HFENs Protect Patients - No New Duty Statement

To: Heidi Steinecker, Deputy Director, CHCQ
Susan Espinoza, Assistant Deputy Director, HRD
Kristanna Rivera, Deputy Director, HRD
Sharron Terry, Labor Relations Specialist
Lily Cervantes, Cal HR Labor Relations

RE: Proposed HFEN Duty Statement

Dear Ms. Steinecker, Ms. Espinoza, Ms. Rivera, Ms. Terry and Ms. Cervantes:

We are Health Facility Evaluator Nurses. The new proposed duty statement shows HFENs will be the primary liaison between CDPH and the facilities. It further shows HFENs will provide consistent feedback, instruction, and education to facility leadership and their staff. Thus, the new duty statement requires HFENs to be consultants for the facilities.

The new duty statement also provides for HFENs to enforce federal and state laws and regulations in the facilities, which is the HFENs current role. We have been trained to enforce and not advise. To do both is a conflict of interest.

Heidi Steinecker has stated that HFENs would adopt facilities, and be present in them, once to several times a week in the consulting role. She emphasized that HEFNs also would be performing enforcement functions in the facilities. There is an inherent conflict of interest when HFENs consult, educate, and advise facilities regarding compliance with state and federal laws and regulations and then evaluate the facilities for compliance with these laws and regulations.

The American Nurses Association's Code of Ethics for Nurses states that nurses may experience conflict arising from competing loyalties in the workplace. It further states as follows: "Nurses in all roles must identify and, whenever possible, avoid conflicts of interest." [Emphasis added] Thus, HFENs are required to point out the conflict of interest that arises from the new duty statement to ensure a proper duty statement is produced.

In 1986, The Institute of Medicine published a report titled, "Improving the Quality of Care in Nursing Homes." The report pointed out the conflict in surveyors' dual role as consultants and as enforcers in nursing homes. The report stated, "The committee believes that current federal policies requiring consultation undermine state agency efforts to eliminate substandard providers and deter marginal facilities from repeating violations. Federal and state procedures for enforcement should be modified to reorient the program toward enforcement rather than consultation and to encourage states to adopt a stronger enforcement posture." As a result of this report, the Nursing Home Reform Act of 1987 was enacted by Congress, which focused on enforcement.

The proposed new duty statement will hurt residents because it is fatally flawed. We implore CDPH to base the duty statement on data and science. CDPH must learn from history or be condemned to repeat past mistakes. We are advocates for the residents in facilities and we demand a duty statement that promotes their safety.

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