August 2014

HONOReform Extends Thanks and Congratulations to New Hampshire

In this blog, HONOReform executive director Steve Langan, included in the photo with Governor Hassan, thanks colleagues in New Hampshire for two new important laws–and he includes a recent AP story.

Steve Langa shakes Governor Hassan's hand at New Hampshire bill-signing ceremony
Steve Langan shakes Governor Hassan’s hand at New Hampshire bill-signing ceremony

Congratulations and many thanks to our colleagues in New Hampshire, many of whom are included in the August 6 AP article by Rik Stevens, which is appended below, for their determination to create and pass legislation in New Hampshire that will help protect patients there.

“We believe these two new measures will be of great benefit in insuring the safety of the patients who are receiving care in our hospitals and also in insuring the integrity of the healthcare delivery system,” said Steve Ahnen, president of the New Hampshire Hospital Association. “These laws are an important step forward in preventing these horrific acts from occurring again in New Hampshire and, potentially serving as a model for the rest of the nation.” Read more

Making Lemonade: One CRNA’s Story of Addiction and Recovery – Part 2

Anita Bertrand, CRNA, will be presenting at the upcoming AANA annual meeting
Anita Bertrand, CRNA, will be presenting at the upcoming AANA annual meeting

Anita Bertrand is a certified nurse anesthetist. She will be giving the 11th Annual Jan Stewart Memorial Lecture at the AANA 2014 Nurse Anesthesia Annual Congress. Her story of addiction and recovery is continued from last week. We are grateful to her for sharing her story of addiction and recovery today and next week.

Prevention
During that time of active addiction, it never occurred to me I’d be asked to drug test, as random drug screening was not practiced in any of the healthcare setting I have been employed. But, how often could we identify a HCW with a developing addiction problem or one that is already out of control by instituting random drug screens? Some HCWs could be helped before harm is caused to patients, or before being discovered in a fatal event, as what happens in specific HCW professions such as anesthesia or ICU nursing. The “survivalist” behavior demonstrated as the brain becomes hijacked by the disease of addiction shows us how little control the addicted HCW has over the outcome of the disease. It WILL be fatal to the HCW left untreated, and in the process may contribute to harm to patients as well.

How many physicians, nurses, technicians, and aides working across the country are struggling with this disease and have no resources available due to fear, shame, stigma, isolation? In my state alone there are hundreds of nurses who are being monitored in the alternative to discipline program sanctioned by the state and the Board of Nursing. These are nurses who are getting help and treating their disease while being monitored in their work environment. This does not count the number of nurses who do not fit the profile to be accepted into the program and are under state board monitoring. This does not include the physicians, dentists, technicians, and other HCWs in the state. This does not include the number of HCWs who have not been discovered or who will succumb to the disease in the future.

Since no profession is immune to this disease, 10% of the number of all HCWs would amount to how many across the country? What needs to happen to not only bring more awareness and education to the problem, but to change the mindset of the industry so that HCW can get the help they need and be able to return to their professions as healthy, recovering providers without the stigma and discrimination? I am extremely grateful for the individuals who intervened for me so that I could get the help I needed before harming a patient or causing further harm to myself.

There is no doubt that we are lacking in understanding of the diseases of addiction and alcoholism. When education is provided, it focuses on the patient with the diseases, and seldom includes the HCW as a patient, and as our career choice being a setup for the triggering of the disease. Individuals who gravitate toward a career as a HCW may have a predisposition toward the disease; access and availability become the trigger. This access and availability may complete the gamut of things that fall into place when the HCW is experiencing trials and tribulations of life events…those HCWs who would not otherwise fall prey to the disease.

When we take action to prevent and treat the disease early, we eliminate the need for law enforcement and criminal actions.

Treatment and Returning to the workplace
We know that approximately 10% of society as a whole has problems with addiction/alcoholism, and unfortunately the majority of these people end up in jails, prisons, and institutions that do very little in the treatment of the disease. The disease is the culprit for the criminal behavior and the treatment is focused on treating the behavior rather than the disease.
Some states have alternative-to-discipline programs for HCWs so that they may obtain treatment while maintaining their licenses “National Association of Alternative Programs” .
There are many states that do not have such programs in place. In some cases the HCW chooses not to, or is unable to enroll in these programs due to legal consequences of the disease. For the states that do not have any kind of alternative to discipline program, the HCW’s ability to obtain employment in the future is essentially ripped away as the licensing board suspends or revokes the license.
Returning to practice in the healthcare setting after treatment for the disease of addiction and alcoholism is extremely difficult. Few hospital settings will employ nurses who have had a history of addiction treatment and are under a monitoring contract with their respective board of nursing or alternative to discipline programs. Again, there is a lack of knowledge and support for both the employer and employee. This realization and understanding on the part of the addicted HCW produces another roadblock for the addicted HCW to willingly seek help for this chronic, progressive, fatal disease.

Gratitude
Personally, I am grateful for the program in place that directed and monitored me before and during my return to work as a healthcare provider. I am extremely grateful for individuals who supported and employed me, giving me a chance to demonstrate that this disease is treatable, and that with treatment, it is possible to continue my career as a HCW and provide safe patient care.

At the end, this is my wish. In the effort to continue to provide safe patient care I encourage HONOReform and all of its great colleagues to continue to do all they can—at the state and federal levels—to prevent drug diversion and help addicted healthcare workers. I pledge my support to my HCW colleagues. As my friend Evelyn McKnight says, “Lives depend on it.”

Making Lemonade: One CRNA’s Story of Addiction and Recovery – Part 1

Anita Bertrand, CRNA, will be presenting at the upcoming AANA annual meeting
Anita Bertrand, CRNA, will be presenting at the upcoming AANA annual meeting

Anita Bertrand is a certified nurse anesthetist. She will be giving the 11th Annual Jan Stewart Memorial Lecture at the AANA 2014 Nurse Anesthesia Annual Congress
September 13-16, 2014 Orlando, Florida. We are grateful to her for sharing her story of addiction and recovery today and next week.

A recent report by the CDC identifies drug diversion in health care settings as the cause of potential exposure of blood-borne pathogens to nearly 30,000 Americans over a ten year period “Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel”. Drug diversion is commonly attributed to healthcare workers (HCW) who are addicted to drugs. In my experience as an addicted HCW, I understand how this inconceivable incidence can occur, although it seems incomprehensible that I could be the cause of such devastating harm to my patients, others and to myself. I also understand the impairment the disease of addiction causes to the HCW’s ability to make rational and safe decisions for both self and for patients under his or her care.

There are many unanswered questions and I don’t have all of the answers:
• How many HCWs are suffering from the disease of addiction/alcoholism and hiding in fear of the future, not getting treatment and/or have no access to treatment upon discovery?
• How many of my colleagues are practicing and do not recognize or are willing to admit they are chemically dependent?
• How many HCW recognize the dependency and have no idea what to do?
• How many families, friends and employers suspect a problem and don’t know what to do to help?
• Can helping addicted HCWs contribute to drug diversion prevention and lessen the risk to patients?

Addiction is a disease, not a choice.
My experience as a HCW with an addiction to opioids has demonstrated that I did not, and do not have, control over my behavior when actively using. The disease had taken over my thinking and decision making capabilities when it comes to the use of, and administering of drugs to patients.

My behavior was incomprehensible, both in terms of what I did in order to obtain the drug of addiction as well as in the manner in which I took care of patients. The harm caused to patients by HCWs is both direct and indirect, in the lack of care, provided by the HCW and in the inability to be cognizant of the care provided. The HCW active in the disease of addiction is constantly focused on when and how to obtain/divert the next drug, thereby not focused on the patient and his/her needs or care. I understand how unsafe injection practices occur when addicted HCW are not identified and treated. I also understand how the disease continues to progress to more and more risky behavior for both patient and provider when action is not taken to arrest the disease.

There are many limitations to identifying HCWs with the disease of addiction. My disease was permitted to progress for many months as I became more careless and harmful to both myself and patients under my care. In the end I was grateful to have been discovered, for I realize today that the fear and shame would have carried me to my death.

Stigma of Addiction
Fear and shame are the emotions that isolated me. Even though I knew how to find support and treatment, the tremendous fear and shame of being identified and removed from the workplace in order to get treatment paralyzed me. I knew the insurmountable stigma of this disease would follow me, in terms of my license and career.

The disease of addiction/alcoholism causes abhorrent and sometimes, criminal behavior. Discovered in active addiction/alcoholism, HCWs are commonly terminated. Removal from the workplace is the only appropriate action for both patient and provider safety. But with termination, they are left without a means for the desperately needed treatment for the disease. When HCWs have a stroke, a heart attack, are diagnosed with cancer, or a hyper/hypoglycemic crisis, they are removed from the work environment, encouraged and supported in treatment for their disease, and permitted in most cases to return to the work when their disease is stable or in remission. Additionally, it is common that friends and colleagues go to great lengths to assist the HCW by covering shifts, providing meals for the family, and even giving up PTO time to help the HCW in financial crisis due to their disease.

Compared with other disease conditions, support for the addicted HCW is in short supply. Lack of knowledge and understanding of the disease, stigma, and misjudgment prohibits others from being helpful. The recent USA Today piece, “Doctors, Medical Staff on Drugs Put Patients at Risk” covered some of my story. But, there is much more to say. My husband was left with a two year old, starting a new job and having no immediate family in the city while I went off to treatment 1000+ miles away for 18 weeks. Where were all our friends? Where were all the colleagues I’d worked with all those years? Nobody brought over a casserole or offered to babysit so he could have a break and take care of himself. The inability to ask for help extends to the families, who also face the stigma and shame surrounding this disease. Addiction and alcoholism impacts everyone who cares and knows the HCW.

This stigma only perpetuates the disease, the denial, and the ability to obtain lifesaving treatment. That fear, shame, and stigma prevented me from asking for help early in my disease when I had a moment of clarity. It prevented my husband from understanding the depth of the problem so that he could seek help for me.

Next week, Anita continues her story of addiction and recovery.

“Doing all I can to protect patients”

A St. Louis nurse, fearful for the welfare of her patients, facilitated a necessary change in procedure. This is her story.

OSHA regulations protect healthcare workers in the workplace
OSHA regulations protect healthcare workers in the workplace

Recently, OSHA issued a citation against SSM Healthcare, located in the St. Louis Missouri metropolitan area. The SSM Health Care system was fined because of safety violations that potentially exposed healthcare providers to bloodborne pathogens.

Here is a link to a recent article, in which the situation is fully explained:

http://www.ksdk.com/story/news/local/5-on-your-side/2014/07/23/ssm-health-care-osha/13073791/

Unfortunately, health fair participants were put at risk. But OSHA only deals with employee safety.  An investigation by the Joint Commission is ongoing; however, those results may not necessarily be made public. It is unknown at this time if the local or state health departments or the CDC will become involved.

I am grateful for the support of representatives of HONOReform, who listened to and validated my concerns and referred me to additional resources at the CDC and the FDA.

I tried my best to facilitate change within the healthcare system. Although many people at the healthcare system were provided with the most up to date information and some changes were made incrementally, not all policies and procedures were brought up to necessary standards.

If you have been to a mass health screening that included point-of-care blood testing you that was conducted by the SSM Healthcare System in the St. Louis area, you may call 877-759-5575 option 2. This phone number is for only those who attended a Health Fair sponsored by SSM. All others who are concerned about past exposures may want to contact your Primary Care Provider for further evaluation.

The greatest risk of exposure from these types of events is exposure to Hepatitis B (because of it virulence). Additionally, HIV and Hepatitis C are blood borne pathogens that one needs to be concerned with as well.

All shared glucometers and cholesterol-lipid meters should be disinfected with a hospital grade disinfectant and allowed to air dry for two minutes or as recommended by the manufacturer of the disinfecting agent. Additionally, body fat analyzers, if handled by those who had a finger-stick and may have blood on their fingers/hands, should be disinfected as well.

In an upcoming blog post here at HONOReform, I will explore these standards, which come right out of the information provided to us by CDC, in more depth.

We are not trying to embarrass anyone, nor cause undue worry. However, for peace of mind and in order to get prompt medical care if exposures have occurred, participants of previous health fairs or mass health screenings should be tested for bloodborne pathogens. I encourage these patients to be tested.

Also, I am recommending that health fairs that include point-of-care blood testing be suspended until they are fully evaluated. Perhaps health fairs that include point-of-care blood testing should be eliminated due to the large number of outbreaks linked to shared glucometers and other unsafe practices such as shared lancet devices?

Avoiding risk to patients—always being mindful of what we are doing, and following the guidelines that have been established for us—is so important.

Even though it was not easy, I am glad that I made the decision to do all I can to implement these standards and protect our patients.

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