At Morgan Stanley Children’s Hospital in New York City, the 58 tiny beds for sick newborns are almost always filled. But nurses who work there say there are often too few of them to provide all of the care the babies, and their worried families, need.
One of those neonatal intensive care nurses, Shanna Murphy, says she has not forgotten the new mother who got upset when she felt her crying infant was being ignored. Ms. Murphy, 28, said she wanted to soothe the baby, but she had her hands full with another patient whose condition had become unstable and required near-constant monitoring.
“I’m often put in a situation where I’m having to choose between patients and not able to fully support my families,” Ms. Murphy said. “We have a family-centered care model, but I cannot do that under these current conditions.”
Now, she and more than 10,000 nurses are demanding a sharp increase in their ranks at three of the city’s biggest hospital systems — Mount Sinai, NewYork-Presbyterian and Montefiore. Their union, the New York State Nurses Association, has threatened to strike over staffing levels, an issue that has become an increasing source of contention at hospitals around the country.
Last year, staffing disputes were a central topic when nurses in five states picketed and threatened to strike hospitals operated by HCA, one of the country’s largest health care providers. In Vermont last year, hundreds of nurses walked out while demanding increases in staffing.
“It’s one of those issues that you could get a fistfight started in a room full of nurses around,” said Sean Clarke, executive vice dean of the N.Y.U. Rory Meyers College of Nursing.
Nurses and their unions often cite as a model the rules California adopted 20 years ago, which require hospitals to maintain prescribed ratios of nurses to patients in each treatment unit. No other state has imposed staffing levels, though Massachusetts requires intensive care units to have at least one nurse for every two patients, Mr. Clarke said.
Last fall, voters in Massachusetts overwhelmingly rejected a ballot question about placing broader limits on how many patients nurses could be assigned to care for after the hospital industry mounted an intense campaign against it. That was the first statewide vote anywhere on the issue, Mr. Clarke said.
In New York, the three hospital systems, negotiating collectively as the New York City Hospital Alliance, have refused to agree to ratios or other limits on nurses’ workloads. Executives of the hospitals prefer a more fluid approach to allocating nurses based on the needs of patients at any given time. The alliance claims that the three systems have added 2,000 nurses over the past four years.
“Our hospitals have been recognized time and again as among the highest-quality institutions in the nation, proving our approach to staffing works,” Linden Zakula, a spokesman for the alliance, said. “Rigid, inflexible staffing ratios are unnecessary and do not work, because they override the professional judgment of our nurses and crowd out other important care team members.”
Negotiators for the hospitals recently offered $50 million toward the hiring of more nurses, a move that spurred the union to postpone a strike date that had been set for Tuesday. Though negotiations have resumed, the two sides remain far apart. The union, however, has not set a new strike date.
Staffing decisions should not be reduced to a one-size-fits-all approach when it comes to something as complicated as health care, hospital industry officials said.
“No two hospitals are alike,” said Lorraine Ryan, a senior vice president of the Greater New York Hospital Association. “Staffing decisions need to be made by nursing professionals based on patient acuity, the experiences and competencies of the nursing team delivering direct patient care, and other demands on the care-delivery team.”
But the nurses said the alliance’s offer was far from sufficient to yield enough staff members to provide proper care in all areas of the hospitals. Karine Raymond, a nurse in the cardiac catheterization lab at a Montefiore hospital in the Bronx and a negotiator for the union, said each of the three hospital systems needs at least 300 to 400 additional nurses.
Ms. Murphy said the neonatal unit she works in, which is part of the NewYork-Presbyterian system, should have about 30 nurses on duty — one for every newborn whose condition is unstable and one for every two who are “getting ready to go home” — but often has only about 25.
“We’re almost drive-by nursing,” Ms. Raymond said, adding that nurses want to “actually sit with our patients and spend time with our patients and their families.”
Anthony Ciampi, a cardiac telemetry nurse at NewYork-Presbyterian and a vice president of the union, said nurses sometimes have to care for as many as 15 patients at a time. “That’s not fair and it makes no sense,” he said.
Patients notice how short-staffed the hospitals are “when they hit the call bell and nobody comes,” Mr. Ciampi said.
The union has been campaigning for years for what it calls “safe staffing.” It cites a study published in the Journal of the American Medical Association in 2002 that found that the likelihood of a patient dying in a hospital rose by 7 percent when the average number of patients assigned to each nurse there increased by one.
Still, Mr. Clarke, who was a co-author of that study, said it remained a matter of debate whether the benefits of minimum staffing levels, unit by unit, are worth the costs to hospitals.
In California, hospitals are allowed to assign nurses as many as four patients in emergency rooms and some units where patients’ illnesses are not so acute, but as few as one or two in operating rooms and intensive care units.
The 2018 ballot question in Massachusetts would have set similar ratios. It was supported by many Democratic officials, including Senators Elizabeth Warren and Bernie Sanders. But it was opposed by the Massachusetts Health and Hospital Association, which was armed with an independent study that concluded the changes would add as much as $949 million to health care costs in the state.
The New York State Nurses Association points to the rising income of hospitals in California as proof that the ratios did not bring about the financial doom that some opponents had forecast. No California hospitals went bankrupt or closed because of the mandate, the association said. Higher levels of staffing also reduced nurses’ injuries and burnout, cutting down turnover and the costs associated with replacing experienced nurses, the union added.
Ms. Raymond said that after no progress was made on the issue at a recent negotiating session, some nurses felt they had been “hoodwinked” by the alliance. Those nurses argued that the union should have stuck to its threat to strike while continuing to try to reach a deal, she said.
Both sides said neither pay nor benefits were sticking points in the talks.
If the nurses were to walk out, the hospitals would have to bring in thousands of replacements from around the country at a cost of several million dollars. In a letter to their chief executives, City Council Speaker Corey Johnson and several other council members urged the hospitals not to let the impasse reach the point of a “reckless and needless shutdown of our hospitals.”
The letter said the staffing agencies that would provide the replacements were “ill-equipped and not competent” to provide adequate care. “More patients will die and more patients will suffer needless adverse health effects,” it concluded.
GM quiet about Cruise driverless taxi fleet as deadline looms
As the self-imposed deadline for the self-driving taxi service from General Motors Co.’s autonomous vehicle development unit looms this year, the San Francisco-based GM Cruise LLC has gone quiet.
Hype for Cruise’s potential built up in late 2017 and into 2018 as the former start-up laid the groundwork for a commercial launch of its autonomous technology. Increasingly, however, company leaders have said a launch of Cruise’s driverless taxi service would be “gated by safety,” a hedge that has been repeated since October when GM’s self-driving unit partnered with Honda Motor Co.
Meantime, the industry at large has started pulling back on some of its autonomous-vehicle optimism. A fatal accident involving one of Uber’s self-driving test vehicles spurred an industry-wide reassessment of how to best validate the complex technology required to make a car navigate public roads without the help of a driver. As investors and industry observers wait to see Cruise’s robo-taxi service in action, experts say the 2019 deadline is hardly a deal-breaker for the driverless-vehicle unit’s future.
“The real question is not whether Cruise is on track for 2019 or not — it’s whether GM has the stomach to gut this thing out to completion and do everything it’s really going to take to get there,” said Mike Ramsey, an automotive analyst for research firm Gartner Inc. “Does GM have the stomach to spend money — that they don’t have a ton of — and sacrifice areas that make money now to stick this out?”
GM is trying to prove as much. The company is executing a sweeping restructuring that includes stopping production at five North American plants and cutting 15 percent of its salaried workforce. The goal is to cut costs and redirect precious capital toward expensive autonomy, electrification and mobility efforts.
The rollout of the technology has always been guided by safety, a Cruise spokesman said, reiterating what GM and Cruise executives have said in recent months. Leaders also say the quiet period for Cruise is a result of the Silicon Valley workforce’s focus on getting the technology right.
GM is planning to spend roughly $1 billion on Cruise in 2019 after spending about $700 million last year. That includes hiring another 1,000 people over the next nine months. Cruise has also garnered some $5 billion in outside investments from Japan’s SoftBank Investment Advisers and Honda.
And executives say a change in leadership ushers in a new phase for the self-driving car unit. Former GM President Dan Ammann took over as CEO of Cruise effective Jan. 1. He replaced co-founder Kyle Vogt who moved into the role of chief technology officer. Ammann and Vogt say the shuffle allows both executives to focus on their strengths as Cruise moves toward deployment.
But Cruise’s original vision of a driverless taxi fleet of cars without steering wheels or pedals is still stuck in neutral more than a year after the company asked NHTSA permission to put the cars on public roads. It took NHTSA about 14 months to respond to the petition, advancing it to the public review stage last month.
GM’s long wait for a response is evidence that gaining the necessary federal approval is no small step, nor is it guaranteed. Federal safety regulation language revolves around human drivers and vehicles engineered to be piloted by a human driver — as opposed to artificial intelligence.
GM CEO Mary Barra has said the San Francisco team could proceed without federal approval of the steering wheel-free models by launching the service with the safety driver-piloted test vehicles already on public roads. But even if GM Cruise doesn’t start ferrying customers in one of its lidar-equipped Chevrolet Bolt EVs by the stroke of midnight on Dec. 31, experts seem to think the company will be forgiven.
“If GM were to potentially recast its projected time horizon for the launch and rollout of its GM Cruise unit’s service at a later time (i.e. significantly beyond 2020),” Morgan Stanley analyst Adam Jonas wrote in a recent note, “we believe the stock market would be largely understanding.”
Sam Abuelsamid of Navigant Research, which recently ranked Cruise as one of the leaders in the autonomous vehicle race, said the company’s self-imposed 2019 deadline is largely arbitrary.
“If we don’t see a driverless taxi service from Cruise by the end of this year, it will not be the end of the world,” Abuelsamid said. “In the long term it’s better to delay and do this the right way — and Uber made the case last year for what happens when you rush this technology.”
Uber suspended all testing of self-driving cars last March after one of its autonomous test vehicles struck and killed a pedestrian in Arizona. The ride-hailing giant was rushing its autonomous vehicle development to keep up with leaders like GM’s Cruise and Alphabet’s Waymo LLC.
What followed was an industry-wide reckoning with autonomous-vehicle testing practices. Many companies took their driverless test vehicles off the roads while they revamped testing practices. Uber wouldn’t resume autonomous vehicle testing for another nine months. Waymo walked back promises to take human safety drivers out of its autonomous Chrysler Pacifica minivans. And GM appeared to quietly abandon plans to begin testing autonomous vehicles on the busy streets of New York City.
“This is normal,” Ramsey said. “None of what changed in the last year constitutes failure. This is just what happens when something that is really hard, but has a lot of promise, comes around. This is how new technologies get commercialized.”
Yemeni-Americans in New York City are boycotting the New York Post after a damning Ilhan Omar cover story
Yemeni-American shop owners across New York City are denouncing the New York Post in light of a controversial cover image put forth by the publication featuring the 9/11 terrorist attacks and a stand alone quote from Democratic Rep. Ilhan Omar.
“Here’s your something. 2,977 people dead by terrorism,” read last Thursday’s headline, appearing to suggest Omar, a Somali American congresswoman from Minnesota, was dismissive of the attack on the Twin Towers.
The cover was in reference to a speech Omar delivered last month at an event for the Council on American-Islamic Relations.
“For far too long we have lived with the discomfort of being a second-class citizen, and frankly I’m tired of it, and every single Muslim in this country should be tired of it,” Omar said. “CAIR was founded after 9/11 because they recognized that some people did something and that all of us were starting to lose access to our civil liberties.” (CAIR was founded in 1994, and an Omar spokesperson later told the Washington Post that the freshman lawmaker misspoke and meant to refer to the fact that the organization had doubled in size after 9/11).
Omar has faced backlash in recent weeks from the media, commentators, and politicians alike. Last Friday, President Donald Trump shared a video on Twitter blasting Omar for the speech. In the days since Trump’s tweet, Omar said she has experienced an increase in death threats. As of Monday, the video remains on his Twitter page.
New York City’s Yemeni-American community says they are worried that the New York Post’s front page will encourage anti-Muslim violence and rhetoric. As of Saturday morning, ten well-known Yemeni store owners had agreed to stop selling the tabloid, while Yemeni taxi drivers passed out fliers about the boycott to other Yemeni-owned establishments across the city, according to The New York Times.
In an open letter, the Yemeni American Merchants Association said the New York Post’s front page “provoked hatred against Rep. Omar,” and lambasted its decision to publish as “cheap and sensational tabloids that undermine national unity and entice violence and hate for the sole purpose of circulation and sales.”
“This rhetoric threatens the safety and wellbeing of Rep. Omar, Muslim leaders, and the larger Muslim American community at a time when Islamophobia is at an all-time high,” the letter added.
INSIDER reached out to the News Corporation, the New York Post’s parent company, for comment. On Sunday, the Yemeni American Merchants Association announced its formal boycott at a news conference outside of the News Corporation’s building in Manhattan. People in attendance displayed signs that read “boycott hate” and “New York Post take your paper back.”
The association has issued a set of demands, including a public apology to Omar by the Post, and a request that the publication’s editor-in-chief, Stephen Lynch, step down from his position.
Yemeni-American store owners have previously turned toward political activism: after the president issued a ban on travelers in 2017 from seven Muslim-majority countries, including Yemen, thousands of Yemeni-Americans closed shop and gathered together to rally against the policy.
“It’s not the first time that the New York Post basically spreads hate and fear in their newspapers,” Ayyad Algabyali, the association’s director of advocacy, told the Guardian, adding that there is “no end date” to the boycott and “this might be for good.”
Fire Mauls Beloved Notre-Dame Cathedral in Paris
Notre-Dame cathedral, the symbol of the beauty and history of Paris, was scarred by an extensive fire on Monday evening that caused its delicate spire to collapse, bruised the Parisian skies with smoke and further disheartened a city already back on its heels after weeks of violent protests.
The spectacle of flames leaping from the cathedral’s wooden roof — its spire glowing red then turning into a virtual cinder — stunned thousands of onlookers who gathered along the banks of the Seine and packed into the plaza of the nearby Hôtel de Ville, gasping and covering their mouths in horror and wiping away tears.
“It is like losing a member of one’s own family,” said Pierre Guillaume Bonnet, a 45-year-old marketing director. “For me there are so many memories tied up in it.”
Around 500 firefighters battled the blaze for nearly five hours. By 11 p.m. Paris time, the structure had been “saved and preserved as a whole,” the fire chief, Jean-Claude Gallet, said. The two magnificent towers soaring above the skyline had been spared, he said, but two-thirds of the roof was destroyed.
“The worst has been avoided even though the battle is not completely won,” President Emmanuel Macron said in a brief and solemn speech at Notre-Dame on Monday night, vowing that the cathedral would be rebuilt.
“This is the place where we have lived all of our great moments, the epicenter of our lives,” he said. “It is the cathedral of all the French.”
The cause of the fire was not immediately known, officials said. But it appeared to have begun in the interior network of wooden beams, many dating back to the Middle Ages and nicknamed “the forest,” said the cathedral’s rector, Msgr. Patrick Chauvet.
No one was killed, officials said, but a firefighter was seriously injured.
The fire broke out about 6:30 p.m., upending Mr. Macron’s plans to deliver an important policy speech about trying to heal the country from months of “Yellow Vest” demonstrations that had already defaced major landmarks in the capital and disfigured some of its wealthiest streets.
The tragedy seemed to underscore the challenges heaped before his administration, which has struggled to reconcile the formidable weight of France’s ideals and storied past with the necessity for change to meet the demands of the 21st century.
A jewel of medieval Gothic architecture built in the 12th and 13th centuries, Notre-Dame is a landmark not only for Paris, where it squats firmly yet gracefully at its very center, but for all the world. The cathedral is visited by about 30,000 people a day and around 13 million people a year.
For centuries France’s kings and queens were married there. Napoleon was crowned emperor in Notre-Dame in 1804, and the joyous thanksgiving ceremony after the Liberation of Paris in 1944 took place there, led by Charles de Gaulle.
World leaders congregated at the cathedral in a memorial service for Mr. de Gaulle in 1970, and then again for President François Mitterrand in 1996.
On Monday evening, as the last rush of tourists were trying to get in for the day, the doors of Notre-Dame were abruptly shut without explanation, witnesses said. Within moments, tiny bits of white smoke started rising from the spire — which, at 295 feet, was the highest part of the cathedral.
Billowing out, the smoke started turning gray, then black, making it clear that a fire was growing inside the cathedral, which is currently covered in scaffolding. Soon, orange flames began punching out of the spire, quickly increasing in intensity.
The French police rushed in and started blowing whistles, telling everyone to move back, witnesses said. By then, the flames were towering, spilling out of multiple parts of the cathedral.
Tourists and residents alike came to a standstill, pulling out their phones to call their loved ones. Older Parisians began to cry, lamenting how their national treasure was quickly being lost.
Thousands stood on the banks of the Seine river and watched in shock as the fire tore through the cathedral’s wooden roof and brought down the spire. Video filmed by onlookers and shared on social media showed smoke and flames billowing from the top of the cathedral.
Jean-Louis Martin, 56, a native of Dijon in eastern France who works at the university in Geneva, gasped as the flames leapt up. “It hurts me,” he said. “There are no words. It’s just horrible.”
The crowd gasped and cried in horror when the spire fell. “Paris is beheaded,” said Pierre-Eric Trimovillas, 32.
Vincent Dunn, a fire consultant and former New York City fire chief, said that fire hose streams could not reach the top of such a cathedral, and that reaching the top on foot was often an arduous climb over winding steps.
“These cathedrals and houses of worship are built to burn,” he said. “If they weren’t houses of worship, they’d be condemned.”
The city’s prosecutor’s office said it had opened an investigation.
Monsignor Chauvet said firefighters were able to save some of the cathedral’s artworks but did not say how much was damaged inside the building. A linen fabric associated with Saint Louis, the Holy Crown of thorns and the cathedral’s treasury were saved.
Mr. Gallet, the fire chief, said firefighters were still rescuing artworks in the building, hours after the fire had started. The main risk, he said, was the smoke within the cathedral, and the fall of materials, including melting lead.
The cathedral had been undergoing extensive renovation work. Last week, 16 copper statues representing the Twelve Apostles and four evangelists were lifted with a crane so that the spire could be renovated.
The cathedral had been in dire need of a thorough and expensive restoration, André Finot, the cathedral spokesman, told The New York Times in 2017.
Broken gargoyles and fallen balustrades had been replaced by plastic pipes and wooden planks. Flying buttresses had been darkened by pollution and eroded by rainwater. Pinnacles had been propped up by beams and held together with straps. In some places, limestone crumbled at a finger’s touch.
Glenn Corbett, an associate professor of fire science at John Jay College in New York, said construction work and renovations had long been a dangerous combination.
“There’s a history of churches and synagogues and other houses of worship falling victim to construction fires,” he said, adding that one of the reasons for the peril was the proximity of open flames on torches, sparks from welders and other hazards on scaffolding to other flammable materials.
In recent years, the Friends of Notre-Dame, a foundation based in the United States, estimated that the structure needed nearly $40 million for urgent repairs. The French state, which owns the cathedral, already devotes up to 2 million euros a year in upkeep, or about $2.4 million.
The fire came during Holy Week, six days before Easter Sunday. For Roman Catholics, the cathedral has been a spiritual pilgrimage site for generations. France has a deep Catholic history, and nearly two-thirds of its population is Catholic, even though fewer and fewer attend Mass.
“It’s apocalyptic,” said Eleanor Batreau, 45, who organizes pilgrimages to Lourdes and sometimes works at Notre-Dame. “It reminds me of Dresden burning. I’m a Catholic, and Notre-Dame is a symbol of Mary.”
The risk of the fire is not just to the cathedral itself, but also to the gargoyles that cover its walls and to the stained glass, particularly its “rose” windows.
The largest of its bells, which dates to 1681, managed to survive the French Revolution and has been rung at some of the most important events in French history, including both World Wars.
Bernard Fonquernie, the architect in charge of the cathedral’s restoration in the 1980s and 1990s, said that he believed much of the building, its furnishings and its stained glass could be saved. “The stone vaulting acted like a firewall and it kept the worst heat away,” he said.
Yet the fire is likely to be just the latest, if most dramatic, insult to a landmark that has endured decades of neglect and damage, some at the hands of French revolutionaries, through its more than 850-year history.
Victor Hugo’s 1831 novel, “Notre-Dame of Paris,” noted even then that “one cannot but regret, cannot but feel indignant at the innumerable degradations and mutilations inflicted on the venerable pile, both by the action of time and the hand of man.”
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