Abu Ghraibs at home
by Htun Lin
Like the rest of the world my shop is full of dismay and discussion over the atrocities coming out of Iraq both in Abu Ghraib prison and Al Qaeda’s beheading of Nicholas Berg.
The military hierarchy is trying to protect itself by fingering a few low level grunts for the Abu Ghraib atrocities. Many generals and Senators “investigating” this are ready to target a few individuals for court martial and not address the systemic abuse of prisoners coming from the imperatives of high command.
Healthcare workers can relate to this. Many of our coworkers have been singled out and fired for patient injuries when the real cause is actually systemic.
On the Abu Ghraib scandal no one is paying much attention to Army Spc. Joseph Darby, a 24-year-old MP who simply did the right thing when he broke the silence when he saw the soldiers around him following orders to do these unspeakable acts while his superiors assured him all was OK. The whole situation didn’t sit right with him, and he took the extraordinary step of sending his misgivings up the chain of command.
We healthcare workers are also often told to ignore state regulations when we are given patient workloads deemed unsafe. When we object, often we’re singled out as being “insubordinate." The more persistent worker will sometimes go beyond her immediate manager and report the abuse to the union or a state agency. But overseeing agencies always have ambiguous loyalties, to regulate but also to promote industry’s bottom line financial health.
No matter how many investigative commissions are created from the top to determine facts, the truth is it is the grunt or worker on the front line who makes the ultimate determination about what is right. Workers are constantly torn on the job between doing the right thing versus fulfilling the demands of the hierarchy. For example, in healthcare we have several inspections a year by various governmental agencies and peer review. These inspections are purportedly for quality control, but in reality those inspected are given advanced notice so they can sweep even chronic problems under the rug just long enough to pass.
Instead of all the pompous debates over legal minutae by constitutional scholars, this one courageous act by one simple soldier has, in effect, challenged the whole Pentagon and indicted the Bush administration's blatant violation of Geneva Conventions.
In the late '90s when the California Nurses Association had a protracted campaign to get some control over quality of care, they publicized the abuses and neglect suffered by patients under managed care. It was a daily chronicling of a “hall of shame.”
When inhuman abuse, whether in prison or in an HMO, sees the light of day, there is a collective indignation that can bring moral clarity. The Pentagon was forced to submit to Congressional hearings only when someone like Darby in the frontlines exposes abuses. When our HMO management found they couldn’t stop the truth from coming out, they finally ended their stonewall and decided to give the nurses’ union what they wanted by setting up new positions called “quality liaisons," filled by nurses who would have a say in setting standards and determining whether or not the hospital met those standards.
Nurses on the front line, who were really excited about the new liaison positions, are complaining that in practice they are not being heard. There are too few quality liaisons and it is hard for any given nurse to see a liaison on the floor when problems occur. Our union leaders need to understand that any contract is only as good as shop floor enforcement.
Imperatives that come from the management hierarchy are always concretely at odds with what is happening on the ground. Supposedly our mission is to “totally focus on the patient, providing the highest quality health delivery possible at the lowest cost,” but what really happens in practice is cutting costs to the bare bones in order to maximize profits. The hierarchy is obsessed with “revenue enhancement.” Their customers, corporations looking to reduce health care costs, are courted with new cost sharing plans which shift more costs to their workers as well as patients.
Recently, an administrator came to our staff meeting, complaining that our “numbers are miserable.” She said, “your revenue collection rate directly impacts the budgeting process for the hospital. The anticipated revenue is already figured into next year’s budget. If you don’t collect it, departments will have to be closed, jobs will have to be eliminated, service cuts will be implemented. Your individual performance will be monitored. Those who do not meet performance criteria will be counseled. If the problem persists, action will be taken up to and including termination. If you’re not able or willing to bring up your collection rate, maybe you need to find another job.”
We workers are fully aware that we are made to perform certain duties according to the inhumane dictates of a world we feel we did not create. Should I do this? I’ve been given an order and there are consequences if I don’t follow it and do as directed.
We need to develop more confidence to speak out about what we know from experience everyday and do so collectively. We need to be able to freely determine our work lives together, to give direction to the whole organization, whether it's an army or an HMO.
It is not the higher-ups that we can rely on to address abuses, since they're part of the problem. Only when workers take full responsibility for our social existence, can we end the separation between the alienating imperatives of the organization and our individual sense of what is right and wrong.
Published by News and Letters Committees