Industrial Disease

Medicine is about healing. Or at least it should be. Unfortunately, current trends have pushed healing far down on the priority list. Medicine is a business, health care an industry and the primary motivation for every action is profit.

Doctors are forced to see more patients during shorter time periods and are routinely kicked from insurance plans if they can't meet quotas or regularly prescribe unprofitable procedures or medications -- whether or not the procedures are needed. And they have been subjected to gag rules that prohibit them from prescribing procedures not covered by insurance plans.

Hospitals have cut back on nurses, meaning each nurse has to care for more and more patients and work more and more hours with more and more stress. And less qualified aides are being called upon to perform basic technical services -- drawing blood, cleaning and disinfecting wounds -- formerly performed by nurses.

All of this helps cut health care costs and ratchet up profits.

And with health care mergers creating bigger and bigger companies seeking out larger and larger profits, things are only bound to get worse. That is, unless patients and health care professionals step in and force changes.

A coalition of caregivers, patient advocates, labor and consumer groups in New Jersey is working to do just that. It has placed an eight-bill package before the New Jersey Legislature that would:

* increase nurse-to-patient ratios;

* limit the number of hours that residents and interns work and eliminate compulsory overtime for nurses; and

* guarantee access for the public to information on hospital and nursing home staffing ratios, patient complaints and the number of "adverse patient incidents" reported.

The package has met resistance from hospitals and nursing homes who say the bills are "as much about job security for nurses as about patient care." (Ron Czajkowski, spokesman for the New Jersey Hospital Association, in The Record of Hackensack)

But Patients First, which formed about two years ago to fight for a New Jersey's patient bill of rights, says the bills are necessary because cost-cutting trends in the health industry are resulting in diminished care for patients -- and could compromise the safety of both patients and health-care workers.

A statewide survey of hospital nurses conducted by the Health Professionals and Allied Employees Union, a Patients First member organization, found that nurses believe quality of care is suffering as nurse-to-patient ratios rise. According to the survey:

* 95 percent of nurses reported inadequate staffing;

* 67 percent said patients were being discharged without instruction;

* 50 percent said there were increases in re-admissions and injuries;

* 38 percent said there were errors in medication;

* 30 percent said they've seen an increase in patient accidents; and

* 80 percent said there has been a delay in basic care and 50 percent said there have been failures by overworked nurses and staff to recognize and report symptoms.

These are alarming numbers -- so alarming, in fact, that 40 percent of the nurses told the HPAE that they would not want their own family treated in their hospital.

And that's where Patients First comes in, according to Maryellen Kluxen, a registered nurse who works as Patients First's staff coordinator. The organization, which already has won passage of legislation requiring the use of safe needle systems to prevent accidental needle sticks, hopes to get the rank and file members of the unions that represent health care workers into the political process, to get consumers involved, to get them to lobby state legislators and get bills passed that protect workers and patients.

"The goal is to build a coalition and to become a group that speaks for patients, that becomes a patients advocacy group," she said.

And Patients First is not alone. Organizations across the country are fighting to change the way the health-care industry functions, to return decision-making to patients, nurses and doctors and to ensure that care and healing come before profits. A ballot initiative in Massachusetts, slated for the 2000 election, would require that all uninsured residents be insured, that patients be allowed to choose their doctors and that doctors and nurses be allowed to perform their jobs without interference and that patients get access to information on HMOs. Doctors are unionizing and nursing unions have stepped up their efforts across the country.

Jim Hightower, in his newsletter The Hightower Lowdown, says "Democratizing health care requires the kind of grassroots rebellion that is already moving in various cities and states where citizens are pushing their own initiatives to put people in charge of the system."

Patients First is just one of those rebellious groups. But it is already helping to make change happen.

If you live in New Jersey, you can get involved with the Patients First effort by calling 201-262-5005, ext. 39, or e-mailing

You also can contact the Ad Hoc Committee to Defend Health Care by visiting its web site at or Physicians for a National Health Program at its web site ( or by calling 312-554-0382.

Hank Kalet is a poet and regional managing editor for two central New Jersey newspapers.

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