Posts from the ‘Diana Mason’ Category
I met Charles Graeber, an award-winning journalist, about 5 or 6 years ago through a colleague at the American Journal of Nursing who was his friend. She told me he was working on a very interesting story and would benefit from talking with me. Over lunch, Graeber told me that he was investigating the circumstances surrounding the 16 years of scores of killings by Charles Cullen as a registered nurse. I recalled news reports surrounding Cullen’s arrest at the end of 2003, when press referred to him as the “Angel of Death” because he had injected patients with deadly doses of cardiac drugs, insulin and other powerful medications that are usually used to save lives, not end them. Sometimes his killing was random. Other times, it was carefully planned. The story was disturbing and I worried about how this might affect how the public viewed nurses. One rogue nurse could undermine the public’s confidence in all.
Graeber has published his investigation in a new book, The Good Nurse: A True Story of Medicine, Madness, and Murder,published by Twelve, an imprint of the Hatchette Book Group. I finished the book right before last night’s 60 Minutes aired a half-hour report on Graeber’s investigation and included an interview with Cullen. While the 60 Minutes story illustrates some of the key points in Graeber’s book, it falls short of capturing just how complicit the multiple hospitals were in not reporting their suspicions of Cullen to the state board of nursing or the police. In fact, Graeber’s careful recounting of phone and in-person recordings and depositions shows two hospitals actually resisting detectives’ attempts to gain information and obtain Pyxis records, patient charts, or personnel files.
What had been disturbing to me became appalling. Why would hospitals simply boot Cullen out the door with the promise of a neutral reference, even when it was clear to them that he was involved in patient deaths? Why would they not report it to the state board of nursing, even if they thought the deaths were from errors that Cullen had made? And why would they shut down one of their own nurses, Pat Medellin, who was working at St. Luke’s Hospital in Fountain Hill (Bethlehem), PA, at the time and who had made the connection between Cullen and deaths on her unit? The hospital administration told Medellin that their investigation of Cullen was closed. Medellin had the courage to alert the police anyway. And it took another courageous nurse, Amy Loughren (now Ridgeway), to help detectives get a confession out of her former colleague, Cullen.
Edie Brous, RN, JD, a nurse attorney and former president of The American Association of Nurse Attorneys, told me that the hospitals likely feared the media coverage if Cullen’s murders became public. They would worry about their liability exposure, their reputation in a competitive market, and the impact on donations to their institutions.
At the end of The Good Nurse, Graeber notes that the New Jersey legislature passed two laws in 2004 in response to the Cullen killings. One is the Patient Safety Act and then the Health Care Professional Responsibility and Reporting Enhancement Act. Together, these laws require hospitals to report “serious preventable adverse events” to the Deparment of Health and Human Services, report nurses’ performance problems to the state board of nursing, and maintain records related to patient complaints about staff for seven years. The laws give hospitals a measure of protection from civil liability. But Graeber also notes that there are not teeth to the laws–they do not include penalties for hospitals that don’t comply.
After reading the book, I’m left wondering why the attorneys general for PA and NJ would not investigate hospital administrators whose actions could constitute aiding and abetting a criminal and covering up knowledge of a crime. Because the hospitals didn’t report Cullen when he was still in their employ, he went on to kill more patients. Graeber estimates that as many as 300 patients died at Cullen’s hand, making him possibly the most prolific serial killer in the nation’s history. But the hospitals that let him go quietly from their institutions without even alerting the police and state board of nursing bear some responsibility for subsequent deaths by Cullen. They put their own reputations and interests before the wellbeing and protection of patients.
Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing
Today is National Healthcare Decision Day–a time to make sure that you and your loved ones have documentation confirming who will be your health care proxy or agent in the event that you are unable to make your own health care decisions. Today, these fabulous Hunter College School of Nursing students are at the Brookdale Campus, talking with people about “advance directives” and helping them to complete a health care proxy form, living will, and other forms to ensure that people’s preferences regarding treatment are respected. Other students will be joining them throughout the day. Tomorrow, the students will do the same thing at the Main Campus on Lexington and 68th Street in NYC.
If you can’t get there, go to the web site for the National Healthcare Decision Day campaign at http://www.nhdd.org/ad/ for information and resources about these issues. And remember to tune in to Healthstyles this Thursday night from 11:00 to 11:30 on WBAI, 99.5 FM, NYC (www.wbai.org) to hear my Hunter colleague Dr. Vidette Todaro-Franceschi, PhD, RN, and lawyer Tina Janssen-Spinosa of the New York Legal Assistance Group talk about these issues.
As yesterday’s events in Boston demonstrated, you never know when you might need a health care proxy, so why wait?
These fabulous Hunter nursing students didn’t wait. They have theirs completed and have planned the two-days of information sharing at the College to help others do the same.
Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing
Have you talked with your loved ones about what is important to you regarding end-of-life care, such as whether you would want to be resuscitated if you were terminally ill and your heart stopped beating? Or whether you would want artificial hydration and nutrition if you were terminally ill and couldn’t make health care decisions for yourself?
April is Health Care Decision Month—a time to all of us to reflect on some of the decisions that we or our loved ones might confront around how we die. In keeping with this theme, Healthstyles is focusing its programs this month on how to have the conversations about how we want to die and how to take the legal steps in ensuring that others respect our wishes.
The first program aired last week on WBAI, 99.5 FM (www.wbai.org) and focused on why it’s important to complete an “advance directive” that designates who will make health care decisions for you it you become unable to do so.
The second program airs tonight and focuses on how to actually have the conversation about your health care wishes with someone who will serve as your health care proxy. These are not easy discussions for people who may not be comfortable talking about their own death or the death of a love one. But they are absolutely essential if we want to ensure that someone is acting in our best interests if we become incapacitated.
The third program will air next week and walk you through how to complete an advance directive and health care proxy form, as well as tell you how to make it available to health care providers. But you first have to have the conversation with a loved one.
If you didn’t listen to last week’s program, you can do so by clicking here: D&D_0001
Tonight’s program airs at 11:00 PM, but you can listen to it by clicking here: D&D_0002
The last program will air on April 25th and will discuss other legal documents related to end-of-life care, such as the POLST—Provider Orders for Life Sustaining Treatment—and the Do Not Resuscitate documents.
For the entire series, Healthstyles producers Barbara Glickstein, RN, MPH, and Diana Mason, RN, PhD, talk with Tina Janssen-Spinosa, JD, Staff Attorney for the New York Legal Assistance Group where she is Program Coordinator for Total Life Choices, an initiative to disseminate information about end of life planning and help people in their planning needs; and Vidette Todaro-Franceschi, RN, PhD, Professor of Nursing at Hunter College, City University of New York, and expert in end of life issues.
Remember that planning for the end of our lives is about planning for how we want to live.
Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College.
April 16th is Health Care Decision Day. It’s an opportunity to jump start those conversations about end of life preferences–or advance directives–that you’ve postponed. At Hunter College, the Hunter Student Nurses Association, the Hunter-Bellevue School of Nursing, and the Center for Health, Media & Policy at Hunter College are sponsoring an information table at the Brookdale Campus on 25th Street and 1st Avenue on April 16th from 1:00 to 8:00, and on the Main Campus at 68th and Lexington on April 17th from noon to 6:00. The undergraduate nursing students, in addition to helping to plan the two days, will staff the tables and help people to make sense of the various forms that will be available. (The photo above was taken at a similar event that the students did earlier in the academic season at the Main Campus.)
Of course, people will be encouraged to first talk with their loved ones about their preferences for end-of-life care and what’s important to them. The forms can be completed when having these conversations and then mailed into the New York Legal Assistance Group for registering them on a secure online storage service to enable health care providers anywhere to respect and honor your health care wishes. This service is available thanks to Tina Janssen-Spinosa, JD, of the NYLAG. Or people can simply make copies and give them to their health care providers, though the online repository ensures that new providers also know your wishes.
I wrote a commentary in the American Journal of Nursing about the need for health care professionals–nurses, in particular–to lead the public conversations about the importance of these “advance directives” and received an email from Jerry Soucy, RN, BSN, CSS, CHPN, Staff Educator at the VNA Care Network and Hospice in Southborough, MA. He shared a blog post from the local chapter of the Hospice and Palliative Nurses Association about MOLST–Medical Orders for Life-Sustaining Treatment–another opportunity to have patients wishes be visible to health care providers no matter where they are moved in a hospital. The post emphasizes that Susan Block’s four questions to guide end-of-life conversations are probably more important than any form: Read more
Today, Diane Rehm’s radio program included an hour-long discussion on the role of nurse practitioners with Reid Blackwelder, MD, family physician and president-elect of the American Academy of Family Physicians; Mary Agnes Carey, senior correspondent for Kaiser Health News; Ken Miller, PhD, RN, CFNP, nurse practitioner and associate dean of The Catholic University of America School of Nursing; and Sandra Nettina, MS, ANP, nurse practitioner at Columbia Medical Practice in Columbia, Md., and past president of Nurse Practitioner Association of Maryland.
There was one thing missing from this otherwise great discussion of the issues related to nurse practitioners being able to practice with full authority (without legally mandated physician collaboration or supervision). Nurse practitioners bring additional knowledge and skills to their practice that are just what primary care needs. They understand patient-centered care, listening carefully and responding to what patients and families say they need and want. They are experts in health education and counseling, as well as care coordination. These skills matter when we’re trying to transform our health care system into one that emphasizes health promotion, wellness, and chronic care management.
Most discussion of nurse practitioners’ roles center around their ability to diagnose and treat disease. They are prepared to do so with common acute and chronic conditions, and they know when to refer patient with symptoms of uncommon diseases to physicians–and without a legal mandate to do so, as has been shown in about a third of the states in the U.S. But we need a primary care system that can focus more on preventing diseases, promoting health, and helping patients to be knowledgale about and capable of promoting their health.
Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing