Ilene Corina: “I couldn’t believe it when the doctor said ‘no’.”

Ilene Corina, PULSE of New York

The National Patient Safety Foundation (NPSF) annual Congress will bring some 1400 patient safety champions from around the country to New Orleans May 8-10 2013, to collaborate, brainstorm, teach and learn. As guest blogger for the NPSF Congress, I'm privileged to share the amazing stories of some of the champions of patient safety who'll be attending. This profile will cross-post on the NPSF Congress website this week.

Who: Ilene Corina

What: President, PULSE of New York

Member, NPSF Board of Governors, 7 years 

ICorina@aol.com

www.pulseofny.org, www.patientsafetyconsultants.com  

Ilene Corina has experienced the best and worst in health care. Her first child bled to death after a routine surgery. Her agony intensified after his death, when the surgeon who’d dismissed her concerns about her son's bleeding post-surgery refused to take her phone calls. But it was another event years later that would propel Ilene into a lifetime of patient advocacy. Today she believes that in order to stay on top of health care, there is no substitute for sitting at the bedside of a patient.

Pat Mastors: What brought you to patient safety in the first place?

Ilene Corina: Most people think it was the death of my first child, Michael in 1990, who bled to death from a tonsillectomy, that sent me into the work of patient safety, but that's not true.  I was in too much pain then. The impetus was the feeling of helplessness years later when my youngest child needed surgery.

Matthew was born severely premature at just 23 weeks. His team in the NICU was amazing, and he survived. But when he was three years old, and I needed an anesthesiologist for his surgery in 1996, I was told I couldn't choose the anesthesiologist myself.  Even though my son was born premature, had 24 hour nursing care and lung problems, and I went to meet the anesthesiologists in the weeks before his surgery with his list of medications, lung x-rays and medical records. When the doctor said "no"-- that I would have to wait until the day of surgery and see who would be available-- I was stunned. The system was taking away my right to choose a doctor for Matt, after I'd helped get him over the painful humps so early in his life.  I was determined to change things-- or at least be heard. I knew it was time, right there, to change the rules, were I ever to need to do this again. 

 

The joy in all of this is that Matt not only survived being born so early, he had no disabilities and today is a healthy young man in college. I credit that to the partnership between me and his medical team, back when he was born. I like to think I experienced the worst in healthcare and I experienced the best. I now want people to know what I know.

Pat Mastors: What’s the most encouraging thing that’s happened in the past year in patient safety? The most concerning?

Ilene Corina: The work that I am doing on Long Island is growing.  Our Patient Safety Advisory Council has grown and we have looked at patient safety as it pertains to individuals, not just a society as a whole. Some of the groups I have worked closely with are people with disabilities, adults with low literacy, transgender patients and teen moms.  All our work is at the grassroots level. I learn more than I can teach, and that's exciting!  We are teaching about patient safety, and then learn what it's like to walk in their shoes, what their obstacles are, and how they’re navigating them. Then we develop tools to help them feel more empowered and improve their care.  We hope to help the people who work in the healthcare system understand what we have learned and incorporate our findings into their work. 

  

I think the most concerning thing is still the lack of funding available for our type of work.  There are hundreds of community members representing breast cancer support, HIV/AIDS, Autism, veterans and bullying, but not enough representing patient safety.  It's hard to grasp or show the full scope of the need when there are only a few of us working on the changes.

Pat Mastors:  What will you uniquely bring to the discussion at the Congress?  

Ilene Corina: I am not presenting at the Congress but I will be looking for collaboration...NPSF is the leader in bringing the patient and families voice to the table.  I like to think that we do the same at PULSE,  bring everyone's voice to the table.

Pat Mastors: Where would you like to see more energy focused?

Ilene Corina: Two areas. Our Family-Centered Patient Advocacy is growing and our small classes fill up now. I would love to hold classes more often.

I also think that the people who make the big decisions in the hospital setting may be losing track of what goes on at the bedside. I feel obligated to spend a certain amount of hours a year with people I do not know at their bedside so I can watch independently what happens and practice what I preach for others to do. Do they wash their hands or introduce themselves to the patient?  Are they giving out pills in little paper cups and not asking the patient her name?  Is the doctor asking the patient questions and having the patient answer appropriately?  Does the nurse seem stressed?    I need to know what is happening at the bedside.  If problems need addressing, I will write to the hospital and I also blog about my experiences. These are things no one can see regularly unless someone is willing to plant themselves at the patient's bedside…and I am willing! 

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Pop The Cork.. Get in There!

Finally I received a phone call to say I’m being treated at the Royal Marsden. I explained why I wanted to be treated by them and they were more than happy for me to jump ship and join them. It was explained that in a year I may have to leave them once the Herceptin is done, but this will be reviewed then. They are requesting all my notes to review my treatment and to sit down and explain the results. They were surprised that no-one had taken the time to explain anything since finishing the chemotherapy and radiotherapy. That my notes were not present at my last appointment for me to ask any questions was inexcusable.

Every question the Royal Marsden asked I said I could not answer because I did not know. I said to be perfectly honest I’ll be happy just to put this whole mess behind me. I explained my only concerns were from the recurrence and my pathology report from my mastectomy in 2009. That my calls of concern were ignored, and if it was not for my vigilance my recurrence would not have been detected until it was too late.

So now I can breathe a sigh of relief and I meet my new oncologist on the 1^st May.

And from there I want to share my first attempt at an oil painting. Yes it is a portrait of me and I’ve entered it into a competition. The title of the painting is... 

‘Contemplation with a big C.’

Thank you Marie Beattie for the title xx

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Being Pro-Active

Yesterday I spent two hours inside the Houses of Parliament and it was an eye opener. A plumber is employed to fix a leek, a dentist fixes your teeth and a doctor cures the sick, but what credentials does a Health Minister need to be a Health Minister?

Just go to a University and study as a barrister and be a private secretary to the prior Health Minister that’s all. From there you surround yourself with experienced individuals in their chosen field as advisers  With the guidance of these individuals in the background decisions are made. Or at least that’s how I understand it, but I’m open to corrections.

For 30 minutes in a committee room I listened intently as our health minister was quizzed on breast cancer risks, awareness and early detection in the over 70’s. For each question asked her reply at the end was others in that field would have a better reply because she did not want to say something that was incorrect, but if she had experience or interest in the medical field it would have shown in her replies.

The next hour and a half with the other three other guest speakers were no better. To sum the day up there is room for improvements across the board for treatment, awareness and general care, but surely they already know this? And when will we see these improvements? Well maybe next year or the year after.

I actually now understand why the NHS is in a mess.

House of Parliament Toilets.

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Brigham and Women's Hospital team: "Glad to know you"

When bombs went off near the finish line at the Boston Marathon, runners and spectators grabbed their loved ones and scrambled to get out of the way.

Joshua Kosowsky and Heidi Crim scrambled to get closer.

Joshua is Clinical Director of the Emergency Department at Brigham & Women’s Hospital in Boston. Heidi is Nursing Director. Both were sitting with me at a conference room in Maryland when the horror of Monday’s carnage entered our consciousness through texts, Twitter and emails. We had a moment of silence for the victims. Moments later Joshua and Heidi were threading their way to the exit doors, en route to the airport, back to Boston and their hospital. They would join their colleagues who were now working on 31 of the 140 people injured in the blasts. Hours later more of the Brigham team would head back to Boston, with those left behind on alert to see if and when they were needed.

For the past couple of days we’ve all been together at the Institute for Patient- and Family-Centered Care (IPFCC) seminar in Annapolis. We patient advocates are here to work with some of the best and brightest people—or at least those actively striving to be the best-- who deliver care at the nation’s hospitals. Our collective mission: to see what we can learn from each other.

Yesterday morning Joshua, Heidi and other clinicians and administrators from “The Brigham”, as it’s called, were assigned to a small work group of 15 people. There were 14 from the Brigham, plus a facilitator from the IPFCC-- and me. The Brigham team had brought along their own Senior Patient and Family Advisor, Martie Carnie (I quickly saw that the team appreciates and relies on her.) So what made me the “lucky one”, the lone non-Brigham person there? Maybe it was pure geography (I’m from Rhode Island). Whatever. I felt lucky to literally have a seat at the table with folks from one of the best hospitals in the world. As to how they’d feel about having me there, I had no clue.

We went around the table introducing ourselves. Maureen Fagan, Executive Director of Brigham's Canter for Patients and Families, set the tone—the Brigham was here for ideas on tackling a challenge: treating people who come in through the Emergency Room with the same embracing welcome they’re known for giving patients who have the advance time to plan their admission. As she concisely explained things, Maureen looked me in the eye. She used my name. I felt “seen”, and included. It encouraged me, as the session continued, to offer my two cents here and there. Joshua asked how we could make clinicians accountable when they do stuff like not wash their hands…the times it’s out of arrogance, not forgetfulness. I had some thoughts on that, too, and he seemed to listen to me. Heidi described what the Brigham “welcome” should feel like. “When you come to us, through whatever route, we need to tell you, to make you feel, that you are ours.”

Later, after more key team members had left for Boston and the rest of us found a television and could begin absorbing the monstrous images, members of her team told us what a great leader Maureen is, and what clarity she brings to their work. They told me that Joshua was really one of the

Janet Razulis & Julie Celano of The Brigham conferring

good guys. That he’d written a tremendous book to help patients navigate their care in the hospital.

Today, the “day after”, our now-smaller group gathered to pick up where we had left off. Power cords snaked from phones whose charges were depleted by the morning’s non-stop texts and emails. The team gathered around iPads to watch as their CEO answered TV  news anchors’ questions calmly and thoroughly. In a world of chaos and unpredictability, the Brigham staff here in Annapolis exuded a quiet confidence…that their team was in place, doing what it was trained to do.

We’re here at this conference looking for tools and allies to achieve a more functional, responsive and patient/family-centered culture of medical care. Yet despite its dysfunction, its imperfections (and yes here are many), there is also this stunning excellence—the culmination and embodiment of massive compassion, training, service and practice. It truly is a beautiful thing.

At its heart, the root of good medical care is compassion. As Martie, the Brigham advocate, says, “we can’t always control the outcome, but we can control the experience”.

Somehow, I think the people going into the Brigham-- yes, even those who never expected to go there and entered through the Emergency Room-- will know just what she means.

Left to right, Shelita Bailey, Lynne Blech, Maureen Fagan, Rosemary O'Malley, Kristen Koch...some of the Brigham team

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Rick Boothman: "The Dogmas of the Past Are Inadequate"

It's the kind of story you hear too often from medical insiders: the elderly patient should never have had major surgery in the first place. The poor medical care she received that caused her suffering and death was bad enough. Worse for lawyer Rick Boothman was when he found out out the surgeon who'd operated on her had been sued three dozen times before. But the tipping point for Boothman came when the hospital CEO angrily told him to just do what he'd been hired to do-- defend the hospital in the family's wrongful death claim. 

In this week's post leading up to the National Patient Safety Foundation Congress 2013 May 8-10, Boothman shares the story of his unlikely career change, what drives him to champion transparency and disclosure, and how he's inspired by the words of Abraham Lincoln. 

 

Who:  Richard C. Boothman, Chief Risk Officer, University of Michigan Health System

How many years attended Congress?  6 years (he's on the Board of Governors)

boothman@med.umich.edu

 

Pat Mastors: What brought you to patient safety in the first place? Can you share one iconic personal moment of impact/success/motivation? 

Rick Boothman: I actually “backed into” patient safety and for that reason, I probably see things differently than many.  In my former professional life, I was a trial lawyer representing Michigan and Ohio hospitals and doctors in malpractice litigation – I did that for 22 years and loved my work.  But during my entire time as a trial lawyer, two observations increasingly plagued me:  one, the enormous human cost of patient injuries not only to patients, but to caregivers I represented as well.  The damage to patients – at least someof the damage to patients, is often obvious – seriously altered and lost lives, etc., but the impact to our caregivers is something we don’t talk about very much, something we often don’t even acknowledge, and something I do not believe we understand very well. Litigation of course, exacerbates the tragedy for everyone concerned.  I was always struck by the magnitude of this problem across the board and the heartbreaking impact it had on those involved.  Second, not once in 22 years did any of my clients ever ask me what they should have learned from the cases I handled.  In fact, on several occasions, I DID raise lessons learned after cases were completed and every time, it was clear that in their view, my job was to defend cases, not wade into hospital business. 

The experience that tipped the scales for me occurred just before I left private practice.  I was representing a small community hospital in a wrongful death case that arose from bilateral [double] knee replacement surgeries on a seriously medically compromised 85-year-old woman who got septic [developed a serious infection] and lingered miserably for months until her death.  Doing even ONE knee replacement on this patient demonstrated highly questionable judgment-- she had problems more serious than knee pain-- the decision to do two replacements was completely indefensible.  When I checked the court records, I discovered that the orthopedic surgeon involved had been sued 32 times!  He was uninsured and had settled a recent case with some real estate from Northern Michigan.  In my opening letter to my client I urged the hospital to trigger the peer review provisions in its medical staff bylaws because this surgeon seemed both incompetent and reckless to me.  I received an angry call from the hospital CEO who told me that the surgeon “single-handedly kept the orthopedic service afloat”; he reminded me that I was hired to handle the medical malpractice claim, not create other issues. 

For years I saw how counterproductive litigation was-- that the “deny and defend” culture effectively inhibited the kind of accountability that was essential to improving patient safety.  Honesty isn’t just an ethical imperative-- as a practical matter, you can’t fix a problem until you first acknowledge a problem exists and you accept ownership of it. 

Having represented the University of Michigan for more than 20 years, having seen its vulnerable underside and inner workings, I knew it to be an organization with impeccable ethics filled with amazingly skilled and dedicated caregivers of all stripes.  When an opening arose in the legal office in 2001, I saw an opportunity to make a difference across a whole community of caregivers. I wanted to do something that would logically ameliorate some of the pain I saw in both patients and caregivers, and move the focus from responding defensively to patient injuries to a proactive effort to improve safety as THE gold standard for addressing the malpractice problem that plagued the community of patients and the people who care for them.  My original plan was to take two years, put the architecture in place and return to my work as a lawyer.  So much for planning, eh? 

We are all in this together.  We will only fix these problems together.  Litigation by its nature is counterproductive to that reality and I was determined to do my best to shift the focus to make sure we learn from our patients’ experiences. 

Pat Mastors: What is the most encouraging thing that’s happened in the past year in Patient Safety? The most concerning?

Rick Boothman: The most encouraging thing that I’ve observed is the decided shift and attention to these issues across the board.  Groundbreaking people like Lucian Leape and Don Berwick and Bob Wachter and Peter Pronovost and a host of others have been at it such a long time-- such a stunningly long time-- and it’s encouraging to see now much more openness, and even a sense of urgency to patient safety.  The other encouraging development is the increased attention being paid to the very fabric of our patient/provider relationships.  We must move to more of a partnership with our patients.  I hate the concept of informed consent for instance, because in most places, informed consent simply means getting a form signed.  Even when it’s done well, informed consent is consigned to special events like having a procedure or surgery done.  The quality of the conversation between caregiver and provider should be uniformly high and tailored to the patient’s needs and situation-- not relegated to a conversation to be had only when a patient is scheduled to have surgery.  I’m encouraged by the dialogue that is growing around this.  Lastly, I am encouraged by growing attention to the well-being of our health care workers of all stripes.  I believe the evidence clearly demonstrates that healthy and happy workers, people who find joy and meaning in their work, actually provide more thoughtful and safe care to our patients.  I believe we have taken our health care providers for granted for far too long and again, if we’re all in this together, we need to pay closer attention to their well-being, physical and emotional well-being. 

The most concerning thing to me is our health care community’s seeming addiction to quality and safety thresholds dictated by outside agencies.  I deeply respect the work that the Joint Commission does for instance, but at some level, don’t you think we all should be embarrassed by the fact that organizations like the Joint Commission [TJC] even exist?  We need greater ownership of these safety and quality issues.  I’m aware that for many hospitals, simply getting through their surveys is considered an accomplishment.  Thresholds set by outside agencies should represent the floor, not the goal.  I sit on the board of the Michigan Hospital Association Keystone Center’s Patient Safety Organization and reportedly, there are hospitals in Michigan that acknowledge no sentinel events [an unanticipated death or serious physical or psychological injury to a patient not related to the natural course of the patient's illness] year after year.  Amazing, isn’t it?  I suppose we should be knocking their doors down to understand and replicate what they’re doing, eh?  Accountability remains a challenge. 

Pat Mastors: What will you uniquely bring to the discussion at the Congress?

Rick Boothman: Being not grounded in the old status quo, I think I can bring a fresh set of eyes and a perspective that others might not have.  I can question why we do what we do easier than someone whose very identity is tied to their roles as established in the status quo.  One of the most important quotes that resonates with me are Abraham Lincoln’s words to the Congress in 1862 when he said, "The dogmas of the quiet past, are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise-- with the occasion.  As our case is new, so we must think anew, and act anew.  We must disenthrall ourselves, and then we shall save our country.“   I am impressed constantly by the level to which we are too invested in the status quo.  As Lincoln said so eloquently, we MUST disenthrall ourselves and think anew and act anew because our challenges are new. 

Patience is NOT a virtue when people’s lives are at stake.  We are far too patient with ourselves.  We are far too embedded in the old ways.  We need a greater sense of urgency around efforts to improve.  

Pat Mastors: Where would you like to see more energy focused?

Rick Boothman: I would like to see greater efforts to understand how we create perverse incentives that operate at cross-purposes to our overall goals.  Fee-for-service reimbursement predictably favors care delivery systems and medical judgment that is wasteful, for instance.  Certain professional compensation models foreseeably encourage some caregivers to cut corners.  I would guess, for instance, that no hospital root cause analysis would be robust enough to consider listing the manner in which we compensate surgeons as THE root cause for why some surgeons think it’s acceptable to have two cases proceeding at the same time in two different operating rooms.  We need to be more thoughtful about how incentives drive behaviors that put patients at risk or use valuable resources in meaningless ways.  I would also love to see far greater emphasis on the huge component of our population whose health care needs are not served at all, or are grossly underserved.  It’s immoral that in a country as wealthy and gifted as ours we have kids who never see a pediatrician. 

The University of Michigan Health System's open and honest approach to patient injuries, patient safety and claims has been featured on National Public Radio's Weekend Edition with Scott Simon, All Things Considered, and Marketplace, the New England Journal of Medicine, CBS News, CNN, MSNBC, the New York Times, the Wall Street Journal and many other media outlets. In 2005, Boothman advised then-Senators Clinton and Obama in the formulation and introduction of their MEDiC Act.

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Tea and Cake

Yesterday I asked the nurse who administered the first cycle of chemotherapy if I could see my notes. This nurse is a jolly soul with a sweet disposition. When doing her rounds she makes sure everyone is comfortable and takes her time to log down everything. That’s why I asked her if she had logged the issue with my arm and the FEC treatment I was on. She straight away went to the relevant page within my medical notes showing me what she had written for that first cycle. She read back what she had written to both me and my husband. I asked the nurse so why did the registrar say nothing was written down? Why did I have to go through all that unnecessary pain? With a tilted head and a reassuring tone she said I don’t know. 

She personally understood why I had asked for the referral and was apologetic which something no-one else has done since the damage was done. Her reply, no patient should go through unnecessary pain or stress the treatment itself is bad enough. We both agreed it all fell on communication with my oncology team. Then we spoke about my cardio results and if it had been explained properly. She mentioned the 57% was just within the margins of having the Herceptin. That if I have any further chest pains to ring my oncology team and request an emergency appointment for imaging to be repeated sooner.

This is the first time someone has taken the time to properly explain my results with my medical records present. There are still questions that are unanswered like am I now in remission or not, but for now until I hear from the Royal Marsden there is nothing more I can do.

On a more cheery note I had a lovely time in central London today. I went to a Daniel Sandler make-up seminar and came away with a goody bag. And as a bonus I had Tea and cake at the Cavendish Hotel with a bunch of lovely ladies. The breast cancer lottery maybe complicated, but watching a bunch of women with beaming smiles only makes me more determined… too have fun.

The above ladies have/are battling Bowel Cancer and fingers crossed will be doing a calendar to raise awareness. Gina Potter bottom center is a lady I met via my FB account. She traveled to London to be Daniel Sandlers make-up model for the day. The Picture was taken by the fantastic Stephen Potter, Gina husband.

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Finally....

It only took three weeks and a phone call to remind my BC nurse I had not changed my mind about the referral to the Royal Marsden, but finally she found the time to phone me back to say a letter had been sent that day. Her excuse was a recording had been left in a rack somewhere and had been overlooked. To me it dissolves any doubt I may have felt about the decision to move away from the hospitals treating me. Yes I understand the fact she and the team have other patients, but that is not my problem. My concerns are strictly for me and my wellbeing.

I feel a bit like the Lion in Wizard of Oz…I have a roar, but no-one is listening. It is no good when people see you more like a bag puss that is easily muffled, but when you put my back up against the wall my claws come out.

I’ve been told so many good things about the Royal Marsden I know I’m in safe hands.  

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