>Pfizer Settles - More or Less - Some of its Asbestos Liability </b><br /><br />Most people would not think of Pfizer as a producer of asbestos.  However, the back-story, as <a href="http://www.philly.com/philly/business/20130627_Drug-maker_Pfizer_fails_to_escape_costly_asbestos_case.html">reported</a> in the Philadelphia Inquirer, and as we discussed <a href="http://hcrenewal.blogspot.com/2011/01/curious-case-of-pfizers-asbestos-claims.html">here</a> in 2011, is that<br /><br /><blockquote class="tr_bq">Pfizer used to have a minerals, pigments and metals division and, <i>in 1968, it bought Quigley Company Inc</i>., which made insulation for heavy industry.<br /><br /><i>Quigley's Insulag contained asbestos.</i></blockquote><br />So,<br /><br /><blockquote class="tr_bq">Quigley stopped production at its facility in Old Bridge, N.J., in 1992.  When it filed for bankruptcy in 2004, Quigley faced more than 160,000 lawsuits, most related to asbestos product liability.</blockquote><br />By apparently holding out the legal fiction that Quigley was an independent entity, Pfizer seemed to use to use the bankruptcy filing to delay making any payment of these claims, most of which likely involved illnesses due to asbestos exposure.  As the Inquirer article said,<br /><br /><blockquote class="tr_bq">Pfizer has spent the nine years since arguing that bankruptcy law protects it from such lawsuits.</blockquote><br />notwithstanding the fact that Pfizer itself is hardly bankrupt.<br /><br />But now, as Bloomberg reported (<a href="http://www.theday.com/article/20130627/BIZ03/306279581/1044">via</a> the New London [CT] Day),<br /><br /><blockquote class="tr_bq"> Pfizer Inc.'s non-operating Quigley Co. won permission to <i>end almost nine years in bankruptcy</i> under a plan that resolves most asbestos claims against the former insulation maker and its parent, the world's largest drugmaker.<br /><br />U.S. Bankruptcy Judge Stuart Bernstein in Manhattan Wednesday approved a Chapter 11 plan under which <i>Pfizer will contribute assets worth $964 million. He rejected a prior plan almost three years ago, saying Pfizer was improperly using Quigley's bankruptcy to shield itself from asbestos claims.</i></blockquote><br />Note that Pfizer has consistently argued that it should bear no responsibility for the effects of the asbestos made by its subsidiary:<br /><br /><blockquote class="tr_bq">'Pfizer has never been found derivatively or directly liable for injuries allegedly caused by Quigley's asbestos- containing products,' [Pfizer spokesman Christopher] Loder said.</blockquote><br /><div id="r1PostCPBlock" style="background-color: white; border: medium none; color: black; left: -99999px; overflow: hidden; position: absolute; text-align: left; text-decoration: none;">Pfizer used to have a minerals, pigments and metals division and, in 1968, it bought Quigley Company Inc., which made insulation for heavy industry. Quigley's Insulag contained asbestos. <br />Read more at <a href="http://www.philly.com/philly/business/20130627_Drug-maker_Pfizer_fails_to_escape_costly_asbestos_case.html#AltGBB8oXa8YPkAC.99" style="color: #003399;">http://www.philly.com/philly/business/20130627_Drug-maker_Pfizer_fails_to_escape_costly_asbestos_case.html#AltGBB8oXa8YPkAC.99</a></div>Furthermore,<br /><br /><blockquote class="tr_bq">Pfizer has said throughout the case that it never made or sold Quigley's products and it doesn't have liability for them. Asbestos, once widely used as an insulator, was later shown to cause cancer.</blockquote><br /><b>Convenient Fictions</b><br /><br />This case received little notice in 2011 and is receiving little notice now, and mainly for its business implications.  Yet the reporting does suggest  dots to connect to reveal some larger hypocrisies.<br /><br /><u>Dedicated to improving health and well being? </u><br /><br />Pfizer asserts <a href="http://www.pfizer.com/about/history/history.jsp">on its website</a> that it<br /><br /><blockquote class="tr_bq">has remained dedicated to discovering and developing new, and better, ways to prevent and treat disease and i<i>mprove health and well being for people around the world.[italics added]</i></blockquote><br />Yet despite this supposed dedication to health and well-being, it has long delayed any possible compensation to people who may have acquired severe, if not fatal disease from contact with one of its products. <br /><br />As per Bloomberg, note the examples of<br /><br /><blockquote class="tr_bq">people like Brenda Hagerich, 62, of Hot Springs, Ark., may get payments on their claims. Hagerich, whose father died in 1999 of mesothelioma, said she has been waiting for a second distribution of a $125,000 payment.</blockquote><br /><u>Ownership without responsibility </u><br /><br />According to current media reports,  Pfizer attorneys repeatedly contended that because Quigley was a subsidiary of Pfizer, Pfizer could not be held accountable for its actions.  Yet Pfizer owned, and presumably thus gained all revenue from and chose the leadership of Quigley.  At best, maintaining this fiction seems heartless given Pfizer's stated interest in peoples' "health and well being."<br /><br /><u>Who knew asbestos was dangerous? </u><br /><br />The current reports seem to imply that Pfizer's accountability should be mitigated because at the time it acquired Quigley, no one knew that asbestos was hazardous.  The Bloomberg report stated,<br /><br /><blockquote class="tr_bq">Quigley made asbestos-containing products from the 1940s to the 1970s, including Insulag, a powdered insulation. Pfizer, based in New York, bought the company in 1968.</blockquote><br />But,<br /><br /><blockquote class="tr_bq">Pfizer has said throughout the case that it never made or sold Quigley's products and it doesn't have liability for them. Asbestos, once widely used as an insulator, <i>was <b>later</b> shown to cause cancer</i>.</blockquote><br />The last sentence implies that asbestos was only shown to cause cancer after Pfizer acquired Quigley in 1968.  However, this suggests a lack of knowledge of medical history.<br /><br />In fact, evidence that asbestos was dangerous would have been readily available in 1968. Pulmonary asbestosis was recognized in 1927.(1, noted in 2).  Furthermore, <b><i>by 1952</i></b>, as per Dr Richard Doll(3),<br /><br /><blockquote class="tr_bq"><i>The majority of workers (cited by Hueper, 1952) consider that a causal relationship between asbestosis and lung cancer is either proved or is highly probable</i> and the reality of the relationship was agreed at the recent International Symposium on the Epidemiology of Lung Cancer.</blockquote><br />Doll reported further data <b><i>in 1954</i></b> and concluded,<br /><br /><blockquote class="tr_bq"><b><i>lung cancer was a specific industrial hazard of certain asbestos workers...</i></b>.</blockquote><br /><b>Summary </b><br /><br />So while Pfizer officials ought to have known that in 1968 it was acquiring a company that made products that likely caused lung cancer, for more than 40 years, they have managed to stall payments to now mainly the heirs of people who acquired severe disease due to those products.  This clearly suggests that in this matter the company leadership has consistently put its revenue ahead of its ostensible dedication to peoples' health and well being.  Then again, this is hardly the first example of dubious ethical conduct by Pfizer.  See <a href="http://hcrenewal.blogspot.com/2013/01/pfizers-pfourteenth-settlement-small.html">this post </a>for a list of the 14 legal settlements of allegations of misconduct made by Pfizer since 2000, only one of which was related to the current case.<br /><br />Furthermore, dedication to short-term revenue over everything else has resulted in huge wealth for Pfizer's hired managers.  <a href="http://online.wsj.com/article/BT-CO-20130314-712087.html">Per</a> the Wall Street Journal, only the latest example is,<br /><br /><br /><blockquote class="tr_bq"><i>The total 2012 compensation for Pfizer Inc. (PFE) Chief Executive Ian C. Read was valued at <b>$25.6 million</b></i>, up 2.5% from 2011, as the drug maker hit two out of three key financial objectives last year.  <br /><br />Mr. Read's compensation was based partly on the company exceeding targets for total revenue and adjusted earnings-per-share, while missing its target for cash flow in 2012, Pfizer said in a proxy statement filed Thursday with the U.S. Securities and Exchange Commission.</blockquote><br /><br />Presumably, the total revenue target would have been a bit lower if Pfizer had managed to set aside assets to pay the asbestos related claims discussed above in 2012 rather than in 2013.<br /><br />This relatively <a href="http://hcrenewal.blogspot.com/search/label/anechoic%20effect">anechoic</a> example shows how hollow ring most of the claims by leaders of big health care organizations that they value patients' and the public's health.  That may be convenient public relations puffery, but again and again the bottom line seems to matter more to them.  We have shown numerous examples of <a href="http://hcrenewal.blogspot.com/search/label/mission-hostile%20management">mission-hostile management</a>, and of leaders <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">compensated outrageously</a> out of proportion to their contributions to patients' and the public's health.  Thus, why should health care professionals, or patients believe that anything they do puts patients ahead of money?<br /><br />As we have said so often, health care professionals and society at large needs to hold large health care organizations' leadership accountable for their missions, and push out leaders who put their own pocketbooks and their organizations' revenue ahead of patients' and the public's health.  <br /><br /><br /><br /><span style="font-size: x-small;"><b>References</b></span><br /><span style="font-size: x-small;"><br /></span><span style="font-size: x-small;">1.  Cooke WE.  Pulmonary asbestosis.  Br Med J 1972; 2: 1024.</span><br /><span style="font-size: x-small;">2.  Hasan FM, Nash G, Kazemi H. Asbestos exposure and related neoplasia: the 28 year experience of a major urban hospital.  Am J Med 1978, 65: 649-654. Link <a href="http://www.ncbi.nlm.nih.gov/pubmed/707524">here</a>.</span><br /><span style="font-size: x-small;">3.  Doll R. Mortality from lung cancer in asbestos workers.  Br J Indust Med 1955; 12: 81-86.  Link <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1035472/">here</a>.  </span>

Pfizer May No Longer be Able to Delay Paying Its Asbestos Claims of Nearly $1 Billion

Pfizer, which claims to be the "world's largest research-based pharmaceutical company," is one step closer to paying a nearly ...

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Shut Up and Sell - the Corporate Physician's New Motto?

Evidence has been seeping into public view about the extent physicians who sign up to <a href="http://hcrenewal.blogspot.com/search/label/corporate%20physician">take care of patients as corporate employees</a> give up their professionalism.<br /><br /><b>Shut Up...</b><br /><br />In April, 2013, Medscape published an <a href="http://www.medscape.com/viewarticle/781964">article</a> whose striking title was "<i>Can You Speak Out Without Getting Fired or Being Labeled a Troublemaker?</i>"  The answer was basically "no."<br /><br /><blockquote class="tr_bq">Physicians often see problems at their workplaces relating to patient quality of care, financial practices, mistreatment of staff, and other issues. But <i>as more doctors take jobs as employees of hospitals, medical groups, and other large organizations, they increasingly face the same dilemmas as millions of other working stiffs. When they come across actions or policies that they don't think are right, they have to decide whether it's worth it to speak out and get labeled as a troublemaker -- or perhaps even get fired.</i><br /><br /> Across the country, a growing number of physicians are indeed losing their jobs -- and often their hospital staff privileges -- after protesting employment conditions. Such complaints may involve patient quality-of-care problems, short staffing, misallocation of funds, improper financial incentives, fraud and abuse, discrimination, overuse or withholding of medical services, or other misconduct, say organized medical groups, employment attorneys, and physician recruiters.</blockquote><br />Of course, physicians swear oaths to put the needs of their individual patients first, and doing so within a large organization might well involve protesting conditions and practices that may affect the quality of care or even endanger patients.  But woe unto physicians who try to fulfill their professional responsibility when doing so goes up against the top executives to whom the physicians must now report.<br /><br /><blockquote class="tr_bq">'We were naive when we went into this,' says Maria Rivero, MD, who with her professional colleague and significant other Derek Kerr, MD, filed administrative complaints against their long-time hospital employer in 2010. 'We thought if we just brought it to people's attention, they would fix the problem and leave us alone. <i>But if you blow the whistle on high-level executives, you need to prepare to be harassed and lose your job</i>.'</blockquote><br />Even working within the system to fix problems can lead to big trouble,<br /><br /><br /><blockquote class="tr_bq">Still, the formal professional approach doesn't always work either. Cloyd Gatrell, MD, an emergency physician who was employed by EmCare, says that he and his wife Kathryn, a nurse, voiced concerns and presented data to executives at Carlisle Regional Medical Center in Pennsylvania in 2008 and 2009 on <i>what they saw as inadequate nurse staffing levels that endangered patients.</i><br /><br />After getting no results, Dr. Gatrell contacted the state health department, prompting a state inspection that found insufficient staffing. In 2010, he was <i>fired by EmCare at the request of the hospital,</i> according to his 2011 lawsuit against the hospital and EmCare claiming violation of whistleblower protection laws. <i>His wife was fired earlier, and she sued separately.</i> The hospital issued a statement declining comment on the litigation.<br /><br />'We're supposed to be advocates for patients, but <i>being employed puts us in a precarious position in taking a position on patient interests that's against what the hospital administration favors,</i>' says Dr. Gatrell, whose suit is in the discovery stage. 'I think a physician still has that responsibility.'</blockquote><br />Physicians who sign contracts with corporate employers, perhaps thinking that they will have less bureaucracy with which to contend and a more certain salary than they did in private practice, seem blissfully, or willfully unaware that those contracts may take away their ability to control their practices and stand up for their patients. <br /><br /><br /><blockquote class="tr_bq">Still, federal and state whistleblower laws only provide protection from retaliation for physicians in certain situations, such as those employed by public entities or those who complain about civil rights violations or Medicare and Medicaid fraud and abuse. Otherwise <i>doctors may have to rely on contract provisions or on state employment law, which may not offer much protection.</i><br /><br />[An anesthesiologist on the AMA Board of Trustees and his hospital system's board,] Dr. Annis says that the AMA's new statement of principles for physician employment -- which asserts that physicians should not be retaliated against by their employers for speaking out on patient care issues -- <i>provides support for doctors when they raise legitimate professional concerns with their employers.</i> He says it's best for physicians to work through their medical staff organization.<br /><br />But Dr. Gatrell points out that <i>the AMA statement explicitly accepts that physician employment contracts may allow hospitals to strip doctors of their medical staff membership and clinical privileges at the same time they are terminated,</i> known as a 'clean sweep' clause. 'If that's accepted by the AMA, the rest of the principles protecting physicians are meaningless," he argues. "<i>If physicians can be fired without cause and then automatically lose their medical staff membership and its due process protection, how many will dare be a patient advocate?</i>'<br /><br />Some experts <i>advise physicians not to sign employment agreements with such onerous provisions</i>. But others say that physicians often have little leverage to remove them. 'It's not an equal negotiating table,' says Dr. Gatrell, who's now working for a small urgent care practice.</blockquote><br />A May, 2013 <a href="http://www.medscape.com/viewarticle/782136">article</a> again in Medscape about the "4 Top Complaints of Employed Doctors," explained why physicians often see a lot they could or should protest to assure the quality of their patients' care,<br /><br /><blockquote class="tr_bq"> Some doctors report that hospital administrators treat them with a lack of respect. One female doctor said, also on condition of anonymity, that her biggest challenge on her job was '<i>how to handle nonphysician high school grads bossing you around when they function as your 'superiors' in your employer's organization. They manage their insecurities by bullying physicians and through passive aggressiveness, but always seem to gain the upper hand with those at the top</i>.'</blockquote><br />These are the sorts of brilliant administrators often hired by brilliant top executives, maybe at a cheap price to keep the bottom line and <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">executive compensation</a> healthy..  Furthermore, given that as we have discussed, "<a href="http://hcrenewal.blogspot.com/search/label/financialization">financialization</a>" of hospital management often puts a bigger priority on short-term revenue than on quality care, as per one senior physician,<br /><br /><br /><blockquote class="tr_bq"> 'physicians are being increasingly targeted when they get in the way' of hospitals' agendas</blockquote><br />To make more money faster, many hospital systems now seem to want physicians to only make referrals for lucrative tests and treatments within the system, even if some patients might be better served elsewhere,<br /><br /><br /><blockquote class="tr_bq"><i>The AMA recently issued guidelines for physician employment stating that 'a physician's paramount responsibility is to his or her patients.'</i> Employers should not retaliate against physicians for asserting their patients' interests, according to these guidelines. <i>'In any situation where the economic or other interests of the employer are in conflict with patient welfare, patient welfare must take priority,'</i> the AMA says.<br /><br />The guidelines also <i>call for employers and employed physicians to disclose to patients any agreements or understandings they have that restrict, discourage, or encourage particular treatment or referral options.</i><br /><br />Nevertheless, <i>employed physicians are often expected to refer patients within their own groups and send tests to a hospital laboratory or imaging center</i>. Hospitals may tell employed surgeons which kinds of joint implants to use, and according to a New York Times article even whether to implant defibrillators in Medicaid patients. It's unclear how often any of this is disclosed to patients.<br /><br />'What we doctors say is that we're ethically bound to our patients because we took an oath, and that's what our license is based on,' says Linda Brodsky. 'But many hospitals say, '<i>No, you're employed here, and what we say goes.</i>'</blockquote><br />Note that so far there seems to be little evidence that the AMA guidelines about physician employment are being honored other than in the breach.  It is also disappointing that the leadership of the medical society that represents internists seems so unworried,<br /><br /><blockquote class="tr_bq"> <i>David L. Bronson, MD, President of the American College of Physicians, disputes Brodsky's assertion that hospitals tend to squelch doctors who criticize leadership for policies that they believe harm patient care. In fact, he says, healthcare organizations may identify outspoken physicians as potential leaders,</i> 'as long as they're collaborative and trying to solve problems, and not just be a thorn in the side of everyone they know. Organizations are looking for physician leaders, and physicians who can collaborate and not just be adversarial can go far inside organizations.'</blockquote><br />I would guess, having seen so many examples of <a href="http://hcrenewal.blogspot.com/search/label/generic%20management">generic management</a>, <a href="http://hcrenewal.blogspot.com/search/label/mission-hostile%20management">mission-hostile management</a>, management that seems more <a href="http://hcrenewal.blogspot.com/search/label/financialization">focused on the money than patient care,</a> and management that seems to be able to <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">make itself rich</a> without evidence that it has done anything noteworthy to uphold hospitals' clinical missions, that hospital systems that promote physicians who are willing to speak out against hired executives are vanishingly rare.<br /><br /><b>And Sell</b><br /><br />In June, 2013, Beckers Hospital Review published an <a href="http://beckershospitalreview.com/hospital-physician-relationships/teaching-doctors-how-to-sell.html">article</a> suggesting that now hospitals are going beyond just pressuring employed physicians to refer potentially profitable patients within the system, and now are pressuring physicians to act as salespeople to their colleagues,<br /><br /><blockquote class="tr_bq"> A few hospitals are beginning to train their employed physicians to "sell" the hospital, which involves asking referring doctors in the community to send patients their way....  <i>the pressure to bring doctors into sales is mounting.</i></blockquote><br />The author, the former publisher of Modern Healthcare, made a remarkable argument based on a definition that seems wildly optimistic,<br /><br /><blockquote class="tr_bq"> Customer service lies at the core of salesmanship. The Business Dictionary defines salesmanship as satisfying customer needs through a sincere and mutually beneficial process aimed at a long-term relationship.</blockquote><br />Of course, skeptical physicians used to exposure to the sales tactics pharmaceutical and device companies use (look <a href="http://hcrenewal.blogspot.com/2007/05/fool-me-once-shame-on-you-fool-me-twice.html">here</a>, <a href="http://hcrenewal.blogspot.com/2008/03/what-drug-reps-really-care-about.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2008/04/more-about-cynical-world-of-drug-reps.html">here</a>,  for example) might wonder why the author did not discuss such marketing tactics as the employment of half-truths and biased information, and the use of emotional appeals to trump reason and logic. <br /><br />That the author was serious was shown by his list of seven pointers for hospitals seeking to transform its employed physicians into marketers.<br /><br />Of course, physicians who are already "key opinion leaders" employed by drug and device companies, whose marketing executives may think. that "key opinion leaders were sales people for us," (see <a href="http://hcrenewal.blogspot.com/2008/06/key-opinion-leaders-were-sales-people.html">this post</a>), might not be fazed by now being asked to market their own hospital.  Never mind about Principle II of the <a href="http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/principles-medical-ethics.page?">AMA Code of Ethics</a><br /><br /><blockquote class="tr_bq">II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.</blockquote><br /><br /><b>The Moral of the Story</b><br /><br />We have previously discussed various aspects of the travails of the brave new world of the <a href="http://hcrenewal.blogspot.com/search/label/corporate%20physician">corporate physician</a>.  Physicians and other health professionals who sign on as full-time employees of large corporate entities have to realize that they are now beholden to managers and executives who may be <a href="http://hcrenewal.blogspot.com/search/label/mission-hostile%20management">hostile to their professional values</a>, and who are subject to <a href="http://hcrenewal.blogspot.com/search/label/perverse%20incentives">perverse incentives</a> that support such hostility, including the potential for huge <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">executive compensation</a>.  Physicians seem to be willing to sign <a href="http://hcrenewal.blogspot.com/search/label/contracts">contracts </a>that underline their new subservience to their corporate overlords, and likely trap them within <a href="http://hcrenewal.blogspot.com/search/label/confidentiality%20clause">confidentiality clauses</a> that make blowing the whistle likely to lead to extreme unpleasantness. <br /><br />It is disappointing that even medical societies that ostensibly support physicians' professional values have been afraid to warn against such employment, or do much to help physicians trapped within it.<br /><br />Physicians who go to work for big corporations have to realize that they may be forced to put corporate executives' vested interests ahead of their patients.  Patients whose physicians work for big corporations must realize that their health care will now be corporate, with all that entails. <br /><br />  As I have said before, we need to challenge the notion that direct health care should ever be provided, or that medicine ought to be practiced by for-profit corporations. I submit that we will not be able to have good quality, accessible health care at an affordable price until we restore physicians as independent, ethical health care professionals, and until we restore small, independent, community responsible, non-profit hospitals as the locus for inpatient care. <br /><br /><br />

Shut Up and Sell - the Corporate Physician's New Motto?

Evidence has been seeping into public view about the extent physicians who sign up to take care of patients as corporate employees give up ...

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Monetary losses and layoffs from EHR expenses and EHR mismanagement

More on monetary losses and layoffs from EHR expenses and EHR mismanagement:<br /><br />1.  <b>Layoffs to balance the budget...</b><br /><br /><a href="http://www.news-record.com/news/local_news/article_da765340-d912-11e2-9eac-001a4bcf6878.html">http://www.news-record.com/news/local_news/article_da765340-d912-11e2-9eac-001a4bcf6878.html</a><br /><br /><blockquote class="tr_bq">... <a href="http://www.wakehealth.edu/">Wake Forest University Baptist Medical Center</a> [Winston-Salem, NC] said in November 2012, that it would cut 950 jobs — <b>6 percent of its total staff</b>.<br /><br />Electronic records programs continue to push costs higher. The Winston-Salem Journal reported that Wake Forest’s <b><a href="http://www.epic.com/">Epic</a> </b>[EHR]<b> program caused $8 million in work interruptions </b>during the 2012-2013 year alone. Wake Forest is cutting costs at least through June 30 <b>to make up for some of Epic’s expense.</b> Its efforts include furloughs, wage reductions and other cuts.</blockquote><br /><br />2.  <b>Cerner EHR Project Loses U.K. Hospital 18 Million Pounds</b><br /><br /><a href="http://www.informationweek.com/healthcare/electronic-medical-records/ehr-project-loses-uk-hospital-18-million/240157036">http://www.informationweek.com/healthcare/electronic-medical-records/ehr-project-loses-uk-hospital-18-million/240157036</a><br /><br /><blockquote class="tr_bq">... Royal Berkshire Foundation Trust's implementation of Cerner Millennium electronic health record system is costly to maintain and hard to use, causing patient backlogs ... British hospital's attempt to implement an electronic health record (EHR) system has been so disastrous that it has had to write off £18 million ($28 million).<br /><br /><span id="articleBody"></span><br />... "Unfortunately, implementing the [EHR] system <b>has at times been a difficult process</b> and <b>we acknowledge that <i>we did not fully appreciate the challenges and resources required in a number of areas</i></b>," said the hospital's chief executive, Ed Donald.  </blockquote><br />In 2013, I find the statement "<b><i>we did not fully appreciate the challenges and resources required in a number of areas</i><i>" </i></b>remarkable.<br /><br />Dear Mr. Donald, please allow me to introduce you to a novel concept:<br /><br /><b>A Google search.  (Free, no less.)</b><br /><br />Try this, for example:  <a href="https://www.google.com/search?q=healthcare%20IT%20failure">https://www.google.com/search?q=healthcare%20IT%20failure</a><br /><br />(I note that competent experts in my field, Medical Informatics, given appropriate executive presence - including hiring and firing authority, instead of the usual 'internal consultant' roles - could have prevented your organization's mistakes, and for a <i>mere fraction</i> of the £18 million.) <br /><blockquote class="tr_bq"><br />A campaign against public sector waste in Britain, The Taxpayer's Alliance, has seized on the hobbled project as an especially <a href="http://www.taxpayersalliance.com/waste/2013/06/nhs-trust-loses-18-million-system.html#more-51005">egregious example of bad procurement</a>. "[NHS] trusts must work a lot harder to get a good deal for the taxpayers footing the bill," it warned.  <span style="color: red;"><i><b>[I guess money doesn't grow on trees in the UK as it seems to in the US -ed.]</b></i></span><br /><br />The row comes in the same week British Parliament members expressed frustration that the funding scheme that supported other British hospitals' investment in EHRs, the controversial £9.8 billion ($15.2 billion) National Program for IT cancelled in 2011, <a href="http://www.informationweek.co.uk/healthcare/electronic-medical-records/zombie-it-contract-refuses-to-die/240156793">continues to cost the country millions</a>, with contracts in some cases not set to expire for 12 more years. <span style="color: red;"><i><b>[NPfIT in the NHS - see query link </b></i></span><i><a href="http://hcrenewal.blogspot.com/search/label/NPfIT">http://hcrenewal.blogspot.com/search/label/NPfIT</a></i><span style="color: red;"><i><b> - ed.]</b></i></span><br /><br />Berkshire, however, opted out of that program in 2008 and had instead linked with the <b>University of Pittsburgh Medical Center to help it implement Millennium</b>. </blockquote><br />I am merely the messenger here...<br /><br />-- SS

Monetary losses and layoffs from EHR expenses and EHR mismanagement

More on monetary losses and layoffs from EHR expenses and EHR mismanagement: 1.  Layoffs to balance the budget... http://www.news-record.com...

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No Blues, but Lots of Green for St Louis Hospital System CEOs

A recent<a href="http://www.stltoday.com/business/local/hospital-ceos-see-double-digit-pay-hikes/article_431263e2-81c9-5367-b0bd-f48885169adb.html"> article</a> in the St Louis Post Dispatch provided the latest examples of how hospital <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">executive compensation</a> continues to defy gravity.  In summary,<br /><br /><blockquote class="tr_bq">In recent years, executives at St. Louis-area nonprofit health organizations have seen<i> annual double-digit increases of as much as 40 percent in their total compensation packages,</i> which typically include salaries, bonuses, pensions and health benefits.<br /><br />Such pay hikes occurred as these nonprofit organizations enjoyed their largest operating margins in years,...</blockquote><br />The examples include...<br /><br /><b>BJC Healthcare</b><br /><br /><blockquote class="tr_bq">Steven Lipstein, president and chief executive of St. Louis-based BJC Healthcare, received a <i>total compensation package of about <b>$3.3 million</b></i> in 2011, the latest year currently available per BJC’s tax filings. That’s a 40 percent hike over his compensation of $2.3 million in 2010. A year earlier, he received a 4 percent increase.</blockquote><br />In particular,<br /><br /><blockquote class="tr_bq"> According to BJC’s 990 tax filing, Lipstein’s 2011 compensation of $3,279,956 included a base salary of $920,576; bonuses and incentive pay of $2,213,555; other compensation of $15,733; deferred compensation of $99,651; and $30,441 in 'nontaxable benefits.' </blockquote><br />Also,<br /><br /><blockquote class="tr_bq">Five BJC executives received total compensation packages in 2011 <i>exceeding <b>$1 million.</b></i></blockquote><br />For comparison, note that<br /><br /><blockquote class="tr_bq">The health system paid about $1.7 billion in salaries and benefits in 2011 to its 28,559 employees — <i>an overall increase of nearly 5 percent</i> over its labor costs in 2010, when it had about 250 fewer employees.</blockquote><br />So Mr Lipstein's compensation rose much faster than the system's total labor costs.  Also,<br /><br /><blockquote class="tr_bq"> BJC employees — which include a spectrum of jobs from administrators, physicians and nurses to medical technicians, office workers and supply clerks — earn annual salaries and benefits on average totaling about $58,343. Lipstein’s pay package of $3.3 million for 2011 was <i>56 times greater than the average BJC employee’s compensation.</i></blockquote><br />So the CEOs compensation was much larger than that of the average employee, and seems to have risen much faster.<br /><br /><b>SSM Health Care</b><br /><br /><blockquote class="tr_bq">William Thompson... [is] chief executive of Creve Coeur-based SSM Health Care, which operates 18 hospitals in four states. He received <i>total compensation of <b>$2.3 million</b></i><b> </b>in 2011 — a 26 percent increase over 2010.<br /><br />Some of that pay hike was attributable to a change in jobs. Thompson, SSM’s former chief operating officer, assumed the role of chief executive in August 2011. In 2010, his pay increased 95 percent from $918,229 to $1.8 million.</blockquote><br /><b>Ascension Health Alliance</b><br /><br /><blockquote class="tr_bq"> Anthony Tersigni, chief executive of Ascension Health Alliance, received<i> total compensation in fiscal year 2012 of<b> $4 million</b></i> — a 12 percent increase over the previous year. A year earlier, he received a 6.5 percent increase over the previous year in his former role as chief executive of Ascension Health. </blockquote><br />In addition,<br /><br /><blockquote class="tr_bq"> Nine executives at Ascension’s headquarters received total compensation in fiscal year 2012 <i>exceeding <b>$1 million</b>.</i></blockquote><br /><b>Mercy Health</b><br /><br /><blockquote class="tr_bq">Lynn Britton, chief executive of Mercy, received <i><b>$2.2 million </b>in total compensation</i> in fiscal year 2012 —<i> a 15 percent increase</i> over 2011. A year earlier, he received an 18 percent increase.  </blockquote><br />And,<br /><br /><blockquote class="tr_bq">Five current and former Mercy executives received<i> total compensation in fiscal year 2012 exceeding $1 million.</i><br /><br /></blockquote><blockquote>Myra Aubuchon, a former Mercy senior vice president who left the health system in 2010, received<i> a payout in fiscal year 2011 of <b>$3.4 million</b></i> for retirement benefits, severance and other compensation. In fiscal year 2012, she received an additional $405,339 in compensation.<br /><br />Mercy executives are provided additional perquisites, including<i> first class and charter travel on Mercy’s aircraft</i> and the opportunity at times for their <i>spouses to accompany them</i> to business and other events. Executives and staff fly to and from some business meetings in <i>Mercy’s midsize corporate jet, a Rockwell Sabreliner. </i></blockquote><i></i><br /><b>The Usual Talking Points</b><br /><br />So all CEOs of the St Louis area's bigger non-profit health care systems made more than $1 million, often several  times that.  Most of the systems had multiple other hired executives who made at least $1 million.  Often executives received other perks far beyond anything received by other employees, such as travel on corporate jet aircraft.   <br /><br />We have noted that nearly every attempt made to defend the outsize compensation given hospital and health system executives involves the same talking points.   We first listed the talking points <a href="http://hcrenewal.blogspot.com/2011/09/talking-points-sans-original-thought-to.html">here</a>, and then provided additional examples of their use <a href="http://hcrenewal.blogspot.com/2011/09/more-repeats-of-talking-points.html">here</a>, <a href="http://hcrenewal.blogspot.com/2012/03/example-of-how-complex-takes-control.html">here</a> <a href="http://hcrenewal.blogspot.com/2012/12/health-care-hired-managers-not-playing.html">here,</a> and <a href="http://hcrenewal.blogspot.com/2013/05/executive-compensation-as-legal.html">here</a>.   They are:<br />- We have to pay competitive rates<br />-  We have to pay enough to retain at least competent executives, given how hard it is to be an executive<br />-  Our executives are not merely competitive, but brilliant.<br /><br />The Post-Dispatch article provided more examples of these stereotypical justifications.<br /><br /><u>Competitive Rates</u><br /><br /> The SSM CEO actually seemed to make such an argument to justify his own pay,<br /><br /><br /><blockquote class="tr_bq">'I’ve been (at SSM) for 33 years, and for a lot of those years I wasn’t paid nearly the salary I’m paid now,' Thompson said. 'If you look at the revenue, I don’t think I’m over- or underpaid.'</blockquote><br />He provided no data to support is argument. <br /><br />And again,<br /><br /><br /><blockquote class="tr_bq">Salaries and benefits for nonprofit health executives 'need to be competitive if we are going to be able to attract the talent needed to run these very complex organizations,' he said.</blockquote><br />How that talent was defined was not apparent. <br /><br />The chief of  public relations of Ascension Health Alliance added,<br /><br /><blockquote class="tr_bq"> [Chief advocacy and communications officer Jon] Glaudemans said that Ascension is seeking “to remain competitive in a market that is increasingly complex and characterized by challenging regulatory circumstances, including implementation of the Affordable Care Act.”</blockquote><br />From the senior vice president for human resources for Mercy Health, Cynthia Mercer, we had this contribution,<br /><br /><blockquote class="tr_bq">'We’re competing for the same pool for talent,' Mercer said. 'It’s difficult to secure talent. ...'</blockquote><br />She did not provide a definition of talent either.  Note that she also said,<br /><br /><blockquote class="tr_bq"><span class="print_trim">We feel that it’s very important as a ministry to be just in our approach, respecting the dignity of each of our co-workers regardless of their position.  </span></blockquote><br /><span class="print_trim">She did not explain the justice provided by the top executives' use of private corporate aircraft and the free travel provided to their spouses.</span><br /><br /><u>Retention</u><br /><br />An example came from the chief PR flack from Ascension,<br /><br /><br /><blockquote class="tr_bq">'We are required to be competitive, but we also have a mission to care for those who are poor and vulnerable. Candidly, many of our executives could do better for themselves working in other environments.'</blockquote>He did not give evidence that his or any other local executives were in great demand in such other environments.  He certainly did not try to reconcile how an organization with a mission to care for "the poor and vulnerable" was making a multimillionaire out of its CEO.<br /><br /><u>Brilliance</u><br /><br />The chief public relations flack at Ascension Health Alliance provided this example,<br /><br /><blockquote class="tr_bq">'When we look for leadership of our ministry, we need to draw from the best and brightest to serve those who are poor and vulnerable,' said Jon Glaudemans,...</blockquote><br />Whether his use of the term "best and brightest" was meant to be an ironic allusion to the leaders who lead the US into the controversial and bloody Viet-Nam War was not clear. <br /><br />In response to the first Post Dispatch article, a physician, self-described as " a 40-year veteran of Washington University Medical School and BJC hospitals," wrote a<a href="http://www.stltoday.com/news/opinion/mailbag/letters-to-the-editor/bjc-s-chief-executive-lipstein-is-worth-his-compensation/article_3c5d00e5-8867-50d6-8a28-825765db8929.html"> letter</a> in Mr Lipstein's defense.  To prove the CEO's brilliance, Dr Robert G Levitt gave him personal credit for a number of accomplishments, such as addressing readmissions for congestive heart failure patients, and avoiding outbreaks of multidrug resistant bacteria in intensive care units, that seem to be more likely to have resulted from diligent work by health professionals.  He praised Lipstein for actually "respond[ing] to emails from physicians and staff," which hardly seems brilliant.  Finally, he noted "BJC has not laid off workers as other St. Louis hospital systems have done to save costs."<br /><br />It only took three days for that point to be proven wrong, as the St Louis Post-Dispatch then<a href="http://www.stltoday.com/business/local/bjc-healthcare-lays-off-employees/article_7faa2efb-5380-5cdb-91ae-0bf3280c13cd.html"> reported</a>, "BJC Healthcare began on Wednesday laying off 160 employees, the first layoffs in the company’s 20-year history."  <a href="http://www.bizjournals.com/stlouis/blog/health-care/2013/06/bjc-cuts-administrative-staff-some.html">Per the St Louis Business Journal</a>, these layoffs may include at least some "direct patient care staff," that is, e.g., nurses, and were due to declining revenue.  <br /><br /><b>Summary</b><br /><br />The St Louis Post Dispatch main article on CEO pay opened thus,<br /><br /><blockquote class="tr_bq">Trimming medical costs is the latest mantra among hospital executives, government bureaucrats, insurers and benefit managers as they grapple for ways to contain U.S. health care spending.But executive compensation in the health care industry shows few signs of hitting a ceiling. </blockquote><br />It included comments by Professor Harold Miller of the Center for Healthcare Quality Payment and Reform and Carnegie-Mellon University,<br /><br /><blockquote class="tr_bq">'But if a health care executive’s pay is based on the amount of revenue they generate, the problem is in the incentive,” he said. “Basically, hospitals get rewarded by putting more heads in beds. It works against the goal of affordable health care. We need to start paying these executives to keep people healthy.'</blockquote><br />And he noted the danger is,<br /><br /><blockquote class="tr_bq">when executives start chasing their own compensation rather than the good of the company. We’ve seen that in banking, and that can happen in health care</blockquote><br />I would argue that this is already what is going on. Non-profit organizations whose missions include taking care of poor people pay their top executives millions of dollars. We have yet to see any logical, evidence-based justifications for such generous and ever rising compensation.  This compensation is increasingly out of proportion to what other employees are paid   Their compensation may rise even when their organizations' finances are challenged (see the example of the BJC layoffs above).  Nearly all rationalizations of their compensation are made by people whose jobs depend on the executives they are defending (as above), or by other hired executives who may be eager to defend their brethren.  <br /><br />As long as hired executives chase compensation rather than uphold the health care mission, expect their personal fortunes to increase, and the mission to wither.<br /><br />We await  true health care reform which would ensure health care organizational leadership that puts upholding the health care mission ahead of lining their pockets.  . 

No Blues, but Lots of Green for St Louis Hospital System CEOs

A recent article in the St Louis Post Dispatch provided the latest examples of how hospital executive compensation continues to defy grav...

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Affinity RNs Call for Halt to Flawed Electronic Medical Records System Scheduled to Go Live Friday

At my May 30, 2013 post "<b>Marin General Hospital's Nurses are Afraid a Defective EMR Implementation Will Harm or Kill Patients ... CEO Cites Defective HHS Paper and Red Herrings As Excuse Why He Knowingly Allows This To Continue</b>" at <a href="http://hcrenewal.blogspot.com/2013/05/marin-general-hospitals-nurses-are.html">http://hcrenewal.blogspot.com/2013/05/marin-general-hospitals-nurses-are.html</a>, I lamented that hospital management felt they could ignore clinicians calling for implementation postponement of what they viewed as bad health IT, dangerous to patients, with impunity.<br /><br /><b>Finally, </b>medical professionals stand up to imperial hospital management that, in a perhaps criminally negligent fashion (e.g., see my post on the <b>ECRI Deep Dive Study on Health IT harm</b> at <a href="http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html">this link</a>), ignores its clinicians over too-rapid deployment of health IT.<br /><br />Also see newspaper article at <a href="http://www.cantonrep.com/news/x393137745/Affinity-nurses-seek-delay-on-electronic-records#axzz2WcOMZpvF">http://www.cantonrep.com/news/x393137745/Affinity-nurses-seek-delay-on-electronic-records#axzz2WcOMZpvF</a>.<br /><br />(The hospital management is extolling the safety of the new Cerner system.  What could <i><b>possibly</b></i> go wrong?  -- I'd bet the executives, despite their fiduciary duties towards maintaining a safe hospital environment, have no idea about Cerner defects such as at the FDA MAUDE database; see "<b>MAUDE and HIT Risks: What in God's Name is Going on Here?</b>" at <a href="http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html">http://hcrenewal.blogspot.com/2011/01/maude-and-hit-risk-mother-mary-what-in.html</a> or are familiar with "<b>Medical center has more than 6000 'issues' with Cerner CPOE system in four months" </b>at <a href="http://hcrenewal.blogspot.com/2010/10/medical-center-has-more-than-6000.html">http://hcrenewal.blogspot.com/2010/10/medical-center-has-more-than-6000.html</a>.  Instead, unpaid bloggers do their work for them to protect patients....)<br /><br /><b>See this: </b><br /><br /><div style="text-align: center;">-----------------------------</div><blockquote class="tr_bq"><div class="MsoNormal"><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt;">For Immediate Release - June 18, 2013</span></b></div><div class="MsoNormal"><i><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">For more information: Michelle Mahon, RN, 234-207-6706 or Liz Jacobs, RN, 510-273-2232</span></i></div><div class="MsoNormal"><br /></div><div align="center" class="MsoNormal" style="text-align: center;"><span style="font-size: large;"><b><span style="font-family: "Times New Roman","serif";">Affinity RNs Call for Halt to Flawed Electronic Medical Records System Scheduled to Go Live Friday</span></b></span></div><div class="MsoNoSpacing"><br /></div><div class="MsoNoSpacing"><br /></div><div class="MsoNoSpacing"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Affinity Medical Center RNs in Massillon, Ohio are calling on hospital officials to delay the planned June 21 implementation of the Cerner electronic medical records (EMR) system, until the hospital bargains with the nurses and proceeds in a safe manner. </span></div><div class="MsoNoSpacing"><br /></div><div class="MsoNoSpacing"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">The direct-care RNs, represented by the National Nurses Organizing Committee (NNOC) in Ohio, an affiliate of National Nurses United (NNU), say that nurses, the primary users of the complex system, have had insufficient training, which will put patients at risk. The implementation, which has been done without bargaining with NNOC, reflects yet another violation of federal labor law by Affinity, nurses say.</span></div><div class="MsoNoSpacing" style="margin-bottom: 12.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><br />Nurses have documented their concerns in a detailed letter to hospital officials. Those concerns <b>include woefully inadequate training, short staffing in the first days of the roll out, and the subsequent risk of harm to their patients</b>.  The system, they say, has the potential of violating the Ohio Nursing Practice Act because it doesn’t permit RNs to communicate individualized, potentially life-saving information about their patients. </span></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">The letter, which RNs attempted to deliver to hospital officials on Friday, cites nationally recognized experts in health information technology who reinforce the RNs’ concerns. Most notably, the Institute of Medicine (IOM) has concluded that the failure to include RNs in all steps of this transition is one of the most significant barriers to successful, safe implementation of electronic health records systems. </span></div><div class="MsoNormal"><b><br /></b></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><b>Hospital officials have continued to refuse to meet with nurses, and would not accept the letter.  <span style="color: red;"><i>[Willful ignorance? - ed.]</i></span></b> Without bargaining with the union or acknowledging the nurses’ concerns, the hospital added a few more trainings late Friday, but the RNs say that remains far from adequate.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Over the last few years, American healthcare corporations have invested heavily in information technology (IT) systems, which make up a multi-billion dollar market. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">“RNs who actually use these systems day in and day out have found that the kind of care they can provide with this new technology is limited,” said NNOC Co-president Cokie Giles, RN. <b>“The programs are often counterintuitive, cumbersome to use, and sometimes simply malfunction. Nurses are finding that the technology is taking time away from patients and fundamentally changing the nature of nursing.” </b></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">NNOC/NNU has successfully negotiated clauses in its contracts that allow RNs to play a greater role in reviewing and approving new technologies before they are introduced, and that the new technologies will not supersede RN professional judgment.  </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">“I have been chosen as a ‘super-user,’ said Amy Pulley, an RN who works in the endoscopy unit of the hospital. “I’m not sure what makes me ‘super’ with the limited training for this complex system that I’ve received. I’m concerned that the manner in which this technology is being implemented may pose serious disruptions in patient care.”</span></div><div class="MsoNormal"><br /></div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt;">Highlights of RN Concerns on the Implementation of the Cerner Electronic Medical Records System at Affinity Medical Center</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br /></div><div class="MsoNormal"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Inadequate Staffing</span></b></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Several units will be severely short staffed for the transition, despite the fact that the hospital has been planning on the “go live” date for several months. </span></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">The entire hospital and all portions of the system will go live at once, referred to as the “big bang” approach, which has a very low rate of success, rather than implementing it in trial, pilot stages.</span></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">They are utilizing the ‘super-user’ model which will pull nurses from direct-care so they can be available to teach, leaving several units without enough nurses to care for patients.</span></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">The hospital refuses to decrease the number of elective procedures or provide additional staff during the transition time.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Lack of training </span></b></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Some nurses have received only one day of training.</span></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Super-users have received no education or training in the system beyond what is provided to the other users. </span></div><div class="MsoListParagraph" style="margin-left: .25in;"><br /></div><div class="MsoNormal"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Design flaws</span></b></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Placement of the workstations are ill conceived—RNs must turn their back to patients while documenting. </span></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">During one education session, the system crashed because 17 users at one time overloaded it.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Failure to consult nurses</span></b></div><div class="MsoListParagraph" style="margin-left: .25in; text-indent: -.25in;"><span style="font-family: Symbol; font-size: 12.0pt;">·<span style="font: 7.0pt "Times New Roman";">        </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Several concerns were brought to management’s attention which they were unable to answer. One example— how will RNs override the system in the event of an emergency? </span></div><div class="MsoListParagraph" style="margin-left: .25in;"><br /></div><div class="MsoNoSpacing"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Affinity is one of five hospitals in California, Ohio, and West Virginia that are part of one of the nation’s largest for-profit hospital chains, Tennessee-based Community Health Systems where affiliates of NNU are pursuing federal action for significant violations of RN rights. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">The National Labor Relations Board held a five-day hearing in May in a complaint filed by the nurses and NNOC over Affinity’s refusal to bargain a first contract and retaliation against RNs for advocating for their patients and their colleagues. A decision by an NLRB administrative law judge is pending. CHS affiliated hospitals in West Virginia and California are facing similar sanction from federal officials. At one of the California hospitals last week, a U.S. District Court judge issued an injunction ordering the hospital to return to negotiations with the RNs.</span></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">CHS is the second largest for-profit hospital chain in the United States, and one of the wealthiest. Over the past five years, CHS reported over $1.5 billion in profits to the Securies Exchange Commission. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="color: #1f497d; font-family: "Arial","sans-serif";">Michelle Mahon, RN </span></div><div class="MsoNormal"><span style="color: #1f497d; font-family: "Arial","sans-serif";">National Representative</span></div><div class="MsoNormal"><span style="color: #1f497d; font-family: "Arial","sans-serif";">National Nurses United</span></div><div class="MsoNormal"><span style="color: #1f497d; font-family: "Arial","sans-serif";">mmahon@nationalnursesunited.org</span></div><div class="MsoNormal"><span style="color: #1f497d; font-family: "Arial","sans-serif";">234-207-6706</span></div></blockquote><br />I believe the nurses should strike if their concerns are not heeded.<br /><br />I once worked in a highly-unionized city Transit Authority; I believe the unions would have shut the Authority down in the face of even a fraction of concerns like this that could impact pubic safety - and their own memberships' careers and lives.<br /><br />-- SS<br /><br /><b>6/20/13 addendum:</b><br /><br />I note that this EHR medical device (per FDA) is non-FDA approved, nor vetted by any regulatory agency.  Apparently the hospital believes it has the prerequisite skills and expertise to vet this device for safety.  Who, exactly, will take responsibility for bad outcomes?<br /><br /><div style="font-family: inherit;"><span style="font-size: 100%;">FDA's Chair of the Center for Device and Radiological Health, Jeffrey Shuren, MD JD, stated </span><span style="font-size: 100%;"><span style="font-size: 100%;">explicitly </span>that EHRs were medical devices on Feb. 25, 2010 (see testimony to the HHS Health Information Technology HIT Policy Committee at <a href="http://web.archive.org/web/20120320111030/http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_910717_0_0_18/3Shuren_Testimony022510.pdf" target="_blank">this PDF</a>) that:</span></div><div style="font-family: inherit;"><span style="font-size: 100%;"><br /></span> </div><div dir="ltr" style="font-family: inherit;"><span style="font-size: 100%;"> </span></div><blockquote dir="ltr" style="font-family: inherit; margin-right: 0px;"><div dir="ltr"><span style="font-size: 100%;">... Under the <a href="http://www.fda.gov/regulatoryinformation/legislation/federalfooddrugandcosmeticactfdcact/default.htm">Federal, Food, Drug, and Cosmetic Act</a>, <b><span style="color: red; font-style: italic;">[that regulates all drug, medical devices, etc. in the United States - ed.]</span> HIT software is a medical device</b>. Currently, the FDA mandates that manufacturers of other types of software devices comply with the laws and regulations that apply to more traditional medical device firms. These products include devices that contain one or more software components, parts, or accessories (such as electrocardiographic (ECG) systems used to monitor patient activity), as well as devices that are composed solely of software (such as laboratory information management systems)... </span><span style="font-size: 100%;"><b>To date, FDA has largely refrained from enforcing our regulatory requirements with respect to HIT devices.</b></span></div></blockquote><br /><br />I also note that patient informed consent to its use in their care is likely not being sought.  Should it?  If not, why not?<br /><br />-- SS<br /><br /><b>9/2/2013 addendum</b><br /><br />The comment by "Anonymous August 20, 2013 at 11:24:00" has many characteristics of a sockpuppet (see <a href="http://hcrenewal.blogspot.com/2010/01/more-on-perversity-in-hit-world.html">http://hcrenewal.blogspot.com/2010/01/more-on-perversity-in-hit-world.html</a>) - ignoring everything written in the post and expressing perverse and deranged views.  See it, and my response, in the comment section.  A post about an anti-health IT union dispute such as this is a strong potential sockpuppet magnet.<br /><br />-- SS

Affinity RNs Call for Halt to Flawed Electronic Medical Records System Scheduled to Go Live Friday

At my May 30, 2013 post " Marin General Hospital's Nurses are Afraid a Defective EMR Implementation Will Harm or Kill Patients ....

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