New York
nurse Westchester/Lower Hudson Valley Edition | july/august 2019
the official publication of the new york state nurses association
Republican and third party candidates, pp. 12-17
RNs battle the opioid crisis, p. 3 Cheryl Wilkinson, RN, and Cathryn Kalisch, RN, at the methadone clinic
Corporate opioid pushers pp. 4, 7-10
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New York Nurse july/august 2019
People power and social change
W Judy SheridanGonzalez, RN, NYSNA President
Advocating for patients. Advancing the profession.SM Board of Directors President Judy Sheridan-Gonzalez, RN, MSN, FNP judy.sheridan-gonzalez@nysna.org First Vice President Anthony Ciampa, RN anthony.ciampa@nysna.org Second Vice President Karine M. Raymond, RN, MSN karine.raymond@nysna.org Secretary Tracey Kavanagh, RN, BSN tracey.kavanagh@nysna.org Treasurer Patricia Kane, RN pat.kane@nysna.org Directors at Large Anne Bové, RN, MSN, BC, CCRN, ANP anne.bove@nysna.org Judith Cutchin, RN judith.cutchin@nysna.org Seth Dressekie, RN, MSN, NP seth.dressekie@nysna.org Jacqueline Gilbert, RN jackie.gilbert@nysna.org Nancy Hagans, RN nancy.hagans@nysna.org Robin Krinsky, RN robin.krinsky@nysna.org Lilia V. Marquez, RN lilia.marquez@nysna.org Nella Pineda-Marcon, RN, BC nella.pineda-marcon@nysna.org Verginia Stewart, RN verginia.stewart@nysna.org Marva Wade, RN marva.wade@nysna.org Regional Directors Southeastern Yasmine Beausejour, RN yasmine.beausejour@nysna.org Southern Sean Petty, RN sean.petty@nysna.org Central Marion Enright, RN marion.enright@nysna.org Lower Hudson/NJ Jayne Cammisa, RN, BSN jayne.cammisa@nysna.org Western Chiqkena Collins, RN chiqkena.collins@nysna.org Eastern Martha Wilcox, RN (1962-2019) martha.wilcox@nysna.org Executive Editor Jill Furillo, RN, BSN, PHN Executive Director Editorial offices located at: 131 W 33rd St., New York, NY 10001 Phone: 212-785-0157 Email: communications@nysna.org Website: www.nysna.org Subscription rate: $33 per year ISSN (Print) 1934-7588/ISSN (Online) 1934-7596 ©2019, All rights reserved
e see it happen throughout history. When people have had enough, it takes only a spark to ignite the flame of mass resistance. The Revolutionary War of our United States was brewing over time—fueled by rebel organizing activities—but it was the tea tax and the Boston revolt that set a lot of things in motion, followed by several other events in rapid succession. Civil Rights legislation in the 1960s only occurred after years and years of struggle, sparked by some publicized brutal events in the South and massive demonstrations in Washington, DC. National Health Insurance (and even a national health system) was supported by most Americans and presidents throughout the 19th century but was cleverly discarded, first by the American Medical Association (AMA) in the 1920s and then by the newly empowered insurance industry in the 1950s in partnership with the AMA. The power of organizing
Ironically, it was the growing national consciousness nourished by the civil rights movement that led to the crushing defeat of Barry Goldwater in 1964, forcing the wealthy anti-worker right wing of the nation to step back and lick its wounds. This moment in time created an environment for the passage of a slew of progressive legislation in that decade, including the compromise national insurance programs Medicare and Medicaid. Teachers unions in West Virginia—a “right to work” red state—responded dramatically to inadequate funding and additional cuts last year. Fed up with the lack of commitment and progress in negotiations over time, a statewide school employee strike was called— with 100% participation. Lasting little more than a week, it brought the state government to its knees and resulted in a variety of victories for the state’s students and teachers. The recent general strike in Puerto Rico, which resulted in the ousting of the governor, was unprecedented in the history of the United States. It was sparked by scandalous emails, but had
July 22, 2019: General Strike in Puerto Rico, ultimately ousting corrupt governor.
been building over many years of widespread victimization, corruption and the lack of autonomy of a nation. However, the revolt wouldn’t have happened were it not for grassroots organizing over time. Registered nurses in the second half of the 20th century were subjected to draconian rules, horribly oppressive working conditions, abysmal salaries and received little or no benefits or pensions. This changed dramatically as a result of massive unionization drives and, significantly, strikes, wildcats, sickouts, boycotts and job actions of the 1970s and 1980s. Salaries quadrupled, serious benefit plans were initiated, working conditions improved and professional autonomy became the “sell” to recruit new nurses who were essential to the growth of the powerful hospital industry. Millennial nurses often hear baby boomer RNs talk about the “Golden Years” of nursing back then. This wasn’t a result of hospital CEO compassion for our profession, although the community hospital environment, even in some academic facilities, gave the illusion of “family.” The improved quality of nurses’ lives was the direct result of nurses organizing, taking action and demanding their rights. Nursing today
That autonomy is under attack— and has been over the last 10 or 20 years, as the extraordinary control over healthcare by the insurance industry, rather than by health pro-
fessionals and patients, has grown. This takeover has resulted in more redundancy than ever (think EMR), factory-like conditions in hospitals (doing more with less), de-professionalization and infantilization of the profession (scripts, rote protocols, near obliteration of in-person in-service programs), and the widescale proliferation of sicker, needier patients under our care without an increase in commensurate staffing, support or resources to care for them. Healthcare today
People with serious illnesses continue to face bankruptcy due to costs. Consider the recent murdersuicide of an elderly couple in Washington State, who chose this route, faced with bills they could not pay. People say, “How can this happen in America?” Mergers, acquisitions and hospital closings continue to make our workplaces look more like Walmart than facilities of loving care. Privatization and contracting out—“giving away our practice”—attempt to destroy union density and the benefits of caregivers across the spectrum. Rational proposals for end-of-life care rarely get the attention they deserve, resulting in the most costly component of healthcare that rarely improves the quality of life. The pharmaceutical industry’s (Big Pharma) unregulated power has not only escalated costs beyond the realm of imagination (think Continued on page 6
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july/august 2019
RNs battle the opioid crisis
T
he opioid epidemic has reached crisis levels in recent years. Throughout the country, far too many people are either battling addiction themselves or are affected by the substance abuse of a loved one. Registered nurses at HealthAlliance Hospital of the Hudson Valley’s outpatient methadone clinic are on the frontlines of this fight every day. RNs Cheryl Wilkinson and Mary Guip work in the clinic and have seen first-hand that addiction does not discriminate. “I have seen an increase [in addiction] in younger kids—kids who are 15 or 16. We have adults as young as 18 all the way up to people in their 70s,” said Wilkinson. “The rise of fentanyl is so troubling,” said Guip. “It’s everywhere. It’s getting scary out there.”
A human approach
Wilkinson believes better education is needed about addiction. “These patients are treated differently than other patients in other facilities, and they shouldn’t be. There is a huge stigma surrounding it.” Guip agrees that there is a lack of empathy around the issue. “As well as being an RN and a distributor of methadone, I am also a certified
Mary Guip, RN
CASAC [credentialed alcohol and substance abuse counselor]. I’ve done the coursework to understand addiction and substance abuse. Our client population are some of the most wonderful people. I have nothing but respect for them. “Unfortunately, there is a failure of continuity of care. They leave treatment and go right back into fragile situations—abusive partners or family members, poor living arrangements,” she said. “Ninety percent of substance abuse patients have suffered some sort of serious trauma. That needs to be addressed. We need to approach them with a humanistic point of view.”
In addition to the critical services the methadone clinic provides, Wilkinson says there are other methods of combating the opioid crisis that are desperately needed. “We need even more Narcan kits out there,” she stressed. “We need more providers of Vivitrol, and we also need to have quicker approval processes. We technically got rid of waiting lists, but when you’re told you may have to wait six months to a year—how can you wait?” Cathryn Kalisch, RN, agrees that more needs to be done. “More funding is needed. More staff is needed. I think we need clinics open longer. All of this will help the people, the many people who are not being served,” she said. “We need more access to treatment in jails, access to transportation for folks who need to travel to other facilities for treatment. A huge barrier to treatment is the lack of education.” Despite the challenges, NYSNA nurses at the clinic are making a difference for their patients at the bedside and beyond. “It’s not just dispensing—it’s also counseling. A lot of these people have no one else to speak to,” said Wilkinson. “Sometimes there are pregnant mothers who come here, and they might otherwise be mistreated. We need more empathy.” Saving lives
The methadone clinic at HealthAlliance Hospital of Hudson Valley
Said Guip, “I would encourage any RN to enter this field, anyone who has a desire to make a difference in our community.” “People come here to be cured, to live normal lives and hold down jobs, repair relationships with family,” Kalisch said. “This absolutely saves lives.” Due to widespread concern over the rising number of overdoses, elected officials in New York and the federal government are stepping up efforts to aid communities ravaged by the epidemic. The State Senate recently passed legislation that provides additional resources for those struggling with and recovering from the disease. And in March, New York Attorney General Letitia James filed the most comprehensive lawsuit in the country against the manufacturers of a widely prescribed prescription opioid.
“
These patients are treated differently than other patients in other facilities, and they shouldn’t be.” Cheryl Wilkinson, RN, HealthAlliance Hospital
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Opioid crisis:
Make Big Pharma pay!
By Jill Furillo, RN, NYSNA Executive Director
More than 2,000 lawsuits have been filed by cities and states across the country.
O
ne ne of the biggest drug busts in history may finally be done. Two dozen pushers up against local, state and federal authorities are giving up. It took almost a quarter century of investigation, witness preparation, trial (in some cases) and settlement. The pushers: a handful of giant pharmaceutical corporations; their product: opioids. Authorities estimate that hundreds of thousands of Americans
have died in the past two decades of overdoses related to prescription opioids. The drugs were sold by companies, some with household names, like Johnson & Johnson. Another company, Purdue Pharma, maker of OxyContin, profited from the opioid crisis as well as from treatments for the very problem the company had helped create. The con
No one is without a sad story about opioids and the terrible grip they have had on the lives of patients, family and friends. The drug companies produced opioids and then dispatched their sales force to persuade doctors of their benefits. The truth was that opioids are highly-addictive, cited as
the starting point in the downward spiral of heroin addiction and fentanyl use. In August, the Sackler family, owners of Purdue Pharma, besieged by lawsuits, were said to be finalizing a settlement of $10-12 billion and exiting from the business. Purdue Pharma is expected to file for bankruptcy. A reckoning
There are today approximately 2,000 lawsuits pending around the country filed by states and cities, including by NYS Attorney General Letitia James, against opioid makers. A federal judge in Cleveland overseeing the cases is working toward a “global settlement,” worth tens of billions of dollars. There is still a distance to go, as 34,000 cities and counties yet to file lawsuits are not in global settlement talks potentially worth additional billions. OxyContin came on the scene in 1995, when the FDA gave its approval to the pain relieving drug. The marketing of the drug came under scrutiny over the next decade. Johnson & Johnson’s deceptive marketing practices were brought to light in a case filed by the attorney general of Oklahoma. On August 26, a judge ruled against J&J, finding that the company was responsible for decades of opioid addiction and thousands of overdose deaths in Oklahoma. Key to the Oklahoma case was a finding of “public nuisance,” as defined by state law as “unlawfully doing an act, or omitting to perform a duty, which act of omission annoys, injures or endangers the comfort, repose, health or safety of others…” [my emphasis]. J&J was
ordered to pay the state $572 million, an small amount compared to the company’s $81 billion in sales in 2018. Still, the finding puts pressure on others to enter into global settlement. (For more on this significant finding, see pages 7-10.) How to best use these settlement funds? A public nuisance of this magnitude can only be offset by an investment in public health. First, we must learn from the experience of the tobacco settlement. In 1998 tobacco manufacturers settled with 46 states related to deceptive practices and the epidemic of tobacco-related illness and death. The industry was forced to pay $125 billion to the states. Payments to safety net hospitals and treatment centers
This is the precise moment for us to focus our demands on the use of the forthcoming opioid settlement funds: public health money for funding safety net hospitals and public health and communitybased treatment centers. Additionally, it is also important to recognize the critical role Medicaid has played in treating opioid addiction. An Urban Institute study released in August found that the number of Medicaid-covered prescriptions for buprenorphine, which eases opioid cravings and withdrawal symptoms, increased almost five-fold nationally between 2011-18. It is now an established fact that expanding Medicaid helps states combat the opioid epidemic and must receive the bulk of these payments. Make Big Pharma pay!
Funding our safety net system in New York and elsewhere expanding Medicaid programs directed towards opioid addiction prevention and treatment are the concrete steps towards achieving the care to those affected by this crisis. A U.S. Medicare for All health system can ultimately bring an end to the diabolical death spiral. Make Big Pharma pay!
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Public Health
july/august 2019
New data supports safe staffing
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ttend any NYSNA rally and you’ll hear dozens, or even hundreds, of nurses chanting loudly, “Safe staffing saves lives!” It’s on our tee shirts, tote bags, buttons and leaflets. NYSNA members know it because they live it every day; understaffing can have devastating effects on patient care. A new study recently published in the Journal of Nursing Administration1 provides additional empirical evidence to the commonsense argument that nurse understaffing puts patients at increased risk of negative outcomes and avoidable complications. The study analyzed data related to RN staffing levels and healthcare-associated infections (HAIs) at a large urban hospital system from the period 2007-2012. The HAIs included in the analysis were urinary tract infections (UTIs), bloodstream infections (BSIs) and pneumonia (PNUs) that occurred on or after the 3rd day of admission. Surgical site infections were not included due to incomplete data sets. RN staffing levels were determined based on two shifts: 7:00am-7:00pm and 7:00pm7:00am. A designation of
understaffing was based on the RN-to-patient ratio compared to the median staffing level on that unit. If staffing was below 80% of the median for that shift, it was considered understaffed. The analysis took into account factors such as patient age, stay in a skilled nursing facility prior to admission, comorbidities that put patients at higher risk for developing infections, medical procedures and treatments that increase the risk of infection (catheterization, ventilator intubation, etc.) and medications that impair the immune system among other factors. HAI rate 15% higher when understaffed day and night
Over 100,000 patients were included in the study, over 4,000 of whom developed the type of HAIs included in the study during their stay. The study found that the rate of HAIs was 15% higher on units that had RN staffing levels on both day and night shifts of less than 80% of the median. This is not the first study that links RN understaffing to increased patient risk of HAIs. However, the study authors argue that this study improves the data already
Centers for Disease Control and Prevention (CDC) video published on Mar 26, 2014
in existence because it addresses a number of deficiencies in previous studies in terms of better data and improved design. Authors conclude that, “Nurse administrators need to implement effective solutions to ensure adequate nurse staffing and provide safe and reliable care to acutely ill hospitalized patients.” Nurse safety also at risk
Not only patients are at risk. Multiple studies have also found that inadequate staffing leads to higher rates of occupational illness and injury to nurses and other healthcare workers. Healthcare executives pride themselves on using empirical evidence to guide their facilities’ practice. When it comes to RN staffing levels, the evidence is quite clear: staffing levels have a direct effect on the health of both the patient and the RN. Listen up, CEOs – Safe Staffing Saves Lives! (Endnotes) 1 Shang, J., Needleman, J., Liu, J., Larson, E. and Stone, P. (2019, May). Nurse staffing and healthcare-associated infection, unitlevel analysis. Journal of Nursing Administration, 49(5), 260-265.
The study found that the rate of HAIs was 15% higher on units that had RN staffing levels on both day and night shifts of less than 80% of the median.
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Solidarity at Disability Pride Parade
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NYSNA members at the Disability Pride Parade
n July 14, NYSNA nurses proudly marched down Broadway in Manhattan in solidarity with New York’s disabled community, families and advocates at the Fifth Annual Disability Pride Parade. Founded by famed jazz pianist Mike LeDonne in 2014 in honor of his daughter Mary, the parade has put a spotlight on people with physical and cognitive disabilities, promoting awareness, visibility and inclusion.
It has been 29 years since the signing of the Americans with Disabilities Act, yet disabled people still face discrimination and biases in many facets of life, including healthcare. Physical and procedural barriers to accessing care, stereotypes about disabilities, insufficient health coverage and disparities all factor into inequitable health outcomes. NYSNA nurses stand with the disabled community in advocating for full inclusion because equal access to quality, affordable health-
care is the right of every New Yorker. According to AccessibleNYC, nearly one million New York City residents live with some form of disability. Statewide, the number is more than three million. NYSNA members were happy to show their support for their fellow New Yorkers and advocate for a community that is frequently marginalized when it comes to healthcare.
People power
that threatens every one of us. Nurses see the results of such changes as we care for victims of hurricanes, floods, heat waves, droughts, forest fires, and their secondary impacts: vector-borne illnesses, mass migration and homelessness, mental illness such as depression, PTSD and suicides, stress-induced cardiac complications, carcinogens and mold-related respiratory diseases, family disintegration and more. Deregulation, anti-union legislation, the proliferation of lowpaying dangerous jobs, increased corporatization of public services, continued use of fossil fuel for energy needs, scapegoating those with fewer options to survive—these are not answers to our problems. They
worsen the situation and distract us from the need to reinvigorate our country to tackle the challenges we face as a society. Nurses have a unique role to play in not only caring for our patients day to day, but in our political involvement in educating the public and ourselves about the need to come together to confront these challenges. We need to nurture our natural inclination as humanitarian caregivers and healers to be part of this movement and not allow our employers—or government officials—to destroy that essential component of who we are. We need to reject the notion that positive change is not possible and instead, be the change we want to see.
Continued from page 2
insulin, EpiPens, etc.), but clearly played a role in the current opioid epidemic affecting communities across the United States. And many of us, even those with “good” insurance plans, find that over time we pay more, get less, wait longer and become more and more frustrated with the healthcare bureaucracy that we have no control over. The future…
Scientists agree that there’s an existential crisis facing our planet: the specter of intense climate change
Caring for all
“At NYSNA we care for all New Yorkers, and so many times the disabled community is pushed aside,” said Judith Cutchin, RN, NYSNA board member, President of the H+H/Mayorals Executive Council, and nurse at Woodhull Hospital. “We’re here to stand in solidarity and let them know we, the NYSNA nurses and the public health system, are here with you. We want to make sure they get what they need and that their rights are respected.” For NYSNA delegation member Flandersia Jones, RN, of BronxCare Health System, supporting the disabled community comes from a place of love. “As nurses, we don’t discriminate and we take care everybody. That’s why we came out here to show our support. We care. We love. That’s what nurses do. Regardless of your race, color, gender, sex, ability—we care for you,” said Jones.
New York
nurse special edition | july/august 2019
the official publication of the new york state nurses association
Corporate opioid pushers
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New York Nurse july/august 2019
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Anatomy of a corporate drug bust y 1994, mega-corporation Johnson & Johnson (J&J) capitalized on an opportunity that was to reap its shareholders billions in profits: raw ingredients for opioid painkillers. J&J had bought a business that grew and processed opium poppies in Tasmania, off Australia’s coast. The U.S. Food and Drug Administration approved OxyContin made by Purdue Pharma that year and J&J became the leading supplier of the drug’s ingredients. J&J developed a special strain of the poppy, which it called “Norman.” This strain became a core painkilling chemical agent, thebaine, in OxyContin—Purdue Pharma’s blockbuster drug. With a sales force of 1,000, Purdue became famous for paying the highest bonuses in the industry, energizing sales reps to hawk the idea that OxyContin was non-addictive. Deceptive sales
Jennifer Adamo, RN
Up close Members like Jenny Adamo, RN, who works Med/Surg and ED on Staten Island at Richmond University Medical Center, see the opioid epidemic up close. She has watched as patients arrive at the hospital strung out on opioids, or worse. “We are extremely concerned and troubled,” Adamo said. “It’s a constant. With addiction, people aggressively look for drugs—all types of ‘drug seeking.’ It’s an entire generation of adults reliant on opioids.” “Abuse is common, with the patient not realizing that they are addicted. These are heavy duty drugs.”
By 2007, Purdue’s deceptive sales tactics tripped them up and federal authorities took action. Purdue and three top executives pleaded guilty in federal court to criminal charges that they misled regulators, doctors and patients about the drug’s risk of addiction and its potential for abuse. They paid a fine of $600 million. But the charges were reduced to misdemeanors, with no jail time. To drug makers this was perceived as a wrist slap and they “continued its aggressive promotion of the drug, playing down its risk and overselling its benefits,” reported the New York Times. “I think it would have made a considerable difference if these people had been arrested and done jail time,” Sister Beth Davies told reporters this year. She related her story about the ravages of opioids in Appalachia. In 2001, she and others in Pennington Gap, Virginia, confronted Purdue Pharma executives about the overzealous marketing. Dr. Richard Sackler, the founder’s son, responding to their querries and Sister Beth remembered, “It was always profits over people.”
After years of refusing to share records of drug sales, a federal judge this year ordered the release of seven years of data, exposing the paths of more than 70 billion pills distributed to about 83,000 pharmacies across the country. One such pharmacy in Clinton County, Kentucky, sold 6.8 million pills between 2006 and 2012. Many pharmacies had annual double-digit growth in pain pills, according to an analysis by the Washington Post. Since 2006, 41 people have died of prescription opioid overdoses in the county. For some of these pharmacies there is no public record of scrutiny by authorities. The Drug Enforcement Administration had maintained its database for about two decades, “but did not regularly mine the records to identify pharmacies buying unusual quantities of opioid pills,” wrote the Washington Post. The DEA relies on drug companies and pharmacies to monitor and report suspicious purchases. “Letting the industry police itself helped fuel the epidemic” concluded the Post. “There were just too many people dying from these drugs in such a small place,” said Clinton County Coroner Steve Talbott. Deceptive sales practices and willing pharmacists and doctors combined to carry out drug sales on a
Raymond and Beverly Sackler: He was the last of three brothers who founded Purdue Pharma. All three were MDs. Raymond passed away in 2017 at the age of 97, leaving a multibillion dollar estate.
monumental scale nationwide. The opioid epidemic also morphed: it started with prescription pills, which led to increased heroin use and has now spawned the fentanyl crisis. The Sackler family, meanwhile, established itself as one of the leading philanthropic givers in the U.S. They were celebrated for their multimillion dollar gifts to museums and universities. But that was to come crashing down. “Public nuisance”
On August 26, 2019, a court in Oklahoma issuing a stronglyworded opinion against J&J. (See p. 9 for excerpts.) The company’s practices were found to be a “public nuisance” derived from its harm to the public’s health. Through its subsidiaries, J&J eventually supplied Continued on page 10
New York Attorney General Letitia James announcing the filing of a lawsuit against the manufacturers of opioids, including the Sackler family, March 28, 2019. She described the suit as the nation's most extensive.
NEW YORK NURSE july/august 2019
In the District Court of Cleveland County, State of Oklahoma vs. Johnson & Johnson
“
causing a public nuisance”
Excerpts from the Oklahoma trial court decision against Johnson & Johnson
“
ore than 2,100 m Oklahomans died of... opioid overdose”
“
J ohnson & Johnson... cultivated and processed opium poppy plants”
“
. ..supplied to other drug manufacturers”
“
‘ low risk of abuse and a low danger‘ of prescribing opioids”
“
fforts...intended e [to] increase profits from opioids.”
“
i ncreased opioid prescribing was the solution”
“ “
t arget high-opioidprescribing physicians.” s ubstantial payments...that influenced prescribing physicians”
State of Oklahoma vs. Johnson & Johnson
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Drug bust Continued from page 8
opium-based ingredients for a range of drugs—including hydrocodone, morphine, codeine and buprenorphine. An award of $572 million was handed down. J&J lawyers said they would appeal the ruling. One indication of J&J’s size and profitability: the award was considered so small that the company’s stock actually rose when news of the ruling was announced. Still, it triggered a domino effect among other pharmaceutical corporations, as they foresaw major damage awards levied against them and, unlike J&J, had insufficient resources to weather the storm. “Global settlement”
The Sackler family’s Purdue Pharma made known its progress toward a settlement worth $12 billion. Others are said to be working with a federal judge in Cleveland on a “global settlement” that could amount to hundreds of billions of dollars. These include Teva Pharmaceutical Industries, Mallinckrodt and Endo International. In Oklahoma alone, more than 326 million opioid pills were dispensed to state residents in 2015, enough for every person in the state to receive 110 pills, according to court papers. The interconnectedness of the drug businesses was testified to at the trial. “There would have been no OxyContin without J&J ramping up in Tasmania,” Dr. Andrew Kolodny of Brandeis University and a plaintiffs’ expert told the New York Times.
Protesters have gathered in front on the Metropolitan Museum in New York City, where the “Sackler Wing” is located, on several occasions. The family has used profits from OxyContin sales in its philanthropic giving.
Court documents show how J&J sought to persuade doctors that pain was undertreated, training its sales representatives to use “emotional selling” to get across the idea that patients were being harmed by undertreatment. Another concept was “pseudoaddiction,” or the idea that if patients were asking a doctor for higher doses, they were not necessarily addicted but needed more of the drug to treat their pain. Opioids to street drugs
Researchers have repeatedly found that drug marketing can influence the behavior of doctors. And doctors and hospitals were more inclined to trust J&J over other pharmaceutical companies because of its carefully cultivated reputation through decades of careful messaging and product management, experts told the Oklahoma court. No more. Today, alarms are going off at high volume. “[T]here’s no question that this epidemic began with the rampant overprescribing of those painkillers and that their overuse was fueled, quite deliberately, by the pharmaceutical industry’s efforts,”
editorialized the Times. “As innumerable court documents and investigations have shown, opioid makers, including Purdue and Johnson & Johnson, routinely and knowingly misled the public about their products. They played down the risks of addiction, insisting that their drugs were safe and, if anything, underutilized. And they combated growing concerns with aggressive lobbying and public relations campaigns. These tactics contributed to sky-high levels of opioid abuse, addiction and overdose. They led, almost directly, to the street drug problem that the nation is confronting today. And they secured handsome profits for opioid makers and suppliers.” Pay it back
The crisis has taken an enormous toll on the nation’s economy, costing an estimated $78.5 billion a year in healthcare, lost productivity and involvement by the criminal justice system, according to the Centers for Disease Control and Prevention. It’s time the drug companies pay it back.
medical missions
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july/august 2019
Making an international impact
N
urses brought their dedication and healthcare expertise to the Dominican Republic, and Mexico this summer, bringing NYSNA’s 2019 total of medical missions to seven. In the Dominican Republic, eight nurses and a doctor travelled to the San Bartolo community in Santo Domingo and the village of San Gregorio de Nigua, located in the San Cristóbal province, to provide healthcare to underserved communities. Working side by side with host organization Asociación Nacional de Enfermería (ASONAEN), the National Association of Nurses, NYSNA members treated nearly 500 patients. “We took care of patients from ages 0 to 90. We’ve seen some hypertensive emergencies, some hyperglycemic emergencies, and some primary care issues,” said Casey Smith, a registered nurse at Mt. Sinai. “It’s been very beautiful, and everyone has been welcoming and friendly.” Rachael Omonywa, RN, also of Mt. Sinai agreed: “My experience was amazing. I have made new friends and met and been able to care for patients of different races and ages. I love it here.” Caring for migrants
NYSNA volunteers were recognized and honored for their service with a plaque at an ASONAEN conference attended by hundreds of Dominican nurses. Members were able to learn about the ongoing struggles nurses face there— including staffing. At times, the nurse-to-patient ratio can reach as high as 1:130. Fifteen-hundred miles to the west, a group of nine nurses witnessed firsthand the effects of the humanitarian crisis in Mexico as they travelled to the city of Ciudad Hidalgo, Suchiate, in the state of Chiapas. The city lies on the Suchiate River, which separates the country from Guatemala. The region is a frequent stop for migrants journeying to the Southern border of the United States. Upon arrival, nurses were welcomed by a group of local volunteers who helped promote the
“
[T]he community is great, the people are grateful, and you’re giving back. It’s such an amazing feeling.”
Nurses saw hundreds of patients in Chiapas, Mexico.
mission. Over the course of three days, NYSNA volunteers provided much-needed healthcare services to nearly 600 patients—a mix of migrants and locals who came to be seen by and give thanks to the nurses who treated them during last year’s mission trip. An educational delegation
In Cuba, a 19-person delegation of NYSNA members and other volunteers was received by officials at the Ministry of Health where they learned of the difficulties in providing healthcare in the country due to the U.S. embargo. During the educational sessions, nurses talked about staffing with hospital directors at Hospital Hermanos Ameijeiras, discussed curricula at the Lidia Doce Nursing School, and were received by Health Committee
President Congresswoman Cristina Morales at the National Congress. NYSNA nurses relished their experiences in the three countries and appreciated the opportunity to both give back and learn about other countries’ and caregivers’ approaches to care. “This is an awesome experience,” said NYSNA Director Seth Dressekie, RN, of the NYC Human Resources Administration. “In the case of medical missions, the community is great, the people are grateful, and you’re giving back. It’s such an amazing feeling.” “I would recommend medical missions for anyone who really is serious about helping and treating underdeveloped nations,” said firsttime participant and nursing student Margaret Mobley. “The experience that you have is unbelievable.”
NYSNA Director Seth Dressekie, RN, NYC Human Resources Administration
Casey Smith, RN, in the Dominican Republic
NYSNA members of the delegation to Cuba
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New York Nurse july/august 2019
Republican and third party Below are Republican and third party candidates with their positions on issues, where available. President Donald Trump
Joe Walsh
Former Governor Bill Weld
Minimum Wage
Climate/ Green New Deal
NYSNA supports workers’ rights, strong wages, collective bargaining, the right to organize and supports the elimination of laws banning union security. NYSNA is in favor of the Protecting the Right to Organize Act (PRO Act) to strengthen protections for employees engaged in collective action, to facilitate collective bargaining and to provide for stronger remedies for employees under the NLRA.
NYSNA supports the Raise the Wage Act, which would raise the federal minimum wage to $15/hour by 2024.
NYSNA supports the Green New Deal and combatting climate change to protect public health.
Against
Strongly supports Janus ruling.
According to Labor “A roadmap to destroy the Secretary Alexander American economy.” Acosta, Trump does not support an increase in the minimum wage.
Unclear where he stands now, but in Congress, Walsh ran hard against Obamacare and opted out of the generous congressional healthcare plan.
N/A
N/A
Unclear – Walsh recognizes that human activities impact climate change and says the Republicans should acknowledge it as a problem.
Against
N/A
Against. As governor, he vetoed minimum wage increases in his state.
Said the Green New Deal sounds expensive, but the U.S. should rejoin the Paris Agreement.
Max Abramson
Against
Strongly Right-to-Work
Voted against raising the minimum wage in New Hampshire to $12 an hour.
America should lead the world in developing alternative energies. “We can create more jobs and build more manufacturing” and bring energy costs down through free market competition.
Dan “Taxation is Theft” Behrman
Against
N/A
N/A
N/A
Unclear – wants people to be able to choose whatever healthcare that they want.
N/A
N/A
Unclear
Medicare for All
Unions/ Janus
NYSNA’s Position
NYSNA supports the Medicare for All Act of 2019, introduced by Senator Bernie Sanders (D-VT) and 14 of his colleagues. In the U.S. House of Representatives, it is sponsored by Rep. Pramila Jayapal (D-WA) and Rep. Debbie Dingell (D-MI).
Pres. Donald Trump (R-NY)
Joe Walsh (R-IL)
Former Gov. Bill Weld (R-MA)
(Libertarian-NH)
(Libertarian-TX)
Souraya Faas (Libertarian-FL)
NEW YORK NURSE
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july/august 2019
candidates and issues Max Abramson
Dan Behrman
Souraya Fass
Trade
Immigration
Reproductive Rights
Guns
NYSNA supports trade policies that protect American workers and the economy and opposed NAFTA and TPP.
NYSNA supports immigration policies to protect people seeking U.S. asylum; provide DACA recipients a clear path to citizenship; and respect the dignity of every person (No kids in cages!).
NYSNA support the Women’s Health Protection Act of 2019, which guarantees safe and affordable care.
NYSNA supports the public health position on gun control to establish policies that protect our patients and communities, including the Help Empower Americans to Respond (HEAR) Act.
Working on revisions to NAFTA.
Wants a wall on the U.S.-Mexico border and has insisted on it, causing the longest partial government shutdown in history.
The newest administration rules ban The Second Amendment “will never be taxpayer-funded clinics from making repealed.” abortion referrals and prohibit clinics that receive federal money from sharing office space with abortion providers.
Unclear
For a wall and border security.
Anti-abortion
Strongly supports free trade.
For more work visas, a guest worker “I’m a pro-choice Republican.” program, more agents and better technology. Against a border wall and citizenship for undocumented immigrants.
Against giving guns to people with any history of mental illness. For “focusing on gun safety rather than gun ownership.”
N/A
Not clear – says he is proimmigration but supports secure borders.
Opposes taxpayer funding for abortion and Planned Parenthood and has consistently voted this position.
Strongly pro-second amendment; advocated to expand the New Hampshire Stand Your Ground bill to include the use of guns not just in self-defense but to defend others in response to non-deadly force.
Supports free markets.
Does not support the border wall.
Unclear – says this is about taxes and opposition of control; wants to change the conversation to why abortions are happening.
N/A
N/A
Unclear – has said, “… those who Pro-life but would not impose her belief Against gun control. arrive illegally seem to have more on others. Abortion should be decided rights and advantages than the on the state not the federal level. hardworking American citizens who were born here.”
After the August 2019 shootings in Texas and Ohio, Walsh said that an assault weapons ban would do nothing to prevent mass shootings.
Other
Walsh says that he is running to the right of President Trump.
For reducing the size and scope of government, rolling back all income tax, closing the Federal Reserve and IRS, ending daylight saving time and massively culling the criminal justice system.
Continued on page 14
14
New York Nurse july/august 2019
Adam Kokesh
John McAfee
Arvin Vohra
Kim Ruff
Medicare for All
Unions/ Janus
Minimum Wage
Climate/ Green New Deal
N/A
N/A
N/A
Against government regulation of the environment.
Against
N/A
Against raising the minimum wage.
N/A
Against
N/A
Against raising the minimum wage.
N/A
Against
N/A
For eliminating the minimum wage entirely.
For selling all government owned land and removing all laws limiting the liability of private property owners as a way to protect the environment.
N/A
N/A
N/A
Against
Retired Teamster
(Green Party-NY)
Favors a community-controlled national health service with publicly owned clinics and hospitals governed by a federation of locally elected boards.
Unclear – but pledges to guaranty an income above poverty.
Proposed a Global Green New Deal funded by money from military spending cuts reinvested in Green Energy, Regenerative Agriculture, and Basic Human Needs Around the World.
Dario Hunter
Supports
Pledged to protect workers’ rights and unions and to stop firings without just cause.
For a $15 an hour minimum wage.
“Under the REAL Green New Deal there will be full employment – with public works jobs and green jobs.”
Strongly supports
In the past he has spoken out for the rights of all workers to organize.
For a guaranteed universal basic income of $1,000 per month, which would increase with inflation.
Strongly supports the prioritization of Green Energy.
Adam Kokesh (Libertarian-AZ)
John McAfee (Libertarian-TN)
Kim Ruff (Libertarian-AZ)
Arvin Vohra (Libertarian-MD)
Sedinam Kinamo Christin MoyowasifzaCurry (Green Party-CA)
Howie Hawkins
(Green Party-OH)
Ian Schlakman (Green Party-MD)
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july/august 2019
Sedinam Kinamo Christin Moyowasifza-Curry
Howie Hawkins
Dario Hunter
Ian Schlakman
Trade
Immigration
Reproductive Rights
Guns
Other
Believes in voluntary trade based on ownership.
For securing our borders and ending the incentive structure that encourages illegal entry. Against amnesty for illegal aliens.
Against abortion, but opposes government standing in the way of choice.
Has wielded a gun in protest of Second Amendment restrictions in states where public use of firearms is illegal.
His platform is based on a plan to abolish all government in favor of the “localization” of government.
N/A
Against increasing restrictions on border security. For denying illegal immigrants access to subsidized healthcare.
Pro-choice, but believes it is not the government’s prerogative to ban abortion.
Against restrictions on current process for “Freedom for the people is my purchasing guns. only goal.”
For ending government restrictions on free trade.
For abolishing ICE and pardoning fully all otherwise innocent people who are in the U.S. without government permission; against border walls, as antithetical to freedom and liberty.
“There is no medical consensus on when life begins so we just relegate it to one of personal belief – is the fetus life or property? You own yourself. Government has no right to tell you what to do.”
Against all restrictions on the Second Amendment, excluding weapons of mass destruction. For disbanding the Bureau of Alchohol, Tobacco and Firearms.
Unclear — “Make Trade Not War.”
For open borders and removing all restrictions on immigration.
Believes reproductive rights are outside the boundaries of state and federal government and are a matter of individual choice.
For eliminating all gun-free school zones and remove all restrictions on gun ownership as a way to promote school safety.
Vohra has been called an “anarcho capitalist;” he believes in ending the welfare state, abolishing public schools and ending the income tax.
N/A
N/A
N/A
N/A
Curry is an anti-capitalist, anti-imperialist, who is seeking to break what she perceives as a color barrier within the Green Party.
For European-style “Open Borders – Fair Trade Zones with Free Travel for Work, Shopping and Recreation.”
For open borders, legalizing undocumented immigrants and replacing the customs and border patrol and ICE with an agency committed to the administration of open borders.
Supports “full and improved Medicare for All that covers all medically necessary services, including abortion and all reproductive health services.”
For nationalizing the gun industry, banning and buying back military assault weapons, universal background checks, a mandatory gun safety test for gun owners and a 28-day waiting period for gun purchases.
For trade laws that protect “the labor, human rights, economy, environment and domestic industry of partner and recipient nations,” giving local industry and agriculture an edge over foreign corporations.
Against “unwarranted deportations and detentions, night raids and separating undocumented immigrant families.” For creating an achievable path to citizenship for immigrants.
“Contraception and abortion must be included in all health insurance policies in the U.S., and any state government must be able to legally offer these services free of charge to women at the poverty level.”
For an assault weapons ban, Brady Bill background checks, background checks for private sales and sales at gun shows, no immunity from lawsuits for gun manufacturers, etc.
Strongly opposed to the expansion of free trade.
For open borders and abolishing ICE.
Strongly supports a woman’s right to an For gun control legislation, including unrestricted abortion. background checks for sales at gun shows and requiring a license for gun ownership.
For an Open Revolutionary Socialist Platform, ie “creating a true international human rights focused agenda that’s anti-capitalist, anti-imperialist and anti-colonialist.” Continued on page 16
16
New York Nurse july/august 2019
Brian T. Carroll
Joe Schriner
Joshua Perkins
C. L. "Connie" Gammon
Unions/ Janus
Minimum Wage
Climate/ Green New Deal
Strongly supports
N/A
Unclear – claims to support climate and environmental protections.
For dismantling Obamacare, Medicaid, N/A (American Solidarity & Medicare and moving to a Regional Health Care System, including a Party-OH) local tax to cover a local version of Medicare and Medicaid for poor, uninsured people. Emphasis on diet, exercise and the environment.
N/A
Proposed turning the White House into the Kyoto Protocol Home Zone and pushing for reforestation, adding teeth to the EPA, and shifting to a more “decentralized” society withs local production for local consumption.
Joshua Perkins
Medicare for All Brian T. Carroll
For expanding Medicare and making (American Solidarity it higher quality than for-profit systems. Party-CA)
Joe Schriner
Has not settled on a particular (American Solidarity plan, but believes we need more government intervention. Party-TX)
N/A
We should explore universal basic income to learn more about it. Supports the principal of an income for all.
Climate policy is a matter of pragmatism and political feasibility – how can we deny modern conveniences to those without in India and China? Strongly supports nuclear energy and other alt. energy sources, as well as the use of geoengineering to stop global warming.
C.L. “Connie” Gammon
N/A
Right-to-Work
N/A
N/A
N/A
N/A
N/A
Supporters of the Green New Deal must accept that achieving environmental prosperity in the future may require economic sacrifice now.
Called on members to sign up as citizen cosponsors for Medicare for All.
WFP National Director Maurice Mitchell has stated that unions “built the American middle class. They brought us the [40]-hour work week and employer-based healthcare. They raised wage floors and ended child labor.”
Strongly supports a $15 an hour minimum wage on the state and federal levels.
Called on members to sign up as grassroots cosponsors of the Green New Deal.
(Prohibition Party Nominee-TN)
Mark Charles (Independent-NM)
Working Families Party (WFP)
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Working Families Party
Mark Charles
Trade
Immigration
Reproductive Rights
Guns
Other
N/A
Unclear – “Families will not have to Pro-life hide or fear separations. It means that DACA kids will be fast-tracked for citizenship.”
For tightening interstate and mail-order sales and enforcing the laws that are already on the books.
N/A
For “Amnesty for all illegal “I am against abortion, period. Life immigrants and family reunification, begins at conception.” a living wage, benefits and optimal working conditions for all new arrivals to the country.”
For banning semi-automatic weapons, gun registration and a mandatory requirement for gun training and carry insurance, etc.
N/A
Unclear – for immigration reform but how it should be reformed has not been clarified.
Pro-life – would criminalize the abortion procedure but not women.
Focus should be shifted away from mass shootings to gun safety through targeted interventions in high-risk communities.
Strongly supports free For strong border security. trade on a reciprocal basis among equals.
Anti-abortion
Enthusiastic supporter of the Second Amendment.
N/A
N/A
N/A
N/A
Calling for justice for Native Americans and an end to institutional racism.
Against the TPP and passing the reactivation of a Fast Track mechanism, which allowed the U.S.’s entry into NAFTA and the WTO.
Petitioning to abolish ICE.
Released a joint statement with other progressive groups calling for the withdrawal of support for any Democratic candidate who is not prochoice.
Has endorsed candidates who advocated for stricter gun laws.
In 2020, Working Families Party has said it will endorse one of the following six candidates for president of the U.S.: Bernie Sanders, Elizabeth Warren, Cory Booker, Julian Castro, Bill de Blasio or Kamala Harris.
18
New York Nurse
upstate
july/august 2019
but I had so many other patients I couldn’t sit there and comfort her and talk to her about her diagnosis, and just be there for her the way I needed to be.” Nurses at the hospital are not only fighting for a contract with enforceable staffing ratios, they are also demanding health benefits and fair wages that allow for the hiring and retention of the best nurses. “Nurses are leaving because they are so stressed—their mental health is taking a hit,” said Rule. Fighting for benefits RNs and allies picketed outside of Vassar Brothers Medical Center.
VBMC RNs say ‘patient safety cannot wait’
NYSNA at the Fair NYSNA Members shared the importance of Safe Staffing for all New Yorkers during their return to the 2019 Great New York State Fair, held August 21 – September 2 outside Syracuse, New York. Volunteers gathered signatures in support of the legislation which will once again be featured during the 2019-20 legislative session in Albany.
W
aving signs and chanting “Vassar, Vassar, shame on you,” Vassar Brothers Medical Center RNs came out in force on August 21 to bring awareness about severe understaffing at the facility and to advocate for a fair contract. “We’re really concerned about staffing ratios,” said Vassar Brothers RN Beverly Codrington. “Nurses are taking care of as many patients as possible the best they can.” Beyond basic care
Undeterred by a big downpour, hundreds of nurses and allies spent their lunch breaks and day off picketing in front of the hospital,
which is the largest employer in Poughkeepsie. Nurses are demanding lower nurse-to-patient ratios in their new contract with the hospital in an effort to better protect themselves and their patients. “It’s not safe for the nurses, patients, families, [or] future nurses,” said Robin Rule, RN. “My daughter wants to be a nurse one day, and I want her to go into a profession where she is safe and she can safely take care of patients. “It’s not all about providing basic care, it’s about providing that compassionate care because that helps them heal also,” said Rule. “I will always remember having a patient find out she had pancreatic cancer,
Westchester Medical Center NYSNA RNs Zina Klein and Jayne Cammisa (above, L to R) enjoyed a day at the NYSNA exhibit greeting fairgoers. Jayne, a Lower Hudson/NJ Regional Director on NYSNA’s Board of Directors, dedicated her day at the exhibit to the memory of NYSNA Board Member Martha Wilcox, RN, who passed away this past June. Martha loved the fair, and was a dedicated volunteer for many years.
NYSNA members braved the rain to speak out for safe staffing and a fair contract.
Colleen Perez, RN, works in the hospital’s PACU. As a two-time cancer survivor, maintaining her health benefits is critical. “If we were to lose our health benefits in this upcoming contract, I’m not sure where that would leave me or my family,” said Perez. Perez said that on a typical day in the PACU there are four or five RNs caring for 40 patients. With the expansion of the hospital set to open in the spring next year, nurses could be at increased risk of taking on even more patients. It’s far beyond what they can safely handle. “We provide excellent care to our community members, and we want to have the resources to continue this care,” said Perez. “And as we provide this care to our community, we also want to have the means to care for our families.” As contract negotiations continue, NYSNA nurses at Vassar Brothers are not letting up, as they continue to let the public know that patient safety cannot wait.
NEW YORK NURSE July/august 2019
NYC – Carine Samuel, RN, and Kevin Garrett, RN, help patients struggling with addiction and co-conditions at Interfaith Medical Center.
long island
– NYSNA members come together
with family and the community at the Long Island Ducks baseball game.
Around the state 9
capital/north country
– RNs at Albany
Medical Center hold a forum to advocate for safe staffing and a fair contract.
western region
– Nurses at ECMC are helping
those suffering from opioid addiction take steps towards recovery.
central region
– Central New York nurses
battle an opioid epidemic that touches all units—from the Emergency Department to Labor and Delivery.
– RUMC nurses take to the picket line to demand a fair contract and staffing standards.
staten island
19
NEW YORK NURSE
Non-Profit US Postage Paid NYSNA
july/august 2019
131 West 33rd Street, 4th Floor New York, NY 10001
2 WLHV
INSIDE
Nominate an Outstanding Advocate Corporate opioid pushers, pp. 7-10
The NYSNA Convention will honor outstanding advocates from our profession in fields including nursing practice, collective bargaining, organizing, legislative, media, peer assistance, and student nurse leadership. Sound like someone you know? Nominate them today at www.nysna.org/nominate-outstandingadvocate. Nominations are due on September 15.
Opioid crisis: Make Big Pharma pay!, p. 4