“Somebody is Going to Die”

Nurses take the Fall for Management Failure to Protect Patients

Dan Walter
Oct 3, 2016 · 6 min read

Reading about Chris Christie’s Bridgegate scandal, I learned that the Port Authority of New York and New Jersey — which controls some of the busiest airports, tunnels and bridges in the world — has 6,800 employees, manages tens of billions of dollars in assets, and has a $7.8 billion annual budget. If you live in the area, you know that you can get around pretty well, and most people take the generally smooth management of the enormously complicated transportation infrastructure in the greater New York area for granted.

The executive director of the Port Authority gets paid $290,000 a year.

Upstate, far from the behemoth PANYNJ, there’s a non-profit healthcare corporation in the Finger Lakes region called Cayuga Health Systems. The larger of its two hospitals is Cayuga Medical Center in Ithaca, which has about 1400 employees and a budget of about $175 million.

Included in this year’s budget are thousands of dollars in advertising to convince Ithaca townsfolk that their community hospital is safe — because, lately, that’s something people there are not taking for granted. Mismanaged labor relations have led to understaffing, which has caused reports of patient injuries, close calls, and at least two deaths. The hospital is dysfunctional, in the sense that the workforce is not — as management would have you believe — one big happy family.

The CEO of Cayuga, John Rudd, makes about $500,000 a year, including healthy bonuses, which is just about the same amount of money that the hospital takes in by soliticiting donations from the community. Patrons of the medical arts in Ithaca might do well to ask just what it is they are getting for their contributions.

A family member was admitted for chest pain months ago. They determined that she must have had a cardiac event and lost oxygen and was in a coma. The next day they deemed her brain-dead and told the family to prepare to remove her from life support.

Turns out she had a reaction to an overdose of medication they provided that her chart indicated she should not have. She is now at home and fine. There was no cardiac issue. The folks at CMC tried to have the family pull her from life support because they made a med error.

The whole place is corrupt at the Director level and up. All employees there need union representation to get real changes.

You should go back and read that again. After a medication error, they gave the woman up for dead — and it makes you wonder what role the transplant folks played.

With reports like the one above circulating, a visit to local hospital began to seem like a risky proposition. In response, executives began touting an “A” rating from a hospital evaulation organization. What they aren’t telling people is that they got the rating by declining to report whether there were enough nurses on staff. And the likely reason they’d rather not talk about that is because many experienced nurses have left CMC in recent months due to labor turmoil, which has been festering since Rudd, a finance guy, took over from the previous CEO, a doctor, in 2013.

Another notable aspect of the report which managment is not eager to share is the lack of doctors at CMC who specialize in working the Intensive Care Unit, a category in which Cayuga registered the worst score of any hospital — 5 out of a possible 100.

As the scorecard notes, “there are higher death rates in hospitals where ICU patients are not cared for by intensivists,” and CMC’s low score is borne out by statistics from the New York State Department of Health. The hospital ranked 196 out of 215 when it comes to your chances of getting out of that hospital alive.

Some don’t.

Some come very close and don’t even know it.

One nurse suspected a doctor was administering exactly the wrong intravenous fluid to a patient. She confirmed her suspicions by calling the National Poison Control Center. She relayed the information to the doctor, who responded by increasing the dose.

This same doctor was then sent to plug a gap in the ER trenches. They asked him to sink a femoral line into a critically ill patient. It took quite a few deep plunges with that big-bore needle, but he finally got it. Except that he had placed the line in the femoral artery — a colossal mistake that was obvious to nurses. They asked if maybe he wanted to get an X-ray to confirm the line placement. The Doc indignantly rejected the suggestion and shipped the patient to the ICU. The nurse who got him in the ICU saw that the line was “pulsatile,” jumping with every heartbeat. There was blood in the line.

If this patient walked out of that hospital he or she was very lucky indeed.

I was hospitalized in June at CMC and it was a nightmare. It was so bad in terms of cleanliness and care that I tried to leave. I was told if I did my insurance wouldn’t cover me and I would owe the hospital a fortune. They made so many errors in my care I was scared to be there, I had blood all over my covers my arm from a bad port in my arm. I ask many times for them to put in a new one due to a serious error made in my spinal tap, they put the blood pressure cuff above the port, blood was every where. Finally they came to remove the port in my arm, covered in blood they took it out, and didn’t clean the wound or my arm just put a bandage over it. I was extremely concerned over infection due to being on biological drugs for RA that lowers the body to fight infection. The next morning I had my doctor release me. I was so glad to get out of there!

Among the many tragedies flowing from this failure of management is the heavy price that the nurses are paying. At progressive, enlightened — and much safer — hospitals across the country, executives engage their workers in the patient safety process, they listen to them and they recognize and reward them when they report unsafe conditions. At Cayuga, two experienced, long-time nurses are being made to walk the plank — mainly because they have been active union supporters.

Executives at CMC are terrified of a union, but they brought the hoary specter on themselves. Union organizers are opportunists by definition, and the barbarians of Local 1199 wouldn’t be pounding at the gates if management knew how to run a hospital. But they are out there now, and the CEO is responding in precisely the wrong manner, like a West Virginia coal baron.

This is a problem everywhere. Nobody wants to pay for nursing. Staff is non clinical, top heavy. Management gets bonuses for keeping nurse-to-patient ratios high. Outcomes do not matter, only money matters to these people. Greed is the only thing that counts.

In describing the conditions at Cayuga, one former worker told me that if executives don’t allow workers a voice in patient safety soon, “somebody is going to die.” As it is, senior leadership at Cayuga has swept incidents described above — and others — under the rug. Instead of rewarding transparency, they are punishing it.

This is outdated and obsolete hospital management theory.

When corporate leaders get hauled before Congress, they always talk about their duty to the shareholders. I wonder what the CEO of a medical center would say, there in the hot seat of a House committee, about where lie the duties of those entrusted to run a community hospital.

Who are the shareholders? And what value are they getting for the exorbitant salaries being paid to the top executives at Cayuga?

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