Where I Stand — Mike O’Callaghan: Patient care should come before financial bottom line

Saturday, March 21, 1998 | 12:46 p.m.

MIKE O'CALLAGHAN is executive editor of the Las Vegas SUN. This column first appeared in the Henderson Home News

DURING THE PAST FEW YEARS, all of us have watched ourselves and millions of other Americans being forced into health-maintenance organizations (HMO) and in effect less personalized medicine and patient care. This resulted from the zooming cost of health care that was cutting down access to vast numbers of people. Now we have more access but not necessarily to the doctors, nurses and hospitals we like and trust. We are shepherded unceremoniously into the offices of doctors we don't know and they in turn herd us into the hospitals preferred by the HMO that we or our company pays for health services. It's truly a degrading system, no matter what way you view it.

HMOs are getting even bigger and are merging into real power brokers that dictate the health care legislation passed in many states. Nevada is no exception, in fact, the maneuvering now going on to have Nevada Medicaid patients and indigent child health services becoming cash cows for a large health group is strictly a political muscle play by giants. In the process, we can only hope the tax supported University Medical Center doesn't become an even heavier burden for taxpayers. We should be even more concerned about the possibility of UMC eventually being purchased by some national health giant.

Gov. Bob Miller will be leaving office at the end of this year. He should be assured that his bright legacy in the fields of education and health care aren't dimmed at the last minute by his staff allowing powerful friends to gain and patients to lose. What some wealthy health organizations couldn't achieve as lobbyists in the 1997 Nevada Legislature they are attempting to do now before the Legislature meets again next year.

At the national level, members of Congress with a social conscience are seriously considering giving more power to doctors and patients. This has driven business leaders right up the wall because they foresee greater expenses that will result from the protection the proposed legislation will give both patients and doctors. Doctors, nurses and patients all have much in common while the financial bottom line and the almighty dollar are what drive HMOs. I doubt if the muscle of HMOs can be as effective in Washington as it has been in Carson City. Look for some new patient protection laws before Congress adjourns this fall.

While on the subject of health care, it would be wise for Nevada's chief executive to take a close look at what his State Board of Nursing is trying to do. Because of my own experiences in military and civilian hospitals, I have the greatest respect for the key role played by professional registered nurses. It was nurses who kept me alive in a MASH unit and during transportation by train and plane to military hospitals. Healing and physical rehabilitation was also the result of good nursing care. The skill of doctors makes it possible for patients to live and nurses give them the desire to live.

Now along comes the Nevada State Board of Nursing with the cockamamie plan to downgrade the nursing care of Nevadans. This shocked me because I've always looked at that board as one to protect the high standards of nursing and not allow medical providers to cheapen nursing care. This, sad to say, is exactly what the state board is attempting to do. Shame on them. They want to give caregivers power to demand that registered nurses delegate patient care to health care provider, nursing assistants and unlicensed people. This can further downgrade nursing care but make a healthier financial bottom line.

So who is pushing this kind of nonsense? It's not the nurses or hospitals. So who is it? Somebody with plenty of monetary and political muscle must be pushing it. After reviewing the makeup of the board, it's possible it doesn't take too much pushing.

When opposing this move by the State Board of Nursing, clinical nurse specialist Wallace J. Henkelman wrote the attorney general warning what the results would be. Henkelman wrote, "I strongly feel that the adoption of this amendment would seriously erode the safety of health care currently being provided to the citizens of Nevada by allowing, and even encouraging, health care institutions to utilize lesser trained, unregulated, and therefore cheaper, alternatives to current categories of health care providers. Since the mission of the Board of Nursing is to protect the public from unsafe nursing care, they, and not the individual health care institutions, should control standards of qualification and training for all nursing care providers."

All of us had better be alert to what's happening to the high quality of health care Americans had come to expect when ill or injured. Things won't be getting any better unless Nevadans make their feelings known before it's too late to save what we still have left.