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Jewish World Review June 18, 2001/ 28 Sivan, 5761

Suzanne Fields

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Consumer Reports

Purses for nurses -- THE Patients' Bill of Rights could be called the Patients' Right to Sue, since that's what Congress is arguing about.

The Democratic bill would make losing defendants pay out more money than the Republican bill, and it would allow for suing insurers in state as well as federal courts. In state courts, there are no limits to certain punitive damages caused by delay or denial of treatment and/or low-quality care. The Democrats would cap federal-court awards at $5 million.

Republicans, who would cap federal-court punitive damages at $500,000 at the federal level, call the Democratic bill a trial lawyer's dream. The White House further contends that allowing patients to go to state courts would frighten small insurers and companies and this would inevitably force insurers to cut back benefits.

Of course, the polarities are not divided absolutely according to party lines. There's lots of wooing on both sides of the aisle.

But even if all the particulars of the bills become law, damage awards would go only to the few who have been badly harmed, such as the poor guy whose good left leg is amputated when the right one is supposed to come off, or the woman who gets the wrong blood transfusion. For most of us, who are merely subject to mediocre care, the legislation under consideration won't mean much.

We can't sue for merely mediocre care and that's what many of us get a lot of the time. Mediocre now passes for the norm, with long waits in doctors' offices and in hospital emergency rooms, along with undecipherable bureaucratic gibberish on those long forms that have to be filled out for reimbursement.

Perhaps the biggest problem is captured in the slang word "attitude.'' The doctors are angry about the rules and forms, patients are angry about the rules and forms. Everybody blames somebody else for the surliness that has become an epidemic.

Last year I spent several days in hospital for back surgery and came face to face with Nurse Ratchet herself, a woman in the crisp white uniform who told me to wait another hour for a pain pill because she was busy with paperwork: "We're changing shifts.'' I thought she was joking. She wasn't.

In her defense, she was tired and overworked, but as a patient in pain I wasn't interested in excuses. Nurse Ratchets have multiplied for one terrible reason that a patients' bill of rights can't do anything about. The nation suffers from an acute nursing shortage. When my 90-year-old mother was temporarily assigned to what was considered a top quality rehabilitation center after she fell and broke her pelvis, she had to hire around-the-clock private nurses to get the attention she needed.

"You need a fat purse for a private nurse,'' a sick senior told me. Even a nurse's aide hired for simple tasks is expensive and can, and often does, come with little or no training.

Nurses have always been the hub of the medical profession, relieving the doctor to attend to crucial medical problems while taking care of the crucial routine, from checking the flow in the intravenous line to delivering the pain pills on schedule.

Consumer Reports on Health recently advised patients in hospitals to consider hiring private nurses -- if they can afford them -- to avoid hospital "blunders.'' But blunders are only part of the problem. To give nurturing care -- which is why most nurses go into the profession in the first place -- is becoming increasingly difficult.

When insurers cut reimbursement, hospital and rehabilitation centers cut staff numbers. Hospital managers call this downsizing "process re-engineering.'' Patients who are not considered acute are quickly discharged, often leaving unprepared families with a burden of care. That leaves the most seriously ill patients cared for in understaffed hospitals. When you add to this mix an acute nursing shortage, you've got a prescription for medical mistakes.

Before the arrival of contemporary feminism, becoming a nurse was a respected goal for young women, but now that so many women are training to be doctors (and lawyers and airline pilots and merchant chiefs), nurses have become the Rodney Dangerfields in the corridors of the sick: They don't get no respect.

One study predicts that in 10 years, 40 percent of all nurses will be over age 50. The number of students who enroll in nursing school continues to decline. As vacancies go unfilled, hospitals recruit foreign nurses who are trained to lower standards than our own.

A focus on damages, as tempting as that may be, is a little like listening to an ailing heart from the wrong end of a stethoscope.

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© 2001, Suzanne Fields. TMS