When lifelong Michigander Richard Curbelo changed into his Beaumont Royal Oak hospital gown in January of last year to undergo a routine colonoscopy, he had good reason to believe that he was in a world-class medical facility. Beaumont Royal Oak in suburban Detroit was long regarded among the top-tier of U.S. regional hospital systems, one of the busiest surgical centers in the country. Working at Beaumont bestowed a certain prestige, a message reinforced with the hospital system’s “Do You Have a Beaumont Doctor?” — unquestionably one of the best branding campaigns in U.S. healthcare history.
Unknown to Curbelo, he was about to be sedated by a nurse anesthetist working for a controversial anesthesia outsourcing firm that had taken over the function at Beaumont just weeks earlier. Curbelo no doubt also was unaware that the heads of cardiology at Beaumont had written to the chair of the board’s hospital system warning “in the strongest possible terms” they had “serious concerns” about the outsourcing firm’s capabilities. Curbelo also likely was unaware that a former Beaumont board member had written to Michigan attorney general Dana Nessel warning her that patients likely would die because of the deterioration of Beaumont’s standards of care under former CEO John Fox, who an internal survey revealed lacked the trust and confidence of most Beaumont doctors.
Curbelo died from complications relating to an intubation. Colonoscopies are known in medical parlance as “never events,” meaning the procedure is deemed sufficiently safe that it’s unacceptable for things to go awry. Intubating a colonoscopy patient is also extremely rare. What went wrong isn’t publicly known, but one possible reason was an unfamiliarity with Beaumont’s emergency procedures.
As an anesthesiologist with sterling credentials explained to me, a significant turnover in anesthesia staff at a hospital puts patients at risk. Emergency protocols at hospitals aren’t consistent, and high turnover means there’s considerable anesthesia staff who are clueless what to do when things go south.
Although the outsourcing firm managed to retain about 50 percent of Beaumont’s previous staff anesthesiologists by offering them lucrative signing bonuses, it still needed to replace the other 50 percent. The nurse anesthetist who intubated Curbelo was visiting from Beaumont Dearborn, a hospital that previously used a different outsourcing firm than the one employed by Beaumont Royal Oak. The anesthesiologist overseeing the nurse anesthetist was visiting from Detroit Medical Center. Chances are they never met when Curbelo arrived at the hospital.
When Beaumont’s Rapid Response emergency team arrived to tend to Curbelo, he was too far gone to save.
In the twin cities of Minneapolis/St. Paul and Duluth, a nearly three-day strike staged by the Minnesota Nurses Association (MNA) just ended at 15 major hospitals in those cities. The strike, the largest private sector nurses strike in U.S. history, could prove to be a watershed moment, one that exposes why America has the most expensive healthcare system among developed nations yet experiences the poorest outcomes.
Nursing unions vary dramatically in terms of quality of leadership and the resolve of their members. It’s clear that the MNA are a savvy organization with the PR smarts to take on hospital managements with far deeper pockets and resources. The MNA has already scored a significant victory: A survey conducted on behalf of the union found that more than 50 percent of Minnesota voters have an unfavorable view of hospital executives and CEOS, while just 11 percent said they viewed hospital executives favorably. By comparison, 84 percent of those polled said they viewed nurses favorably.
The response of Minnesota hospital executives to the MNA’s strike reflects a certain arrogance and dishonesty and makes clear why they are embroiled in a labor dispute. They brought in scab nurses and told Minnesotans that their facilities were sufficiently staffed to provide care comparable to the nurses they replaced.
“Our replacement agency has done a phenomenal job filling our RN needs,” Melissa Burlaga, a spokeswoman for St. Luke’s hospital in Duluth declared in a statement. “Every position we requested has been filled with qualified, licensed nurses who will join our other highly skilled inpatient care team members to continue providing safe, top-quality care.”
What Burlaga really means is that St. Luke’s corralled sufficient persons with pulses and RN degrees willing to cross picket lines and sell their souls for mega bucks. The U.S. hospital industry has come to regard doctors and nurses as widgets, easily replaceable at the drop of the hat, regardless of training or years of experience. A nurse with 20 years of experience, particularly if they worked at St. Luke’s the entire time, isn’t comparable to a fresh-faced nurse right out of school.
Moreover, there are additional risks with replacement nursing staff regardless of experience. Healthcare today is increasingly tech-driven, and critical equipment such as drug infusion pumps require specialized training. Getting access to various wards can sometimes be challenging; I was told of an incident at Beaumont where a visiting anesthesiologist was called for an emergency but couldn’t get access to the patient because IT hadn’t granted him access to that area of the hospital.
The Minnesota media, which unlike Michigan’s media doesn’t appear to be shills for the hospital industry, has reported that the scab nurses who replaced the striking workers were so-called travel nurses that hospitals across the country must increasingly rely on to keep their doors open. I’m typically a big supporter of travel nurses, as they command higher compensation and are forcing hospitals to pay their staff nurses more and treat them better. However, I question the wisdom and integrity of any travel nurse who crosses a picket line, as they are furthering the interests of overpaid hospital managements at the expense of patient care and quality.
There are nurse staffing agencies that specialize in scab labor. One of them is HSG Strike Staffing, another is Huffmaster Healthcare Strikes, and another is US Nursing Corp. which claims to have “staffed or helped avert more than 95 percent of all healthcare labor disputes nationwide.” US Nursing even has an app to alert scabs about the latest hospital strikes.
Scab nurses are well compensated. According to media reports, some Minnesota hospital scabs received as much as $12,000, plus travel, lodging, and training expenses, for less than a week’s work. The average Minnesota nurse makes $80,960 a year. Collecting all the promised money is possibly a different story.
I’m impressed with the MNA’s messaging, but there’s still room for improvement. While the MNA spotlights the excessive compensations of Minnesota hospital CEOs, they don’t provide any context.
For example, the union notes that Fairview Health Services CEO James Hereford in 2019 received $3.3 million in compensation in 2019, up from $1.8 million the previous year. Fairview operates 10 Minnesota hospitals and has 34,000 employees. Hereford holds an undergraduate and a master’s degree in mathematics.
By comparison, Tomislav Mihaljevic, CEO of Cleveland Clinic, was paid $3.6 million in 2020 to run what is universally regarded as one of America’s best hospital systems. Cleveland Clinic is a global operation, with more than 21 hospitals and 226 outpatient locations in Ohio and around the world, including Abu Dhabi, London, Toronto, Florida, and Las Vegas. Cleveland Clinic has 72,500 employees.
Mihaljevic is an elite cardiac surgeon, having performed more than 3,000 procedures and published more than 140 peer review articles. He holds a patent on a novel system for minimally invasive cardiac surgery.
More importantly, the MNA’s demand that Minnesota hospitals be required to maintain minimum nurse/patient staffing levels is backed with academic research showing it would save lives. Linda Aiken, the director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, told The Intercept for each additional patient that a nurse takes care of, there’s a seven percent increase in the patient’s likelihood of dying.
In 2004, legislation took effect in California that imposed minimum nurse/patient staffing levels at state hospitals. A study Aiken and other researchers published on the NIH’s website found the staffing mandate not only saved lives but resulted in improved nurse retention.
California hospitals fought tooth and nail to oppose the staffing requirement, saying it would be too costly. Stanford Hospital and Sutter Health, both headquartered in Northern California, still rank among the most profitable hospitals in the country.
Minnesota residents would be wise to support the demands of their state nurses as if their lives depended on it. In fact, they do.