Travel, Masks, Public Health Emergencies and Criminalizing Medical Errors
Written by Dr Nick on May 2, 2022
This months episode of “News you can Use” on HealthcareNOWRadio features news from the month of April 2022
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
This week top of mind is the big increase in travel and the recently renewed Mask Mandate till May 3 – which could mean it expires as this episode goes live. The US renewed the Public Health Emergency and Craig does a great job of explaining why this extension is so important and all the potential impacts that could occur if it were to disappear
We talk about clinician strikes, clinician pay, and burnout and end revisiting the case of RaDonda Vaught, the former nurse criminally prosecuted and now convicted of gross neglect of an impaired adult and negligent homicide – essentially the criminalizing of medical errors.
Listen in to hear a detailed breakdown of the system errors, lack of bar codes, limited search capabilities, and why a culture of safety is what we need where the system that allowed this tragic mistake to happen, is changed not where the individual is scapegoated
You can read more about the series here and the concept of keeping up with innovating in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in.
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Raw Transcript
Nick van Terheyden
And today as I am each and every month, I’m delighted to be joined by Dr. Craig Joseph. He’s the chief medical officer for Nordic global. And we are talking about news you can use for this month, Craig, thanks for joining me.
Craig Joseph
As always, my pleasure to be with you. And I understand that you’re not in your normal sounding closed studio.
Nick van Terheyden
No, it’s, it’s almost a throwback Thursday kind of experience. Because when I first started podcasting, I used to do this live. And in fact, I’m in one of those live experiences right now I’m in an airport. So if you happen to hear some background noise, there will be no prizes for guessing which airport I’m in really doesn’t matter. But it’s the necessity of a selective use of the mute button to try and minimize as much of that. And that’s really, one of the primary topics that I thought we would start talking about was the increase in travel. And literally, just recently, the extension to the mask mandate. But unlike previous extensions, it was only two weeks. And I actually did an unofficial poll with some folks, I like to get the sort of consensus. And interestingly, the consensus was very much it was going to be extended. I was in the camp that thought that this was really past its time. But it’s extended. But interestingly, only two weeks, do we see this possibly disappearing? And what are your thoughts about it? I know, I have some thoughts about it,
Craig Joseph
as well. And I think that we we disagree a little bit on whether we’re going to wear masks when we don’t when we don’t have to. I think that what’s happening now with regard to the mask mandate on the airplanes and in airports and buses and trains, is that the CDC is buying time, right? What is going to happen with this new variants that has kind of been sweeping England, and it’s should be starting to come up and affect us. And so far fingers crossed, seems to be that we’re okay. And and it doesn’t seem to be significantly changing hospitalizations or, you know, people getting very sick. And I suspect that the CDC says, you know, we need two weeks to two figure just to be sure that, that this is, you know, new variants is not going to cause us any serious problems. Because Can you imagine what would happen? Dr. Nick, if they took away the mask mandate, and then three weeks later, re instate reinstated, the mask my mandate, and I suspect that would be that would cause a few problems. I like you have been on a lot of airplanes recently. It’s really, so to speak, taken off for me. And people are, in my experience are wearing the masks and not complaining. But boy, the flight attendants and the pilots are just pushing it real hard. And that, you know, by pushing really hard, I mean, hey, we don’t like wearing these masks either. So please don’t take it out on us. And I think everyone has gotten that message. And I think it would be a real shame. If we took away the mandate, and then had to bring the mandate back. I would if I were a betting man, I would not bet a lot of money. But I would bet a small amount of money that in two weeks, it will be it will be reversed in will there will be no more mass mandate a
Nick van Terheyden
very small amount of money. Well, so the consensus here would be, you know, lifting of the mass mandate, but that implies in this instance, that you think that the stats are not going to impact the decision making. And you know, my question around this and you’re right, we do disagree a little bit. And I will tell you that I’ve sort of seen both ends of the spectrum on track travel, I’ve seen this sort of, you know, relaxed approach, let’s be honest, it is impossible to drink, and eat whilst wearing a mask. I don’t use a straw, even before COVID I hated straws, and I still don’t use them. And eating is a whole thing. And I’ve seen, you know, very aggressive implementation of this mask requirements, you know, asking people to put the mask back up between bites between sets. And I know people take a little bit of liberty but ultimately, you know, the difference between one end of that spectrum and the other is this essentially people’s response. And I think what you’re doing is you are alienating the population with a policy that has started to really impact. And the other thing, I’ve got to say, I’m my, my tears are falling, as I look around me, and I see young children who struggle with interactions, because they cannot reconcile faces, you know, and interact in the way that they need to, especially at the young ages. So, I certainly hope so. But the other thing I would say, relative to that assessment of, you know, whether we should or shouldn’t is, are we measuring the right thing? So, if we measure cases, we can continue to find cases, potentially, because it seems like there’s a new variant and you know, but is it causing as additional trouble or, you know, death, or morbidity and mortality. And I’m not so sure that that’s the case. And I also don’t think bed utilization necessarily fulfills that purpose. Because if you weren’t pre COVID, bed utilization was extremely high, because that’s the way the system is designed. So I’m not sure how we titrate this, and if the mandates are the right way to approach this,
Craig Joseph
you’re right. infectious disease experts that I, I follow, I think today said we’re not measuring serious disease, we’re measuring bad colds at this point. Among the majority of the population who have either a already been infected, and survived, and B, or B have been immunized, plus or minus, also being infected by Omicron, and delta before it so yeah, I do think people are a little gun shy about taking away some of these things we’ve seen a major city to do is Philadelphia was a Philadelphia or, yeah, Philadelphia, who, who had taken away mass mandate, and then reinstated it because their numbers, their case, numbers were going up. And that, you know, you could just I, even I am a proponent of mass wearing when in large crowds around people who, who seem to be coughing. And even, I would think that it’s not going to be good to be bouncing back and forth. And, and that’s what we were kind of teasing about our disagreement, I said that I thought that I would be wearing surgical paper surgical mask, which is, you know, fairly loose fitting and, and doesn’t hurt my ears. I will probably be wearing that for a while in airports and on airplanes. I to like you even though I know the science says the airports really the gross place, right? And the the, the airplane is pretty safe. You know, heck, I would just appreciate not getting sick, not getting sick with colds, forget about COVID. And, and so when I’m in a large crowd, I will probably, you know, bring a mask. And when I sit down to eat as long as well, if I sit down to eat, and that means I’m not wearing a mask, and I still think there’s some there’s some there’s unquestionably some benefit. The question is whether the you know, I think we’re in the area, we’re in the range now where people are just going to make their own personal decisions, and acknowledge that often those decisions are not going to be based on science or harvest data, right? Hey, I just want to wear a mask because these three people over there sitting over there are hacking up a lung. And I don’t I know, statistically they don’t have COVID they just have colds, I don’t want that. I don’t want that flu, I don’t want whatever it is that they got. So I’m just gonna wear mask and that’s okay. You know, that’s not that was stigmatized. I think that stigma is gone. And, you know, I hope that people are just able to do it, some people are much more rigorous about washing their hands and others. I think we all live on a spectrum of whatever we’re comfortable doing. And that’s okay. And whether the science supports it or not, if someone wants to be a little bit more, you know, wants to be a little bit more careful and slow, slightly decrease the risk of getting a cold and that’s that should be that should be fine.
Nick van Terheyden
Yeah, I think that’s, you know, fair point. And I think the issue of personal responsibility. I like your concept around, you know, the freedom now to put on a mask. It’s interesting, that might be the new response. That would be extraordinarily acceptable. You know, previously you’d be in an elevator or lift as I would call it, and somebody would be coughing and you might be a little bit awkward about that, but And now suddenly we’ll see people pulling out masks and putting them on and in front of the person, you know, and that’s virtue signaling at its premium version, I think so.
Craig Joseph
I was I was literally on two airplanes yesterday coming home. And of course, I’m wearing a mask in the in the airport as I’m, as I’m required to in the United States. But there were people sitting around me waiting before the we could board the plane, who were coughing. And I was just giving them the death walk. I try not to but I did on the inside, for sure. I was giving them the you know, the depth look
Nick van Terheyden
of that requires your depth look to be visible from your eyes only, of course, is that really the case? It didn’t.
Craig Joseph
I don’t think it was effective, Dr. Nick, but, but I would just like other girls, now, I was not thinking they’re going to kill me with their COVID. I wasn’t thinking that because I just thought, hey, you know, they clearly are sick, and I don’t want to be around them. And I’m glad, I’m glad I’m wearing this surgical mask. And I realized that they can still get me sick, I realized that, but the chances are lower. And and that makes me feel that makes me feel a little bit better than if I were just sitting, I would have had no other recourse than stand up and move. And so yeah, I do think that that, and we’ve seen that, you know, in people from Asian countries, right, I think we’ve discussed this had been wearing surgical masks, in airports and on your public transportation and actually in the public for decades, and it’s not a stigma and people kind of just shrug their shoulders and and move on with their day not understanding nor caring to understand why the person next to him is wearing a mask. So yeah, we saw
Nick van Terheyden
we saw the benefit for click for sure. In the first year of the pandemic, we saw zero, almost zero flu cases as a direct consequence. I mean, no, no, no question in my mind, of all of the mask wearing social distancing. So I think all good things. So for those of you just joining, I’m Dr. Nick the incrementalist today, I’m joined as I am each and every month by Craig Joseph, he’s the Chief Medical Officer with Nordic global, we’re discussing News You Can Use talking about travel mask mandates being extended. And in fact, the they did renew the public health emergency status, which is slightly different. I think that’s more about reimbursement and payment for activities. I think that’s gone out for another three months. I mean, obviously, we still have many potential consequences of the COVID disease, including long COVID. I’ve seen that with some friends that is very significant, obviously, entirely appropriate. And I think, you know, I wonder if that will continue to be extended, or we find some better way of sort of supporting people through that disease process.
Craig Joseph
But I think you’re right, in terms of you know, I think most people who travel will realize very quickly when the when the mask mandate and for public transportation goes away, I suspect most Americans will not be think that they’re as affected when the public health emergency goes away. However, I would argue that the public health emergency is actually much more important day to day for, for the public. And so, you know, what are we talking about? Certainly reimbursement. So, certain things that were not allowed prior to the public health emergency. Are we’re talking about telehealth, though, right. So it’s not just reimburse that sort of reimbursement, but the the relaxation of rules that have been in place, that, hey, if you want to talk to a doctor, they have to be in the same state as where you’re physically located. Some of those have been some of those laws and rules have been have been relaxed and would instantly go away with a with a public health emergency gone. Also, some of the handy dandy rapid tests that we use are approved by the FDA via immersion via the public health emergency powers. And when that public health emergency is revoked, all of a sudden, a bunch of these tests that are out there no longer have the FDA permission. Because they didn’t have they weren’t able to go through, you know, dot all the i’s and cross all the t’s. Also, there are I think we’re getting close to the point where it’s not relevant, but some of the vaccines that are out there have been approved, kind of have not gone through formal approval yet. Now, I think that that’s not true. I’m certainly not the expert here, but I think that’s not I think that the big ones for adults have all been now formally approved but some of the detention of those two smaller children are based on smaller datasets and with less experience because obviously, they just started doing the testing. Much more recently, so. So there are effects that are going to come when that public health emergency goes away. And I believe the government promised all of us, but most of the industries that are affected that they would have prior notice. And so it’s not they can’t give us a week or two and just say, Okay, it’s gonna start well, yes, it could, but it would be very bad.
Nick van Terheyden
Yeah, so I think great points. I mean, those are significant things that I don’t think we can afford to lose. So hopefully, there’s some plans in place, but three months down, you know, there’s an awful lot of kicking the can down the road. In politics, it would appear and I think we need to address things a little bit more long term, in our approach, particularly with public health. Subsequent subsequent to that, there’s been significant impact on the clinical folks. And we’re seeing strikes looming. In California, I believe 93% of nurses voted to come out and Sasa there’s a bunch of others. Do you think we’re gonna see more of that?
Craig Joseph
Well, you know, we’ve all there have been nursing strikes. Occasionally, there are physician strikes, long before COVID. But all the reasons I think that they were striking, are they’re in and more numerous than, than ever before. And so yeah, the pandemic has really done a number. And I don’t think that the public really understands the significance of the effect of the pandemic, just based on the amount of work, we’re not even talking about what the buyer I’m not talking about the virus affecting nurses and doctors, of course, it does, as as everyone in the population, but fewer and fewer people are carrying the same or heavier load. And that doesn’t, that can’t keep going. And now nurses have seen in particular, that perhaps they’ve been underpaid. For let me think about this forever. I am not an expert in pay for any clinician. However, we’ve seen that nurses that they travel, which really becomes there, they’re not no longer an employee of a hospital, but really a contractor. That’s always been an option. Well, hospitals have always looked for some nursing and other kinds of clinical staff who they needed for a specific reason, and they couldn’t hire fast enough. But now, the same nurse could almost go across the street to a hospital across the street and significantly improve their their salary, not benefits, because they’re not they’re not employees, but their their salary, a significantly improve that, which makes them think well, wow, this is actually what we’re worth. And so I suspect you’re right that this going on strike renegotiating contracts, demanding benefits is only going to go up. And as a nation, we’re going to have to see how we can how we can deal with that and pay for that.
Nick van Terheyden
Yeah, and it extends beyond nurses, but and other clinicians. And I’ve certainly seen in other countries, I don’t know about the US whether there’s been strikes, you know, across other clinical domains there was in Australia prior to my working out there, it had a massive impact. It was very quick in terms of effectiveness, and I think, was helpful in sort of establishing that value proposition. But it’s more than clinical. I mean, I think of, you know, the likes of supermarket workers who, you know, we all suddenly discovered were essential parts of our community and delivering a service that, you know, we just take for granted, but, you know, we’re on the front lines, but get minimum wage, and, you know, that’s not a living wage for many folks. I think it’s a real struggle. So, you know, expect much more of this. And, you know, that leads into sort of a follow up to our discussion from last month we talked about Redonda. The nurse in Vanderbilt that has been convicted and is now a criminal for making a medical mistake. We talked a lot about that, but I think the feelings continue to explode, I think adds to that overwhelming nature. And you talked about that specific group and the fact that they have been underpaid, overworked, they’ve had additional workloads. And now we’ve seen, you know, an additional stress or on that community and beyond, I think it doesn’t stop at the nurse’s. I just, I am so troubled by this. And I’ve seen certainly the other position, I think you and I both share the view that this is not the way forward. I’ve seen others who say, Well, she made mistakes, and you know, multiple instances and so forth. But that’s not the whole story, isn’t it?
Craig Joseph
Absolutely not. And I think, you know, we all start a conversation with someone died, and someone died, that would not have died directly due to a medical errors. And these things are very rare, but they do happen, and they’re devastating. And so, you know, we have to acknowledge that that tragedy. That said, this is exactly why nurses, specifically a critical care of ICU nurses are saying, Why am I doing this again? Why Why? Why am I taking on this responsibility? I am human, I am going to make a mistake. We’ve all made mistakes, doctors, nurses, therapists, we’ve all we’ve been pharmacists, we’ve we’ve all made mistakes. But often, most of the time, almost always, either we catch them or someone else catches them before they lead to a serious problem. And so this is a rare thing. I think what you’re alluding to is that the whole story was not well, a nurse made a mistake, and she shouldn’t have done that and someone died and she must not go to jail. There are systems in place that are supposed to help decrease the chance that you’re never going to go down to zero, but significantly decrease the chance of making a mistake. And you know, some of those as we’ve, as we’ve read about what happened here, neither of us has first hand knowledge where all we really know what we’re what we’re reading. But, you know, they there were there were systems that were that were functioning beforehand, and are functioning now that were not functioning then at that hospital. And so, you know, for instance, there was no ability to do barcode med administration, which is where the nurse would take an order that was in the system, and would take the medication out through the through the medication cabinet, and would use a barcode reader to scan the patient’s ID band. So we know we have the right patient, and then would barcode read the medication, which is usually in a pouch or if it’s an ambulance got a little barcode on and then the computer would be able to give a big thumbs up green checkmark that say, Yeah, this is the right patient. And this is the right medicine, the right dose, the right route and the right time, the five rights and so that that’s a system that’s in place at most US hospitals in most units that was not working due to, as I understand it technical problems. When the nurse went to the med box to override, which again does not typically happen and not emergencies. The system didn’t function the way that I think many of us would have hoped. she typed in the beginning letters of the brand name of the medication she wanted, which was Versa ve but the system was programmed not to acknowledge that there’s the existence of brand names, even though it’s a very common for doctors and nurses to use the brand names. And it only showed her a list of generic names. And the one that started with ve was Becky Romeo, which is a paralyzing agent, and she mistakenly picked up that that vial. So we could go on and on to talk about, you know, what are some of the specific technical things that should have been there in place to help prevent to help ID that this was this was going to be a problem. They were not in place. And we were counting solely on a human who we’ve already established is overworked. Oh, and by the way, she was training another nurse. So she had multiple things going on at the exact same time. And it’s just a it’s a you know, we talked about the Swiss cheese effect when all the holes all the layers of the safety net, all have to line up just perfectly for a mistake to kind of go through. And that’s exactly what happened. And I hope that everyone acknowledges that if we just kind of humans to never make a mistake. We are going to be sad and have many more funerals and much more morbidity and medical problems than then we should if the systems were in place.
Nick van Terheyden
Yeah, I think that eloquently stated, I would say, you know, as somebody else, I’m quoting someone else here that, you know, a culture of safety is one in which the system that allows a mistake to happen is changed, not one in which the individual is scapegoated. And ultimately, a culture of safety correlates with better patient outcomes. You know, we’re getting the opposite with this based on what I’m hearing, and I think you described very clearly multiple points of failure that, you know, are not attributable to a single. And certainly, you know, the lack of intent here is a huge deal for me, but unfortunately, as usual, we’ve run out of time. Just remains for me to thank you as always, for making the time. And joining me on the show, Craig,
Craig Joseph
thank you. It’s my pleasure and safe travels to you
