Saturday, May 30, 2009

Casey's Law

I met an amazing woman last Friday. Her name, Charlotte Wethington.

How do you recover from the death of your son, your only child? As if his death isn't bad enough, it came from a disease that is treatable. The disease of chemical dependence. Her 23 year old son Casey died of an overdose of heroin. And the sad thing is this, she had taken her son to the emergency room for an overdose...2 previous times! After his first ER visit...for an overdose of heroin...he was discharged because he refused to enter treatment. Why? Because there was no law that allowed the parents of a child over the age of 18 to mandate treatment. Even though an addict is incapable of making a rational decision when it comes to the use of drugs, they still can't have him admitted. And consider this. Casey was "recovering" from an overdose. Common sense tells you this person is OBVIOUSLY incapable of making a rational decision regarding treatment for drug addiction!

Ahhhh yes...this is the land where a land owner can lose control over what they do with their land if an endangered flea is found on their property. But intervene when a human is suffering from a treatable disease that renders them incapable of making a rational decision. Ohhhh no.....we wouldn't want to do that!

This country has lost it's mind!

The second ER visit within less than a year was for another heroin overdose. OK. Second OD in less than a year. Doesn't it seem "logical" that the person has demonstrated an inability to make rational decisions regarding the use of a potentially fatal drug? But again, we can't interfere with an irrational decision that might cause a death, but we WILL interfere with a terminally ill person's right to die with dignity. We WILL intervene if someone with severe, chronic, unrelenting pain that can't be cured seems to be taking "too much" pain medication. Even though it has been prescribed by a board certified pain specialist. Oh my! We wouldn't want this person who has no hope of a cure for their pain to become addicted! But it IS OK to let an already addicted individual die from their disease once it's already happened because we can't mandate them to treatment which is life saving!

What the hell is wrong with this picture?

When they were getting ready to discharge Casey, a nurse in the ER told his mother that her son hadn't lived long enough yet, he was too young to have "hit bottom" yet. He hadn't "lost enough". She said to the nurse, "What happens if never grows "old enough"? What happens if his "bottom" is death?" She had no idea she was predicting the future. Her son died several weeks later from one last overdose.

Charlotte, not willing to simply grieve the loss of her son, decided to make a difference. She began to research how to get a law passed. When she was told she would never succeed, she kept on plugging away. When more people told her it would take nothing less than 5 years to accomplish the passage of a bill. She did it in 2 years! As she told me in our discussion, rather than give up when a door would close in her face, she would find another and walk through that one.

I told her she was my hero for having the guts to do what needed to be done regardless of who it ticked off and who didn't like it.

I guess that's the power that a wounded mother is capable of, even if the wound was a fatal one...for her only child.

Wednesday, May 20, 2009

The Unethical and Unprofessional Response by the Health Care Community in Lebanon, Ohio

"Two Caretakers Indicted for Allegedly Stealing Drugs in a Warren County, Ohio Nursing Home"

That was the headline in Cincinnati newspapers and on TV and radio news in the tristate area. As I read the story, I thought back to my experiences over the past 19 years.

The first thing that jumped out at me was the comment by the executive director of the nursing home. He stated they contacted the police who then watched the nurses over the next 2 years.

Excuse me? WATCHED them for TWO YEARS!?

Why? To gather evidence in order to make an arrest and seek a successful prosecution. Why would you not intervene sooner? If these nurses were addicted to opioids, why would you allow the disease to continue to progress, risk the well being of those entrusted to their care, and possibly allow the nurse...your employee and colleague...to possibly cause a potential auto accident or die from an accidental overdose?

Would they watch an employee with signs of tuberculosis, swine flu, MRSA, or other illness to see if they would steal antibiotics or other medications to deal with their illness? Would they put the residents at risk for infection or harm to catch the nurse steeling medications or other hospital equipment? Of course not. So why is it permissible to allow them to continue diverting opioids in order to get enough evidence for an arrest and conviction?

Easy answer. Few people, including doctors and nurses, believe addiction is a disease. They receive little education regarding the disease during training. Few nurses recognize the signs and symptoms in a colleague. Even if they do they rarely intervene for fear of being wrong, or harming the nurse's career. They wait until they can no longer ignore the signs and then they terminate them, report them to the police or both. Instead of intervening in order to get them out of the clinical area and into treatment, they eliminate the "problem" by firing them. This allows the disease to continue to progress. It also allows an impaired professional to go to another facility where they may harm clients or themselves.

The Code of Ethics for Nurses is very specific about the impaired nurse. Statement 3.6 says the colleagues of an impaired nurse are ethically required to intervene in order to protect the patients and to advocate for the appropriate treatment and rehabilitation of the impaired nurse. This advocacy also includes appropriate and fair legal response.

None of this happened in the incident in Lebanon, Ohio. They placed residents at risk in order to gather evidence for prosecution. They allowed a chronic, progressive, potentially fatal disease to progress. They placed the lives of innocent bystanders AND the lives of the nurses in jeopardy in order to look tough in the "war on drugs".

There are no winners when this happens...only losers. he biggest losers are the nurse, their family, and society at large.

The only real casualty in the war on drugs are those unlucky enough to have the disease.

Thursday, May 14, 2009

Ending Nurse's Week by Facing the Hidden Epidemic of Impaired Nurses.

FOR IMMEDIATE RELEASE

Contact:
Jack Stem
Peer Advocacy for Impaired Nurses, LLC

513-833-4584 (Cell)
513-231-4280 (Home)
jack@jackstem.com
http://www.peeradvocacyforimpairednurses.com


Ending Nurse's Week by Facing the Hidden Epidemic of Impaired Nurses.



Dateline: Cincinnati, Ohio May 14, 2009 – How can a nurse, doctor, dentist, or any other health care professional fall prey to substance abuse and addiction? Their training should decrease the risk of becoming an addict, right? RN Magazine tackled this topic in their April issue with the article, “Drug Addiction Among Nurses: Confronting a Quiet Epidemic. Many RNs fall prey to this hidden, potentially deadly disease. (April 2009 issue of RN Magazine)

Cincinnati's own Jack Stem was one of professionals interviewed for this article. He, along with Patricia Holloran, RN, author of “Impaired: A Nurse's Story of Addiction and Recovery” (Kaplan Publishing, 2009), and Marilyn Clark Pellett, RN, JD, an attorney who has represented nurses in disciplinary hearings before the Connecticut Board of Nursing for many years, were contacted because of the number of nurses struggling with this chronic, potentially deadly disease. Stem is a recovering addict and former emergency room nurse and certified registered nurse anesthetist. He has been a peer advisor since 2005, and is the chair of the Peer Advocacy for Practitioner Wellness Committee of the Ohio State Association of Nurse Anesthetists.

“This disease still carries a heavy stigma for those unlucky enough to find they have it. Despite the amazing growth in the knowledge and understanding of this disease, that knowledge hasn't made it to the front line care giver. Nurses and doctors still make decisions based on what I call the 3 Ms; Myth, Misbelief, and Misinformation. As a peer advisor for Ohio's nurse anesthetists, my job is to educate all practitioners and incoming students about the risk of substance abuse and addiction. This disease is the number one health risk associated with the practice of anesthesia, yet many anesthesia providers are unaware of that fact, or choose to ignore it. Denial about the disease isn't exclusive to those who have it. Friends, family and colleagues also fall victim to denial.”

Mr. Stem started his consulting and educational company, Peer Advocacy for Impaired Nurses, LLC, last October (2008) when it became clear he was receiving more and more calls from non-anesthesia nurses looking for help. The Ohio board of nursing developed an alternative to discipline program in the mid to late 1980's for nurses who voluntarily sought help for their impairment. The Ohio Nurses Association provided the monitoring service for Ohio nurses enrolled in the program. The alternative to discipline program is currently under review and the ONA is no longer involved. “As a result, nurses are caught between a rock and a hard place. They fear for their license, their ability to return to nursing after successful treatment for their disease. But their biggest fear is the stigma they will face from their family, the public, and their nursing colleagues”, says Stem. “Despite the acknowledgement by the AMA, ANA, and other professional organizations, that addiction is a disease, the attitude of health care providers continues to be negative, especially toward impaired professionals. If we ever hope to change the way addicts are treated personally and medically, we must first educate the health care providers about the disease of addiction. If health care professionals don't get it, how can we ever expect the average Joe and Jane to change their view?

We have over 25 million people in this country struggling with substance abuse and addiction. The average age where a person first tries a mood altering substance is under 12. The most common place they obtain drugs is the medicine cabinet. Why are we continuing to do things the way we always have when it clearly hasn't been successful? I'm just one individual who has experienced the shame and guilt associated with this disease. I was lucky to have people who love me enough to refuse to give up or let me give up. I'm just trying to pay that love and respect forward. No one should have to fight their own colleagues to get the treatment they need and deserve. Especially when their colleagues are health care professionals.”

Mr. Stem has joined forces with LaTonia Denise Wright, RN, BSN, JD, and a leading attorney dealing with nursing and licensure issues in Ohio, Kentucky, and Indiana. Wright and Stem have developed a series of workshops for nurses in the Greater Cincinnati area. These workshops will focus on the disease of chemical dependence, recognizing an impaired colleague, and taking steps designed to safely remove the impaired nurse from practice while helping them enter treatment programs designed to deal with the unique needs of addicted health care professionals. Ms. Wright discusses the legal and licensure issues facing the nurse dealing with substance abuse and addiction. She also provides valuable information covering a wide variety of legal issues many nurses are unaware they face on a daily basis in their practice. The workshops begin on March 30, 2009 and will be offered throughout the remainder of the year.

About Peer Advocacy for Impaired Nurses, LLC

Founded by Jack Stem in 2008 to improve patient care and safety and to assist nurses in achieving long-term recovery. These goals are accomplished by assisting the nursing profession in early recognition and intervention of the impaired nurse. A variety of services are provided, including educational programs and workshops, assisting organizations in developing effective policies and procedures for preventing substance abuse and dealing with impaired nursing staff. Additional services are designed to assist the impaired nurse in obtaining appropriate, evidence based treatment for substance abuse and chemical dependence, relapse prevention, and recovery “coaching”.

For information on these and other services, a copy of the titles and dates of the workshops for nurses, or to make a reservation, contact:

Jack Stem
Peer Advocacy for Impaired Nurses, LLC
513-833-4584 (Cell)
513-231-4280 (Home)
Email: jack@jackstem.com
Web Site: http://www.peeradvocacyforimpairednurses.com
Seminar dates: http://peeradvocacyforimpairednurses.com/workshops.html
Blog: http://advocacyforimpairednurses.blogspot.com/

For information on the programs and services provided by The Law Offices of LaTonia Denise Wright, LLC, contact:

LaTonia Denise Wright, RN, BSN, JD
The Law Offices of LaTonia Denise Wright, LLC
11427 Reed Hartman Highway, Suite 205
Cincinnati, Ohio 45241
Phone: 513-771-7266
Email: ldw@nursing-jurisprudence.com
Web Site: http://www.nursing-jurisprudence.com/
Blog: http://www.advocatefornurses.typepad.com/
Representing, Counseling, and Advising Nurses.

- End -

###

Wednesday, May 13, 2009

Treatment program for public safety officers

If you or someone you know is a public safety professional (police officer, firefighter, paramedic, or EMT) struggling with substance abuse and addiction, Treatment Solutions Network has a program specifically for these professionals.

Follow this link for more information: http://www.treatmentsolutionsnetwork.com/power/

Tuesday, May 12, 2009

Workshops

I have teamed with LaTonia Denise Wright, RN, BSN, JD to provide a series of workshops for nurses in the Greater Cincinnati area. There are 2 one hour presentations at each workshop. The first hour deals with addiction/impaired nursing practice. The second hour deals with legal issues facing nurses in their practice. The size has been limited to 25 participants. For information on the dates, topics, and to register follow this link:

http://peeradvocacyforimpairednurses.com/workshops.html

You can now register and make your payment online through PayPal. Even if you don't have a PayPal account you can pay with your credit card. Follow this link to register and pay online.

You may contact me by email at jack@jackstem.com or by phone: 513-833-4584

Hear we go again.

I had a most interesting and frustrating telephone conversation today. A representative of a local nursing program contacted me with questions about the workshops I'm providing with LaTonia Wright, RN, BSN, JD. Our topics focus on substance abuse/chemical dependence and legal issues (related to addiction as well as other legal issues) facing the nurse and nursing profession. Since we've just started these workshops, attendance hasn't been what we hoped for, but we realize it takes time to get the word out. I digress...back to the phone call.

As I explained why I started my company and my mission, I discussed the obstacles we face when dealing with the disease of chemical dependence, such as:
- addiction isn't accepted as a disease (it's a lack of willpower or lack of morals)
- "they" did this to themselves
- if they loved their family, they would stop doing this
- how could they let this happen? After all, they are health care professionals, they should know better!
- treatment doesn't work, so why bother

The caller's response was almost textbook, as if reading from a script or a "FAQ" brochure.

Caller: Nurses receive education about the disease in training, don't they?
Me: Yes, but the focus is mainly on "caring" for the addict (talk about an oxymoron!). Even more likely is a focus on the consequences of the actions of the addict's use of an addictive chemical or participating in an addictive behavior. Things like cirrhosis, gastritis, gastric ulcers, pancreatitis, infections (including sexually transmitted diseases, hepatitis, etc.), accidents, crime, violence (domestic and otherwise), loss of job, income, divorce, etc.

Caller: Nurses know this is a disease.
Me: No they don't. They may pay lip service to the disease concept, but their attitudes and actions speak loudly...gossip, rejection, hostility, etc.

Caller: The incidence of addiction in nurses and doctors is less than the general public. After all, they are trained health care providers.

Me: Actually, the incidence is the same in health care professionals, even higher if you practice in certain specialties such as anesthesia, emergency room and other critical care areas. Training about addiction provides no more "resistance" than training in oncology prevents cancer, or training in endocrinology prevents diabetes. Education MAY help early recognition and treatment, but it doesn't prevent the possibility of disease.

Caller: The relapse rate is so high. Doesn't this mean treatment isn't as successful as treating other diseases?

Me: No, because we don't approach addiction in the same manner we approach other chronic diseases. For all chronic, potentially fatal diseases we all know early recognition, treatment, and continued follow-up provides the best chance for remission. Is that the approach used for addiction? No. We wait until the addict hits "rock bottom", treat them with outpatient therapy (when research clearly shows increased effectiveness of long term inpatient/residential treatment), with little, if any, follow up.

If we waited until the person with cancer had signs that could no longer be ignored, provided treatment with inadequate doses of chemotherapy for too short a time, with little or no follow-up, how many remissions would we see? Not many!

There-in lies the problem. Addiction is not accepted as a "legitimate" disease. Research has identified the areas of the brain where addiction takes place. It has determined the brain chemicals (neurotransmitters) involved, how "cues" can trigger activity in those areas of the brain even after documented decades of abstinence. There is a very specific set of signs and symptoms associated with addiction. It occurs in all cultures and all socio-economic classes. Yet we continue to approach the person with addiction in the same ineffective manner used since addiction was described thousands of years ago (China and Middle East cultures have described substance abuse as early as 5,000 years ago). We continue to base our decisions on the three "M's" of addiction...Myth, Misbelief, and Misinformation. This the way we approach any situation where we have no factual understanding. Look at diseases such as Hansen's Disease (Leprosy), congenital blindness, seizure disorders and HIV. The first three were almost universally accepted as a punishment from God (in the case of congenital blindness the punishement was a result of the parent's sin), or demon possession. Then, when science began to discover the pathology of disease(s), those misbeliefs were eliminated. Yes, there are still some who continue to believe the myths, but generally it's from a lack of education. Because the topic is skirted or ignored, there has been little progress in treating addiction.

No one wants to talk about it. Ignore it and it will go away. The disease won't go away, but the addict will...either to prison, or to the morgue. Certainly not an acceptable outcome in the 21st century.

Saturday, May 9, 2009

The Power of Recovery and the 12 Steps

I received a surprising email today, although, as someone who has experienced the power of the 12 Steps in my own life, I shouldn't be surprised.

The email was from a relative who has experienced the power of addiction and the even stronger power of recovery. This relative spent a fair amount of time incarcerated for several activities conducted while under the influence. I hadn't heard from him in over 20 years! I received the email today, making amends for some of the things that had occurred over the years. Yes, I accepted his amends, How could I not? I made those same amends to the people I've hurt over the years as a result of my using days.

The 12 Steps can work miracles in the lives of those who choose to truly follow them. Will we never make mistakes again? Of course not...after all, we are only human. But when we do mess up, we have the opportunity to make those amends. Recovery is a program of progress, not perfection. As with any other chronic disease, the risk of relapse...re-activation of the active form of the disease is always possible. That's exactly why we take things one day at a time.

Wednesday, May 6, 2009

A Tribute to Bill Wilson, Co-Founder of AA

(Author Unknown)

We died of pneumonia in furnished rooms where they found us three days after when somebody complained about the smell.

We died against bridge abutments and nobody knew if it was suicide and we probably didn't know either except in the sense that it was always suicide.

We died in hospitals, our stomachs huge, distended and there was nothing they could do.

We died in cells, never knowing whether we were guilty or not. We went to priests, they gave us pledges, they told us to pray, they told us to go and sin no more, but go. We tried and we died.

We died of overdoses, we died in bed (but usually not the Big Bed). We died in straitjackets, in the DT's seeing God knows what, creeping, skittering, slithering, and shuffling things. And you know what the worst thing was? The worst thing was that nobody ever believed how hard we tried.

We went to doctors and they gave us stuff to take that would make us sick when we drank on the principle of "so crazy, it just might work," I guess, or maybe they just shook their heads and sent us to places like Drop kick Murphy's. And when we got out we were hooked on paraldehyde or maybe we lied too. And the doctors and they told us not to drink so much, just drink like me. And we tried, and we died.

We drowned in our own vomit or choked on it, our broken jaws wired shut. We died playing Russian roulette and people thought we'd lost, but we knew better. We died under the hoofs of horses, under the wheels of vehicles, under the knives and boot heels of our brother drunks. We died in shame. And you know what was even worse was that we couldn't believe it ourselves, that we had tried. We figured we just thought we tried and we died believing that we hadn't tried, believing that we didn't know what it meant to try.

When we were desperate enough or hopeful or deluded or embattled enough to go for help, we went to people with letters after their names and prayed that they might have read the right books, that had the right words in them, never suspecting the terrifying truth, that the right words, as simple as they were, had not been written yet.

We died falling off girders on high buildings, because of course ironworkers drink, of course they do. We died with a shotgun in our mouth, or jumping off a bridge, and everybody knew it was suicide.

We died under the Southeast Expressway, with our hands tied behind us and a bullet in the back of our head, because this time the people that we disappointed were the wrong people.

We died in convulsions, or of "insult to the brain," we died incontinent, and in disgrace, abandoned. If we were women, we died degraded, because women have so much more to live up to. We tried and we died and nobody cried.

And the very worst thing was that for every one of us that died, there were another hundred of us, or another thousand, who wished that we could die, who went to sleep praying we would not have to wake up because what we were enduring was intolerable and we knew in our hearts it wasn't ever going to change.

One day in a hospital room in New York City, one of us had what the books call a transforming spiritual experience, and he said to himself "I've got it" (no, you haven't, you've only got part of it) "and I have to share it." (Now you've ALMOST got it) and he kept trying to give it away, but we couldn't hear it.We tried and we died.

We died of one last cigarette, the comfort of its glowing in the dark. We passed out and the bed caught fire. They said we suffocated before our body burned, they said we never felt a thing, that was the best way maybe hat we died, except sometimes we took our family with us.

And the man in New York was so sure he had it, he tried to love us into sobriety, but that didn't work either, love confuses drunks and he tried and we still died.

One after another we got his hopes up and we broke his heart, because that's what we do. And the worst thing was that every time we thought we knew what the worst thing was something happened that was worse.

Until a day came in a hotel lobby and it wasn't in Rome, or Jerusalem, or Mecca or even Dublin, or South Boston, it was in Akron, Ohio, for Christ's sake.

A day came when the man said I have to find a drunk because I need him as much as he needs me (NOW you've got it).And the transmission line, after all those years, was open, the transmission line was open. And now we don't go to priests, and we don't go to doctors and people with letters after their names.

We come to people who have been there, we come to each other. And we try. And we don't have to die.

Monday, May 4, 2009

Treatment Failure or Inappropriate Treatment Paradigm?

Report: David Hasselhoff Hospitalized for Alcohol Poisoning

Monday, May 04, 2009

AP

David Hasselhoff

Actor David Hasselhoff was rushed to a Los Angeles hospital Saturday after his teenage daughter reportedly found him unconscious on the floor of his Encino California home as a result of alcohol poisoning.


The former “Baywatch” star reportedly registered a staggering .39 blood alcohol level. The legal limit in California is .08 percent.

A rep for Hasselhoff later said the actor regretted drinking too much Saturday, but is otherwise doing fine.

I wasn't surprised to read this story. And the comment by the Baywatch star is a perfect example of the pathological denial that is a part of this disease. "He
regrets drinking too much, but is otherwise doing fine." Excuse me? Fine?

Mr. Hasselhoff has been to treatment in the past and had a famous video filmed by his daughter when he was so drunk he couldn't get off the floor. This latest story is a good indication of how far his disease has progressed. Without intensive long term, residential treatment, Mr. Hassellhoff will undoubtedly be found dead in the next 5 to 10 years.

Many will point to this incident as proof that drug treatment doesn't work. On the surface that appears to be a logical conclusion. That would be an incorrect conclusion.

Condemning ALL addiction treatment modalities as failures because Mr. Hasselhoff relapsed is the same as saying when a person with cancer dies it proves ALL cancer treatments don't work, or that antibiotics don't work because someone died of overwhelming sepsis.

The scientific and medical approach to "legitimate" diseases such as cancer, cardiovascular disease, diabetes, etc. is based on one simple principle...recognize the signs and symptoms of the disease as early as possible and then begin the evidence based treatment protocols as soon as possible. The longer we wait to seek medical assessment and treatment, the more difficult treatment becomes, and the chance of a full recovery decreases.

Yet this is exactly what happens in almost all cases of addiction, regardless of the chemical abused. Most individuals don't recognize the early signs of substance abuse and addiction, especially if it's a family member or a colleague. When the disease progresses and signs become more pronounced, the family and colleagues may refuse to believe that the person is developing the disease of addiction. When the signs of addiction can no longer be ignored, they might tell the person to seek help. The addict isn't capable of recognizing the disease in themselves (pathological denial) and generally reacts in anger, telling everyone they don't have a problem and they can handle it themselves. Finally, someone will spout one of myths associated with this disease: "He hasn't hit bottom yet. Treatment won't work until the addict hits bottom.

Bottom for the disease of addiction (this includes alcohol) is death. The last time I checked, death can't be treated successfully.

In order to get the addict into treatment, an artificial bottom is created through a planned and rehearsed intervention. Once the addict accepts the gift of treatment, the protocols must be evidence based (that means they can show evidence of successful treatment outcomes) and of sufficient time and intensity to achieve the desired results...abstinence from mood altering drugs and a change in the way they approach life's situations. Recovery breaks through the wall of denial of the addict, the family and colleagues while providing safe detoxification from the drugs of abuse. It provides a safe environment and the addict is taught to recognize stressors and cues that lead to drug use, and then develop skills to deal with those triggers in order to remain clean and sober.

Returning to old places and the people we used drugs with is one of the major risk factors involved in returning to drug use. Moving back home with a family who received no counseling about their issues and inappropriate behaviors developed while trying to deal with the addict is like throwing an endangered species right back into the polluted lake that was killing them in the first place.

This is a family disease, both genetically and environmentally. If the addict is treated and the family is not, relapse is likely. It's time to change the paradigm of this disease and the treatment methods from an acute model (wait until there is a crisis and send them to short term treatment) to a chronic disease model (recognize it early, intervene, and treat it aggressively for longer periods of time, and then have appropriate followup care and support). Until that happens, there will be more tragedies like Mr. Hasselhoff.