National Nurses United

National Nurse magazine July-August 2014

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J U LY | A U G U S T 2 0 1 4 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 9 RNs and NPs who work every day as patient advocates are not OK with this model of care. Our patients deserve better." Jenevieve's death is the ultimate reminder that Kaiser's corporate policies, cuts, and restructuring have very real, devastating, and irreversible consequences for patients and their families. It was a little after midnight April 4 when Jenevieve's mother, 23-year-old Andrea Olguin, arrived at the San Lorenzo home she shares with her parents, baby daughter, and 3-year-old son after getting off her shift as a cashier at the local FoodMaxx supermarket. Olguin and her partner, Ferdinand Dagatan, both pay for Kaiser insurance through their respective jobs, so that they and the children could enjoy the security of "double coverage." When Olguin walked into the bedroom where Jenevieve was sleeping, she noticed that the baby was oddly sticking her arms straight out. When Olguin picked her up, Jenevieve's body was stiff and appeared to be having a seizure. The 6-month-old was also burning up with a high fever. Olguin's moth- er, Patricia Paler, gave Jenevieve a dose of infant Tylenol and her parents rushed her off to seek help at Kaiser Hayward, the near- est emergency room. At the hospital, staff collected blood and urine samples and sent them off for testing, but nobody could immediately tell what was wrong with baby Jenevieve. She was running a 104-degree fever, vomited twice while at the ER, and had an elevated heartrate—though this last detail was not pointed out to them, her parents said. No pediatrician examined Jenevieve. After bringing down her fever to 99 degrees, the emergency department staff sent parents and baby home around 5 a.m. with some over-the-counter fever reducer and Pedi- alyte. "They just dismissed her," said Olguin, shaking her head during an interview with National Nurse in late July. "I was irritated that nobody could answer my questions. I felt like I wasn't being heard." Olguin knew that something was wrong; this was not normal behavior from her chubby, stubborn baby girl who loved to eat mashed sweet potatoes and play with her big brother and family members. This is the point, said Richter, at which she believes Kaiser's treatment of Jenevieve diverged from what would have been previ- ously provided when Kaiser Hayward still staffed an inpatient pediatrics unit. "Of course these are 'what ifs' and it is my opin- ion, but based on my experience, that baby would definitely have been seen by a pedia- trician and likely admitted for observation. This was a six-month-old with a high fever for no obvious reason. Our pediatricians are pretty conservative and err on the side of safety," said Richter, who has worked nearly 38 years for Kaiser and almost all that time as a pediatrics RN at Kaiser Hayward. She now works in the newborn care clinic at Kaiser San Leandro. "We would have watched that baby overnight and likely completed the sepsis workup and treated the baby with antibiotics. She might have still gone downhill, but we would have been there to do something for her." Richter said that one pediatrician should have been on duty in the neonatal intensive care unit and could have been called for a consult, but that did not happen for whatever reason. Back home, the family got only a couple hours of sleep before Jenevieve woke up shrieking. Her fever was way back up, she was grunting, her lips were blue, and she was struggling to breathe. When Olguin undressed her, she noticed light purple blotches on her diaper area. Olguin resisted going back to the ER because she wanted to go to a pediatrician, but her mother convinced her otherwise. "I felt they would take care of my granddaughter," said Paler, fighting back tears. "Now I'm eating my words." During their second visit, still no pediatri- cian examined Jenevieve. The emergency room doctor ordered a breathing treatment, and as Olguin held the baby, she noted that Jenevieve was starting to jerk her neck and trying to wriggle away. Her eyes looked like she was in pain. The staff tried to assuage Olguin that the baby was just scared and unaccustomed to the new environment. Olguin and her mother also observed that one of Jenevieve's feet was purple. Soon, big purple patches were appearing all over Jenevieve's body: forehead, chest, stomach. They were informed that a pediatric intensive care unit transport team was coming down from Oakland to transfer Jenevieve there. When the transport team arrived a little after noon, Olguin said that the pediatrician took one look at Jenevieve and ordered everybody except critical staff out of the room. After an hour of working on the baby, the doctor pulled the parents aside and said, "I'm not going to lie to you. Be prepared for the worst." Jenevieve had a bad meningococ- cal infection and her blood had gone septic. She was going into organ failure. The next hours were a blur as the team worked to get Jenevieve stable enough for the drive up to Oakland. Once there, after a battery of tests, doctors told Jenevieve's fami- ly that the baby was essentially brain dead. Olguin and Dagatan eventually allowed the staff to withdraw life support, and Jenevieve passed away on April 12, 2014. After Jenevieve's death, Olguin and Dagatan learned through Paler, who has worked some 14 years as a dermatology receptionist at Kaiser in Union City, that the nurses of the California Nurses Association had been contesting closure of the Hayward pediatrics unit. They soon contacted a union representative in hopes that sharing Jenevieve's story will help restore these basic services at Kaiser San Leandro and spare other families the suffering and grief they experienced. "Nobody should have to go through what we went through," said Dagatan, wiping away tears. On May 22, Jenevieve's family members, Kaiser RNs, and community members held an emotional vigil and protest at Kaiser Hayward to demand that pediatrics reopen. Olguin and Dagatan continue to work with the RNs toward this goal, and the nurses will continue to make an inpatient pedi- atrics unit in the region an ongoing issue in their contract talks. "We want justice for Jenevieve," said Olguin. "This was a system failure. They did not have the resources. They didn't have the right doctors, the right staff. We want change. I want them to put back those units for their patients, especially the kids. There should not be shortcuts in medicine." —Lucia Hwang

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