A Lot to Be Thankful for, I Suppose

I guess I should be thankful that I have insurance, even though BCBS of Texas just sent me a letter informing me that my 2009 premium will increase by 9%. Yeah, I am grateful to pay even more for bare-bones coverage that I haven’t used once since the 1/08 effective date. At least BCBS was nice enough to offer a couple of alternative, less expensive plans for me to consider. Both are HSAs like the plan I have now. One has the same deductible as my current plan ($2500), but I would have to pay 15% more in coinsurance for only an $8 reduction in monthly premiums. Not worth it. The other has a $5000 deductible (eeek!), but covers all INN (in-network) services at 100% after the deductible is met and offers a $23 reduction in monthly premiums.

Despite the intimidating deductible, the latter plan is worth investigating for me personally, especially since I confirmed on-line that the OOP (out-of-pocket) maximum is the $5000 deductible, meaning that if I incur stratospheric healthcare charges, I’m only out $5000 provided I stick with contracted providers. Although, it would mean a significant financial setback, I have the funds set aside to pay this amount if illness or injury should strike. This is in addition to the amount I set aside to cover preventative medical and dental care and a routine prescription on an annual basis. If the monthly rate reduction is $20 or more, I would be tempted to switch to the $5000 plan and plug the approximate $240 in monthly savings into my HSA, which I plan to fund to the $3000 maximum in 2009 if all goes as planned. I suspect, though, that given the 100% coverage perk, I would have to go through the underwriting process again, which is a major pain in the ass. Then again, since I just went through underwriting at this time last year, and I haven’t seen any healthcare providers since, there’s no new information to review. Maybe, they could fast-track me somehow. Naaaahhh!

The insurer sent along a new application for which I’m sure I’d have to pay a non-refundable fee, so I tried in vain to get through to customer service to confirm whether I’d actually have to reapply to switch to the $5000 plan, go through underwriting again, and pay a fee. But, of course, being the day before Thanksgiving, it appears that only two customer service reps are servicing the entire BCBS Texas membership because after wasting 30 precious daytime cell phone minutes waiting for a representative, I still couldn’t get through. I will try again next week before I resign myself to paying the 9% increased premium for my current plan. In the meantime, I’m thankful that despite suffering from a wicked cold at the moment, I enjoy good health, which affords me the privilege of considering a $5000 deductible plan. I’m also thankful that I’m not a chatty Kathy and can waste the occasional 30 daytime minutes on hold without incurring outrageous overage charges. I resolve to be a well of gratitude, at least until I attempt to contact customer service again.

Big Pharma Throws a Tantrum

The physician I work for operates two offices, and both are frequented by pill reps hocking everything from blood pressure medication to anti-depressants, and of course, oral contraceptives, since my employer’s specialty is OB/GYN. Most of the reps are obnoxious, but none more than this immature twit who throws a tantrum when she thinks we’re favoring other pills over her beloved Loestrin24.

This “girl” is in her mid-20s and not too bright, but she believes that since her father is an OB/GYN, she’s down with the healthcare professional crowd. She thinks the nurses and medical assistants are her friends and tells us all sorts of unprofessional TMI, such as how she spent most of her college years drunk like everyone else (say what?), that she has a learning disability (I’ll say!), and that she can’t find a good man to settle down with (the horror!). She also badmouths all other pills, even going so far as to tell me that the pill I’d taken for over five years was “a really bad pill.” I responded that perhaps I should sue my physician of twelve years who just happens to be on the faculty of a well-respected medical school for prescribing me “a really bad pill” that happened to do me a “hell of a lot of good” seeing as how I remained un-pregnant and symptom-free while on it. She didn’t have a response, but one can’t expect an articulate exchange to occur with this person who has no compunction whatsoever about revealing how she graduated with a 2.something GPA in some bullshit major.

Lately, she’s taken to pouting openly and slamming the sample cabinet doors to illustrate her discontent with our perceived disloyalty. My colleagues have tried to reason with this entitled dumbass by explaining to her the financial hardships faced by individuals in the real world, specifically that they cannot afford to pay $40-50 per month for any brand-name pill and that’s why we give them prescriptions for brand-name and generic medications, so they can get what they can afford. But, healthcare ethics and simple logic hold no sway with this ignorant creature who doesn’t know the first thing about women’s health issues. Perhaps, she has too few brain cells left thanks to her collegiate binge-drinking. Then again, maybe she’s just stupid.

In any case, something must be done about this brat. I don’t have much faith in my employing physician, since he tends to be somewhat of a pacifist with the reps. He mostly ignores them, Ms. Loestrin24 included, except to sign paperwork and sample the sweets they bring, leaving the staff to deal with their endless drama. Luckily for me and for her, our paths haven’t crossed since the escalation in her behavior. I don’t care too much for children and even less for childish adults. I won’t have any problem showing her the door after I lecture her about what “a really bad pill” she’s hocking.

They Want to Hire Me to Spy on You

I just received a personalized recruitment letter from Aetna urging me to apply for a telephonic Disease Management position in Sugarland, a Houston suburb. I know I’d be a shoo-in for this opportunity because I have tons of healthcare espionage experience with one of Aetna’s major competitors. Actually, I wasn’t a very good spy. I spent most of my time helping members sort out their claim issues, which was totally outside my job description. I was supposed to punt all these calls to a “Rapid Resolution” expert in the claims department, but I’m not a big fan of passing the buck, especially when the member has my direct number and will contact me for follow-up. I know just enough about the claims payment process to be a major pain in the claims department’s ass and a major asset to members.

I’m not surprised about receiving a recruitment letter even given the economy because turnover in these positions is high mainly, I think, because the nurses who apply have no idea what they’re getting into. Many of them are “getting older” (their words, not mine), are tired of hospital shift work, and like to talk on the phone. They think they’re just going to chat with people about their health and benefit plans. In reality, these jobs are where nurses come to die. Take a look at the following job descriptions in my recruitment letter:

Disease Management
Disease Management offers education and case management services for members who have chronic health conditions such as asthma, coronary artery disease and juvenile diabetes. As a member of our Disease Management team you will be able to view Aetna members holistically, considering multiple diseases or conditions across all benefits plans, and deliver individualized programs based on their unique needs and preferences.

AND

Beginning Right Maternity
As a Case Manager, you will utilize clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate healthcare outcomes for members. Your responsibilities will include assessing members’ health status and care coordination needs, including discharge planning. You will offer member outreach and provide information, education, and follow-up activities.

Oh, Aetna, could you been any more frickin’ vague? How about hiring Renegade RN to rewrite your job descriptions, so applicants can get a better idea about what the job truly entails? Here goes:

Disease Management
Disease Management offers harassment and stalker services for members who have chronic health conditions such as asthma, coronary artery disease and juvenile diabetes that cost the company a ton of money. As a member of our Disease Management team you will be able to view Aetna members as greedy consumers, considering how to keep the sicker-than-shit ones out of the hospital while keeping a close eye on their benefit maximum, so you can kick them off the rolls ASAP, and deliver canned healthcare advice anyone with access to a computer or a television or a functioning brain stem can find.

AND

Beginning Right Maternity
As a Case Manager, you will follow the company’s computerized script in a talk-to-the-hand-kiss-my-bureaucratic-chain-of-command process to harass, negotiate with, and manipulate the poor bitches by threatening to withhold payment if all parties won’t comply with your care plan in an effort to find the cheapest healthcare outcomes for greedy, knocked-up consumers. Your responsibilities will involve monitoring pregnant women’s every move with an especially keen eye on those aging, high-dollar heifers, their sicker-than-shit preemies, including figuring out how to boot all of them out of the hospital more quickly. You will offer targeted espionage efforts and canned healthcare advice anyone with access to a computer or a television or a functioning brain stem can find.

So, Aetna, can I get an interview?

Why Consumer-Driven Health Plans Screw the Consumer

This New York Times article mentions the increasing number of companies offering high deductible health plans (HDHP) for 2009. Some are shifting entirely to these so-called consumer-driven plans. The popular theory behind these plans is that shifting more healthcare costs to the consumer will result in decreased costs overall because people will choose their care more carefully, thereby increasing competition among providers and decreasing healthcare costs and wasteful spending. Never mind the fact that competition among providers in our current, unchecked system has not reigned in costs at all. They continue to skyrocket well beyond inflation. It’s true that consumers are less likely to utilize care when they have to pay huge amounts, which should decrease costs in the short-term, but it will do nothing to promote prevention and management of illnesses before they become severe or life-threatening, and of course, outrageously expensive.

A key problem is that consumers, even when they assume full responsibility for researching the most affordable, quality care, do not have all the information they need to make informed decisions. Namely, providers and insurance companies alike withhold critical information about costs and contracts, so that consumers are left with the burden of paying upfront, sometimes 2-3 times the actual amount, until they sort out the contracted rate many months later. For example, I have several years experience with an HDHP, both on a group plan with my former employer and now on an individual plan. While under my former group plan, I visited a specialist for a rather benign, yet chronic problem. Being a relatively healthy individual, I had not yet met my deductible, so the provider asked to be paid upfront for the full cost of the visit, or rather his version of the full cost of the visit.

Here’s the rub. If I fulfill my end of the bargain by seeing an in-network (INN) provider, I am obligated to pay only the contracted rate for services, not the wildly inflated cash price the provider thinks his services are worth. Each INN provider negotiates contracted rates with particular insurers. The rates may be different for each insurer, but the two parties know what amounts will be paid and under what circumstances. But, neither of them will divulge this information to patients aka consumers! In my case, the billing department said they didn’t know the contracted rates. This is a lie, and this lie is being perpetrated by many providers who are too lazy to look up the contracts. In their defense, I know they may have hundreds of contracts and it’s not really feasible to have all this information at their fingertips, but this is no consolation to the HDHP consumer who gets screwed because she or he has no idea what the actual cost is.

In short, I was asked to pay $360, which I begrudgingly did because I had no way of knowing the contracted amount and needed to see the doctor for a follow-up visit. I certainly wouldn’t be allowed to come in for a follow-up if I hadn’t paid for the first visit. They essentially had me over a barrel. When I received my Explanation of Benefits (EOB) several weeks later, it showed the allowed amount for the entire visit was $120. The provider charged me three times the contracted rate, and it took six weeks and three phone calls to the billing department to get my $240 refund. I was told on multiple occasions by the provider that they had not yet received payment and that all refunds were processed on a monthly basis. Not only did they overcharge me, but they enjoyed over a month’s worth of interest on my hard-earned money, which I complained about to the billing manager. She acted surprisingly nonchalant about the amount I was initially charged as if this was no real concern to her.

And, it isn’t, of course, because the bottom line is that unethical providers will collect as much as they can knowing that most consumers are simply too ignorant, sick, or frustrated with the system to demand the fair price. They are not bearing any financial risk when they overcharge patients who comply with their usurious demands. They are no better than the Wall Street fat cats and predatory banks and lenders who are mostly responsible for the economic debacle we’re experiencing right now. And, it’s the little people who are losing. The insurance companies wash their hands of responsibility by stating that contracts are private and cannot be disclosed even to the those whom they directly affect—healthcare consumers.

So, to all the free-market-will-cure-all-of-healthcare’s-ills acolytes, I ask how consumers are supposed to determine the most affordable care if they are not privy to contracted rates and the true costs of services. Sure, some insurance companies have websites showing average costs of care for certain procedures, but these are marginally helpful and inaccessible to a large portion of the population that doesn’t have internet access. Moreover, even knowing the supposed going rate for a particular service does little to help one bargain with a provider who prominently displays a sign in the window stating, “Payment is expected at time of service.” Insurance companies should be legally required to disclose contracted rates for every billable service at the consumer’s request. Likewise, providers should be legally prohibited from charging more than the contracted rates for any billable service. Only then will we have the transparency necessary for the consumer to get a fair shake in determining the best care at the most affordable price.

Out-of-Network, But Not by Choice—How to Get Your OON Care Paid at the INN Rate: Part II

Congratulations! You survived your emergent illness and/or injury, and you’ve been discharged home to convalesce in peace. Not so fast, trooper. You may have gleaned some useful tips from my previous post on getting your OON emergency claims paid at the INN rate, but now you face the even bigger hurdle of getting your medically necessary, non-emergent OON care covered at the INN rate. I know you think that you won’t be using OON providers once you’re discharged because you plan to see your established INN physicians, and hopefully, this is the case. However, there are a few scenarios where access to outpatient INN care is incredibly burdensome and/or nonexistent.

For instance, if you happen to reside in a rural area where there are few healthcare providers (e.g., physicians, laboratories, physical therapists, home health agencies, durable medical equipment [DME], etc.), you could find yourself limited to OON providers. Moreover, your condition may require care from providers that typically aren’t contracted with any insurance companies. These providers are usually highly specialized physicians—hand and retinal surgeons and pediatric neurologists come to mind—or niche service providers, such as prosthetists, infusion companies, and respiratory therapists. These specialty providers are often OON because quite simply, they don’t have to be INN to garner their fair share of patients and healthcare dollars. Their skills are rare and in demand, and thus, they can be reasonably certain that when their services are needed, insurance companies will have no choice but to pay up and handsomely!

So, what recourse do you have if you find yourself facing one of the above scenarios, and the insurance company balks at paying for OON care at the INN rate? You can contact your insurance company’s preauthorization line and ask for a coverage GAP or network exception. You will need to be prepared to explain the extraordinary circumstances that leave you no option but to receive OON care (i.e., that you live in a rural or medically underserved area and/or there are no INN specialists available to treat your condition). The GAP exception request will be reviewed to confirm whether what you are contending is, in fact, true—that your care cannot be furnished by INN providers. If it is approved, you can expect that your OON care will be paid at the INN rate for at least a limited time period.

Insurance companies do not advertise the GAP exception process because they would love nothing more than for poor, ignorant you to believe you have to utilize your OON benefits, or worse, pay whatever the provider charges if you happen to have no OON benefits. The reality is that most companies have policies in place to address true “gaps” in their INN service areas. For example, the large insurer I worked for had the policy that if the nearest INN healthcare provider was located more than 60 miles or 30 minutes drive time from the member’s home address, we were obligated to honor GAP exceptions and pay OON providers at the INN rate. The same goes for treatment from providers like the aforementioned who are generally never INN.

Of course, this does not give you carte blanche to access services not explicitly authorized by the insurer. Just because you received the okay to have OON care at the INN rate from one provider does not mean the same goes for other services. Everything has to be reviewed individually on its own merit. Also, understand that your insurer will never agree to pay for OON charges at the INN rate indefinitely, so do not assume anything, and always request the authorization of services in writing. As always, you will need to remain vigilant in reviewing your EOBs to ensure your claims are being paid correctly going forward. Remember the electronic billing morass I discussed in the previous post? It will continue to be the bane of your existence.

I won’t lie to you. Negotiating the GAP exception process is a bitch, but the alternatives are to fork out your own big bucks (if you’re lucky enough to have discretionary funds) or forego care that could quite possibly save your limbs and life. Aren’t these reasons enough to summon your inner bitch and fight a system that is perfectly content with allowing you to deteriorate and die for lack of affordable treatment? Yeah, so you need one hand to steady your walker. There’s no reason you can’t raise the other and make a call, okay multiple, frustrating calls. You get my point. Stand up for what’s rightfully yours!

Nurse Wannabes: I'm on to You!

I dislike posers of all stripes, but especially those of my own profession. Nothing chaps my hide more than to have a patient haughtily announce that she’s a nurse, too, and come to find out, she’s a medical assistant or a nursing student or worse, is still trying to pass the licensing exam. Word to dumb, dumber, and dumbest—you are not an RN or an LVN/LPN until you pass a licensing exam! So, please do not attempt to intimidate me with your ignorant bravado as I prepare to start your IV. I just might miss and have to stick your poser ass again. It serves you right for defiling the profession.

How do I figure you as a scammer? Well, if it’s not your idiotic, nonsensical chatter about medical conditions you learned about by watching ER and Grey’s Anatomy, then it’s your dyslexic interpretation of commonly used abbreviations in the medical profession. You see, we have our own jargon, and when you massacre it, we know you’re not one of us. Surprise!

I want to give a special shout-out to the woman who prattled on about being a nurse, yet wrote “NDAKF” next to the “Allergies” portion of her medical history form. Nice. I know you were wondering why I inquired about your allergies given your thorough, oh-so-medically-informed, answer. The truth is I’m pretty sure you meant “NKDA,” which refers to “No Known Drug Allergies,” but I just wanted to confirm you weren’t on some higher, more evolved plane of nursedom that I have yet to achieve. Turns out, you weren’t. You were just trying to pass yourself off as one of us, and you failed miserably.

Here’s some advice for next time: know your role and shut your hole! I worked hard to earn my degree and to pass the licensing exam, and I’ll be damned if I’m going to sit by idly while you make a mockery of my profession. Contrary to what you may think, I have a right to question you, especially when I think you don’t know what you’re talking about. Better study up next time, girlfriend. Renegade RN is one hell of an examiner, and you better have your A-game on if you want to play me.

Out-of-Network, But Not by Choice—How to Get Your Emergency Claim Paid at the In-Network Rate: Part I

You collapse at work, and a co-worker calls 911. An ambulance is dispatched to take you to the nearest hospital where you are admitted. While hospitalized, you undergo multiple x-rays and procedures, utilizing the services of radiologists, pathologists, and anesthesiologists—physicians that you will likely never see (while awake, at least) and whose names you probably won’t recognize when you receive their bills. You’re finally discharged to home sweet home, which just happens to be in a far-flung rural area where there are no INN (In-Network) specialists who can treat your condition within a 60 mile radius. You’re understandably shaken by this sudden turn of events in your life, but you’re focused on getting well as quickly as possible, so you can return to work. All is progressing nicely, until multiple EOBs (Explanation-of-Benefits) start arriving in your mailbox indicating that you owe thousands of dollars for OON (Out-of-Network) services that your insurance plan either doesn’t cover at all or covers only at a paltry percentage (e.g., 40-50%). Your stress quotient increases exponentially, and you teeter on the edge of sheer panic at the thought of owing so much to OON healthcare providers that you had no part in choosing due to the emergent nature of your illness and/or the special circumstances involving continuity of care. Moreover, the idea of battling your insurance company on the legitimacy of the astronomical charges while convalescing is enough to send you back to the ER.

As someone who’s intimately familiar with the labyrinthine bureaucracy of health insurance companies, I understand the unfairness of erroneous OON charges to plan members’ bottom lines. I offer the following tips to getting your OON charges justifiably reprocessed at the INN rate:

*Contact your insurance company ASAP about OON charges incurred due to emergency situations. In some cases, claims representatives can simply send your claims for reprocessing with the information you’ve given them. However, in most cases, you will have to appeal the claim in writing following strict guidelines set forth in the EOB. Keep detailed records of dates, times, and names of people you speak to, and send all documents via certified mail.

Insider Information: OON charges are a nightmare with electronic claims processing because the system will automatically deny the charge (in the case of no OON benefits) or apply the OON deductible and rate without noticing that the claim was related to an emergency. The only way to process these claims correctly involves a critically thinking human who manually overrides the system to pay the claim at the INN rate. Profit-driven payers loathe paying humans to perform processes they deem automatable even when it means plan members’ pocketbooks will be harmed. They care about volume, not quality of service or ethics.

For life-threatening situations, insurance companies cannot demand that plan members adhere to INN rules. Plan members cannot be expected to waste time locating an INN ambulance provider, and ambulance providers are often required to transport patients to the nearest facility capable of providing care regardless of its network status. Insurance companies do not advertise that they are obligated to process OON charges incurred due to true emergencies at the plan member’s INN rate because they are counting on you to grumble, but not fight the erroneous charges. When you don’t balk, they win big because the burden of higher costs rests with you, the plan member, not them. If you balk with confidence and perseverance, they will eventually capitulate.

*When you appeal, have all your documents in order and stick to the point. Gather necessary records to prove your case (e.g., a copy of the ambulance provider’s trip report and/or your emergency room evaluation showing your disposition, especially if you were admitted). Write a letter with a concise chronology of the events and make sure to emphasize that given the emergency situation, you had no control over the providers who treated you and that you expect all charges to be reprocessed at the INN rate. Be sure to include copies of all EOBs received, and if the appeal involves faxing, request confirmation of receipt, and always follow-up with an appeal in writing submitted via certified mail.

Insider Information: Insurance companies are incredibly fragmented; they are black holes. You can safely assume your information will be lost multiple times, hence the need to maintain meticulous documentation of all correspondence. Resist the temptation to digress in your appeal. Frankly, most insurance company employees could care less about the injustice of your situation, and they don’t respond to emotional pleas. They work in a profit-driven, amoral industry. The common refrain from insurance company executives is that they are not denying care, only payment, as if care and payment are mutually exclusive in our current system. The insurance company knows damn well that if it denies payment, providers are most likely not going to treat for free. They also know that most people in this situation will be unable to pay out-of-pocket, yet they wash their hands of the moral dilemma. So, save your strength, and stick to the facts. To cut through the red duct tape, ask for a medical director (an MD) to review your case.

*If your appeal is denied, you still have options. If you’re covered under a group plan through your employer and your employer is self-insured, you can appeal to your health plan administrator within your human resources department for assistance with getting your claim processed correctly.

Insider Information: It’s been my experience that when self-insured employers learn of egregious decisions like refusing to cover emergency care at the INN rate, they go to bat for their employees and complain loudly to insurance executives. After all, they’re paying the insurance company to perform all administrative duties, and they don’t take kindly to fielding complaints about poor service that waste their time and resources. When all else fails, contacting your HR department usually leads to a favorable outcome. Just make sure to reveal only as much private medical information as necessary for the particular claim you’re contesting. You don’t want to set off alarm bells with your employer that you are a liability because of increased healthcare costs, either real or perceived.

If you have an individual policy or work for an employer who is fully-insured, your options are more limited and time consuming. You can contact your employer to act as a liaison, but their effect will be minimal because they are probably a small account that has little financial clout with the insurer. And, there may not even be a human resources department to whom you can appeal. You can, however, contact your state agency responsible for regulating insurance companies and file a formal complaint, or you can reach out to your elected representatives to intervene (hopefully) on your behalf.

Clearly, these actions require Herculean effort and saintly patience, and there’s no guarantee of positive resolution. But, if you’re one who believes in principle and you have the physical and emotional strength to keep fighting, please persevere. If you live through getting your OON emergency claims paid at the INN rate, see my next post on how to get OON specialty care at INN rates when there are no INN providers in your service area. The battle continues…

Funny Fridays

The following is an excerpt from a patient’s self-completed medical history questionnaire:

Question: Have you ever been diagnosed with a medical condition or experienced any symptoms not listed on this form?

Patient’s response: “seizures when I was a little kid, but not grandmaw [sic] seizures”

But, what about grandpa seizures? Those are the worst! For the record, it’s grand mal seizures.


An overheard telephone conversation with a patient:

Patient: “I had my tubicle ten years ago, and I need to get it fixed.”

Co-worker: “I’m sorry. Did you say tubicle? What exactly did you have done?”

Patient: “You know, a tubicle, so I can’t have no more kids.”

Co-worker: “Oh, you mean a tubal ligation. Well, the first thing you need to do is have your operative report faxed to our office, so that the doctor can review it and determine if you’re a suitable candidate for the reversal procedure. Then, we can schedule a consultation.”

Patient: “Why do I have to do that? I had a tubicle.”

Renegade RN: “No one doubts that you did, ma’am, but the doctor needs to review your operative report to see how your tubal ligation was done and if he can, in fact, reconstruct your tubes. Have you had any other surgeries on your female organs?”

Patient: “No, just my tubicle.”

Score—Patient: 1, Nurse: 0. Some people you just can’t reach.

This Is Why Nurses Leave the Profession

Incidents like this remind me of why I left the hospital bedside. Granted, we’re told there’s more to the story in this particular case of a nurse who was punished by management for bringing an AWOL patient back to the institution without following some asinine protocol. Perhaps, if management were more forthcoming, I might have a clearer picture of Ms. Diasparra’s alleged transgression and feel differently about the outcome, but I doubt it.

Nurse Joyce Diasparra was on her way home from work when she noticed an escaped patient wandering along a dark road. She didn’t have a cell phone to call for help. Fearing for her safety confronting a potentially unstable and violent patient on her own, she did what any prudent nurse or reasonably sane person would do. She went back to her place of work to summon help. Not only did she enlist the help of the security guard, but she went with him in her vehicle back to the scene, retrieved the patient, and escorted him back to the institution. She could just as easily have passed by the patient without notifying anyone, and she certainly didn’t have to retrieve him herself. This is where we witness the dedication of a 15-year employee and the compassion of a true Good Samaritan.

Apparently, management had other ideas about Diasparra’s behavior. According to them, she broke a cardinal nursing rule of never leaving a patient in an unsafe situation. So, we should expect this lone nurse to coax a potentially dangerous patient into her vehicle, subdue him if necessary, and transport him back to the institution without incident. Does this sound like a safe scenario to anyone? Maybe, she should have just tailed him along the road, flashing her lights and shouting frantically at passer-bys to call 911, until he got agitated enough to run for cover, or maybe even into a line of traffic! Yeah, that makes a lot more sense, since, technically, she would never have left his side and broken the pesky rule.

And, playing devil’s advocate, so she may have pissed the patient off earlier in the day as management contends, and based on his interaction with her (we don’t know), the patient decided to make a run for it. This is all the more reason for her to have left him on the side of the road and kept mum. Trust me, nurses don’t relish caring for—how to put this delicately—“difficult” patients. I’m sure if the two of them butted heads, Diasparra most likely wouldn’t have been jonesing to care for him on her next shift. The bottom line is she upheld her duty to care for the patient when she could have looked the other way, and no one would have been the wiser. Her behavior was reasonable and brave, but since it didn’t conform to a hypothetical ideal, she was punished for it.

Sadly, incidents like this are all too common, especially in healthcare institutional settings where the top brass forgets that nurses are humans who care for other humans under extraordinarily stressful and unpredictable circumstances. Nurses have to assess the situation at hand and make the best decision for the well-being of everyone involved often on a moment’s notice. This means some rules are going to be broken, but when the best interests of the patient are served (as they appear to be in this case), we should all have enough common sense not to penalize people for doing what is right in a society where so many think nothing of doing wrong as long as the wrong hurts someone else.

Administrators, educators, and politicians yammer on about the nursing shortage and how to increase enrollment, recruitment, and retention, but they fail to recognize that this maltreatment of dedicated clinicians leads to sinking morale and burnout that ultimately results in nurses leaving the profession. I respect the need for general policies and procedures, but I want respect for my critical thinking skills and my ethical actions that won’t always fall within the confines of policy. Management needs to pull its hypothetical head out of its bureaucratic ass and demonstrate some common sense in these situations, or risk getting left on the side of the road, at least the next time I pass through.

The People Have Spoken.

And, what a joyful noise they have made! All hail the new Decider, President Barack Obama! I am thrilled for him! I only wish I could have listened in on McCain's concession phone call to a supposed terrorist sympathizer and, gasp, socialist. Now, hopefully, we can get to work cleaning up the messes of the past eight years of sheer debauchery.

I don't agree with some of President Obama's views, particularly on health care. He's just not socialist or godless enough for me! However, I think he's taking steps in the right direction, and I'm willing to take baby steps as long as I'm not being led over a cliff. Eventually though, we need to bring the troops home and declare war on the corporate terrorists like insurance companies and Big Pharma. Now, there's a war worth fighting for! Imagine what could happen if we reappropriate $10 billion per month for this cause. Let the revolution begin.