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Hospitals could be dramatically reducing the rate of injuries incurred by nurses. But an NPR investigation finds protecting staff in this way is rarely a top priority. As we've been reporting this month, tens of thousands of nursing employees get debilitating back and arm injuries every year from lifting and moving patients. NPR's Daniel Zwerdling has the next installment of our investigation.
DANIEL ZWERDLING, BYLINE: We're going to tell you now about the case of Terry Cawthorn at Mission Hospital in Asheville, N. C. NPR obtained court records and other evidence about Cawthorn and other workers' admission. And they give a rare glimpse of how some hospital officials have refused to acknowledge that the everyday work nursing employees do - the way they lift and move patients - that work frequently injures them. Cawthorn had been a nurse at Mission Hospital for more than 20 years.
TERRY CAWTHORN: I was one of the hardest working nurses you would ever meet.
ZWERDLING: And you don't have to take Cawthorn's word for it. Her supervisor testified under oath that Cawthorn was one of the best.
TERRY CAWTHORN: Never missed work, came in early, stayed late - I loved being a nurse.
ZWERDLING: On this afternoon, we are talking at Cawthorn's home in a small town outside Asheville. The refrigerator is covered with photos of her family. And they show Terry Cawthorn before the injury. She looked fit, radiant. Today, her arms are sticks. She has dark patches under her eyes. She and her husband say she's lost 33 pounds since she got injured.
TERRY CAWTHORN: The first three years, I couldn't even talk to somebody about it. I would just cry. I'd cry and cry and cry.
ZWERDLING: Have you noticed how Cawthorn sometimes talks slowly? It's because she's in constant pain and she takes high doses of prescription narcotics. Terry Cawthorn ended up taking legal action against Mission Hospital. And court documents tell the story. It was afternoon on her 45th birthday - 2008. A large patient had just had a cesarean section, and Cawthorn was helping move her from the gurney onto her bed.
TERRY CAWTHORN: And she kind of had one cheek on the bed, one cheek on the stretcher. And we had it tilted and things, trying to help her. I'm just going to show you, because we are taught this in nursing school. This is a position...
ZWERDLING: And to demonstrate, Cawthorn bends her knees. She keeps her back straight. And she extends her arms like railings for the patient to grip.
TERRY CAWTHORN: And the second she grabbed on, almost instantaneously I felt like hot tar was just going down my spine into my butt.
ZWERDLING: Cawthorn says by the time she left work, she could barely walk.
TUCKER CAWTHORN: I saw the car drive up on top of the hill.
ZWERDLING: That's Cawthorn's husband. Tucker is a big man.
TUCKER CAWTHORN: I went up the hill, and she could not get herself out of the car. So I wedged myself under her legs and her back, and I eased her out of the car as best I could. And I carried her down the sidewalk into the house - laid her down on the floor.
ZWERDLING: Cawthorn took painkillers and made it back to work the next morning. She reported she was hurt. Then she hurt her back again barely a week later when she lifted another patient. She injured her back a third time a few days after that. And nine months later, Cawthorn became a patient in her own hospital. She had major back surgery called a lumbar interbody fusion. She shows me the x-ray. There's a metal cage around her spine.
TERRY CAWTHORN: Pretty wild to think that that's true to size.
ZWERDLING: Now, state laws say that when an employee is injured badly enough on the job, their company has to pay their medical bills and workers' compensation. But officials at Mission refused. Court papers showed that the hospital's own medical staff concluded that Cawthorn got hurt moving patients, but the hospital argued, no, she hurt her back partly by lifting a casserole out of her oven. And hospital officials said as a result of Cawthorn's back injury, she was not fit to work.
TERRY CAWTHORN: They actually saved themselves the postage and brought the paper that I was let go.
ZWERDLING: I want to get the timing right. You are literally lying in the hospital room two days after major back surgery.
TERRY CAWTHORN: Right.
ZWERDLING: Someone from Mission Hospital comes to your room and gives you the paperwork saying goodbye. Your job is finished.
TERRY CAWTHORN: Yeah. I was so emotionally destroyed. Nursing's not just a job. It's who you are.
ZWERDLING: There's no evidence that Mission's employees get injured more than staff do at other hospitals. But we're focusing on Mission in this story because we got an unusual look inside this one hospital's culture. We obtained court documents and internal hospital emails. We talked to medical staff who treated injured employees. Of course, remember, Mission's not the only hospital with injured nurses. Officials of hospitals across the country have failed to do much about the problem. And industry researchers say there are a few main reasons why. The first is money.
(SOUNDBITE OF VARIOUS NEWS BROADCASTS)
UNIDENTIFIED WOMAN #1: Tonight's top story - a healthcare crisis in the Berkshires.
UNIDENTIFIED MAN #1: The North Adams Regional Hospital is shutting down.
DANIEL MCCHESNEY: It's been a tough couple decades for the hospital industry.
ZWERDLING: Daniel McChesney is co-founder of an industry research firm called DeciBio. Studies started showing decades ago that hospitals can prevent nursing injuries if they're willing to invest time and money. They have to buy special equipment to move patients. And they have to do intensive training for the staff. But McChesney says most hospital executives are preoccupied with other problems.
MCCHESNEY: Their revenues have been stagnant or dropping, and the costs have been going up.
ZWERDLING: Talk about hospitals' costs - they have to prevent infections and computerize their records. And that can cost millions of dollars. They need to invest in new technology. Some hospitals are buying up other hospitals to get bigger and maybe better. So James Collins says no wonder nurses' injuries fall between the cracks. Collins is a research manager at the CDC, the Centers for Disease Control and Prevention. He studied nurses' injuries, and he says safety directors in hospitals have told him, look, we've tried to convince our bosses our hospital needs to prevent nurses from getting hurt lifting patients. But they tell Collins...
JAMES COLLINS: They say when I think I've got the CEO sold that we need to expend the funds for this comprehensive, safe patient-lifting program, in comes the chief of surgery describing the latest laser to improve his surgical outcomes. And he gets the check, and then we're back in the end of the line trying to get out funds next year.
ZWERDLING: To protect the nursing staff.
ZWERDLING: And some researchers say there's one more reason why protecting nurses is not often a top priority.
(SOUNDBITE OF FILM, "MEET THE PARENTS")
ROBERT DE NIRO: (As Jack Byrnes) Hey, hey, look who's up.
TERI POLO: (As Pam Byrnes) Hi, sweetie.
BEN STILLER: (As Greg Focker) Hi.
JAMES REBHORN: (As Dr. Larrry Banks) You must be Greg.
ZWERDLING: Did you see "Meet The Parents?" In this scene, Greg - he's played by Ben Stiller - Greg meets his girlfriend's family and their doctor friends.
(SOUNDBITE OF FILM, "MEET THE PARENTS")
DE NIRO: (As Jack Byrnes) You know, Greg's in medicine, too, Larry.
REBHORN: (As Dr. Larrry Banks) Oh, really? What field?
STILLER: (As Greg Focker) Nursing.
REBHORN: (As Dr. Larrry Banks) That's good. No, really, what field?
STILLER: (As Greg Focker) Nursing.
ZWERDLING: OK, that movie's just a comedy. But Suzanne Gordon says that hospitals and the medical industry have traditionally devalued nurses.
SUZANNE GORDON: Hospital administrators - too many hospital administrators - view nurses as second-class citizens.
ZWERDLING: Gordon's been writing books about nursing issues for 30 years.
GORDON: Historically, hospital administrators viewed nurses as a kind of disposable labor force.
ZWERDLING: Gordon says it's partly because of gender - 90 percent of nursing staff is women. And that's partly because of class. Nurses and nursing assistants don't have much institutional clout, so when hospitals cut costs...
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UNIDENTIFIED MAN #2: Children's Hospital and Clinics of Minnesota is laying-off nurses.
ZWERDLING: Nursing employees are some of the first to go - except during cycles when there's a nursing shortage. And that brings us back to Terry Cawthorn and Mission Hospital in North Carolina. Remember, court documents show that Mission's own medical staff concluded that Cawthorn injured her back moving patients. She had surgery with metal plates and screws. But one of the hospital's officials basically told her, no, we're not responsible for your injury. And the hospital fired her.
TERRY CAWTHORN: I was so mad. I was yelling at her going you can't do this to me. What - what is going on?
ZWERDLING: After the break, we'll take you to Mission Hospital and we'll tell you what was going on.
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CORNISH: We're going to return to our story about a nurse named Terry Cawthorn and Mission Hospital in Asheville, N. C. As NPR's Daniel Zwerdling has been reporting, hospitals across the country haven't done very much to protect their nursing employees from getting hurt. Nurse Terry Cawthorn was injured so badly she had to have a gruesome back surgery. Leaders at Mission Hospital insisted they weren't responsible, and they fired her. Daniel picks up the story.
ZWERDLING: Our investigation found that officials at Mission Hospital often refused to acknowledge that nurses and other staff kept getting hurt doing their jobs - just talk to the medical staff who treated them.
JOSHUA KLAAREN: My name is Joshua Klaaren. I'm a physician assistant, and I worked at Mission Hospital.
ZWERDLING: Joshua Klaaren worked in the employee health clinic admission for six years. He left in late 2012. When nurses and nursing assistants got hurt, when any worker's admission got hurt, they would go to see Klaaren and the other clinic staff. That's what Terry Cawthorn did.
KLAAREN: It's pretty common to see nurses and CNAs who have hurt their back, who have pulled their back with managing patients, moving patients, lifting patients, sliding patients. It's very, very, very common.
ZWERDLING: Did you personally examine employees at Mission Hospital - nurses and others - who you felt were injured at work, that they probably did deserve workers' compensation, but then the hospital denied?
KLAAREN: Yes, that was commonplace.
ZWERDLING: NPR has obtained dozens of internal emails from Mission Hospital. And they show that the doctor who ran the employee health clinic kept warning executives for years our hospital is mistreating injured employees. Those emails went to the hospital vice presidents and the general counsel and a member of the board of directors. But hospital officials basically told the doctor this is not your concern.
We called the doctor. His name is J. Paul Martin. He declined to be interviewed for this story. But there are public court records that scold Mission Hospital for mistreating injured workers.
DOUGLAS BERGER: What is particularly disturbing about this situation is this is a hospital.
ZWERDLING: Douglas Berger was a state judge for 10 years. He served on North Carolina's workers' compensation court. Every state has a workers' comp court so injured employees can appeal if a company refuses to help them. North Carolina's court has ruled over and over again that Mission Hospital refused to help injured nurses and others who got hurt on the job. Just read the cases - in 2002, 2004, 2006, 2011, again in 2012. Berger wrote in one decision that the hospital's refusal to cover an injured employee's medical care was based upon stubborn, unfounded litigiousness.
BERGER: Stubborn, unfounded litigiousness? They were acting in bad faith.
ZWERDLING: The courts said officials made a conscious attempt to mislead Terry Cawthorn so she wouldn't understand that she deserved workers' compensation. They said that's fraud. And the court ordered Mission to pay penalties to punish them. Berger says he can't read the minds of Mission's executives, but companies that don't support injured workers often do it for a simple reason - money.
BERGER: The view is, for every dollar I prevent going to a worker, that's more dollars for the company. Well, every money I spend on a worker is less money I can spend elsewhere in the hospital.
ZWERDLING: And Mission's own reports show that the company has been spending millions of dollars to expand its business.
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UNIDENTIFIED MAN #3: CarePartners Health Services announces this morning it will merge with Mission Health.
ZWERDLING: Over the past decade, Mission has taken over or merged with five other hospitals. It's taken over doctors' practices and other medical firms. Mission's own spokesperson told a national meeting a few years ago we are kind of the 500-pound gorilla in the region.
UNIDENTIFIED WOMAN #2: You have a phone call. It's a pre-op.
ZWERDLING: I went to see the chief executive officer who runs Mission Hospital. His name is Ron Paulus. He's a doctor. To get to his office, you walk into the huge main building through the lobby and up to the executive floor. Paulus says, look, when he took over Mission back in 2010, he didn't even know about all those court cases involving injured employees. But he says as soon as he heard, he essentially told his staff forget the past. We are establishing a new culture here.
RON PAULUS: Whatever is the truth or not the truth about all this different stuff, staff injuries, from the standpoint of, first, the humanity of that injury - these are family members, part of our team. But also, because we want people to be productive and effective, so yes, these are very important.
ZWERDLING: Paulus says to make sure that everybody gets that message, he launched new training programs for the staff. He hired an outside consultant to analyze how has the hospital handled worker's compensation cases since Paulus took over. He says Mission got a glowing report. And he says the hospital has spent what he calls a significant amount of money to buy machines that move and lift patients so nursing employees can save their backs.
PAULUS: When you look at nurses and patients, nurses have the most interaction with patients of any caregiver on the team. And nurses are the most trusted. So when I think about how I look at care delivery within Mission Health, nurses are front and center.
ZWERDLING: After I met with Paulus, I talked with a handful of nurses and other medical staff who still work with Mission or who worked there long after he took over. And they said maybe Paulus has changed the message at the top, but we haven't seen much change. And remember that outside report that Paulus commissioned which he said shows that Mission is doing a great job handling injured employees? Will you give me the copy of this outside independent review?
PAULUS: I don't have a copy of that, and I'll discuss that internally.
ZWERDLING: The hospital spokesperson emailed me later. They will not give me the reports.
TERRY CAWTHORN: That is how the top of the screw is, so it's got...
ZWERDLING: Back at Terry Cawthorn's house - this nurse who worked at Mission for more than 20 years - has better days and worse days. She helps her husband Tucker with his bookkeeping. He repairs air conditioners. She's sometimes shaky when she walks. But they say she's lost more than her health. They say the way Mission Hospital treated her broke part of their spirit.
TERRY CAWTHORN: I really thought that - that I was someone to Mission. And when I got hurt, I meant nothing. I was absolutely nothing to the hospital.
TUCKER CAWTHORN: This - this change has been incredible so far as our lives go. When she was telling her story a while ago and she started (crying) - she started with the day she got injured. It still breaks my heart, because that's the day that changed (crying) - changed our lives.
ZWERDLING: Meanwhile, Mission reports it's still expanding. The company is opening new clinics in two counties and is building a new center for doctors in telemedicine. The company's CEO says it's all designed to take better care of patients. Daniel Zwerdling, NPR News.
CORNISH: Next week, the surprising hospital that is spending millions to prevent nursing injuries.
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