Monday, May 31, 2021

Bad Moon Rising (Musings on being fired for having 'long haul' COVID-19)

Updated: 31 May 2021

INTRODUCTION

The idea for the blog was stimulated by news of an American clinical laboratory scientist being fired after she had been infected with COVID-19 and was recovering from 'long haul' COVID-19, even though she had worked for  the employer (Community Hospitals of Central California) for 33 years. The news item came about because she has sued the employer for wrongful dismissal.(Further Reading)

The blog's title derives from a 1969 song by Creedence Clearwater Revival.

PERSONAL ANECDOTES

First, please note that I had a minor disability (suffered from acute lower back pain attacks) when I first joined UAlberta's Medical Laboratory Science first as a lecturer and clinical instructor for the hospital's transfusion service and later became an assistant professor. Was a candidate for surgery but the Drs decided to treat it conservatively, for which I'm grateful. 

The attacks were severe and my colleagues kindly would pick me up and drive me to work. I managed with a 2-wheel folding walker, and by taking mega doses of the pain killer ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID).

The university's Faculty of Medicine/Department of Laboratory Medicine and Pathology always supported me, even when I had to take extended time off. What they did was designate a hematopathologist resident to give my classes until I could return. One who helped is now in a senior position.

NOTE: If you've read this blog before you will know I'm a contrarian.

Over 36 years working as a medical laboratory technologist and educator, I've seen only two medical lab technologists who ever faced being fired

#1. One was when I worked at Canada's then blood supplier (Canadian Red Cross Blood Transfusion Service, also a transfusion service for the entire city) in Winnipeg. It failed. A compulsory Dr. exam was needed after you were hired, and the Dr. said a girl with deformed hands due to a medical condition could not perform her duties, as we then largely worked manually, did a lot of pipetting by hand. Staff saw she could do the work and I decided to get every lab worker to sign a petition saying she could do the work. She wasn't fired and went on to work many years for the organization, including becoming a supervisor.

#2. The second I heard about as an educator and it disturbed me. I've decided not to give many details to respect her privacy. I knew her well when she worked in a hospital transfusion service and was helping her get her ART (Advanced Registered Technologist), then offered by the CSMLSAfter losing her license to practice as a med lab technologist she became a medical lab aide and to me didn't deserve her fate. I wish I had been able to help her at the time.

SUMMARY

I've read several news items about the story and also the lawsuit , which is available online. What follows is my interpretation of the basic facts of the case. Yours may be different. Most is from the lawsuit, some from news items. The Plaintiff asked for a jury trial.

1. Plaintiff began working for Defendant, Employer, on or about 1 July 1987 as Clinical Lab Scientist. She received good performance reviews and salary increases and was not subject to discipline for her job performance over the more than 30 years of her employment.

2. Plaintiff suffers from several medical conditions including diabetes, cardio-pulmonary disease and traumatic brain injury. Defendant, Employer, is aware of Plaintiff’s medical conditions.

On several occasions when Plaintiff had to take time off work due to illness, Defendant, Employer, subjected her to discipline based on her attendance.

3. In mid-April Plaintiff contracted COVID-19. Her health care provider put her on medical leave for about six weeks.

4. Plaintiff’s health care provider suggested that she request intermittent medical leave due to her continued illness combined with her underlying medical conditions. Plaintiff requested the appropriate paperwork from Defendant, Employer’s leave of absence department. However, Plaintiff’s supervisor told her “you better not” referring to Plaintiff’s request for leave. In addition to this threat from her supervisor, Plaintiff was shunned by her supervisor and coworkers.

5. Within the year last past, without excuse, justification or privilege, agents of Defendant, Employer, including but not limited to supervisor Carol Kelley, published and republished, orally and in writing to third persons, including prospective employers of Plaintiff and other persons who are not parties to this action, the false and defamatory statements about Plaintiff, stating as matters of fact that, among other things: Plaintiff violated company policies; and Plaintiff deserved to be terminated.

My comment: Wow, they spoke to prospective employers and under which circumstances? My experience in Alberta, Canada is when FOIP (Freedom of Information and Protection of Privacy) became law, prospective employers who were not listed in an applicant's application for employment, would not comment except to say the person worked there. 

6. The Causes for Action in the lawsuit, which all relate to violations of  Government Code §12940:

1) Discrimination Based on Medical Condition, Disability and/or Perceived Disability in Violation of ...

2) Failure to Accommodate Disability in Violation of ...

3) Failure to Engage in a Timely, Good Faith, Interactive Process To Determine Effective Reasonable in Violation of ...

“It shall be an unlawful employment practice . . . For an employer. . . to fail engage in timely, good faith, interactive process with the employee . . . to determine effective reasonable accommodations . . .”

Defendant, Employer, knew of Plaintiff’s medical condition and her need for accommodation which consisted of additional medical leave. Yet, Defendant, Employer, failed to accommodate Plaintiff and ignored her requests for accommodation. Defendant, Employer, refused to explore any options to accommodate Plaintiff but, instead, subjected her to unjust discipline and terminated her employment. Accommodation of Plaintiff would not have caused Defendant, Employer, any undue hardship, significant difficulty or expense.

4) Failure to Prevent Discrimination and Discrimination Based on Medical Condition, Disability and/or Perceived Disability in Violation of...

5) Retaliation for Requesting Accommodation in Violation of...

6) Retaliation for Exercising Rights Under California Family Rights Act in Violation of 2 C.C.R. §11094

7) Wrongful Termination in Violation of Public Policy

8) Defamation

Within the year last past, without excuse, justification or privilege, agents of Defendant, Employer, including but not limited to Carol Kelley, published and republished, orally and in writing to third persons, including prospective employers of Plaintiff and other persons who are not parties to this action, the false and defamatory statements about Plaintiff, stating as matters of fact that, among other things: Plaintiff violated company policies; and Plaintiff deserved to be terminated.

The statements made by Defendants and their agents were and are false and constitute defamation on their face in that they communicate to third persons as matters of fact that Plaintiff was a problematic and poorly performing employee who deserved to be terminated from her job. This constitutes defamation per se as false statements tending to injure Plaintiff in her profession.

Plaintiff asks for the following:

  1. For general damages in excess of the jurisdictional minimum of this Court, according to proof;
  2. For special damages according to proof;
  3. For exemplary punitive damages, according to proof;
  4. For interest on the amount of losses incurred in earnings, deferred compensation and other employee benefits at the prevailing rate;
  5. For reinstatement to her job with Defendant, Employer;
  6. For costs of suit, including reasonable attorneys’ fees; and
  7.  For such other and further relief as the Court may deem just and proper.

FOR FUN

Had difficulty choosing a song for this blog but settled on the following, as I wonder how many 'long  haul' COVID-19 folks will suffer a similar fate of the med technologist in this blog. 

I see the bad moon a-rising / I see trouble on the way...

FURTHER READING

  1. Hospital-based clinical laboratory scientist is suing her former employer after being fired due to long-haul COVID-19 illness (5 May 2021)

Friday, April 30, 2021

Stand by me (Musings on ongoing bullying in healthcare)

Stayed tuned for updates, which are sure to occur.

INTRODUCTION
The idea for the blog was stimulated by news of a celebrated, experienced UK nurse who faced being stuck off after in 2017 she saved a woman's life who was hemorrhaging after losing her baby with a blood transfusion in an ambulance. (Further Reading) But, through no fault if hers, the required prescription for a blood transfusion had not been taken onto the ambulance with the patient. The nurse claims she has been the victim of bullying by senior NHS managers after she saved the life of the woman. She was unable to return to work at the trust's insistence for ten months, and resigned after she lost a disciplinary hearing. She had to find work outside the trust and is now practising elsewhere.

She was a finalist for 2020 Florence Nightingale Nurse of the Year after raising 
£100,000 to buy iPads for Covid patients isolated from loved ones. Four years later the Nursing and Midwifery Council concluded the nurse undoubtedly acted in the best interests of the patient and has 'no case to answer'. In some ways this case reminds me of the Bawa-Garba case in UK where a pediatric trainee was convicted of gross negligence manslaughter. (Further Reading)

In addition to this case, harassment and bullying of medical students has been in the news in several nations for a few years. And in my province of Alberta, Canada, in 2016 a noose was hung outside a Black Dr's operating room in Grande Prairie. It was reported almost immediately to hospital administrators by startled bystanders. Yet, according to multiple doctors who wrote complaints, nothing was done to discipline the perpetrator, a white surgeon whom colleagues say still held leadership positions after the incident. (Further Reading)

The blog's title derives from a 1961 song by Ben E. King featured in the 1986 move of the same name.

PERSONAL ANECDOTES
The University of Alberta where I once taught has explicit, well defined Employment Equity and Human Rights Definitions and policies on bullying and discrimination. Yet I'm certain both still exist. The guidelines are followed by all faculties, including the Faculty of Medicine & Dentistry. (Further Reading) It covers pretty much every kind of discrimination, whether direct or indirect: any act or omission based on race, religious beliefs, colour, gender, physical disability, mental disability, marital status, age, ancestry, place of origin, family status, source of income, sexual orientation or political belief, when that act or omission results in loss of or limit on opportunities to work or to fully participate in campus life or offends the dignity of the person.

As a patient I've seen bullying by a Dr. against a trainee and at scientific conventions. As a patient the male Dr. presumably wanted the female trainee (intern or resident) to suffer abuse as a rite of passage that would toughen her up. Few likely report it as the Dr. is all powerful and they fear being judged as troublemakers that could affect their career progression.

At Canadian transfusion medicine conferences I've also witnessed bullying, again by a male Dr. (a 'biggie') against a female Dr. who had presented and was taking comments from the audience. She held her own but his comments were dismissive and abusive and it likely cost her much stress. I wondered why at the time and since and, frankly, suspect he'd not have done that to a male colleague in the same way.

As always, comments are most welcome. Would appreciate hearing about discrimination or bullying you've experienced or witnessed, You can do so by name or anonymously.

FOR FUN
Chose this song because we all need to stand by colleagues in any field when they experience bullying, discrimination, harassment of any kind. Sad to report as items in Further Reading report, the incidence of bullying in medicine remains quite high.

  • Stand By Me (Ben E. King with stars and clips from the film)
FURTHER READING
Nurse who faced being struck off after she saved a woman's life with a blood transfusion has been cleared by an official inquiry (20 Apr. 2021) | Related:
Employment Tribunal of Leona Harris (18 Oct. 2019) | The complaint of unfair dismissal is not well-founded and is dismissed.

University of Alberta: Employment Equity and Human Rights Definitions

Taylor-Robinson SD, De Sousa Lopes PA, Zdravkov J, Harrison R. A. Personal perspective: is bullying still a problem in medicine? Adv Med Educ Pract. 2021 Feb 10;12:141-5. (Free full text)

Bullying in the workplace (1 Sept. 2020, CMA)  | What bullying in health care looks like, why it persists and how to eliminate it from the culture of medicine.

Medicine's bigotry and bullying problem
(Oped in Canada's Macleans magazine, 8 July 2020)

Colenbrander L, Causer L, Haire B. 'If you can't make it, you're not tough enough to do medicine': a qualitative study of Sydney-based medical students' experiences of bullying and harassment in clinical settings. BMC Med Educ. 2020 Mar 24;20(1):86. (Free full text)

Australia: Culture of bullying, harassment and discrimination in medicine still widespread, survey suggests (9 Feb. 2020)

The Bawa-Garba case should usher in a fairer culture in healthcare (9 May 2019)

Thursday, April 01, 2021

Simply the best (Musing on healthcare educators during COVID-19)

INTRODUCTION
I've meant to write this blog for awhile. I'm privileged to look after the mailing lists for University of Alberta's Medical Laboratory Science. As such, even though I no longer teach in the division, I get all messages to students and staff plus more. The blog will focus on medical laboratory education but I suspect it rings true for other health professionals. Had help with ideas for the blog from a former student of mine, who I won't identify at this time.

The blog's title is based on a ditty written by Holly Knight and Mike Chapman, but best known by Tina Turner's recording of it.

HOW EDUCATORS  ADAPTED DURING PANDEMIC
Where to start. I'll need to speak in generalities because it differs depending on the prevalence of COVID-19 in educators' areas. Sample list of key adaptations heath profession educators had to make:
1. Managing the chaos of ever-changing information. Suspect most people know how hard this is as regulations and policies regularly change as new evidence becomes available. Good example is the changing advice on the AstraZeneca COVID-19 vaccine as research and real world evidence become available.

2. Online learning. This was a major transition, involving putting course material online. Much harder for instructors who didn't use Powerpoints regularly, instead had in-class activities. 
Not all students enjoy online learning as much as face-to-face interaction with classmates and instructors, nor do the assignments, required pre-reading, etc. That's true for in person classes too but worse with online learning. Plus it's much easier to be distracted when text messages arrive as today's students pretty much have their cell phones on at all times.

Online learning also put much stress on university, community college, and technical institute IT departments.

3. In introductory courses, depending on when the pandemic was declared, students had a different laboratory experience than in prior years when all routine labs and a final exam were performed before entering the clinical year. Similarly, for other pre-clinical experiences such as phlebotomy visits to outpatient labs, etc.

Ultimately, some in-person introductory lab courses resumed, but required many adaptations in student labs. Examples: Fewer students in each lab space (e.g., one lab becomes two), shower curtains erected for students facing each other on the same bench, between labs sanitizing high touch areas (door knobs, bench areas, reagent bottles).

4. In the clinical year, depending on when the pandemic was declared, students were pulled from the sites until safety precautions could be put in place. This required re-scheduling.

5. Depending on how many institutions, healthcare organizations are involved, processes and procedures could differ, requiring educators to meet the needs of each.

LEARNING POINT
To me all healthcare educators deserve a loud round of applause for how they've had to adapt during the COVID-19 pandemic to constantly changing regulations and policies. In some ways I'm glad I retired decades ago as I would have found this difficult even then.

FOR FUN
Chose this song because to me healthcare educators have been simply the best during COVID-19 pandemic. To me they're heroes similar to those on the frontlines.
As always, comments are most welcome (you can do so anonymously or by name below) and  there are some.

Sunday, February 28, 2021

I will remember you (Musings on healthcare heroes during COVID-19 pandemic)

 Updated: 1 March 2021

February's blog is about healthcare workers who have been infected and died from COVID-19 worldwide, and who have made many sacrifices for us all.

INTRODUCTION
The idea for the blog was stimulated by  a series of news items posted in TraQ's Feb. newsletter (Further Reading). Also by the fact that so many healthcare professionals have put their duty to patients above the safety of themselves and their families. COVID has also highlighted invisible health professionals such as medical laboratory technologists/biomedical scientists who have shone with dedicated work to test for COVID-19 infection. Plus
Emergency Medical Services (EMS) emergency medical technicians Also those who work for low wages in long term care facilities, often immigrants who need several jobs to make a go of it, and  personal care workers. 

I could also focus on many non-healthcare heroic workers during the COVID-19 pandemic. If I've missed any, please send a comment. Examples (Some in Further Reading):
  • Hospital cleaners and maintenance staff
  • Daycare workers
  • Teachers, teachers' aides, school janitors
  • Apartment housekeeping & maintenance staff
  • Meat plant workers (often immigrants) who are often housed in close contact with other workers
  • Grocery and food retail workers
  • Food delivery drivers
  • NEW: Transit workers who transport essential workers to and from work (Thanks, Penny)
The blog's title derives from a 1995 Sarah McLachlan song.

THE EVIDENCE
Folks, there is overwhelming evidence that health professionals and many others have stepped up to the plate during the coronavirus pandemic. I do not need to belabour the point. The aim of this blog is to celebrate their contributions around the globe at great personal cost to themselves not just dying but also anxiety and depression.
  • While the numbers of those dead due to COVID-19 are overwhelming, it's key to remember that each of these folks are individuals, someone's 'significant other', child, mother, father, brother, sister, aunt, uncle, cousin, friend. 
  • As of 12:39 pm Central European Time, 1 March 2021, there have been 113,695,296 confirmed cases of COVID-19, including 2,526,007 deaths, reported to WHO. (Further Reading) 
  • See stories of some folks who have died from COVID-19 (Further Reading)
  • Note that people of colour are more likely to get COVID-19. (Further Reading)  
I encourage you read the items in Further Reading to gain a perspective on what we owe these heroes. Also to see affected people as individuals.

As always, comments are most welcome and there are some below.

FOR FUN
Chose this song because I hope we will all remember the heroes who put their lives at risk during the COVID-19 pandemic. I certainly will, as my husband with a serious lung disease went to the Emergency Dept. by ambulance in Dec. 2020 & spent a week in hospital.
FURTHER READING

Friday, January 08, 2021

I will remember you (Musings on a 1991 graduation speech)

Revised: 31 Jan. 2021

Folks, recently I was cleaning out a file cabinet and came across a typed copy of a speech I'd given to MLS graduates in 1991, nearly 30 years ago. Yes, I'm a lifelong packrat who now must cope with its consequences. Fortunate to have been asked to give a few graduation speeches to MLS grads decades ago. 

On the upside it made me realize that my December blog - Sweet Dreams (Musings on the benefits of a well-rounded education) - had its origins decades ago. So what I did was to scan the speech pages into my computer, convert each .jpg photo to PDF using Adobe Acrobat Pro DC, then export as Word doc so I could copy each page into this blog.

Yes, I realize that some parts of the speech won't make sense to non-MLS grads or to non-medical laboratory technologists/biomedical scientists. Yet I hope that the blog's main theme will resonate with all health professionals. See the tidbits under 'What You Learned' and 'Personal Development' below. 

SPEECH TO 1991 MLS GRADS
Thanks very much Terry [Terry the MC, was a fellow MLS instructor] for your generous introduction. I am really glad to have this time because there are a few things I still need to cover with this class.

First, I thought we would have a spot quiz. I should point out that some of the answers will only make sense to the graduates. So let's begin, then, starting with a test of your long-term memory.

SPOT QUIZ
Question #1How many First Year MLS students does it take to change a lightbulb? Answer: Five: One to change it and four to set up Kohler illumination.

Question #2How many Second Year students does it take to change a lightbulb? Answer: None. At least not in my class. You see, they were all asleep and the light would only have disturbed them.

Question #3How many Third Year students does it take to change a lightbulb? Answer: The whole class. One student to change it and the rest to complain that their friends in other faculties had all summer off to do it. 

Question #4This one is a test of your short term memory. How many Fourth Year students does it take to change a lightbulb? Answer: Again, the whole class. One to change it and the rest to complain that it should be deleted from Path 401 [Course at the time, perhaps no longer exists?] 

Before turning to the last question, could I prevail  upon John S. to come to the podium. Well, this is something you have waited a long time for. Could we have the Gingerbread Lady please. Ladies and Gentlemen - I should explain that the Gingerbread Lady, our very own Rosemarie Cunningham [hematology instructor], always brings students gingerbread men at the end of Second Year. John pulled an Oliver Twist and said, “more please’, during third year. Well, better late than never. Let’s have a hand for this cookie monster. [Rosemarie gave him a gingerbread cookie]

Question 5: And now, so the instructors won't be left out, here's the last question. How many MLS instructors does it take to change a lightbulb? Answer: Ten. One to change it and nine to evaluate whether it was done right.

AMBASSADORS
Now that the spot quiz is over there are a few things that I would  like to talk to you about  in a  more serious vein. A few weeks ago I went to the Ambassador Awards at the Convention Centre. It was attended by people from all walks of life who belonged to associations like the CSLT [now CSMLS] that can bring conventions to the city. The organizers gave out awards and asked all of us to act as ambassadors by promoting Edmonton as a convention site.

The thought occurred to me that in one way or another we all act as ambassadors. For example, when we are tourists in a foreign country, or when we interact with visitors to our city.

So I would like to talk tonight about the idea that all of you - the MLS graduates of 1991 - are going to be ambassadors for MLS whether you realize it or not. No matter what the future holds for each of you, all of the people you will meet will be gaining impressions of MLS through you, your actions, and attitudes.

Now before you say, "Good grief! I can't handle the pressure - MLSers for life" - 1 want to tell you that I have great faith in each and every one of you. As an MLS instructor I have been privileged to share a part of your life for the past three years or so. Let me explain why I think that you will be great ambassadors. In a way I feel like  mosquito in a nudist colony. I don’t know where to start.

WHAT YOU LEARNED
To begin with, there are all of the things you have learned while in MLS. And I'm not talking about the information and technical skills you have assimilated, although these are important. You have learned so much that what you have forgotten would fill a library. No, I'm talking about skills that you will find useful all your lives.

For example, you have learned how to be good listeners. Goodness knows you have had enough practice being listeners during your time here. As you begin your careers, remember the words of  a wise  person  who once said, "good listeners are not only popular everywhere, but  after a while they know something."

You have also learned how to communicate clearly, both orally and in writing. Who can ever forget their first teaching assignment? I should explain that our students give at least three presentations to classmates and instructors beginning with teaching assignments during the Third Year.

I'm sure that some of you think that teaching assignments were cruel and unusual punishment, both for the student and the audience. But, boy, do they ever pay off! The progress you made was really shown during presentation of your research projects. Your instructors and supervisors were very impressed. This will be a real plus for you in any career. I tell you this because I have seen many technologists, scientists,  and doctors who have not had the advantage that teaching assignments provide, namely to express ideas clearly and concisely.

There are many other intellectual skills you have learned, such as your grasp of the scientific method and all that entails. You have developed the ability to be skeptical about so-called established knowledge, and to be open-minded about issues. You know that it is okay to say, "Gee, I don't know, but  I will find out." You know how to learn. You will draw on these skills over and over again, especially because medical laboratory science is evolving so rapidly.

PERSONAL DEVELOPMENT
I would like to shift for awhile to some of the ways you have all grown in your personal development. Those of you who entered MLS lacking self-confidence have seen your belief in your abilities increase. Self-confidence is essential because no one will believe in you if you don't believe in yourself. I'm not talking about being over-confident and self-important, but rather about the quiet self-assurance of people who are competent and know it.

Conversely, if you came with a fair degree of self-confidence, if you were like me at 18 (and trust me, I was18 once - and thought I pretty much knew everything) - then your experiences in MLS have added  to  your growth by teaching you humility.

Your entire Third Year was an exercise in discovering your strengths and weaknesses, coming to terms with them, and  accepting both praise and criticism gracefully. It was hard to be evaluated each and every day of your hospital rotation; it was hard to accept feedback that you may or may not have felt was justified. 

But you all did it, and because of this you will have a big advantage in the workplace, as well as in life. Having a positive approach to learning will  always serve you well. You know that imperfection is only human. The important thing is that we all  try to do better. And keep in mind that misery is optional.

You have also learned what friendship means. In the years ahead, you will remember your friends very fondly. One definition of a friend is "a friend is one who dislikes the same people that you dislike." There is a lot of truth in this, but a  better way to think of friendship is to realize that  the only way to have a friend is  to be one. You have all done that during your university days.

 Thank you very much asking me to speak and for listening.

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As always, comments are most welcome. Now that you've read the graduation speech, please see an earlier blog closely related to this one: Sweet Dreams (Musings on the benefits of a well-rounded education).

FOR FUN 
This song by Canada's Sarah McLachlan seemed right for a speech given 30 years ago. Fact is, I remember all my 'kids' (those I taught decades ago) with a great deal of affection.