Doctors and other health professionals in California can be disciplined or lose their licenses for criminal conduct such as possession of illegal drugs even if they complete a pretrial treatment program and have the case erased from their record, under a ruling that has now become final.
The state Supreme Court unanimously refused Wednesday to take up a physician’s appeal of a ruling that said a licensing agency, such as the California Medical Board, can rely on arrest records as evidence that a license-holder committed professional misconduct, even if the underlying criminal case no longer exists.
That ruling, by a San Francisco appellate panel, is now a binding precedent for all trial courts in California. Besides doctors, it applies to other licensed medical professionals such as nurses and pharmacists.
The case involved a Southern California physician, Brandon Erdle, who was arrested in September 2013 on suspicion of possessing cocaine. His lawyer, Mitchell Green, said Erdle was actually arrested for an unrelated minor crime and was carrying bags with small amounts of the drug that he was about to drop into a medical disposal unit.
One DeLand police officer was fired and two others disciplined after losing meth during an arrest.
The case never went to trial, and the drug charge was dismissed in January 2016 after Erdle went through a treatment program known as pretrial diversion. In the meantime the Medical Board, citing his arrest report, accused Erdle of unprofessional conduct, then issued him a public reprimand in 2016 and placed him on probation.
U.S. nonprofit hospital margins will be negatively affected by an extreme nursing shortage for at least the next three to four years, according to a new report from Moody’s Investors Service.
To attract and retain nursing talent, many hospitals are increasing compensation and offering sign-on bonuses and attractive fringe benefits. However, these incentives are putting expense pressure on hospitals.
“Labor is the largest hospital expense and is increasing faster than total expense growth while outpacing revenue growth,” Safat Hannan, a Moody’s analyst, said. “The lack of qualified nurses will compound these expense pressures and negatively affect hospital margins.”
The nursing shortage is most prevalent in Florida, Georgia, Texas, California, Louisiana, Mississippi, Alabama and West Virginia, according to the report.
How well are doctors, nurses and other workers at your local hospital vaccinated against the flu?
That depends on the hospital.
According to data from the California Department of Public Health, flu vaccination rates among health care staffers at the state’s acute care hospitals range from a low of 37 percent to 100 percent.
Overall, flu vaccination rates among hospital workers climbed significantly in the past several years — from an average of 63 percent during the 2010-11 influenza season to 83 percent during the 2016-17 season, according to the California Department of Public Health. Vaccination rates for the current season won’t be determined until later this year.
But that general increase masks some big variations. Monrovia Memorial Hospital in Los Angeles, Los Robles Hospital and Medical Center, East Campus and Thousand Oaks Surgical Center in Ventura each reported that fewer than 40 percent of their health care workers received the flu vaccine last year. Representatives from those hospitals did not return repeated calls for comment.
On the other end of the spectrum, Rady Children’s Hospital in San Diego reported that every single person working there got the vaccine.
California’s flu vaccination policies for hospital workers, and those of many other states, are far from uniform or ironclad. In various states, health care workers have legally challenged hospital requirements for vaccination on religious and seculargrounds. And some unions in California and elsewhere oppose a legal mandate, partly for civil rights reasons.
Public health officials themselves have different takes on the legal requirements for hospital workers. The Centers for Disease Control and Prevention lists California and Massachusetts among the handful of states where the flu vaccination is mandated for health care workers. But the states’ laws allow health care workers to opt out by signing a form declining the vaccine. For that reason, officials from those two states said they do not actually consider the vaccine mandatory.
Colorado law requires hospital health care workers to provide proof of immunization or a doctor’s note providing for a medical exemption, and requires that non-immunized workers wear masks. Hospitals that achieve a 90 percent or higher flu vaccination rate are exempt from these rules, however.
In California, state law requires that hospitals offer the vaccine free of charge. Many hospitals offer vaccines to personnel in the cafeteria, and during day and night shifts. “The key to getting more people vaccinated is to make it more easily accessible for people,” said Lynn Janssen, chief of the California Department of Public Health’s associated infections branch.
She also said many California counties and hospitals have required health care workers to either get the flu vaccine or wear a mask, which can help prevent spreading illness to others.
Partly as a result, nearly a third of the state’s hospitals now have flu vaccination rates above 90 percent.
Vaccination rates vary significantly among different categories of hospital workers, however. Hospital employees had an average vaccination rate of 87 percent statewide in 2016-17, while licensed independent practitioners — including some physicians, advance practice nurses and physician assistants who do not receive paychecks from the hospital — had a rate of just 67 percent.
The CDC recommends that health workers get one dose of influenza vaccine annually, and cites data showing the vaccine in recent years has been to up 60 percent effective — though it was far less so this year. Dr. Bill Schaffner, an infectious diseases professor at Vanderbilt University School of Medicine in Nashville, Tenn., says there are three principal reasons to get vaccinated: to prevent workers from infecting patients, to keep them healthy in order to care for patients and to spare them a bout with the flu.
A 2017 Canadian study, however, suggests that the benefits of health care worker vaccinations have been overstated.
In any case, just because experts say health care personnel should get the vaccine doesn’t mean they will choose to do so.
“In the studies, and also in our experience, it turns out — to everyone’s great surprise — that health care workers are human beings,” Schaffner said. “Some are too busy, some don’t think the flu vaccine is worth it, some don’t like shots. Some are not convinced they can’t get flu from the flu vaccine.” (Experts say they can’t.)
Because of this, Schaffner said, it’s up to hospital leadership to push staffers to get vaccinated. At Vanderbilt University Medical Center, vaccination rates increased from 70 percent to 90 percent once leaders there effectively made the flu vaccine “mandatory,” he said, requiring noncompliant hospital personnel to present vaccine exemption requests to a hospital committee.
Health officials also encourage patients to ask whether their caregivers are vaccinated.
Jan Emerson-Shea, spokeswoman for the California Hospital Association, said her organization would like the flu vaccine to be mandatory for all health care personnel. Independent physicians have proven an especially challenging group to motivate, she said, since hospitals hold little sway over them.
“I, for the life of me, can’t imagine why a physician wouldn’t want to be vaccinated,” she said. “But they make that choice.”
Yet the California Nurses Association strongly opposes making flu vaccines mandatory, said Gerard Brogan, a registered nurse and spokesman for the union.
He said the union does recommend that providers get the vaccine, but it objects to making vaccination a condition of employment. He said some employees have religious issues or safety concerns about the vaccines and “we think that should be respected as a civil rights issue,” he said.
He also called rules requiring unvaccinated providers to wear a face mask “punitive.”
“It’s almost like the scarlet letter to shame you,” he said.
He said the masks can frighten patients — a contention made by a New York union as well. In any case, he said, wearing the masks is not especially effective in stopping the spread of flu (although some researchers say otherwise). Instead, he said, employees should be encouraged to wash hands and to stay home when they are sick.
Too often, he said, nurses are asked to come in to work when they are ill. He said he was not able to find any nurses willing to discuss their decision not to get the flu shot.
In terms of size, the CHI and Dignity combination would create a larger company than McDonald’s or Macy’s in terms of projected $28 bn of revenue. (Use the chart of America’s top systems to do the math).
Add a third important item to paint the state-of-the-U.S. hospital-industry picture: Moody’s negative ratings outlook for non-profit hospital finances for 2018.
So will getting bigger through merger and consolidation make the hospital business better?
In the wake of the CVS-Aetna plan to join together, the rationale to go big seems rational. Scale matters when it comes to contracting with health insurance plans at the front-end of pricing and financial planning for the CFO’s office, and to managing population health by controlling more of provider elements of care from several lenses: influencing physician care; crafting inpatient hospital care; doing smarter, cheaper supply purchasing; and leaning out overhead budgets for things like marketing and general management.
Health Populi’s Hot Points: In the past two years, I’ve had the amazing opportunity of speaking about new consumers and patients growing into healthcare payors with leadership from hospitals in over 20 states, some more rural, some more urban, and all in some level of financial crisis mode.
After describing the state of this consumer in health and healthcare, and how she/he got here, I have challenged hospital leadership to think more like marketers with a fierce lens on consumer experience and values. That equal proportions of U.S. consumers trust large retail and digital companies to help them manage their health is a jarring statistic to these hospital executives. The tie-up between CVS and Aetna marries the retail health/healthcare segments and responds to this consumer trust issue.
But then, I remind them that nurses, pharmacists, and doctors are the three most-trusted professions in America.
These three professional clinicians are the human capital that comprise the heart of a hospital in a community.
Hospitals should be mindful that trust is necessary for patient/health engagement. And the trust is with hospitals if the organization chooses to leverage that goodwill for a value-exchange. Hospitals are economic engines in their local communities — often, the largest employer in town. “Everyone” in most communities knows someone who works in a hospital.
And hospital employees spend money in communities, bolstering local employment and tax bases.
Partnering with patients means empathizing with them as both clinical subjects and consumers. For the latter, refer to the sage column from JAMA which recommends that Value-Based Healthcare Means Valuing What Matters to Patients. This means thinking about the value-chain of the patient journey, from keeping people well in their communities through to managing sticker-shock in the financial office. The financial toxicity of healthcare is one risk factor threatening the hospital-patient relationship with the patient-as-payor.
As Mufasa told Simba in The Lion King, “You are more than what you have become. Remember who you are.”
Photo: Inside the Mar-a-Lago, courtesy of The Mar-a-Lago Club website.
More than 1,100 doctors, nurses and medical students are urging the Cleveland Clinic to cancel an annual fundraiser planned at a resort owned by President Donald Trump in the wake of his executive order on immigration.
Over the last three days, 1,141 medical professionals have signed an open letter to Cleveland Clinic President and CEO Toby Cosgrove asking him to cut the perceived ties to Trump in light of the executive order that led to a first-year internal medicine resident at the organization being detained and forced to return to Saudi Arabia because her visa was issued in Sudan, one of the countries on Trump’s list
Suha Abushamma, M.D., has sued the Trump administration, CNBC reports, and a federal judge has ordered the White House to explain why she shouldn’t be allowed to return to the United States.
The ban also had a direct impact on nine patients scheduled to receive care at the Cleveland Clinic over the next 90 days.
Many of the medical professionals who signed the letter are students at Case Western Reserve University, which runs the Cleveland Clinic Lerner College of Medicine.
The letter asks Cosgrove to:
Reschedule the lavish fundraiser planned at Trump’s Mar-a-Lago resort in Palm Beach, Florida
Release a public statement that condemns the immigration ban
Pledge to use his power to protect Cleveland Clinic employees from deportation and allow patients to continue to receive care
Emphasize that Cleveland Clinic values diversity and relies on immigrants to provide medical care
Following a decade of unprecedented growth, Geisinger Health System has launched a nationwide recruitment effort to increase its workforce 5 percent, by hiring more than 1,500 physicians, advanced practitioners, nurses and support staff.
And that recruiting “will certainly continue to include many positions in the central Pennsylvania region, where Geisinger was founded and has its corporate headquarters,” according to an early evening statement released by Geisinger.
“Caring for more than 3 million patients every year takes a team,” said Julene Campion, vice president of talent management at Geisinger, in a prepared statement. “Every day, our 30,000 employees strive to improve that care. This responsibility has motivated Geisinger to push the boundaries of geography and healthcare innovation, grow its medical specialty and subspecialty offerings, and recruit the best and the brightest for more than 1,500 critical healthcare positions to better care for our patients in the communities we serve.”
Geisinger is seeking candidates for all levels of employment, including administration, clerical, environmental services, food services, laboratory services, information technology, marketing, occupational therapy, pharmacy and research.
In the past year, Geisinger President and CEO Dr. David Feinberg has also instituted a $10 minimum wage across the health system.