This is an anonymous comment left by one of our readers on a story about the Juan F. Luis Hospital, a firsthand account of working at the hospital and the conditions which led JFL to the brink of decertification by the Centers for Medicare and Medicaid.
Keep in mind that, because it is anonymous we cannot verify its content. And we don’t agree with everything the writer says. But it is so visceral, so raw, so impassioned, that we felt it needed to be shared with a wider audience. The only changes we have made are grammatical, spelling, style and length.
I am a registered nurse with over 17 years experience in non-profit facilities, corporate owned facilities and state facilities. I have had the privilege of working in a variety of settings: all critical care areas, medical, surgical, operating, recovery, high-risk labor and delivery, ante and postpartum, and disaster relief areas such as Florida and New Orleans.
I’ve seen excellent, mediocre and poor healthcare. Gov. Juan F. Luis hospital is the worst I’ve seen, but not because of lack of supplies or equipment, not because of a rundown facility, but because of the attitude and lack of accountability our healthcare community has had, because of the lack of camaraderie with healthcare workers, and the lack of community involvement.
For these reasons I do not believe it is only the hospital at fault that we are now in this healthcare crisis. I strongly believe the following should all be held accountable: the hospital staff, our physicians, CMS, Joint Commission and our community.
I left the hospital after three and a half years because my conscience would not allow me to continue to turn a blind eye to the inhumane treatment our patients received. These are the things I saw with my own eyes:
– Hep-locks embedded in a person’s arm,
– IV tubing and IV sites not labeled with date, time or initials,
– Dressings that hadn’t been changed for days,
– Bed sores that could have been prevented,
– Urine and feces saturated diapers on a person all day,
– Ignored call bells for assistance,
– Wrong medications given, or no medications given,
– Beating patients,
– Refusal to feed patients that could not feed themselves and force feeding patients when they took too long to chew and swallow the food they were being fed,
– Doctors orders not being carried out,
– No policy and procedures and outdated policy and procedures,
– Doctors not responding to calls, doctors not coming in when called in,
– Poor working diagnostic machines (X-ray, CT Scan and MRI) yet patients being billed for the services,
– Blankets and pillows along with other supplies being taken home by staff members for their own use,
– Wrong diagnosis from doctors,
– Radiology staff sending letters to patients saying they have cancer when in fact they did not,
– Hospital walls and ceilings dripping with condensation falling into a patient’s open abdomen while on the operating room table, and more.
While in nursing school I was taught that going to a hospital is like going to visit someone at their home, that we should treat each patient as if they were a guest in our own home.
Shame on all of you involved in his treatment!
To the clinical hospital staff I ask: How can you continue to turn a blind eye? How can you document that an IV is clear of signs and symptoms of infection when you haven’t even looked at it? How can you document that you’ve carried out an order and really haven’t ?
How can you not work together as a team when you know full well that caring for a patient is teamwork? Why is it that those nurses that are now in administration cannot put on a pair of scrubs and help care for patients when there is a staff shortage? I was told by the chief nursing officer that, by the union rules, they are not allowed to treat patients once they’re in administration. Really? Then why did you become a nurse?
To the physicians I ask: Is it really about the money? Because that’s what it looks like. Caring for a patient in a hospital is a "Privilege" for services that you can charge for. Getting a salary from the hospital as well as charging for your services is double dipping.
Is it really because a doctor isn’t born here on St Croix that you cannot accept them as colleagues and work together as comrades? That question is for nurses as well.
To the administrators I ask: Why is having a title – CEO, chief nursing officer, nurse manager, assistant nurse manager, clinical coordinator, etc. – more important than "Quality Patient Care"? How is it that at the end of 2013 we still do not have a Scope of Practice for nurses, nurse practitioners, physician assistants, etc? How is it that we don’t have updated policy and procedures for things like blood transfusions? How is it that we still have inexperienced nurses working triage? How is it that we still have nursing assistants working as emergency room technicians without the proper training? How is that we do not have cardiac monitors in every ER exam room? Where are we supposed to get our patients for the new Cardiac Care Center if our front door (the Emergency Room) is not prepared? Do we really need so many administrators when we have such a "global" shortage of nurses? What about overseeing the housekeeping staff? Surely this small facility could be a little cleaner. What is it that you are "administering?"
To the community I ask: How is it that the community hasn’t come together to address these issues as well? Why is the community going off island for healthcare treatment? Including the same doctors that were born and live here and their family members? Why is the community not actively protesting to have better healthcare? Why aren’t people asking questions and demanding answers?
Why is the community not outraged? It is your body, the body of your friends and family, that are being neglected, mistreated and misdiagnosed. Do you not care about yourself and loved
ones?
And lastly, you need to know that most of us got into healthcare because we really do care. We’re not here to give you a hard time; we’re here to take care of you and your loved ones. So when we ask something of you please remember that. It doesn’t help when you treat us badly, like cussing at us or threatening us with harm. You cannot put a price on saving someone’s life. We don’t get paid that much!
To Joint Commission and CMS (Center for Medicare & Medicaid Services) I ask: If a hospital is to report to both agencies as governing bodies then surely you should be held accountable as well. Clearly the hospital did not get to this point overnight? Both agencies also turned a blind eye. If you hadn’t our hospital would not be in the situation it is in today.
CMS is the agency that governs Medicare and Medicaid services. It sets the rules and regulations for hospitals, longterm facilities and laboratories. Under the rules of the Joint Commission – the nation’s oldest and largest standards-setting and accrediting healthcare body – an organization must undergo an on-site survey by a Joint Commission survey team at least every three years. Laboratories must be surveyed every two years. Where were these guys? Not here.
And lastly, to our local government I ask: All of this starts with you, the government. What are you thinking of? These are your people you are representing, yet you too leave the territory for better healthcare. Why aren’t you taking stronger actions for us regarding healthcare? This community trusted you and the education you received to do better for us. You have failed us as well. You should be setting the example for those of us in the community and yet you shame us.
This hospital was set up to fail from the beginning. It was just a matter of time before it finally was brought to the forefront. An organization that has so many people in high-paying positions cannot sustain without falling at some point. An organization that has no inventory control cannot sustain without falling. An organization that continues to turn a blind eye at the inhumane treatment of another human being cannot sustain without falling! An organization that does not hold itself or it’s governing body accountable cannot sustain without falling.
So now for some solutions:
This community must get really, really angry!
This community must get involved and educated in basic healthcare current events.
This community must raise its standards and stop accepting mediocre at best.
This community must pay attention to their own healthcare as a whole and stop blaming the healthcare professionals. Ask your nurses and doctors questions so that you understand what exactly is happening to you and what exactly are you being treated for. Keep a list of your medications, past medical and surgical history and your doctors names and phone numbers in your wallet. Know what each medication is and why you are taking it; not just its color and size. These are your responsibilities not ours. The same way healthcare professionals have responsibilities, so do you.
This community must ask CMS and Joint Commission for an explanation of why they have continued to give the hospital here accreditation when clearly they shouldn’t have. Also to possibly work a little closer with the hospital to get it to be where it needs to be to meet the standard of quality patient care we all deserve.
This community must hold the government to its word.
Next: Create a financial analysis. A lot of the money that is needed is within the hospital. Create an IT analysis so that we do not continue to spend money on electronic equipment we do not need.
CMS is constantly changing their requirements. They now want all electronic health record systems to be web based. I hear no one talking about the exorbitant amount of money that has already been spent on these systems.
Create a bartering system where patients that owe money can work off part of their debt, for instance, in electrical, plumbing, painting, IT etc., services the hospital needs to maintain its facility can be done by our own community.
Then: Get rid of administrators that are clearly not really needed. This is part of the financial analysis. I’m not saying to fire them, but maybe demote them or cross-train them to do other needed services. Those who are nurses should assist as needed when their is a nursing shortage.
Take away doctors’ salaries from the hospital and allow them to charge for their services.
Create up-dated policy and procedures and keep them updated yearly or as needed.
Have regularly scheduled in-services for the staff regarding the policy and procedures.
Create standing orders for the emergency room (ER) for various common symptoms, such as urinary tract infections, chest pain, shortness of breath, and asthma.
Place cardiac monitors in every ER, intensive care unit progressive care unit room and have a technician monitoring them.
Have only seasoned experienced nurses working triage.
Have only ER techs assisting registered nurses in the ER, not licensed practical nurses nor certified nursing assistance or patient-care technicians. ER techs can: draw blood, star IV’s, get EKG’s done, transport patients, and do glucose finger sticks.
Have CNA’s/PCT’s assisting LPN’S and RN’s on the medical and surgical wards.
Have only RN’s working in the other critical areas with CNA’s/PCT’s assisting.
Hire a Nurse Educator to offer in-house continuing education classes such as Basic Life Support, Advanced Cardiac Life Support, Pediatric Advanced Life Support and Neonatal Advanced Life Support, medication errors, HIV and AIDS, EKG monitoring and reading, and infectious diseases, keeping everyone current and up to date with their licensure requirements.
Cut back on paid holidays.
Continually educate staff on the diversified culture we have in our community. By doing this it can decrease a lot of the frustration both nurses and patients experience.
Hold all staff accountable for their actions by doing regularly scheduled reviews, addressing insubordination issues and medical errors.
Modify radiology, dialysis and rehabilitation units
I’m sure there are many other solutions out there.
Finally, we all need to look at our own attitude and make the changes within ourselves. As healthcare professionals we are taught to improvise when we do not have the supplies we need. This is a small island where people working together as human beings can make it great. Not more, better, bigger or faster; just working with what we already have. Maybe improvising a little when needed.
This is not a "state-side or corporate America" way of doing things. It’s just a humane way of doing things. It doesn’t cost a cent to be kind to one another.
After putting opinion to paper, why do I feel like I’ve just wasted my breath? How discouraging.
Now what??
