Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.
Nursing on Trial
It’s about time that nurses are held accountable for their jobs (“As a Nurse Faces Prison for a Deadly Error, Her Colleagues Worry: Could I Be Next?” March 22). Several measures, training, and computer systems are already in place to try to ensure that nurses do not make medication errors. But they just ignore them or manually override the computer. Medication errors were rampant at my last hospital job. Every hospital has an anonymous system where any employee can report these kinds of errors. I reported several medication errors, and nothing was ever done about it. No meetings, no emails, no “here is an example and we need to do better.” So I gave up reporting them on the system.
A few days before I retired, I was telling the night nurse about a med error I prevented on a new patient admitted the night before. Turns out she was the one who made the error! Her response was, “Shouldn’t pharmacy have caught that?” She took no responsibility for not clarifying the order. And she had been a nurse for over two decades. And the med error was close to an overdose amount, according to the pharmacy.
My experience was that there is very little accountability in nursing unless a manager doesn’t like you. It has nothing to do with the ability to do the job or patient safety.
— Phyllis Mitchell, Laguna Woods, California
— Tom Wriggins, Naples, Florida
I’ve been a registered nurse for two years and was a licensed practical nurse for 10 years. What RaDonda Vaught did is abysmally wrong on so many levels. I cannot believe the number of licensed professionals trying to defend pure malpractice and negligence (“Reaction to the RaDonda Vaught Verdict: KHN Wants to Hear From Nurses,” March 30).
This is not a “system problem,” it’s a RaDonda problem. You’re telling me she should be exonerated after blowing past 10 huge red flags?! They said “Stop what you’re doing and make sure it’s correct. This is a PARALYTIC drug.”
No more system checks would have made a difference because she ignored every single one that came up. Medical professionals rely way too much on technology. Blaming technology and “the system” are poor excuses for what happened.
If I was drinking, then decided to drive my car at 80 mph through a neighborhood, blast through stop signs and red lights and kill a child, should I be forgiven with a slap on the wrist?
Pure and simple negligence. These people trying to defend Vaught are all about professional responsibility, and want RNs to be respected, but think this is OK? The RN is a professional, licensed nurse and is the bottom line against errors that slip through the system. If she would have taken two seconds to think about the five rights, this never would have happened, regardless of whether there were problems with the automated medication-dispensing system. This is basic Nursing 101.
This case really upsets me. The fact nurses are trying to shift blame away from her is alarming. And if they’re worried it could happen to them, then maybe they shouldn’t be practicing.
— Paul Dziejman, Depew, New York
— Katie Wee, Boston
One important cause of potential nursing errors not mentioned in the article is understaffing. My RN sister’s intensive care unit expects as many as six nurses gone soon, from her shift alone. And the worse conditions are, the less likely even agency nurses will accept a position. Do dedicated RNs stay for the patients’ sake, or leave to protect themselves? You can help both patients and nurses by supporting safe staffing legislation in your state.
— Gloria Kohut, Grand Rapids, Michigan
— Sunny Ro, Philadelphia
The Fallout of Prosecuting Medical Errors
In the article “Nurse Convicted of Neglect and Negligent Homicide for Fatal Drug Error” (March 25), I found myself reflecting on my future nursing career. Although it is clear RaDonda Vaught was guilty of a medication error that led to the death of a patient, I can sympathize. The hateful public ridicule she has been given and the defaming comments from the prosecutors regarding her nursing character being “uncaring … and abandoning her patient” are alarming. It creates an alternative narrative of what has taken place, and that is that Vaught intentionally harmed a patient, not accidentally. Reporting any type of medical error whether it is small or large is crucial in identifying safety issues in nursing care and, with the handling of the Vaught case, some nurses may feel that admitting to a mistake can cost them their job and/or their life. To build progress toward improving health care delivery, the handling of medical errors should be judged fairly, and without shaming nurses who have dedicated their lives to protecting and healing patients. As stated in the article, “Health care just changed forever,” and this creates an environment of fear and mistrust, and an unsupportive system for nurses to come.
— Katarina Velardez, San Francisco
— James Barry, Denver
I am saddened that with all the efforts made to advance patient safety that RaDonda Vaught was prosecuted versus Vanderbilt University Medical Center and/or the drug-dispensing vendor.
We know that medication errors occur every day and we need to continuously work to reengineer things to make it hard to make an error. Having been a nurse for many years, I am appalled at the manipulation of calling nurses who work in challenging conditions heroes until something goes wrong.
This error was completely understandable and predictable. First of all, after decades, why are these systems still not programmed to recognize both generic and brand names? That alone would have prevented this medication error.
Secondly, as with all broken systems, when there were known dispensing issues with the drug-dispensing system, why wasn’t Vanderbilt proactive? If nurses needed to override the system routinely, why didn’t a patient-safety expert conduct an FMEA (failure mode event analysis) and remove all high-risk drugs from the drug-dispensing machine?
Vanderbilt has failed patients and nurses and should step up. Without focusing on investigating what went wrong and sharing the findings with other organizations, health care cannot learn. Vendors for these systems are also failing patients and nurses. Shouldn’t there be requirements by now for all searches on these systems to include both brand and generic drug names?
We have created a distraction with this trial to mistakenly help Americans feel safe. We removed this “bad” nurse, so we are safe now. The truth is patients are now less safe than before this verdict. Nurses always live in fear of making a mistake and causing harm. We struggle to continue to work in environments where our voices for patient safety are not heard and are silenced.
This is a step backward for all of American health care in which medication errors remain the No. 1 type of error. We have neglected to be transparent and learn how to prevent another nurse from making the same mistake. This has reaffirmed for me and other nurses that you will be asked to work yourself to exhaustion, give all your mental and physical strength and be called a hero so long as it benefits an organization or society, but when something goes wrong you will be unsympathetically discarded and made a villain. How sad.
— Carole Cassidy, Newtown Square, Pennsylvania
— Garry Klein, Iowa City, Iowa
A Family Caregiver’s Plea
Another essential part of family caregivers should be a requirement for medical records to be able to be accessed by the family (“To Families’ Dismay, Biden Nursing Home Reform Doesn’t View Them as Essential Caregivers,” March 22). I am the legal guardian of my sister-in-law and have no access to her medical records. She is not capable of answering my questions accurately. I need to be able to see those records to monitor her medications and follow what care is being provided. It isn’t as if they don’t use computers. It would require no extra work on the staff’s part. And we should have also access to the same info the staff sees. Because I have no access to her records, it made no sense for me to continue to take her to her own doctor or psychiatrist because I can no longer answer the questions they ask about her activity and her health and eating. I visit twice a week and do some of the little things that the staff misses. There are times I suspect a missed dose of medication or a medication change, but there is no way to know for sure. I am considering moving her to a different facility for this reason. I just think this is a vital part of including family, especially if they have guardianship.
— Theresa Smith, St. Joseph, Missouri
— Lynn Friss Feinberg, Washington, D.C.
Concerns About an Autism Therapy
I’m concerned about the article “Delays for Autism Diagnosis and Treatment Grew Even Longer During the Pandemic” (March 30) because it does not include any input from an actually autistic adult and it supports ABA [applied behavioral analysis] therapy as the gold standard for autism treatment, a theory dethroned by several recent studies. I was recently diagnosed as autistic as an adult and have done thousands of hours of research on what is the best treatment for myself and an underage family member under my care.
ABA is extremely expensive and time-consuming and not proved effective, according to a recent study by the Department of Defense, and could be actively harmful to children receiving the therapy.
In addition, the therapy practice is ethically questionable, as it was founded by Ole Ivar Lovaas — yes, the same guy who founded gay conversion therapy. And forcing an autistic kid to “convert” to looking “normal” is equally harmful.
Therapies that should be recommended for recently diagnosed children should be occupational therapy, to determine sensory issues and a sensory routine to support those needs; speech therapy (if needed); and training in the collaborative problem-solving method by Dr. Ross Greene.
For more expert knowledge than mine on the harms of ABA, see the work of the Therapist Neurodiversity Collective. Thank you for your attention.
— Andrea Hebert, Nashville, Tennessee
— Ndubuisi Okeh, Capitol Heights, Maryland
More on Vaccines and Covid Transmission
As one of your readers, I value your overall mission. I am writing with concern about the article by Aaron Bolton, called “Patients With Vulnerable Immune Systems Worry Vaccine Exemptions May Put Them in Peril” (March 22). The premise of the article is that unvaccinated health care workers are putting patients at risk, ignoring the widely acknowledged fact that vaccination does not prevent, or even reduce, transmission. I would expect greater diligence in demanding objectivity from your featured authors, rather than perpetuating fear-based claims that unfairly target those front-line workers who have been working overtime for the health of the public.
This article offers information on the transmission of covid-19 that may help inform which pieces you choose to run in the future.
— Hannah Miller, Missoula, Montana
— Barbara Katz-Chobert, Philadelphia
Removing the Stigma of Miscarriage
I am a student nurse at California State University-East Bay and am writing regarding the article “After Miscarriages, Workers Have Few Guarantees for Time off or Job-Based Help” (Jan. 26). I would like to start off by simply saying thank you. You discussed a topic that has gone ignored for so long. It is disheartening to read that not even half of our country has enacted laws that provide paid sick leave for miscarriages. My hope is that articles like yours will allow us to have deeper, meaningful, and destigmatized discussions about miscarriages — and, more so, to acknowledge the emotional, mental, and physical impact on anyone who may have experienced such loss.
— Catherine Zelidon-Sarcos, Pittsburg, California
— David Cortright, Austin, Texas
Countering the ‘Abortifacients’ Argument
The morning-after pill and IUDs work by preventing conception, not by preventing implantation (HealthBent: “As Red States Push Strident Abortion Bans, Other Restrictions Suddenly Look Less Extreme,” March 30). The hormonal IUDs create a mucus plug that prevents the passage of sperm. Copper IUDs create a sterile inflammatory reaction that essentially neutralizes the ability of the sperm to penetrate the egg. Emergency contraception pills prevent ovulation. By perpetuating the anti-choice narrative that these methods work by preventing implantation, you are discouraging and stigmatizing their use.
— Amy O’Meara, Kamuela, Hawaii
— Kate Woods, Atlanta
The Cost of Treating Troubled Kids
The $400-plus-a-day average reimbursement per child equates to almost $148,000 a year. That seems like plenty to accommodate one of these children (“Montana Is Sending Troubled Kids to Out-of-State Programs That Have Been Accused of Abuse,” March 25). I also think the story glosses over the challenges that these children present to the schools.
— Mike Morgan, Bozeman, Montana
— Ian O’Neil, Boston
Before you write an article about out-of-state abuse and quote someone …
“Shipping those kids out of state for treatment for behavioral and substance use disorders comes with a high price tag, and often the children’s issues are not resolved or are even worse, said Michael Chavers, CEO of Yellowstone Boys and Girls Ranch. ‘When they return to us, they return with worse outcomes and for higher cost,’ Chavers told Montana lawmakers last fall.”
… you might want to look at the background of the Yellowstone Boys and Girls Ranch, as it had to pay out $300,000 in a boy’s sexual abuse case in 2018. Let’s clean up our backyard first. Do some research before throwing stones. The author of the article should have done better research on the business or people they were using as “experts.” Shame on YBGR and Chavers for making comments as if they are without problems.
— Kim Hover, Stevensville, Montana
Embracing Personalized Medicine
In the article “Big Pharma Is Betting on Bigger Political Ambitions From Sen. Tim Scott” (March 28), KHN describes the Personalized Medicine Coalition and its work inaccurately for a second time (see also “A Senator From Arizona Emerges As a Pharma Favorite,” May 29, 2020). PMC, a 501(c)(3) nonprofit organization comprising 14 distinct stakeholder groups within health care, with the largest segment made up of “research, education, and clinical care institutions,” is not a trade association and does not represent any single industry or business model.
Moreover, your implication that personalized or precision medicine jacks up the costs of pharmaceutical products misses the mark. Its goal, in addition to promising better outcomes for patients, is to lower systemic costs for health care by making it more efficient.
Personalized medicine has been shown to save health systems money while improving patient care. The Teachers’ Retirement System of the state of Kentucky, for example, has found that integrating genetic testing into prescribing decisions saved the system $5,176 per enrolled member by targeting treatments to only those patients who will benefit, sparing expenses and side effects for those who will not. For cancer patients, Intermountain Healthcare has also found that genomic testing can lengthen progression-free survival rates without increasing costs.
Sen. Scott may or may not have his eye on higher office, but he is correct that we could do a lot worse than embrace personalized medicine.
— Edward Abrahams, president of the Personalized Medicine Coalition, Washington, D.C.
The Long Arm of Big Pharma
I just learned about your website, thanks to a recent daily current events analysis done by American history professor Heather Cox Richardson, which cited a link to the amazing webpage providing insight into Big Pharma’s deep-pocket reach into Congress. I have nothing but admiration and appreciation for the work that went into making such a page.
And I say that despite the unfortunate personal surprise and bummer it was to see my congressman listed prominently as the “Freshman Favorite,” Rep. Frank J. Mrvan. Living here in Indiana means Eli Lilly has always had an outsize influence on societal affairs. So the fact that it is at the very top of his list of pharma donors is not surprising. But then there were all the other pharma companies underneath Eli Lilly — an eyebrow-soaring number, actually.
Because the dates go back to 2007, I had been hoping to compare his reputation against his predecessor for this district, Pete Visclosky. The man was highly esteemed and as such remained incumbent here since I can remember, at least since I was in high school in 2000.
I hope your project can fill in data on predecessor representatives. It would help folks like me contextualize just how much pharma donations may have already been a problem. The underlying reality is that each individual receiving donations does so on behalf of a particular office — therefore, my interests as a citizen are aggressively bought out.
I’d like to know if my say with my previous congressional representative was diluted at all. Particularly when it comes to certain personal aspects of the pharmaceutical industry, like the $16,000-a-month medication that kept my mother alive for a while longer in her years-long fight against cancer, which she maintained until one day she couldn’t anymore. (Without the Affordable Care Act’s insurance having “arrived in time” for her finding a lump and being diagnosed, our ability to afford such a treatment would have been nonexistent.)
In other words: I would very much appreciate the possibility to know how angry and resentful, and therefore politically active, I should be when it comes to the donation-driven influence pharma has had on this small bit of democracy assigned to me, my family, my friends, and my home community by and large. Thanks again for the outstanding work. It is very, very appreciated!
— Tomas Feher, Chesterton, Indiana
— Dr. George Monks, Tulsa, Oklahoma
Combating Congenital Syphilis
It’s heartbreaking, yet unsurprising, that the rates of congenital syphilis are increasing in the U.S. (“Babies Die as Congenital Syphilis Continues a Decade-Long Surge Across the US,” April 12). Public health departments are underfunded and reproductive rights have been under attack for many years, especially since Donald Trump’s presidency. The defunding of clinics, like Planned Parenthood, due to anti-abortion legislation across the country, also means that many people seeking STD screening and treatment are losing places to do so. As a birth worker in Los Angeles, I witnessed firsthand how lack of access to health care impacts communities of color through structural racism.
It is unacceptable that babies are dying from a totally treatable illness, due to a lack of staff and resources to help pregnant people with syphilis receive the diagnosis and treatment they need. Just as we had to get creative during the pandemic, this health problem requires creative solutions, partnership, and technology. How great would it be if a patient could receive their STD results and directories of places to pick up medications to get treatment, just as they can with covid-19. A solution must be found quickly. The health and well-being of babies, especially babies of color who are being affected at higher rates, depends on it.
— Candy Ramirez-Hale, Oakland, California