June 27th, 2011
Photo courtesy Lyn Hiatt
For registered nurse Kimberly Hiatt, the horror began last Sept. 14, the moment she realized she’d overdosed a fragile baby with 10 times too much medication.
Stunned, she told nearby staff at the Cardiac Intensive Care Unit at Seattle Children’s Hospital what had happened. “It was in the line of, ‘Oh my God, I have given too much calcium,’” recalled a fellow nurse, Michelle Asplin, in a statement to state investigators.
In Hiatt’s 24-year career, all of it at Seattle Children’s, dispensing 1.4 grams of calcium chloride — instead of the correct dose of 140 milligrams — was the only serious medical mistake she’d ever made, public investigation records show.
“She was devastated, just devastated,” said Lyn Hiatt, 49, of Seattle, Kim’s partner and co-parent of their two children, Eli, 18, and Sydney, 16.
That mistake turned out to be the beginning of an unraveled life, contributing not only to the death of the child, 8-month-old Kaia Zautner, but also to Hiatt’s firing, a state nursing commission investigation — and Hiatt's suicide on April 3 at age 50.
Hiatt’s dismissal — and her death — raise larger questions about the impact of errors on providers, the so-called “second victims” of medical mistakes. That’s a phrase coined a decade ago by Dr. Albert Wu, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health.
It’s meant to describe the twin casualties caused by a serious medical mistake: The first victim is the patient, the person hurt or killed by a preventable error — but the second victim is the person who has to live with the aftermath of making it.
No question, the patients are the top concern in a nation where 1 in 7 Medicare patients experience serious harm because of medical errors and hospital infections each year, and 180,000 patients die, according to a November 2010 study by the Department of Health and Human Services’ Office of Inspector General.
That’s nearly double the 98,000 deaths attributed to preventable errors in the pivotal 2000 report “To Err is Human,” by the Institute of Medicine, which galvanized the nation's patient safety movement.
In reality, though, the doctors, nurses and other medical workers who commit errors are often traumatized as well, with reactions that range from anxiety and sleeping problems to doubt about their professional abilities — and thoughts of suicide, according to two recent studies.
Surgeons who believed they made medical errors were more than three times as likely to have considered suicide as those who didn’t, according to a January survey of more nearly 8,000 participants published in the Archives of Surgery.
Even when they don’t think of killing themselves, medical workers who make errors are often shaken to their core, said Amy Waterman, an assistant professor of medicine at Washington University in St. Louis, who studied the issue in a 2007 survey of more than 3,100 practicing doctors in the U.S. and Canada. Ironically, the survey included doctors at Seattle Children’s Hospital.
“It really affects their confidence as physicians and it affects their ability in the future,” Waterman said.
Records show that Hiatt had cared for Kaia Zautner many times since her birth, when the baby with severe heart problems was first brought to Seattle Children’s. She was close to the child’s family, who sought out her care, records show. She was Facebook friends with Alana Zautner, Kaia’s mom, hospital officials said.
After the overdose, the child’s parents asked that Hiatt not care directly for their baby, but they did not appear to seek retribution, according to an investigation report by Cathie Rea, the hospital’s director of ICU.
“Very calm and reasonable people — understandably upset, but continued to say they ‘didn’t want us to cut off anyone’s head over this,’” Rea wrote. Reached by msnbc.com, Alana Zautner declined to comment publicly.
It’s not clear whether Hiatt’s mistake actually caused the death of the child, who was critically ill. The mistake “exacerbated cardiac dysfunction” in the baby and led to her decline, according to a statement by cardiologist Dr. Harris P. Baden, who cared for Kaia. However, state lawyers said the child’s fragile condition and poor prognosis would have made it difficult to prove legally that the overdose caused her death five days later, records show.
Still, Hiatt was escorted from the hospital after the mistake, immediately put on administrative leave and then fired within weeks.
After the incident, Hiatt "was a wreck,” recalled Julie Stenger, 39, of Seattle, a critical care nurse who worked with Hiatt at the hospital. “No one needed to punish Kim. She was doing a good job of that herself.”
Officials at Seattle Children’s Hospital declined to discuss specifics about Hiatt’s termination, although they said there is “more behind Kim’s case than can be made public” because of personnel and privacy policies.
They said the hospital has since 2007 followed a so-called “Just Culture” model, which recognizes the need to use errors to identify and correct systemic problems, rather than focusing on penalizing individuals.
“The circumstances that led to Kim’s departure from Children’s were tragic on many levels and our heart goes out to the patient’s family and to Kim’s family,” said hospital officials, who responded to msnbc.com only in written statements. “Within Just Culture, staff are not terminated for simple human error.”
Experts in patient safety say terminating an individual worker is rarely the answer to even the worst mistakes, unless they’re the result of repeated, willful flouting of established procedures or intentional harm.
It’s far better to identify and address the problems in the system that contributed to the error, said Mary Z. Taylor, director of patient safety at the Washington University School of Medicine in St. Louis.
“To eliminate them is futile; you will make errors,” said Taylor, who recently launched one of the nation’s few peer coaching program aimed at helping providers cope with
June 27th, 2011
The Washington Post
With trips that began two months after he took office, President Obama has devoted more than half of his out-of-town private-business visits to promoting a single industry: clean technology, which the president says will lead the nation back to economic prosperity.
His praise for renewable-energy projects has been effusive. A day after this year’s State of the Union address, he stood among workers at a small Wisconsin lighting company and dubbed it a “model for the future,” helped by government incentives offering a “leg up to renewable-energy companies.”
He praised workers for “helping to point the way” to a cleaner future while visiting a Charlotte company that makes an electric-car battery component. In Reno, Nev., in April, he lauded a start-up for “growing by leaps and bounds” as it markets a machine that converts waste heat into electricity.
He used similar words a few weeks ago at a Durham, N.C., company that makes energy-efficient lighting, saying it is “helping to lead a clean-energy revolution.”
In all, Obama has visited 22 clean-tech projects on 19 separate trips, all emphasizing economic recovery and a $90 billion stimulus program to promote energy independence. The president has underscored his support by singling out specific companies in speeches and White House radio addresses.
Obama’s unwavering focus has helped him fulfill a campaign pledge to push clean tech, from solar energy and wind power to electric vehicles. But it also has come with political exposure: By emphasizing a sector in which the risks are high, the president has prompted questions on Capitol Hill and from industry about the wisdom of his singular strategy and his political ties to some of the companies chosen for federal attention.
The oil and gas industry, for example, has invested billions in energy innovation and job creation and could benefit from similar presidential attention, said Martin J. Durbin, executive vice president of the American Petroleum Institute.
“He’s missing an incredible opportunity he has to join with us to make a difference in economic growth, job creation, national security and clean technology,” Durbin said. “If you went and added up the number of jobs at these clean-tech companies he visited, in all honesty, I think you’re going to find a very modest number of jobs.”
This month, a congressional energy subcommittee chairman accused the administration of picking clean-tech “winners and losers” by pouring government money into a sector best determined by free-market forces.
Republicans and outside critics also have honed in on the political connections of some companies that have received federal help. The most attention has focused on Solyndra, a Silicon Valley solar company that ran into financial trouble after receiving a $535 million federal loan guarantee commitment. Last week, Republicans on the House Energy and Commerce Committee pressed the Office of Management and Budget to account for its role in the selection. Obama visited Solyndra’s factory in May 2010, only weeks after it became public that independent auditors had questioned whether it could remain a “going concern.”
Some of the biggest investors in Solyndra, which makes easy-to-install solar panels, were venture capital funds associated with Tulsa billionaire George Kaiser, a key Obama fundraiser. Rep. Cliff Stearns (R-Fla.), chairman of the Energy and Commerce Committee’s subcommittee on oversight and investigations, said he is “concerned that there was a hurry to get this money out of the door and that companies and individuals that supported the president were among the beneficiaries.’’
A spokesperson said Kaiser would not comment for this article.
A White House spokesman, Clark Stevens, said Obama believes that renewable-energy innovations will break U.S. dependence on foreign oil and provide thousands of new jobs. The clean-tech sector is filled with success stories, he said.
“The president will continue to support these initiatives and highlight the American ingenuity, the people and the private-sector companies that are helping to generate jobs and foster our nation’s 21st-century clean-energy economy,” Stevens said.
A gusher of cash
In the 2008 presidential race, Obama promised to invest at least $150 billion over 10 years in innovative energy projects, and he corralled extensive support from energy start-ups and venture capitalists. As a candidate, he was the “first that got the importance of emerging-growth companies in creating jobs,” said Mark Heesen, president of the National Venture Capital Association.
Obama collected twice as much campaign money from this group as did his Republican rival, Sen. John McCain (Ariz.). Numerous green-energy investors raised money for Obama and later won jobs or advisory roles in his administration.
The president laid out his agenda in his first State of the Union address, saying that a recession-strapped government must invest in clean energy to “build a new foundation for lasting prosperity.”
There was intense competition for clean-tech stimulus dollars. Energy Secretary Steven Chu said his agency reviewed 50,000 applicants and chose 5,000, a 90 percent rejection rate.
For the winners, there was an added bonus when Obama or his Cabinet secretaries dropped by to tout progress. “You couldn’t get that kind of publicity if you devoted all your advertising budget to it,” said Brendan Doherty, an assistant professor at the U.S. Naval Academy who has studied and written about presidential travel.
Obama began his clean-tech travel in March 2009. At a number of companies the president visited, there were connections — not all of them close, to be sure — to his 2008 campaign. Over the months, Obama touted a Florida’s utility’s electric grid project (a company in an Obama fundraiser’s portfolio was doing extensive business with the project) and a Nevada company that generates emission-free power from waste heat, the warmth radiated by machines or industrial processes (an Obama fundraiser is a partner in a venture fund that has a small stake in the company).
A White House spokesman said these connections were purely coincidental. Numerous factors — including location, accessibility to airports and media accommodations — help decide where Obama will travel, the spokesman said. He said employees and investors in some companies visited by Obama also donated to Republicans and to the president’s 2008 Democratic opponents.
June 27th, 2011
ABC News / By MIKE BOETTCHER
As President Obama sets in motion a drawdown of U.S. troops from Afghanistan, military service members on the war's front lines shared poignant reflections on the milestone and offered a candid assessment of what it means.
Gen. Daniel Allyn, commander of the 1st Calvary Division, said fewer boots on the ground in Afghanistan in the years ahead won't shake the commitment of his soldiers to all that they've been fighting for.
"I have the opportunity of presenting Purple Hearts every night at Craig Hospital to the heroes who gave their all of this effort, and they are absolutely committed to accomplishing the mission," he said. "They are absolutely committed to their buddies, and they know that this matters and it matters for the future of Afghanistan."
Allyn added that he has confidence the Afghan Army, which will gradually take over the security mission from the U.S., feels the same way.
"The bottom line is [that] it's central to the future and, frankly, that's why the future looks very good," he said.
Allyn's deputy, Brig. Gen. Gary Volesky, put the milestone in personal terms.
"I've got a 13-year-old son back at home who has watched me go to Iraq three times and now he sees me in Afghanistan," he said.
"They haven't been attacked [in the United States] since 9/11," he added. "It means something right here to our nation because we're forward fighting the war on terror ... here."
The soldiers of the No Slack Battalion with the 101st Airborne, which has been assigned perhaps the toughest area of Afghanistan, Kunar Province, known as "The Heart of Darkness," told ABC News the costs of the war have been burdensome and painstaking. But from their vantage point, the mission has been a success.
"As with everything, it comes with a cost," said Capt. Ed Bankston. "And the thing I'll always remember is every one of my soldiers and how they performed, especially the ones I've lost."
"We're here to do one thing: We're here to win, and that's what we did, we won," said Sgt. Mendez, who did not want to give his first name. "It's going on a decade we've been fighting this war. ... I don't see us getting out of here anytime soon. But we are making a difference, we are taking it to the enemy now."
The spirit of perseverance amid sacrifice is a recurring theme among men on the front lines, news of a gradual withdrawal notwithstanding.
"The more time I spend out here and the more time I can go on missions and patrols to ensure that the future guys that are coming through aren't gonna get hurt, so be it, I'll do it," said Spc. Patrick Harper. "I'll do it every single day if I have to.
"I truly believe we're making progress here. I truly do. This place is a lot safer than it was when we got here," he said.
Cpl. Thomas Shelton said he believes making his corner of Afghanistan safer also means life will be safer in the U.S., thousands of miles away. He suggested that's what motivates him and his comrades to take the risks that they do when they go into battle.
"I've got a newborn son," he said.
"He's got a daughter that's about a year old," he added, referring to a fallen fellow soldier. "He sacrificed not only his life, he sacrificed that time with his daughter and bringing her up in this world. And he did that for you, he did that for me, he did that for his family back home so that the fight stays here, so that it does not come back to America."
June 27th, 2011
By Heidi Przybyla
Barack Obama’s proposal to end a business tax break worth $72 billion is among the tensions the president may confront as he meets today with Senate Minority Leader Mitch McConnell in an effort to revive bipartisan talks over reducing the debt, three persons familiar with the issue say.
Ending the so-called last-in-first-out, or LIFO, provision, a method of accounting for inventory costs, was among options offered by White House officials for raising $400 billion in revenue over 10 years during seven weeks of negotiations led by Vice President Joe Biden, the people said, speaking on the condition of anonymity because they weren’t authorized to comment publicly.
Republicans want a multitrillion-dollar debt-reduction package as part of a vote to increase the nation’s $14.3 trillion borrowing limit by Aug. 2. The LIFO provision was among possible revenue increases that Republicans opposed when the Biden talks, which included two Republicans and four Democrats, collapsed last week. Biden criticized Republicans for trying to keep President George W. Bush-era tax breaks while advocating cuts in Medicare.
“We’re never going to solve our debt problem if we ask only those who are struggling in this economy to bear the burden and let the most fortunate among us off the hook,” Biden said at the Ohio Democratic Party’s annual dinner at the Greater Columbus Convention Center June 25. “Not only is it unfair to do what they’re calling for, but I think it borders on being immoral.”
An administration official told reporters the day before that House Majority Leader Eric Cantor and Senator Jon Kyl, the chamber’s No. 2 Republican, walked out because they were unwilling to accept any tax increases.
Among these were ending subsidies for oil and gas companies and breaks for corporate jets and tax breaks for Americans earning more than $500,000 a year, according to Representative Chris Van Hollen, a Maryland Democrat who participated in the talks.
Obama and Republican leaders now must bridge the divide as pressure builds for a deal. Moody’s Investors Service this month said it will put the U.S. government’s Aaa credit rating under review for a downgrade unless there’s progress on raising the debt limit by mid-July. Pacific Investment Management Co. LLC Chief Executive Officer Mohamed El-Erian said on CNN that a short-term U.S. default on its debt might have “catastrophic” legal consequences.
Democrats Demand Revenue
Administration officials including Treasury Secretary Timothy Geithner have said they are confident a debt-limit deal can be reached by Aug. 2. Still, Democrats and Republicans so far are dug in on their negotiating positions.
“There needs to be revenues in any deal,” New York Democratic Senator Chuck Schumer told reporters on a June 24 conference call after the Biden talks broke down.
House Minority Leader Nancy Pelosi yesterday said tax subsidies for companies must be on the table.
Cantor “walked away from the table because he doesn’t want to deal with the special interest tax subsidies,” Pelosi said on CNN’s “State of the Union.”
House Speaker John Boehner and McConnell have said Republican conditions for raising the debt ceiling include no tax increases, spending cuts and a government spending overhaul.
California Representative Kevin McCarthy, the third-ranking House Republican, not only rejected any tax increases, he insisted that limits on Medicare must also be included in a bipartisan deal.
Obama has “got to get off the golf course, and he’s got to get engaged,” McCarthy said in an interview on Bloomberg Television’s “Political Capital with Al Hunt.”
The outcome of the tax subsidy issue hinges on whether Republicans decide to break with Americans for Tax Reform’s Grover Norquist, who insists that any elimination of tax breaks must be accompanied by an equal reduction in taxes elsewhere. Forty of 47 Republican senators have signed Norquist’s no-tax- increase pledge.
The LIFO proposal “does put the lie to the idea that Obama and Democrats only wish to tax high-income earners,” Norquist said in an e-mail.
The White House official who briefed reporters said that two separate bipartisan commissions, including the president’s fiscal commission, recommended at least $1 trillion in revenue beyond the expiration of the Bush tax cuts.
The official also cited more than 10 bills signed by former President Ronald Reagan, a Republican, from 1982 through 1988, that included revenue increases along with spending cuts, as well as a 1990 agreement that included more than one-third revenue and two-thirds spending reductions.
Ending LIFO in 2012, which the White House considers a loophole in the code, would raise $72 billion by 2016, according to the nonpartisan Congressional Budget Office. The accounting method assumes that the less expensive inventory remains on hand for calculating taxable income.
As part of his Feb. 14 budget, Obama proposed $357 billion in revenue raisers, many of which were offered by White House officials as part of the Biden talks.
While it included strengthening research and development tax credits as well as other pro-business initiatives like funding for the next generation of broadband, it also included repealing LIFO and deductions for oil and gas companies worth $46 billion.
Repealing LIFO “would be tantamount to a retroactive tax on the savings a company accrued over time,” and could be “devastating” to some companies, according to a March 2 letter to members of Congress from a group of trade associations, including the American Forest & Paper Association and the National Association of Manufacturers.
Democrats are trying to telegraph a renewed commitment to creating jobs and a focus on the manufacturing sector.
Following a June 23 meeting with a group of Fortune 500 chief executives, Schumer and other Democratic leaders said they’re open to new tax preferences for employers, including a partial payroll tax holiday and tax credits for manufacturing and research and development.
In his weekly radio address on June 25, Obama touted a $500 million government program to help companies and universities develop new manufacturing technologies.
More From Bloomberg
To contact the reporters on this story: Heidi Przybyla in Washington at firstname.lastname@example.org;
June 27th, 2011
By Thom Patterson, CNN
(CNN) -- Michel Laberge quit his job to invent a "glorified jackhammer" that he hoped would save the planet. That was 10 years ago.
Now, investors are betting more than $30 million on that jackhammer idea, which may yield a holy grail of energy -- a safe, clean and unlimited power source called hot fusion.
Laberge is trying to do something that no one has ever done: create a controlled "net gain" fusion reaction that creates more energy than is required to produce it. It's the same process that powers our sun. If it works, it could solve huge problems like climate change, the energy crunch and reliance on foreign oil.
But the competition to get there first is stiff. Thousands of scientists backed by the world's most powerful governments are racing against Laberge and his 50 colleagues working at an office park lab near Vancouver, British Columbia.
"This is a bit crazy -- the small guy trying to win the same thing as the big guys," admits the 49-year-old physicist. Some observers in the physics community wonder if upstarts like Laberge are being strangled by giant multibillion-dollar research projects.
Laberge says he's never wanted to rub shoulders with the cool kids at top-shelf facilities at Oak Ridge, Tennessee, and Livermore, California. "It's very boring to work on the big projects," says Laberge. They're "too big, too expensive, too complicated."
But don't call him a rebel. "I like to do some things differently," Laberge says. "I'm nonconventional, but I'm not a rebel."
He fears the next generation, including his own two children, are threatened by a world that's running out of fuel. "If we don't do something about energy we're going to be living in little huts with windmills on top," says Laberge. "For food, you're going to be growing tomatoes on the backside."
A decade ago, it was Laberge's self-described mid-life crisis that brought him to a career crossroads. Despite success designing technology for printing direct mail materials, he remained unsatisfied. "I was cutting the forest and burying you under junk mail," he remembers. "I said, 'What am I doing here?'"
Laberge took a chance and left Creo to chase his longtime fascination with fusion.
"I had fusion on the brain," he recalls.
"I sat at home on my couch for about six months, to the great despair of my wife, calculating all sorts of fusion schemes." Eventually, Laberge had his "aha" moment: a precision controlled piston that hammers giant shock waves into a magnetized sphere -- slamming atoms together hard enough to fuse and create energy.
The idea triggered investments in Laberge's young company, first from family and friends, then from venture capitalists including Amazon.com founder Jeff Bezos. So far, funding has totaled $32.5 million.
That sounds like a lot until you consider that the world's biggest fusion research facility -- under construction in France -- is expected to cost $20 billion. That's billion with a "b."
Named ITER -- the Latin word for "journey" -- the project is funded and staffed by the United States, European Union and five other nations.
China announced in May it will train 2,000 scientists for fusion research. Beijing "is going gung ho on this," says Glen Wurden, a top fusion scientist at the cradle of the atom bomb: New Mexico's Los Alamos National Laboratory. The facility has joined Laberge's company, General Fusion, in a cooperative research agreement.
Does Laberge have a shot? His idea is "definitely worth studying," Wurden says.
Even Ned Sauthoff, ITER's U.S. project manager, is cheering for smaller fusion researchers.
"I would love to see that fusion can be done so economically, and so I hope they succeed," Sauthoff says. "ITER is the way that you go if you really want high confidence. But you have to pay more for high confidence."
The ITER facility won't be complete until 2017. Best case, ITER's first net gain fusion reaction would take place sometime after 2019.
Another giant fusion project, the National Ignition Facility at California's Lawrence Livermore Laboratory, is using the world's largest lasers to attempt a fusion breakthrough by 2012 at a cost of about $5 billion.
"ITER and NIF are expensive and they take lots of energy," says Wurden. "We think there is a cheaper solution between the two."
"Basically, glorified jackhammers are cheaper than lasers," Laberge says with a laugh.
General Fusion aims to achieve net gain fusion experimentally in 2012. By 2018, it plans to complete a power plant prototype that would generate 100 megawatts, enough to power about 100,000 homes.
"We would like to be in a commercial stage of being able to take orders and build power plants by the end of the decade," said Michael Delage, General Fusion VP of business development.
Fusion could change everything -- or not
Could fusion change the way powerful governments behave on the world stage?
Cutting dependence on foreign oil could prompt nations to shift attention away from oil-rich regions. The U.S. military already spends at least $50 billion yearly on "expenditures related to oil," according to the American Security Project, a bipartisan Washington think tank.
The fuel for fusion reactors is relatively cheap and accessible. Fusion reactors would run on fuel made up of two types of hydrogen: deuterium, which can be extracted from sea water, and tritium, which could be produced by the fusion reactors themselves.