Letter to the Editor  
Westside Observer
December 2009, at www.westsideobserver.com

Rebuttal to Nurse Practitioner Jennifer Serafin's November Letter
by Patrick Monette-Shaw

Nurse Practitioner Jennifer Serafin’s November letter about Laguna Honda contained a number of inaccurate statements.

If nursing homes are pursuing efforts to reduce costs, why is LHH keeping its marketing and public relations staff at a cost of nearly $400,000 in annual salary while eliminating doctors?  Why is a marketing department necessary for a captive audience of public health Medi-Cal patients other facilities won’t admit?

Serafin claims there “are no studies in any literature … that states reducing the number of physicians and replacing them with nurses … will worsen patient care.”  Serafin should have reviewed the March 2009 Annals of Internal Medicine article by Paul Katz, MD that I referenced in October; Katz’s article noted marginalizing physicians in nursing homes threatens the overall quality of care to patients with medically complex illnesses, and noted that having a dedicated medical staff improves patient care.  If in-house physicians improve patient care, then not having physicians will worsen care.

Serafin is wrong about “travelling doctors.”  Patients in nursing homes without on-staff physicians do wait weeks to receive medical care, because travelling doctors rely on observational skills of nursing staff.  When overworked nurses miss observing patient conditions, patients do wait weeks to see an MD.

Cutting expenses is one thing.  But why is fox-guarding-the-RN-hen-house Serafin okay with cutting “extra expenses” of MD’s who provide direct care, when LHH has a bloated Nursing Administration Department that doesn’t provide direct patient care, including 16 Nursing Supervisors, 20 Nurse Managers, and 7 Clinical Nurse Specialists paid a combined total of $6 million in 2008 (seven earned over $200,000; 27 earned over $150,000).  Private-sector nursing homes rarely have clinical nurse specialists, multiple nursing directors, and the number of nurse managers and nursing supervisors LHH employs, which “extra expenses” Nurse Serafin ignores.

Had Serafin actually read the Ja report, she’d know it recommends LHH’s certified nursing assistants (CNAs) take on more skilled-care work, by being trained to assume management of behavioral and substance abuse problem patients, which is outside their typical practice area — after CNAs just had their salaries cut 20.5 percent!  Ja’s flawed methodology may have inflated his claim 46 percent of LHH residents have “behavioral diagnoses.”  Ja, and Serafin, fail to note 100 percent have medical diagnoses; cutting doctors providing medical care to both groups isn’t simple cost-cutting.

If Serafin were really concerned about cost-cutting as a necessary part of life, cutting physicians and CNAs would be considered last (not first), since LHH pays its skilled-nursing registered nurses (RNs) the same pay rate ($61.05 hourly) the City pays its acute-care RNs.  The web site www.indeed.com reports¹ RN salaries in San Francisco residential nursing homes average $52,000 annually; the City’s web site shows that effective December 2009 LHH RNs are paid $126,984 after ten years of service, 2.4 times more than San Francisco’s average nursing home RN salary.  For instance, LHH RNs are thought to be paid almost $20 more hourly than RNs at the Jewish Home for the Aged.   Does Serafin know why LHH CNA salaries were slashed, but LHH RN salaries weren’t?

Instead of eliminating doctors entirely, and slashing the pay of CNAs 20.5 percent, how about starting first paying LHH RNs skilled-nursing, rather than acute-nursing, salaries?  That alone would save tens of millions annually!

The City pays its Nurse Practitioners $81.50 hourly (who were paid $300,000 in overtime in 2008), and its Physician Specialists $81.78 hourly (who earned no overtime), so there is no savings to be realized from replacing MD’s with Nurse Practitioners.

If Serafin’s main shtick is “cost cutting,” she should start with cleaning up Nursing’s back yard. Eliminating MD’s is a negative move when it causes medical neglect.

Patrick Monette-Shaw

¹ At the time this rebuttal letter was submitted to the Westside Oberserver, indeed.com reported the salaries of RNs in San Francisco residential nursing homes average $52,000 annually.  On December 12, indeed.com updated its web site, indicating RNs in San Francisco residential nursing homes average $65,000 annually.  The $13,000 difference may well be caused, in part, by Laguna Honda Hospital overpaying its RNs acute-care, rather than skilled-nursing-care, prevailing wages, artifically driving up San Francisco’s average.  LHH’s $126,000 RN salaries remain nearly double the $65,000 average salary paid to RNs in San Francisco residential nursing homes.



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