Thank you for your interest in the work of HONOReform – the only organization dedicated to advancing injection safety. I am asking today for your support of our life-saving work.
Why do we advocate for injection safety?
You will be interested in this story about what happened in my family practice clinic recently that illustrates why we must – together – continue educating healthcare providers and patients about the critical need for injection safety.
My clinic scheduled an assessment by the CDC Nebraska Infection Control Assessment program team. These hard-working nurses and infection preventionists spent a day assessing our clinic’s policies and procedures, making sure that we are doing everything we can to prevent our patients from contracting disease while in our office.
At the end of the day, the assessment team sat down with us to give us their report. Fortunately, we are doing most things right.
But there was one thing that needed improvement. The team found an opened, unlabeled vial of lidocaine in a patient care area. Since the vial had not been disposed of properly, there was a risk that it could be reused improperly, potentially spreading disease.
How do we advance injection safety?
You probaby know that my wife contracted Hepatitis C through unsafe injection practices sixteen years ago. Since then, it is my personal crusade to educate about injection safety. I preach to doctors, nurses and medical students that it is never okay to reuse syringes, needles, medication vials or other medical equipment intended for one time use. But despite my efforts, an unsafe injection could have taken place, even in my own office. In 2016, HONOReform gave educational presentations to 2208 people as well as reaching thousands through social media and virtual audiences. Everyone who has been touched by the retelling of our story joins me in thanking you for your generous partnership and support. We are committed to educating about and advocating for injection safety with every possible opportunity, to keep you and your family safe when you access healthcare.
But even with all our efforts to educate about injection safety, there were eight outbreak investigations of disease transmission through unsafe injection practices in 2016, affecting thousands of Americans! Together we must work even harder to advance injection safety.
Here is how you can spread the word about injection safety
Talk to your healthcare providers about how they are keeping you safe through careful adherence to injection safety guidelines. Pass along HONOReform’s eagerness to provider a quality educational presentation to their professional organization. Here is a useful link: HONOReform’s educational presentation program.
Today I am asking for your support for HONOReform. Your contributions enable HONOReform to educate about the absoulte necessity of injection safety to keep healthcare safe for thousands. Click this “Help Save Lives” link to reach our website to make your gift.
Thank you for your consideration. I hope to hear from you soon.
Thomas A. McKnight, MD
PS Thanks for helping with this important need. Please donate today to help with our educational efforts.
This past week we learned that there was another incident of drug diversion at Swedish Medical Center in Englewood, Colorado. This is not far from Rose Medical Center in Denver, the site of the 2009 drug diversion event which caused 19 patients to be infected with Hepatitis C. So if this seems eerily familiar, you are right, it is.
At last report, no exposure to any infectious diseases have been reported. My sincere hope is this remains to be the truth for the almost 3000 patients who were notified that they may have been put at risk.
But the cold hard facts remain. There was another drug diversion at an HCA hospital, the same hospital system which includes Rose Medical Center. And I am sure the most asked question is going to be “Why?” Why were there not better systems put into place to safeguard again this? Why did we not learn from the mistakes made in 2009?
We ask why because we know this was a completely preventable event. We ask why because despite any reliable data about the frequency of drug diversion in healthcare facilities, primarily due to the covert nature of this crime, we know it is always a possibility, always a risk. We ask why because there are many hospital systems who have successfully been able to monitor, assess and prevent drug diversion incidents.
So while my thoughts remain with those 3000 patients and their families and friends as they await news of their blood tests, I find comfort in knowing behind the scenes the Colorado Department of Public Health and Environment is doing what needs to be done to investigate, educate and keep the risks at a minimum. With the help of the CDPHE’s One and Only Campaign, awareness is being raised among patients and healthcare providers regarding safe injection practices. Or if more information is needed, please contact HONOReform at www.honoreform.org.
Below you will find a guest commentary which appeared in the Denver Post this past Saturday offering solutions for the future.
Nine years ago, HONOReform was launched. We pause here to review our many accomplishments. We give thanks to our loyal stakeholders and supporters, who have made all of this possible!
HONOReform is an original member of the Safe Injection Practices Coalition, which is currently active in seven states and online at OneandOnlyCampaign.org. This award-winning campaign is led by our longtime partners at the CDC.
“Dear sir or madam: you have been potentially exposed to Hepatitis C, Hepatitis B and HIV through unsafe practices by your healthcare provider. Please come to our facility to be tested.”
Those were the opening sentences of an official letter that I received from the Nebraska Health Department in 2002.
Thus began my involvement in malpractice litigation as a plaintiff.
But through this experience, we have developed a new model of malpractice resolution – one that requires not only compensation for the victim, but also safeguards the welfare of the community through remediation of medical error.
I was honored to share this model in a TEDx Omaha Talk last month. Please take a look at the talk, share it with your network, and join our campaign by following HONOReform Foundation’s Facebook page!
Last week, in a blog I wrote on the patient notification in Utah, a situation that is directly related to drug diversion, I mentioned the recent fine levied against Massachusetts General Hospital by the Drug Enforcement Agency.
If this can happen at Mass General, many of us thought, it can happen anywhere. And, sadly, it does.
Among the many acts of drug diversion mentioned in the Settlement Agreement, which is part of the public record, are incidents that involve improper use of injections.
I am grateful HONOReform had the opportunity to respond in the June 12 Concord Monitor to the horrible but all too common report of provider drug diversion by a healthcare worker.
As Steve Langan, HONOReform executive director, said, “Drug diversion may likely be the most enormous elephant in the room, in healthcare.” Anyone who has tried to pay attention to the many conversations on healthcare in the United States knows that there are many gaps and there have been many breakdowns.
If we continue to look the other way and deny and ignore the fact of widespread drug abuse and drug diversion among healthcare workers, more and more systematic challenges will develop.
According to recent statistics, there are as many as 379,000 addicted healthcare workers right now in the United States.
What does this mean for patients? They may not be receiving the medication they have been prescribed, in the recovery room or in other hospital settings. And, worse yet, they may receive an infection of bloodborne pathogens, such as hepatitis C or HIV.
At HONOReform, we believe a first priority in American healthcare is protocol and regulations that prevent drug diversion. This is a problem that can and must be fixed.
Robust materials developed by partners at the Safe Injection Practices Coalition the One and Only Campaign will soon be in place. We welcome the opportunity to help distribute these materials to leadership at healthcare facilities throughout the country.
Messaging and education are essential, important; but, in this case, we need government leaders at all levels to take a stand. Patients have been placed over and over in a vulnerable position, and addicted healthcare workers continue to practice with very little oversight and not nearly enough intervention.
In the near future, we will make an announcement of an upcoming meeting on drug diversion prevention.
Once a year, we take some time from our daily work to reflect on what we accomplished throughout the year and set s ome goals for the upcoming year. We are so grateful to you, our fellow advocates, for your steadfast support of injection safety. Below is HONOReform’s End of Year Report, 2014.
Our Mission and Vision
HONOReform is the only national advocacy organization dedicated to protecting patients through safeguarding the medical injection process “from manufacturing to disposal.” Our vision is a nation in which health care providers always follow fundamental injection safety practices that are designed to protect all patients each nd every time they receive an injection.
HONOReform International Debut
HONOReform representatives, including Evelyn and Tom McKnight, traveled to India in September. Our aim was to visit cities and villages and observe healthcare delivery. We visited hospitals and clinics, and we had the opportunity to meet with local patient advocates. Along with our industry partners, we presented to public health leaders, national government officials and a representative of the World Health Organization. Our goal going forward is to help form an injection safety coalition in India.
Presentations and Media
Led by co-founder and president Evelyn McKnight, who continues to present her story on the ongoing need to always use safe injection practices, HONOReform presented at 30 events attended by nearly 3500 people. HONOReform was featured in national media over 25 times in 2014, and we helped lead the much-quoted April 17 USA Today article titled “Doctors, medical staff put patients at risk.”
Updated HONOReform website
Evelyn and HONOReform are active on social media, particularly twitter (#HONOReform). On our streamlined website, click on “JOIN THE CONVERSATION” to receive up-to-the-minute information from HONOReform (on Twitter and Facebook). Also, be sure to check out and subscribe to the HONOReform blog, “Survivor Stories,” edited by Evelyn and Lauren Lollini. To submit an idea for our blog or an article, contact Steve Langan at 402.659.6343 or steve@HONOReform.org.
Sadly, some healthcare providers in the United States continue to reuse and misuse medical equipment, including syringes. Additional focus areas this year included reuse and misuse of single- and multi-dose vials of medication and responding to increasing reports of drug diversion among healthcare workers. Through the HONOResponse program, active in five states in 2014, HONOReform is poised to help patients and communities immediately following a patient notification or confirmed outbreak.
The SIPC and the Campaign
HONOReform is a proud member of the Safe Injection Practices Coalition (SIPC), which provides support for the One and Only Campaign (OneandOnlyCampaign.org). The SIPC continues to develop and distribute new materials, and we continue to raise awareness among healthcare providers and patients about the absolute need for safe injection practices. In 2014, HONOReform discussed with SIPC colleagues a need to emphasize and extend the patient voice. As always, please contact HONOReform and allow us to help you access the materials that will be most useful to you and your institution—if you are a healthcare worker—or your family—if you are a patient.
Support for State Legislation
HONOReform is particularly proud of our many partners in New Hampshire, who pushed for the landmark “Medical Technician Registry” and “Drug Free Workplace” bills, which were signed in to law in June. HONOReform was also active in working toward legislation in North Dakota—where an injection safety proclamation was established. HONOReform is dedicated to advocating for injection safety legislation at the state level.
Our Academic Partners
HONOReform appreciated the many opportunities this year to meet, in person and online, with students from local and area universities and colleges, as they studied the consequences of unsafe injections. We welcome the opportunity to share the HONOReform story and highlight the need to always emphasize injection safety. Our academic partners include University of Nebraska-Omaha, Midland University, Methodist Nursing College, the College of St Mary, St. Louis University and Southeast Community College—among others.
HONOReform Year End Appeal
We are grateful to our many donors for the ongoing support of our mission. Contributions to our annual appeal for donations, response to a request from founder Evelyn McKnight, were especially helpful. Contributions to HONOReform come in a variety of forms. Thank you for helping us to continue to safeguard the medical injection process in the United States.
Our Goals for 2015
We have designated 2015 the HONOReform “Year of Community.” We encourage HONOReform patient advocates and family advocates, our many partner organizations, and the extended national injection safety network to join us. We encourage you to join HONOReform social media and help us extend the conversation and our reach!
Welcome back to the HONOReform blog, aka “Survivor Stories,” for our second full year of publication. We thank everyone who has had a role in making our blog a growing success—contributors and readers and everyone who has suggested to friends that they should check out our blog and pass it on to others.
And we encourage you to please continue to support our efforts.
Here at HONOReform, community-building is a key to emphasizing safe injection practices and doing all we can to educate the public and reeducate providers on the absolute necessity of injection safety. Read more
If you are a regular member to this blog you will have heard me say these things before, so I apologize for the repetition, but it appears I may not be saying it loud enough. So I am thankful to have the support of fellow patient safety advocates, healthcare workers who understand the broken system as well as a series of talented reporters to help articulate the point.
Our healthcare system is broken, let me say that again, it is broken and not the way the majority of Americans might think after reading that statement. It isn’t about the Affordable Care Act, in fact, just the opposite. It is underneath the polished floors and inside the magnificent facilities. It is behind the scenes, what happens when most people are not watching. Read more
It is a pleasure to announce that Dr. Thomas A. McKnight—Tom—a founding member of HONOReform and our medical director, was honored by Governor Dave Heineman on October 8, 2014. In a special proclamation, Tom was named “2014 Family Physician of the Year” in Nebraska. We are grateful for Tom’s ongoing leadership and guidance.
He is pictured with Representative Jeff Fortenberry and Governor Dave Heineman. The text of his talk is included here.
Thank you Gov Heineman, Representative Heineman, and the NE Academy of Family Physicians. I am humbled and honored by this award. I know that there are many deserving family physicians in our state that provide outstanding, compassionate care on a daily basis to Nebraska families.
I chose to go into family medicine because it provides the opportunity to be involved in peoples’ lives from birth to death. I’ve enjoyed family medicine because of the broad range of challenges emotionally and intellectually that each patient encounter brings. In my daily routine I often celebrate with new parents when they bring their baby to the doctor for the first time and then go to the next exam room to break the news to a married couple that the husband has terminal lung cancer and has only a few months to live. I have to say family medicine is as challenging and exciting now as it was 33 years ago when I started my practice.
After finishing medical school at UNMC i did my residency in Cedar Rapids, IA. I took a temporary position in the ER while we were waiting the birth of Luke. This gave me a chance to see a different side of medicine. It taught me that i wanted to develop long term relationships with patients and that i would only be fulfilled in having my own practice.
We volunteered for 6 months in various Native American Health Centers in NM, MT and AK before we settled in our new home in Fremont. This time period also allowed me to get licensure and staffing in place to open my solo practice in July, 1981. I still remember how happy but anxious i was to see my very first patient with brand new staff. Evelyn and I wonder if it was bravery or foolishness to have a new baby, buy a house, start a brand new practice with no patient base, all with no other income. It worked out. Fremont has been very supportive of us and it has been a marvelous place to practice medicine and raise a family.
The loyalty of my staff is unmatched. In the 33 years of practice 2 employees have been with me from the beginning, 6 have been with me 25 years or more and 9 have been with me for more than 10 years. We have 5 families who have two generations that serve patients with me. With all the stresses and changes in medicine, I think this is remarkable. It shows their dedication to caring for their friends and neighbors in Fremont. Their dedication goes beyond the time they spend at the office. They attend patients’ weddings and funerals, give baby showers for needy patients and organize fundraisers to help with patient’s medical bills. Most importantly they hold patients’ hands when they need a compassionate listener, share in the joy of a new baby and shed tears in the loss of a loved one. Patients know their dedication and i think that often they would rather see their favorite staff member than me. The same devotion the staff shows to our patients they extend to me and my family. They do their best to make my day run as smoothly as possible and that is not easy, given how many emergencies come up in one day. In the years of illness within my own family, they sent supper home with me every day for a year. They took our kids to their activities and hugged me through the time of my mother’s death. We will never forget your kindness and compassion.
The most important part of this journey is my family. They were patient and understanding when i was called from family life to attend to others’ needs. I was privileged to mentor all three sons during their medical education. It was marvelous to see their compassion and care of patients during their family medicine rotations. It gave them an understanding of my career. I’m honored that they have chosen medicine for their own career paths. Its rewarding and sometimes humorous to talk to them about their own patients. I got a phone call from Curtis the psychiatrist recently, asking me how to treat constipation!
The most important person here is Evelyn. She has stood by my side, been the most trusted confidante and understanding partner that i could have. She was the mother, often the father when i wasn’t able to be part of family life. She waited patiently for me many late nights to share the joys and sorrows of my day. I know how difficult it is and she continues to offer her support and love. I am eternally grateful.
Being involved with medical students throughout my career has been extremely rewarding. It is a source of continued stimulation and keeping up with the advancements of medicine. Sharing the joy of their first delivery or the satisfaction of suturing their first laceration gives me a warm feeling. Its interesting to show them private practice medicine and what it is like to be involved in a community. I love following their educational and career advancement and then have them as specialty consultants.
The patient doctor relationship is special. I am privileged to care for 4 generations of families. I am so humbled that they have placed their trust in me, many for 3 decades. We’ve gotten to know each other well and i feel like a part of their lives. They are a part of mine as well; they ask about my family and send me gifts and articles that they know i would like. This is really what family practice is about – caring for families through generations. It is a blessed coincidence that the first baby I delivered in Fremont in 1981 was JoAnne’s baby girl named Christine. I delivered Christine’s baby girl Caitlyn in 2011, the last baby I delivered.
Many things have changed in medicine in the years of my career. Immunizations now prevent many diseases that were devastating to families when i first started practice. I remember many nights interrupted by trips to the ER where i did spinal taps on children, looking for meningitis, which is now very uncommon with meningococus vaccine. We now have genomics to assist with cancer care and cardiovascular disease. We used to have to get hard copy medical journals to research new developments but now i can consult Medscape on my smartphone. Computerized medical records are replacing cumbersome paper charts and will allow patients to have their medical records anywhere in the world. Patients have changed also, for the better. They are more involved and knowledgeable about treatment options. They are full partners in their healthcare, which is better for them and healthcare providers. Patients know their bodies better than anyone and bringing this knowledge to the partnership makes for better health. We need to embrace these changes in technology and patient partnership.
I’ve enjoyed opportunities to serve in ways other than office medicine. Service trips to third world countries, membership on nonprofit boards, medical staff offices and our own patient safety foundation HONOReform has promoted my own personal growth. We have met so many wonderful, committed people in these endeavors. Their dedication inspires me.
Our own experience with medical error and the work of HONOReform has made me a better doctor because i understand both the doctor and the patient side of the relationship. I’m less defensive, more compassionate, and more grateful than i used to be. I’ve learned how to accept responsibility and do the right thing, even when that is a very difficult thing to do. To say “I’m sorry, this is not what i wanted for you” when my care of a patient did not turn out as planned is the right thing to do.
HONOReform is a national organization, and we stay very active here in Nebraska. If I could wish one thing for our state, it would be the adoption of a bill that emphasizes safe injection practices. We have seen many lives here in Nebraska (and throughout the country) altered or ended because of lack of adherence to injection safety. HONOReform is willing to roll up our sleeves and work with Nebraska lawmakers to put an injection safety bill in place. We believe this legislation is overdue.
For all of this, I thank you from the bottom of my heart. Our work is not done, we are eager to see what the next 33 years will bring.