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The novel coronavirus, COVID-19, has left unprecedented marks on society, triggering stay-at-home orders, shelter-in-place orders, ceasing all in-office activities for non-essential businesses, implementing social distancing measures, to mention a few. The airborne respiratory disease is highly contagious and unfortunately, fatal to a percentage of its victims. And as novel as it is, from the limited research we have thus far, one thing is clear: The most vulnerable, with the highest risk of fatalities, are those 65 years and older, those with underlying health conditions, and those residing in long term care facilities. The unfortunate truth for those who live in skilled nursing facilities is that often times, they check off on all of these traits. Skilled nursing facilities are for seniors or dependent adults who have more complex medical conditions and need all-around, 24/7 skilled nursing care.

Despite clear knowledge that the elderly, residents in skilled nursing facilities, those with compromised immune systems and underlying medical conditions are disproportionately endangered by COVID-19, on March 30, 2020, the California Department of Public Health (CDPH) released an absurd All Facilities Letter (AFL)  mandating the admission of COVID-19 positive patients into skilled nursing facilities.

This AFL follows a series of AFLs warning facilities of what is to come, of the potential of an influx of COVID-19 cases, and of the necessary procedures and precautions facilities should implement to protect its residents. One of these AFLs, dated March 20, 2020 states all skilled nursing facilities in California must take precautionary measures to protect their elderly residents from COVID-19 by preventing the initial introduction of the virus in their facility. What is counterintuitive, contradictory, and outrageous of the mandated admission of confirmed COVID-19 patients, then, is this: they claim to want to protect those most at risk of COVID-19 then proceed by implementing the opposite. This CDPH directive directly and carelessly puts the most vulnerable populations in the frontlines of infection and potential death. The existing examples of nursing home COVID-19 outbreaks demonstrate the grim truth: most nursing homes are egregiously unprepared for infection control, let alone readily equipped to handle a wave of COVID-19 positive admissions.

In January 2019, Amtrak sneakily added a forced arbitration clause into their ticket purchasing process. When a customer now wants to ride the Amtrak train, he or she is forced to agree to forced arbitration. Forced arbitration in this context means if the customer has any legal claims against the company, whether in the past, present, or future, the customer can now only bring his grievances to an individual arbitrator rather than to a trial by jury in a court of law or through class action.

The dangers of such a clause are profound and many. First, the clause was so subtly added that it only came to the attention of consumer advocates and political leaders in November 2019. Appalled, these advocates are calling on Congress to take action on behalf of train riders who would no longer have the same protections as those who brought their cases to the court in the past did. Such an immoral clause means the typical protections provided by a court of law and a jury would no longer be available to potential victims of violations from Amtrak. Consumers can only complete the purchase of their ticket if they sign and agree to enter forced arbitration in any case of injury, loss, or violation.

In 2015, when an Amtrak train derailed in Philadelphia, killing 8 and injuring over 200, the victims and their relatives were able to pursue redress through a class action lawsuit. The settlement reached by the parties was $245 million dollars. Although no amount of money could ever compensate for the loss or injury of human life, the protections the plaintiffs had under a court of law were a jury, a trial, and a judge—none of which are available under forced arbitration. They were able to have their case seen by their own peers, not an individual arbitrator hired by the company they were claiming damages against. In forced arbitration, it is the individual arbitrator who ultimately decides the compensation of the parties. This course of action is significantly cheaper and favorable for Amtrak and will not result in the same vindication provided by a trial and court of law. In fact, often times, the arbitrators subtly write in language that are favorable to the companies hiring them.

The consequences of lack of communication between hospitals and skilled nursing facilities (SNFs) are not new knowledge. According to a 2013 study, in the U.S. alone, more than 5 million patients transition from hospital to SNFs yearly. These transitions heavily rely on the thorough communication of healthcare professionals and paraprofessionals to ensure adequate care for patients. However, hospitals and local SNFs typically operate as separate entities causing a myriad of miscommunication. Communication issues that may happen between the facilities include incomplete, contradicting and/or mismatching verbal and written care plans. These problems may cause SNF staff to delay—or never deliver—proper care for patients, resulting in potentially fatal consequences. For example, noting the wrong medication can cause a stroke patient to relapse into another stroke and an avoidable hospital readmission. While many factors can be used as scapegoats to explain these mistakes, these problems are not new, and as professionals in the field, SNFs should establish better communication and points of accountability before accepting a patient to ensure the dignity and quality of care of patients. A recent study published by the Journal of the American Geriatrics Society by multiple medical doctors have indicated that a significant number of hospital readmissions from SNFs were likely preventable.

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