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#CPHC Chat July 2, 2013 Charles Graeber The Good Nurse

GailZahtz In 16 years a nurse murdered 400 patients. For 4 decades @charlesgraeber has been writing on medicine, science & humanity 1 ET #CPHC GailZahtz Yes @zacharyjeans today we have author @charlesgraeber who wrote about Charles Cullen who killed about 400 patients in hospitals #CPHC Lkgg So @charlesgraeber what drew you to the topic of Cullen and how did you research him for the book? #CPHC GailZahtz great question @lkgg In talking- I was fascinated by how @charlesgraeber came to this as a son of a MD, a scientist and an author #CPHC charlesgraeber #cphc is a first tweetchat thanks @GaliZahtz! I'm the author of @TheGoodNurseBK, @nytimes bestseller about #serialkiller charles #cullen Simenona @charlesgraeber @nytimesarts @TheGoodNurseBK such an eye-opening story. Do you think that tragedies like this are going on unnoticed? #CPHC lkgg RT @charlesgraeber: @Simenona Charles cullen was biggest serial killer, but lesser degrees are surely happening- he only spoke to me #CPHC charlesgraeber @GailZahtz @EdieBrous @lkgg #cphc yes tererible story had to be told! took 7 years to write now the real #healthcare discussion underway charlesgraeber family medical people for hundreds years and i grew up hosptials! RT @GailZahtz: as patient and scientist that led you to write @lkgg #CPHC anetto Sounds like a very extreme example of the damage giving a good reference to someone who you don't really think is good can do #cphc pfanderson @anetto This story comes up over and over again. Practitioners who are given good refs to get rid of them #cphc pfanderson @nursefriendly @Simenona @charlesgraeber @nytimesarts @TheGoodNurseBK HR often instruct positive referral letters to avoid lawsuits #cphc nursefriendly @anetto #cphc Legally, you cannot give a bad reference, those that do risk a lawsuit, #defamation. Most give neutral at best. charlesgraeber some hospitals knew better RT @nursefriendly: @anetto #cphc Legally, you cannot give a bad reference, risk a lawsuit, #defamation. #cphc. AutoimmuneGal @nursefriendly @anetto So neutral has to be sign that there is a problem for those evaluating references. #cphc charlesgraeber YES! discovered shocking story MT @AutoimmuneGal: @nursefriendly @anetto problem for those evaluating references. #cphc nursefriendly @AutoimmuneGal @anetto #cphc Nope, #neutral job references are just that. They give dates of employment usually, and little more.

Simenona @nursefriendly @anetto This policy seems outdated, especially in the medical field. #CPHC Nursefriendly @Simenona @anetto Ethically outdated perhaps, but practical and legally acceptable for most employers for problem employees :( #cphc charlesgraeber @nursefriendly @Simenona @anetto @EdieBrous outdated standards? What questions should we be asking re: references #cphc Pfanderson @AutoimmuneGal @nursefriendly @anetto And folk hiring need TRAINING in reading between the lines. #cphc Pfanderson @nursefriendly @anetto Hardest thing to write is a reference letter that pleases the employee but contains hidden red flags #cphc nursefriendly @pfanderson @anetto #cphc Is the nature of the beast with problem #catholicpriests #doctors #nurses - let become someone elses problem. anetto Could this have anything to do with tight budgets in hospitals "Just get it done" = no reference check? #cphc pfanderson @AutoimmuneGal @nursefriendly @anetto Every problem employee I hired had a reference who lied for them, or lied on resume #cphc lkgg But if references are neutral at worst, then references mean??? MT @anetto: "Just get it done" = no reference check? #cphc pfanderson @CHopeMurray @lkgg @anetto It's process. I always checked all refs, sometimes asked for extra. I hired slowly, got in trouble 4 delays #cphc pfanderson @lkgg @anetto I know people who would be unemployable if folk hiring did reference checks. One guy cursed at me for checking his refs #cphc charlesgraeber exactly- new laws MT @lkgg: references neutral at worst, then references mean??? MT @anetto: "Just get it done" = no reference check? #cphc AnneCCPA @nursefriendly Is there the option of refusing to give a reference at all without risking litigation? #CPHC Pfanderson @AnneCCPA @nursefriendly I don't believe so. At least I've been ordered to write positive refs upon threat of lawsuit. #cphc Pfanderson @AnneCCPA @nursefriendly When you say "risk of" that is a wide open field #cphc Nursefriendly @AnneCCPA #cphc You are not required to give anything but dates of employment and whether eligible for rehire in most states. #cphc TechnologyChef @nursefriendly @AnneCCPA If you gets ref's that only provide dates and eligibility, that should be a red flag. #CPHC Nursefriendly @pfanderson @AnneCCPA #cphc A reference, positive or negative is not required by law. Only dates of employment, and eligibility for rehire. Nursefriendly @pfanderson @AnneCCPA #cphc Whether or not they are eligible for rehire is the best tool for raising red flags, it is above legal scrutiny. Pfanderson @nursefriendly @AnneCCPA Legal requirement doesn't stop employee fr threatening to sue for ref. Been there. HR'll say "do it" #cphc

Zacharyjeans @GailZahtz @charlesgraeber Doing a mixer at a Happy Hour can vet a lot of candidates for character. #CPHC TechnologyChef Anyone hiring without doing a ref check is asking for trouble. If reference isn't glowing, suspect hiding something #CPHC Pfanderson @TechnologyChef Even if glowing. One person told me, "Oh, yeah, that was my mother's brother." Another: "That was my roomate's BF" #cphc CHopeMurray @pfanderson @AutoimmuneGal @nursefriendly @anetto authenticity is not just a SoMe problem, it has haunted professional worlds for ages #CPHC AnneCCPA @CHopeMurray Some "bad apples" are able to be inauthentic on cover letters, resumes & excel during interview process #CPHC CHopeMurray @pfanderson @AutoimmuneGal @nursefriendly @anetto Sadly there are few penalties other than dismissal for such deceptions #CPHC Charlesgraeber @EdieBrous - true? MT @CHopeMurray: @pfanderson @AutoimmuneGal @nursefriendly @anetto Sadly few penaltiesl for deceptions #CPHC AutoimmuneGal @nursefriendly @anetto Calls must be made when there is neutral ref w/ tough questions asked - Do legal issues apply same way on phone #cphc charlesgraeber MT @EdieBrous on topic with @djmasonrn @nursefriendly @anetto @cphc re: legal and neutral reference #cphc TechnologyChef @pfanderson Agree. Ask Ref for another ref. Networking references is a way to better insight. #CPHC Pfanderson @TechnologyChef How do you do that? Easier at upper levels, hard at entry level #cphc TechnologyChef @pfanderson ask... Who do you know that worked with this person? Follow-up. Eventually you get to someone candid. #CPHC Pfanderson @TechnologyChef I still say it is really hard to do with entry level positions, and often a real cost-benefit issue for manager's time #cphc TechnologyChef @pfanderson point taken. Depth of reference checking should be based on depth of trust. Entry level should be more supervised. #CPHC Pfanderson @TechnologyChef Exactly. Check refs more closely for positions that are more independent, less supervised #cphc CHopeMurray @nursefriendly @anetto applicants rarely show neutral refs, always the best. Lack of quality refs from quality orgs usually a clue #CPHC GailZahtz TY RT @EdieBrous: @LisetteBrodey @charlesgraeber Truth is a defense to defamation claims <- Please Add #CPHC so we can follow! Nursefriendly @charlesgraeber @anetto #cphc Lots of potential red flags to pick up on, like number of employers over time, etc. Frequent changes is one. charlesgraeber @nursefriendly @anetto great point but in nursing shortage flags were missed or ignored i discovered @TheGoodNurseBK #cphc Pfanderson @nursefriendly @AutoimmuneGal @anetto I've seen both. Need to question gaps in coverage, start dates/end dates ... #cphc Nursefriendly @EdieBrous @charlesgraeber @anetto @cphc #cphc Yes, there are legal ways to leave a paper trail on problem, or suspect employees.

pfanderson @anetto @nursefriendly @AutoimmuneGal Sometimes, not always. Most of us have had an experience of job we didn't fit, boss who hated us #cphc pfanderson @lkgg @nursefriendly @AutoimmuneGal @anetto Not always. If fleeing a horrific job, can be best for both to pretend it never happened #cphc AutoimmuneGal @nursefriendly @Simenona @anetto Passing buck to the next institution & putting patients @ risk-Wish were legal ramifications for this #cphc CHopeMurray @pfanderson @lkgg @anetto worst case I met, org hired employee even when famous previous employer refused to give ref... #CPHC CHopeMurray @pfanderson @lkgg @anetto the hiring manager falls in love with their chosen one...a bit like fans of teams with good QBs... #CPHC Pfandersonb @CHopeMurray @lkgg @anetto That's taking your reputation in your hands and pitching it to the winds. #cphc Simenona @AnneCCPA @CHopeMurray @charlesgraeber @GailZahtz Perhaps more extensive background checks could help with some of these issues. #CPHC AnneCCPA @zacharyjeans Do you mean Police Records check on all candidates? #CPHC zacharyjeans @AnneCCPA that is a good question. #CPHC Criminal Background Checks are legal as far as I know. But must get signature. Reedmonseur @pfanderson @nursefriendly @charlesgraeber Does SM, whether on or off make it tough to hide, ie LinkedIn recs, endorsements, friends? #CPHC Pfanderson @reedmonseur @nursefriendly @charlesgraeber Ppl on LI also offer to trade endorsements. "You scratch my back, I'll scratch yours" #cphc anetto @charlesgraeber You must have gotten great insight into how nurse hiring works with so many hospitals involved #cphc nursefriendly @Simenona @charlesgraeber @nytimesarts @TheGoodNurseBK #cphc No one, #doctors #nurses #hcps wants to be in the middle of an investigation. charlesgraeber @nursefriendly @Simenona @nytimesarts @TheGoodNurseBK absolutely! luckily I had #whistleblower #nurses to tell truth #cphc nursefriendly @charlesgraeber @Simenona @nytimesarts @TheGoodNurseBK Takes a very brave soul to go against the system like that and tell the truth. #cphc nursefriendly @charlesgraeber @Simenona @nytimesarts @TheGoodNurseBK #cphc Let me ask were there #whistleblower protections in place for that #nurse? Pfanderson @charlesgraeber @anetto @TheGoodNurseBK What was the role of other nurses in catching Cullen? #cphc

GailZahtz Your father and grandfather were physicians? And you went between writing and medicine. What led to writing? @charlesgraeber @lkgg #CPHC charlesgraeber #cphc first saw medicine with my grandfather, then dad, in nursing stations, doing mattered. death real. medicine was life.

Pfanderson Really excited about the month of #cphc Twitter chats with @charlesgraeber about "medicine, madness, and murder"

GailZahtz What from your background enabled you @charlesgraeber to reach Charles Cullen when he wouldn't talk to anyone else? @fredschick1945 #CPHC charlesgraeber @GailZahtz @fredschick1945 I worked as lab researcher, dad nephrologist, I didn't set out to judge Cullen, but to learn- so he spoke #cphc GailZahtz Can you tell us about the letter you wrote him @charlesgraeber @fredschick1945 And what enabled you to reach him? #CPHC Lkgg I'd like to know more about your process for getting Cullen to talk Any specific techniques? Or listen w/out judgment @charlesgraeber #CPHC GailZahtz You talked about fond feelings for nurses when you went on rounds with your father @charlesgraeber Can you share? #CPHC GailZahtz How did you balance the good versus the bad nurses in this writing? RT @charlesgraeber: mt ultimately the shame is #nurses are heroes. #CPHC charlesgraeber I let actions of #serial killer and hosptials speak for themselves RT @GailZahtz: How balance good versus the bad nurses? #CPHC Anetto @NurseFriendly Here's the link to the video #cphc GailZahtz You had been writing about science, medicine and more for @wired and others for years. Can you share about it? #CPHC @charlesgraeber charlesgraeber @GailZahtz #cphc amazing to be here path from researcher to #medschool to #nationalgeographic to @TheGoodNurseBK Simenona @charlesgraeber @GailZahtz @TheGoodNurseBK Sounds like an amazing journey. What is next for you? #CPHC fredschick1945 @charlesgraeber @GailZahtz #CPHC And I'll be buying a copy for us to read! Simenona @pfanderson @charlesgraeber @GailZahtz This is so unfortunate that this story is recurring. What can be done policy-wise to stop this? #cphc GailZahtz Important question! RT @Simenona @charlesgraeber This is so unfortunate that this recurring What can be done policy-wise to stop this? #cphc GailZahtz What was underlying that you wanted to achieve for medicine and as a writer that took you on this journey? #CPHC @charlesgraeber Charlesgraeber grew up hosptials, loved science, wanted to cure ALS as kid, discovered eo wilson...MT @GailZahtz I wanted to ask:your writing journey #CPHC fredschick1945 @charlesgraeber @GailZahtz #CPHC I understand the end notes are a whole 'nuther story! charlesgraeber ABSOLUTELY! There was too much for one book ! MT @fredschick1945: @GailZahtz #CPHC I understand end notes are a whole 'nuther story! #cphc

GailZahtz TY @fredschick1945 we'd like to look at each of the end-notes & what the big questions were that haven't been answered #CPHC @charlesgraeber GailZahtz When you published for this peer review article- was it as scientist, author, poet, or all? #CPHC @charlesgraeber @wired charlesgraeber #cphc i started as a poet- under philip levine, american laureatte. he loved humanity. not cold lab study but the warm art of bedside care pfanderson @charlesgraeber Jealous. :) I'm also poet, never met Mr. Levine, but have read him #cphc fredschick1945 @charlesgraeber @GailZahtz #CPHC What do you mean by the "art" of medicine? GailZahtz I'll let him speak on- both the art and poetry of medicine! RT @fredschick1945: @charlesgraeber #CPHC What do you mean by "art" of medicine? charlesgraeber the human element, treating the whole RT @GailZahtz: RT @fredschick1945: @charlesgraeber #CPHC What mean by "art" of medicine? GailZahtz Where do you find the human element among so much tragedy? @charlesgraeber @fredschick1945 #CPHC MarkPitzele There had to be a bigger breakdown than at the hiring phase. Where did the hospitals go wrong? #CPHC nursefriendly @MarkPitzele #cphc Similar situation Mark, where did the Catholic Church go wrong on problem priests? MarkPitzele @nursefriendly Exactly. Usually a system wide failure. #CPHC Anetto What about over reliance on the accuracy of drug control machines in hospitals? But don't they balance/audit the drugs regularly #cphc Charlesgraeber yes discovered hacked machines too RT @anetto:over reliance on the accuracy of drug control machines in hospitals? #cphc

GailZahtz When you were traveling you looked at prosthetics in Cambodia, and worked with the Crumiki witch doctors? @charlesgraeber @anetto #CPHC charlesgraeber @GailZahtz when I worked with Natoinal geogrpahic, studied with tibetian physicians or CruKamai in Cambodia, I found problems same #cphc GailZahtz What were the key problems you found that were the same @charlesgraeber #CPHC charlesgraeber Yes worked belgian ethnobotonist for HIV compounds- MT @GailZahtz: traveling/ prosthetics in Cambodia/ witchdoctors @anetto #CPHC GailZahtz Adding #CPHC MT @charlesgraeber yes, left newspaper in Budapest to goto India- met Dali Lama, started working for monks ....

GailZahtz When we talked @charlesgraeber you said you went into writing as part of the art of medicine, the human element of mystery. Explain? #CPHC Charlesgraeber @GailZahtz #medicine as discovery, malady as mystery- medicine is a love of people. I write stories of people #Osler #cphc GailZahtz What ties stories you've done for @GQ to National Geographic to your passions? #CPHC Simenona @nursefriendly @MarkPitzele Too much freedom once they are on the job is partly to blame. Need better systems of checks and balances #CPHC Charlesgraeber @GailZahtz @fredschick1945 #nurses, patients, all of us people behind uniforms or jonnies, but who's ultimately responsible? is money? #cphc GailZahtz Add #CPHC so we can see! RT @TammyohU: @charlesgraeber I find this frightening Dr. Anna Pou who euthanized people during Katrina- similar? GailZahtz Please add #CPHC RT @EdieBrous: @TammyohU @charlesgraeber @cphc Dr Pou did not euthanize people and she was acquitted - not the same at all EdieBrous #CPHC Dr. Pou is entirely different situation - acquitted for one & not murder like Cullen Pfanderson @GailZahtz @charlesgraeber @fredschick1945 I'm guessing that Cullen must have had many good qualities, been charming, intelligent, etc #cphc anetto @pfanderson Nice looking too. Never hurts #cphc charlesgraeber he can be funny. very smart. passive. then- a switch flips. and he's gone. MT @GailZahtz: People are asking- how did you find him? #CPHC GailZahtz Excellent! Add #CPHC so all can see! RT @EdieBrous: @charlesgraeber @fredschick1945 money of course, and fear of liability, and cowardice Djmasonrn #cphc @charlesgraeber @GailZahtz What will it take to get hospitals to put welfare of patients before their own financial interests? TechnologyChef Would a more comprehensive EMR been able to detect this renegade nurse sooner? #CPHC AnneCCPA @nursefriendly Thank you for clarifying. It would be interesting to see the laws in Canada/ between provinces. #CPHC AutoimmuneGal Medical community protects each other to a fault sometimes. Chalks it up to everyone makes mistakes. #cphc GailZahtz Reporting for 2 decades- do you sense anything different between the Cullen's and the Amy's? #CPHC @charlesgraeber GailZahtz Yes please! We have a month- let's collect all the issues @nursefriendly @anetto so we can read the book, and reconvene #CPHC

Simenona @charlesgraeber @GailZahtz What is the best advice you can give about writing? #CPHC charlesgraeber 1dont assume needs be easy to be good and 2day job! RT @GailZahtz: RT @Simenona: What is the best advice you can give about writing? #CPHC GailZahtz Great! Add #CPHC so all can see! RT @naveen101: @Simenona @TechnologyChef @charlesgraeber I like "Get it written, get it right." AutoimmuneGal @charlesgraeber @GailZahtz @Simenona So writing is hard, but that should not discourage. #cphc GailZahtz advise: mT @charlesgraeber: @naveen101 @Simenona @TechnologyChef absolutely lay it down then edit, two jobs in my book naveen! #CPHC GailZahtz We've gotten a lot of legal questions @EdieBrous perhaps you can join us this month during the journey? @charlesgraeber #CPHC anetto @nursefriendly Cullen would order a drug in the same drawer as the one he planned to use. Just took out killer drug. Covered tracks #cphc GailZahtz We are going to use all social platforms over month @pfanderson @charlesgraeber @anetto to try to capture all of this! #CPHC

LAlupusLady #CPHC ? for @charlesgraeber ~ how can the patient/advocates encourage Doctors to communicate w/ us about all treatment options. charlesgraeber Oh this is perfect for @djmasonrn RT @LAlupusLady: #CPHC ? how can the patient/advocates encourage Docs talk re all treatment options. jensen_jessica Love how this community blends social media with networking and friendship. Thank you all! #CPHC @GailZahtz @LAlupusLady @charlesgraeber GailZahtz We love you! And friendship and networking, and dealing with real and tough issues! #CPHC @jensen_jessica @LAlupusLady @charlesgraeber AnneCCPA @charlesgraeber As a patient/advocate don't be afraid to ask clarifying questions until you understand. Thats their job #pted #CPHC GailZahtz You have amazingly jumped into the project of bring tough issues through @charlesgraeber What would you like discussed? #CPHC

LAlupusLady #CPHC Explore communication & how Drs. encourage patients to take an active role in their treatment @GailZahtz @charlesgraeber Pfanderson @GailZahtz @charlesgraeber We seem to be talking about issues, but missing the story. And how the story was told. Wd like more on that #cphc charlesgraeber #cphc journalism has taught me re medicine is experts have tough time talking to each other and communication=time but yields discovery

pfanderson @GailZahtz @charlesgraeber Storytelling is important for communicating science, care, ethics ... What can we learn from this story? #cphc pfanderson @GailZahtz @charlesgraeber What is the most uplifting part of this story? How can we replicate that? #cphc GailZahtz And what stories do we need to hear over the coming time that weren't within the book?: #CPHC @pfanderson @charlesgraeber Simenona Encouraging open discussion between doctors. Patients with multiple docs often get conflicting advise @GailZahtz @charlesgraeber #CPHC Charlesgraeber so much untold! i cut half but will tweet! RT @lkgg: RT @GailZahtz: what stories weren't within the book?: #CPHC @pfanderson charlesgraeber it's about choices, not monsters RT @pfanderson:@ChatHealth hero and the villain are both nurses. Powerful tweetertotter / parallels #cphc