Tuesday, December 2, 2014

Triple Red Crossed, Laguna Hills CA

For the last 30 years, I've been donating blood.  I remember my first Highland High School blood drive, in the big circular gymnasium, and the first time I laid on a lounge chair and got a needle stuck in my arm to have my blood drawn.  I a teenager, and joked around with the phlebotomist that my friend Todd and I would carry cinder blocks and push start his manual transmission Dodge Omni after we ran a 5K race later that day.  They understood we were kidding, and we enjoyed our snacks afterwards, no one passing out.

Red Cross in Indiana.  Carolina-George Blood bank in South Carolina.  United Blood Services in Arizona.  I've never, in more than 7 gallons, been refused as a donor.  I feel it is part of my civic duty as an eligible donor to give, and to give as often as possible.  Many of my friends and relatives with medical conditions or who take certain medications cannot donate blood, so I always try to donate when I can.   I've got easy to find veins, my organically non-GMO fed beef & organic spinach nutrient rich blood always has enough iron, and it's a great way to keep track of my blood pressure & pulse in a 30 year longitudinal study, since they write it on the back of the card after each donation.
Taken by iPhone 5S, in my car, at 2pm 2Dec2014
So today, I go in to give my double red (ALYX they call it, at the Red Cross) donation…  but let me back up…

Back in July (of 2014), I go in to donate blood, at the same Laguna Hills Red Cross donation center (22971 Mill Creek Dr, Laguna Hills, CA 92653 ) and an untrained, over-reactive, histrionic, overly conservative phlebotomist screener tells me I 'have a rash' on my arms, I won't be able to donate.  I tell her I just cut the grass earlier that day, it's a normal skin color for me, and she doubles down on her rejection.   I tell her "look, I've donated for 7 gallons over 30 years, I am fine."  "It's about patient safety" she retorts.  "Get the director" I instruct her.  The director looks at my arms…   they're fine…   and I am allowed to donate (it was a Saturday morning)…  but paranoid phlebotomist got so flustered that she has screwed up the paper work so I can only donate a single unit, not a double unit.  Fine, just take my damn blood, please.  Now I'll have to come back in 56 days instead of 112 days; thank you for the inconvenience as  try to help you.

I then set up an appointment to give in San Clemente to avoid they histrionics of the Laguna Hills site.  At the last minute, the San Clemente blood drive is cancelled…  and they call me to ask me if I can please donate in Laguna Hills.  I tell them of the hassles I had there, and the Red Cross assures me it won't happen again.  I stupidly and gullibly trusted the Red Cross phone solicitor who gets commissions and incentive pay based upon how many appointments they make, not upon how many lies they tell or promises they break.  My 2nd attempt in Laguna Hills at the end of September 2014, where I am scheduled for a double red appointment, have a confirmation email that tells me I have a double red appointment, and I scheduled it on a week day afternoon to avoid being out-of-energy-and-drained-all-weekend after a double red appointment, turns out to be double booked!  Some other guy waltzed in, just before me, without an appointment, and they put him in the only ALYX double red machine they had.  "Can you come back in 3 hours? That's the next open appointment…" they asked me.  I told them my appointment was Now, and no, 3 hours from now I'll be eating dinner and getting ready to go to bed.  Let's make it a single, Again, due to Laguna Hills Red Cross's incompetence and disorganization. Fine.

60 some days later, I make an appointment online with the Red Cross, to donate double red, this afternoon.  "Are you sure it is not double booked?" I ask them on the phone. "Yes, we'll even have the center call you to make sure their machine is available ahead of time."  "Great".   I Was called an hour in advance, told them I would be there on time.  Arrived 10 minutes early (as I am prone to do), signed in, read my donor packet, and began the pre-screening with a new, poorly trained, overly reactionary phlebotomist.  "You've got a rash on your arm".  "No, that's normal, there's no rash" (see the above picture). "I DO have lots of track marks, from the Seven Gallons Of Blood I've been donating, here…….  here…  here…. " (as I point to all the track marks on the insides of my elbows that Red Cross, Carolina-Georgia, and United Blood Centers have left on my skin). "We have a protocol to follow" she tells me.  "Yes, and humans are allowed to operate within protocols and apply rational, sound judgement in situations.  Please get your director."  The young phlebotomist lumbers off and leaves me in the room, unattended for 5 or 6 minutes.  A 2nd phlebotomist comes in, a little bit older lady in her 30s who speaks English with a heavy Spanish accent.  "You ready?"  I tell her… "I am ready, but, the first phlebotomist thinks I have a rash, so she's gone to get the Director" and I show the 2nd phlebotomist my arms.  "You are fine, no rash where we take out the blood, just little red farder away. Is fine." she tells me with a smile.   "Thank you, please tell your director that."  I tell her, returning her smile.

The director comes in, a Dr Susan B, who has a look on her face like 'dealing with a donor is the LAST thing she wanted' to do today.  She looks at my inner elbows for 1 second, and says "do you have allergies?".  "Yes, to my cat" I tell her.  "You have a rash, you can't donate today."  I tell her, does she really realize what a mistake she is making, to turn down a loyal 7 gallon donor, who has no reason to be rejected, other than her very reactionary & poorly trained first phlebotomist's fears, even when a 2nd phlebotomist said I was fine?  And she blandly replies "we can't take the risk."  Well…  you've not only lost this loyal donor, but I spent 45 minutes with the National Red Cross on the phone, where "Kyle" a very patient Red Cross customer service manager at the national call center wrote up an incident report on the Laguna Hills facility.  I've then spent another 30 minutes composing this blog post.  And it really is a shame, since so many truly needful people require blood donations to stay alive.  I want to help those people.  But poor training and total paranoia on the phlebotomist's and the disgruntled director's parts are preventing that from happening.  If I had something physically wrong or my safety as a patient was being compromised, OK, refuse my donation…   but I am fine.  Dr Desert Flower even looked at the pic I sent to her via text, and confirmed I am fine.  It's sad that bureaucrats afraid of California law suits who guide poorly trained phlebotomists can't see that as well.

I've already made another donation appointment, 10 miles further away, later this week, at a small company blood drive.  I will still try my best to donate my nutrient rich, low cholesterol, healthy blood so that needful patients can benefit from it, despite the Red Cross's bureaucracy trying to prevent them from ever getting it.  I hope I get a rational, well trained phlebotomist this time.


  1. Interesting that they're so risk averse in that one site but not others. When I was working on software for blood donation centers, more than 20 years ago, the testing of blood was done in pools. They'd run a single test on a pool of samples from multiple bags of blood and throw the lot away if the test turned up something. Hopefully the number of bags used per pool was based on some sweet spot on the cost/efficiency v waste curve. I have no idea if they still do that. If they do, that's one reason to be risk averse: one bad bag causes many to be thrown out. But that still doesn't explain why that one site in particular is so much more risk averse than any others.

    I also wonder how the people who work their are evaluated and compensated. Are they being incentivized to be irrationally risk averse by bad management? Do failed tests on blood they drew get linked back to them and impact their livelihood? People generally respond to incentives. This smacks of them being incentivized to be risk averse to the detriment of people who actually need blood. Very odd.

  2. At the main collection center, I wore a white shirt, the lighting was BRIGHT, that I think, emphasized the minor discoloration on one arm, and triggered the irrational reaction. At the blood mobile, the lighting was dimmer, I wore a red shirt, and I was "kinder & gentler" with the initial negative reaction from the first screener, who went and got her supervisor, who was more empathetic. Both center & mobile followed the same screening protocol, identically, but the blood mobile was more human and rational about it.

    They butadiene & iodine the skin for 2 minutes, killing anything that may be on the surface. The testing of the blood is all about what comes out, at the end of the donation, not what is on the surface at the beginning. Each time I've had a skeptical screener, I've told them about my bike wreck, cutting the grass, reacting to my cat… my arms are rarely ever pristine from wrist to shoulder…. and each time they've explained that they are concerned about the "donor's safety" and a "negative reaction to the needle stick site antiseptic" … and that's all well and good, since I've Never Had A Negative Reaction, in over 7 gallons donated, for Thirty Years. If I was going to have a negative reaction to butadiene or iodine by now, it would have manifested itself. The masking tape they use (instead of band aids) after the donation (combined with a cotton ball over the stick site) and the glue in the masking tape has a Much Higher risk of a negative reaction in a dermal sensitive patient than the antiseptics… but that would be a rational, scientific approach.

    In 20/20 hindsight, it is all about managing the initial screener, having a human rapport with the screener and her supervisor, and remaining calm. My obvious eye rolling, exasperated sighing, and "tone of disbelief" on Tuesday at the center was replaced by calm, somber, stories of 20 year old kitty to whom I am allergic on Wednesday, and that won over hearts & minds. Nothing to do about blood samples drawn, everything to do about wether or not to draw the sample. Also, California is a risk adverse sue-happy state. AZ, SC, and IN were not… and I never saw an SEI placard in any of the non-CA sites, ever, in 30 years (and I am rather perceptive). Now that I understand how I was "challenging the decision of a union shop floor worker" and how (in other industries) that causes them to Dig Their Heels In ("are you going to support me in this, or not, Ms. Supervisor???") … I get it.


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