Learning Module Generator

I am an EMT support staff at Loyal Source Government Services. The following is the letter I wrote with all the details, protocols, evidence, and necessary information to file the grievance letter. I want to use all the information that I have provided in my draft letter. Correct, perfect and legalize the information provided: I want to anonymously report an issue that has happened for several months. The reason why I chose to report this through Lighthouse is because I am afraid of retaliation, therefore I would like to remain anonymous due to past experiences, which other methods have failed me. I did not want to complain or submit a formal report. Still, yesterday, the interaction with Edna, the safety nurse for Del Rio sector, became very unpleasant and I felt harassed and targeted. I have been able to dismiss the mistreatment, but as mentioned before, yesterday, March 13, 2025, it became unbearable, embarrassing, and devastating. Moreover, my project Manager, Mr. Hughes, was present during the mistreatment. He called me later to ask about the interaction between Ms. Rivera and me, Mr. Hughes appeared concerned about my well-being. I explained to Mr. Hughes that this was not the first time. I informed him that from the very beginning, Ms. Edna disliked me and started targeting me, belittling me, questioning me, hovering over me when I performed specific tasks, trying to find a mistake to be able to report it, and condescendingly speaking to me. Mr. Hughes also noted that Ms. Rivera said gently and kindly to Janeth, the provider, and Roger, the support staff. After talking to them like that, she turned to me, completely changed her demeanor, raised her voice, became very authoritative, spoke condescendingly, and was very unprofessional. Also, she reprimanded me for something a manager had to address, not her. Thankfully, Mr. Hughes, the program manager, was right outside the office and he could hear the conversation. The new deputy program manager was present as well. I believe Ms. Rivera made sure my managers could realize that I was doing something wrong, which was not the case, since they were present at the time and did not determine that I did something wrong. I tried explaining, but my Mr. Hughes made a facial gesture, stopping me from explaining myself, which clearly made me understand the indirect message he was trying to convey. He was trying to end the turmoil and protect me from further harassment. I understood, and I remained quiet and continued working. Furthermore, we received a patient brought by the Border Patrol Agent (BPA). We followed usual protocols. I asked the detainee to sit so we could assess her child. I asked questions regarding the assessment we must complete on the EMR. Under our protocols, we are to ask thirteen questions that we must document on the EMR. Even when an EMT support staff member is working by him or herself, we are allowed to complete an assessment, and all support staff must ask all those thirteen questions to all the detainees that come into the facility. I proceeded to ask the question. During that time, Ms. Edna asked Janeth, the provider, “what was I doing?” The provider informed her that I was doing my job and needed to assess the patient first and obtain a set of vital signs. Then, Ms. Edna asked why I was asking those questions, as she thought only the provider could do so. Ms. Janeth informed her that it is in our protocols to do so and that when working without a provider, we must complete an assessment of all juveniles. As per LSGS protocol 010, Health Evaluations, under procedures line 6, initial evaluation, b) support staff, (e), it states that “Only perform vital signs and initial assessment/Encounters when assisting providers for one detainee at a time; DO NOT perform vitals and initiate assessment/encounter form for more than one detainee at a time – NO BATCHING. Thus, we must ask the initial thirteen questions when the detainee arrives at the facility, which I did. These thirteen questions are on page 6 of Health Evaluations SOP 010. It appears that Ms. Edna was not satisfied with her answer due to her hearing demeanor, body language, and facial expressions of displeasure, mainly because it was me. As a safety nurse, she should know that this is part of our duties and that we can assist the provider with the assessment/encounter. Unfortunately, every single time I do something, she will question it, try to find something to reprimand me for, and make sure that she can initiate an argument with me and target me in a certain way. She will not do so to any other person. This behavior and treatment have been witnessed by Janeth, the provider I work with regularly, and the support staff I work with, even temporarily. It is so apparent that no one can dismiss how she only targets or has something against me. I do feel like she is bullying me. I am unsure how else to put it in other words, but that is the first word that comes to mind. Every time Ms. Edna leaves the office, Janeth asks me why Ms. Edna is that way towards me, why she dislikes me so much, why she always wants to find fault in everything I do, and why I feel so uncomfortable and try to upset me. At the time, Ms. Edna was also working on the inventory, which is not part of her duties. Our inventory was taken care of and we will continue working on it by adding the recently obtained inventory. Mr. Hughes informed her to let the team work on it, but she dismissed him. She did not carry out his instructions. I asked her not to include the new inventory with the previously organized inventory, but she did not listen. Janeth, the provider and I, had worked all day organizing and counting the inventory, thus, we didn’t want to go over everything again and re-count what we had counted the previous day, incredibly busy at the station. She did not acknowledge me and continued working on the inventory. When Mr. Hughes and the new DPM left, Ms. Edna continued working on the inventory and Roger, the other support member, had to ask her to leave the newly obtained inventory since it had not been counted. Ms. Edna listened to him and then she stopped working on the inventory. Afterwards, she left the station. I remained professional and wished her a great weekend. Also, on this same date, Mr. Hughes and the DPM in training asked the entire team to go with him outside to review the inventory and help with the items that would stay at our location. An excessive number of items needed to be carried inside, and Mr. Hughes also required the entire team's input to determine which supplies we needed. Mr. Hughes had to move quickly since he also needed to deliver supplies to other stations. Mr. Hughes had to communicate with the watch commander from Sector regarding the inventory, thus we had to move quickly and efficiently. Therefore, he asked us all to go outside and assist him temporarily. We did not have any patients then and did not have to complete any additional tasks. The cabinet that contains the prescription medications was locked since we do not use it often. This raises another concern: the cabinet key is hanging on the wall, so anyone can access it. The other cabinet appears to be working now after Roger tried to adjust it and fix it because on March 4, 2025, the U.S. Secret Service came to the USBP Eagle Pass South station to search for explosive, since the U.S. vice president was going to be at the station the following day on Wednesday, March 5, 2025. LSGS management was asked to keep “everything opened.” Mr. Hughes had informed the staff to keep all the cabinets and drawers opened as per orders from the U.S. Secret Service. It appears that Ms. Rivera then called the staff to ensure they locked the cabinets with the medications since she stated that the cabinets must be locked at all times when the staff is not in the office. For that reason, she asked the staff to lock the cabinet, leave the key on a wall perpendicular to the cabinet, and place a note stating that the keys are hanging next to the cabinet. The U.S. Secret Service had to break the cabinet lock because the cabinet was locked. They did not use the keys, but LSGS was previously informed that everything should be kept unlocked. Also, keys visible, next to the cabinets, defeats the purpose. Roger was able to fix the door so that it could close and lock; it appears to be working now. Another incident I recall is when Ms. Edna became very upset after checking the biohazard container. She asked us to explain why gloves, pieces of gauze, and other unexplained or unauthorized materials were in the biohazard container. We explained to her that we could speak for other team members and why they would discard materials that do not belong in the biohazard container. I mentioned to her that Janeth, the provider and I discarded gloves and pieces of gauze that contained blood from a detainee who stated having HIV while also on HIV medication. This patient had an open wound, which we had to treat, thus we used the biohazard container to discard any materials that had visible blood from this HIV patient. Ms. Edna stated that we can only discard materials that had at least “20mL” of bodily fluids but that she would accept “10mL” of visible bloody materials. As per the sign above the biohazard container, it only states, under the “These DO go in the red bag: Contaminated: visibly bloody gloves, visibly bloody plastic tubing, visibly contaminated PPE, saturated gauze, saturated bandages, blood saturated items, blood &body fluids, closed sharps disposable containers. Special handling and marking may be required: certain pathological waste, Trace Chemotherapy. Additionally, there was a question regarding biohazard materials on our annual training. On our annual test, the last question, question 22 asked the following: Items disposed of in the Bio-Hazard bin include: (Select all that apply), and the correct answers were, visibly bloody gloves, saturated bandages and gauze, blood and bodily fluid, and flu swabs. Flu swabs do not contain 10mL or more bodily fluids; most of the time, the bodily fluid is not even visible after swabbing the patient. Thus, it appears that there is contradicting information. Regardless of the facts, Ms. Edna appeared very upset, started to question me, and spoke to me harshly. Subsequently, she immediately called Mr. Hughes to tell him about the findings, and to be allowed to remove the bio-Hazard container permanently, since “we do not know how to use it and what to discard.” She stated that we had a brand new, folded Biohazard box and a red biohazard bag that we could take out when we had the approved biohazard material that needed to be discarded. Mr. Hughes mentioned that each facility must have a biohazard container, and she rebutted his comment by stating that we had a folded biohazard box that can be taken out from behind the cabinet and tucked into place to be used. Then, she threw away the biohazard bag with those items in a regular trash bin, which seemed inappropriate. I did not continue to question her since she would always argue with me and always had to be correct. On Thursday, January 2, 2025, I emailed Ms. Rivera and Mr. Hughes regarding the glucometer quality check log. On a previous day, November 21, 2024, Ms. Rivera told me to perform the glucometer quality check. I was about to leave to go to the restroom and needed to go right away. Giselle Mendoza was also in the office working with me and could perform the QCs. Giselle was sitting down, not doing anything, yet, Ms Rivera told me to do it and handed me the binder and the materials to perform the QC in front of her. She was hovering over me while I was performing and documenting the QC, which made me very uncomfortable, and she was invading my space. I did not say anything about how I felt to avoid any arguments. While documenting the information, I made a common mistake that most team members make. I typed in the correct expiration date but wrote the same expiration date that the previous support staff had entered. Then she started questioning every single item. I began to complete the information under duress. I was going to re-do it, but Janeth, the provider on duty at the time, offered me her white out. Ms Rivera did not say anything at that moment. After I had wiped out the date, she told me that I could not use whiteout and that I needed to draw a line on the mistake, initial it, and re-type it. I know we correct information that way with medical documentation and records. Still, I did not think the same case applied to an internal quality check log when I was going to re-enter the information correctly and with witnesses included. Then, after performing the quality check for the next quarter, I noticed that the support staff that performed the quality check for the date of October 1, 2024, entered the incorrect expiration date, the expiration date from the test strips, instead of the expiration date after the date opened. After I noticed this, I realized that I was being targeted. I noticed that she would rectify my mistakes but not correct anyone else, even if they made the same mistake. On the email I sent regarding my concerns, she replied on January 3, 2025 with the following message “Gotwin, I reviewed the typed information above your entry, if I am understanding this email correctly, I believe what you are looking at is the example line. I will be at the facility this upcoming week and will be happy to review the log with you.” I did not attach the log-in question; I only attached the new log for the current quarter as requested, but she came to the station afterwards and checked the QC Log for accuracy. She did not review or address my findings even though I highlighted the erroneous information on the log, and she did not educate the rest of the staff like she did with me, even though several other staff members make the same mistake. On another note, she mentioned that the subsequent QC is due on December 1, 2024 and sarcastically said, let’s see if someone notices it and performs the QC like it should be done on that day. It was not the end or the beginning of the quarter, but it was an exceptional circumstance that warranted performing the QC on a date that was not customary. She did not mention this comment to any other shift, once again, negative and sarcastic information is only geared towards me. My first shift in December was December 4th, 2024, four days after that specific QC was due. I checked the log because I knew that I was the only one who would be at fault, even though the shift on December 1st, 2024, was supposed to do it, according to Ms. Rivera. Upon checking the log I noted that the December 1, 2024 QC was not done, thus I completed the QC on December 26, 2024, when I realized it was not done. Giselle Mendoza, CMA, witnessed that case, but unfortunately, she is no longer with the company. Giselle also noted the way Ms. Rivera would talk to me. One day, Ms. Rivera responded to me very unprofessionally, which I dismissed since I was unsure if I was exaggerating and took the response as inappropriate, so I did not say anything or react. Still, when Ms. Rivera left, Giselle mentioned to me that she was “shocked” about the response she gave me. I told her I was glad she noticed that because I did not know if it was wrong. Her comment put me at ease because it confirmed that her comment was inappropriate; thus, I was not biased, and I was not being sensitive or dramatic. Moreover, Giselle and I completed the inventory for February on February 1, 2024. We discarded the expired medication using proper protocols and procedures. On my next day off, Ms. Rivera checked the cabinets for expired medication or supplies. In January 2025, Mr. Hughes received a shipment of cold packs. I informed Mr. Hughes that we needed some cold packs because we ran low. He gave us ten new cold packs from the shipment he had just received. At that time, Janeth was the provider and Giselle, the support, was also here. When I returned to work, we would use a cold pack for one of our patients the following week. I noticed we were low on cold packs, and the new ones were not in the cabinet anymore. Ms. Pardo-Carrasco, the provider mentioned that Ms. Rivera returned and discarded the cold packs because they were expired. When I did the inventory with Giselle, we did notice a date of August 2024. When speaking to Ms. Carrasco-Prado in a different conversation, she mentioned a comment Ms. Rivera shared with her. This event happened towards the end of 2024. I arrived at the USBP Eagle Pass South station at my scheduled time. Upon arrival, I took report from the previous shift, which was the night shift. The support staff from the previous shift informed me that a detainee arrived during our shift and stated having a diagnosis of diabetes, and that he was taking Metformin. They noted that the patient was asymptomatic and stable. The detainee was not added onto the white board. When I heard that the detainee was on metformin, stable, and asymptomatic, and was not complaining of anything, I did not worry too much. I settled in and started my shift by clocking in on the EMR, cleaning my station, and reviewing the patient’s information. I was unaware that the regular provider would not be on shift. The provider I worked with regularly took some time off, which I learned afterwards. My partner was running late at the time. Then, a US Border Patrol approached me and asked about the patient’s insulin. I was confused since I received a different type of information. I stopped what I was doing and checked on the detainee. I needed to learn more about this insulin information since it automatically upgrades the patient's seriousness level. I dropped what I am doing to attend to the detainee. I proceeded to ask him questions about his current illness, current medication, and any other medical information about the detainee. The detainee stated that he was in fact on insulin, but he has not taken his medication as prescribed due to the journey to the U.S.A. and that he ran out of his insulin several days before. The patient appeared stable, and no distress was noted. I went back to the medical office, which was unattended since I was there by myself. Ms. Rivera called the medical office and asked me to open the door for her since she did not have access. I stop what I am doing to go to the entrance and open the door. I informed her of the situation while we walked towards the medical office. Then she asked me about the provider, and I mentioned to her I was by myself, she asked me why, and she asked me who was supposed to be working. I told her I had not checked the schedule since it was not part of my duties. I did not have the time to do so either, since I was already busy, and now my medical interventions are being delayed because she is asking me all these questions while I am busy, and I need to take care of the patient. I told her I needed to check the patient’s blood glucose level (BGL). She said, “good! Now I can see what you do and how things are done when no provider exists.” I walked to the area where the patient was located to check his BGL while I waited for the provider, which I still assume will come, but she might be running late. Ms. Rivera decided to follow me everywhere to see what I was doing and how I was doing it. After obtaining the BGL, the values were critically high. That morning was very stressful because Mr. Rivera followed me everywhere, did not let me work, and asked me questions continuously. It was challenging to work that way. For that reason, until this day, I still recall the patient’s BGL which was 540mg/dL. I asked the patient again if he had any symptoms and he denied having any symptoms. He did not complain of anything. I became concerned and decided to act quickly. I knew that this patient had to be transported to the ER. Even though he was calm, and stated feeling well, the results were very high. I knew what I had to do, since I have experience working by myself with LSGS medical CBP facilities. Mr. Rivera started interrogating me while I was trying to think and document on the patient. She start asking “what are you going to do now,” “what do you do next,” “are you going to call the doctor,” “what is the transport procedure for this specific patient,” “what are you going to document,” “where is Giselle, how come she is not here since she is supposed to be here,” “what are you charting,” “are you including blank on your report,” and so on. I am trying to get the patient's documentation and information to be able to call the physician on call. She sat beside me to see what I was typing and doing. She has access to the EMR, so she can review the information that I documented later instead of hovering over me and asking me continuous questions, which was very uncomfortable and unprofessional. Then, she started questioning me about the case, while I was still working on the patient’s file. I called the physician on call, and as I already knew, the physician informed me that the patient needed to be transported to the ER. It wasn't easy to understand the physician. The physician spoke in a low voice, and had an accent that made it difficult for me to understand him well. I got the physician's order and continued with the rest of my work. Mr. Rivera continued asking questions. She asked me: “you know you have to include the orders given by the physician,” “what did the physician tell you,” “what are you going to document now,” how does the transportation process work,” “who are you going to inform regarding the ER transport,” “are you typing blank,” “now that you finished your report, are you going to informed the agents or supervisor to transport the patient,” “what are you doing now, I thought you were done,” etc. When I finished the encounter, there were other steps I needed to take before informing the BP supervisor. I still needed to create the ER transport information. She did not know that I had to complete that step as well, yet she constantly tells me to document everything, chart correctly, add everything we tell the patient, and complete every step correctly. I am trying to do so, but she does not know the documentation steps I need to take to print the summary and ER transportation reports. She kept pressuring me throughout the process. The other support staff were unaware of what was happening, but realised it was serious. She knew how Mr. Rivera was with me and decided to stay outside the office to avoid inconveniences. I had advised the patient to drink plenty of water while waiting to be transported to the ER. Mr. Rivera asked me if I was going to recheck the patient’s BGL, I stated that that I was going to recheck the patient’s BGL after I was done with the paperwork because without the paperwork, the agents are not going to transport the patient since it is LSGS protocol to do so unless it is a true emergency or the patient is unstable and needs to be transported immediately without delay. That was not the case, therefore, I followed standard procedures. While finishing the documentation and printing the records, Mr. Rivera asked me when I would re-check the patient’s BGL, and she said, “30 minutes? " or 10 minutes? And I just said yes, in 10 minutes. Then she asked me why Giselle was not doing anything and why she was not helping me. I told her I would ask Giselle for help as soon as needed. Ms. Rivera asked me why she didn’t tell her to re-check the patient’s sugar. I told her I was going to as soon as I was done, and I needed a few more minutes to complete the file. Mr. Rivera then told me that she would tell her and ask Giselle to re-check the patient’s BGL in 10 minutes. Giselle sets an alarm for ten minutes. Before those ten minutes passed, she asked if it was time to re-check the patient’s BGL, and Giselle replied that three minutes were left. Fortunately, I have worked for a busy 911 fire department and learned to work under extreme duress. Therefore, I could compose myself and complete my duties to care for the patient. She asked Giselle afterwards if it was time to re-check the patient’s BGL, and she said yes. She gathered the equipment and checked the patient’s BGL. At that time, the glucometer read HIGH, meaning the BGL was over 600 mg/dL. They went back to the office to inform me about the new findings. I told her that the patient was ready to be transported to the ER and that the USBP supervisor had all the necessary medical documents. Ms. Rivera mentioned that since the glucometer read HIGH, the BGL is over 500mg/dL. I corrected her calmly and professionally. I let her know that the BGL was over 600mg/dL since the glucometer reads up to 600mg/dL. She rebutted the information I gave her and told me that it is up to 500mg/dL, but in that case, I had to correct her since it is pertinent information. As much as I did not want to prove her wrong, I had to let her know that the previous BGL was 540mg/dL, and she did not say anything afterwards. I could tell she was not pleased with my answer due to her body language, change of demeanor, and tone of voice after she started asking me further questions. I realized that I did not include all the medication information. I did chart that the patient was on insulin, but I was missing other details regarding the medication. Therefore, I left the office to write the patient’s insulin information by hand on the patient’s care report (PCR) to the BP agent about to transport the patient. When I realized that I would not have a provider that day, I also requested that the provider at the ER please prescribe the patient’s insulin since I did not have a provider at the time to prescribe the medication to be administered while the detainee was in custody. It was a long shot, since the providers at the ER do not usually prescribe medications for consecutive days. Generally, they treat them and send the patient back to the station without medication such as insulin. The providers usually inform the patient that they must follow up with their physician. When I went back to the office I informed Ms. Rivera that the patient was still stable, able to walk by himself with a normal and steady gate, that he was breathing adequately, that his skin color was pink, warm, and dry, which is the appropriate skin description for a stable patient. The patient was cooperative and able to follow commands. All his vital signs were within normal limits, which I initially checked before entering them on the PCR. I also informed Ms. Rivera that the patient usually runs high on the BGL, which is probably why the patient did not have any symptoms and stated feeling well. Ms. Carrasco-Prado is an intelligent, fair, sweet, and ethical person. She has always been fair and can tell right from wrong. She does not side with anybody, unless she feels that there is obvious unfairness, injustice, or mistreatment. She is also a true believer that no one should work under duress, that no one should work in an intimidating environment, and no one should have to fear someone at the workplace or anywhere for that matter. She disagrees with the way Mr. Rivera treats me and speaks to me, and she feels the agony I am going through. On the bright side, she can comfort me and try to change the environment to a positive one for the entire staff. Ms. Rivera confided in Ms. Carrasco-Prado that she would check how I completed the process and see if I called the physician and documented the correct information, including the orders received by the physician. Once again, this is very unprofessional. Ms. Carrasco-Prado shared this crucial information with me because she empathised with me and believed it was unprofessional to say that. She was also able to gather more evidence that she was targeting me and found something wrong about me. In the first week of March 2025, Ms. Rivera visited the medical office to see how we were doing and if we needed anything from her. She checked the monthly training sign-in sheet to see who had signed and read the new training. Even though we have the entire month of March to complete the task, she demands it be read and signed immediately. After reviewing the log, she asked me to please read the training documents and sign the log. I told her I had already signed it, so she checked again and said, “oh yes, here you are, you already did it.” Ms. Rivera also mentioned to the opposite shift that she would visit the office on that shift rather than the opposite shift, which I follow. Those comments are Improper and unacceptable, especially from a higher up. This type of comment does not show good character, places mistrust in the person, and gives the company a bad reputation. Several team members have gotten in trouble for similar comments and have even been written up for it. I understand that team members need to vent and want to share personal information. Still, in this case, her comments are not congruent with her position, and she should lead by example and remain professional at all times, since she is the safety nurse and negative remarks against other team members are unfitting. There have been several other comments of that nature directed to me personally. Ms. Rivera, also calls Mr. Hughes immediately about any adverse finding she might have against me or to prove me wrong. After receiving the new protocols to clear patients to travel, she asked me if I had read it. I mentioned that I did, but since I have been with the company for several years, I have experience with this protocol several times. The protocol was almost identical, and the overall idea was the same. She asked if I knew I had to call the supervising physician for each travel clearance or form 2501 when we did not have a provider on site, and if I was working solo. I let her know that it was incorrect. I let her know that we are allowed to clear detainees to travel by air or by ground even if a provider is not on duty. She did not like my response and asked me again if I read the new clearance travel procedure. Once again, I did tell her that I did and I let her know that most of the times, the detainees have been at the facility for several hours or days and if there was a health concern with the detainee, that we would have assessed the patient and called the physician. By the time they are being removed from the facilty, the detainee has been taken care of and they have either obtained the new medications, they have been cleared to travel by the Emergency Room provider, they are stable, and they are taking their medications as prescribed. Before the detainee leaves, we make sure that nothing has changed and the patient is still stable and able to travel. Suppose we find anything wrong with the patient at the time, for example, something that developed overnight, something new, or the patient suddenly does not feel well. In that case, we will do an assessment and an encounter and call the physician. Suppose the detainee has any of the health concerns mentioned in the protocol. In that case, we will call the physician to clear the patient and follow standard procedures, which will most likely involve sending the patient to the hospital, or keeping the detainee at the facility longer until the detainee is clear to travel. Once again, usually detainees are treated as soon as they arrive at the facility or when they complain of something. By the time they are ready to leave, the patient has been stable during their stay and can be cleared to travel. Since the traffic has decreased, it would be feasible to call the physician, but when we have a large number of patients, for example, like we used to have in the past, about 500 to 1000 twice per shift. We could call the physician, but the physician is not going to like that, he is going to question us why we are calling them if the patient is stable, does not have any medical issues, does not take medications, has already been cleared to travel by the ER, or does not meet any of the restricted requirements. It would take days to clear a multitude of detainees to be straightforward to travel if we have to call the physician, and most likely, the CBP agency will not agree with such delays and will take further action to stop those procedures. At CBP, there are times when we have to work fast and efficiently. When detainees travel by plane, they have minimal time to get the detainee ready to leave. The aircraft will not wait for anyone, and the plane will leave at the expected departure time, whether they have the detainees or not. Also, when the detainees board the plane, they are re-screened again by a different medical entity. For that reason, and safety reasons, we ensure that the detainee does not have anything acute that was either missed or developed afterwards. For example, if the detainee develops a fever, this could happen anytime. Patients can have contracted a virus and be stable, asymptomatic, and feeling well. At the same time, they go through the incubation period and symptoms can start developing 1 to 7 days after it. In those instances, we cannot clear the detainee to travel and must evaluate the patient, call the physician, and follow the doctor’s order. CBP rushes us to hand them the 2501 because the bus or plane is waiting for them and the transportation personnel wait for the detainee, hence, we have to move fast and make sure that we screen out the patient and print the 2501 as quickly as possible. Thus, calling the physician every single time detainees are going to leave, which is usually in a group, would delay transportation, and the detainee most likely will miss their departure. Mr. Rivera disagreed with me and stated that what I was saying did not sound right because I am not a provider and should not be authorized to clear detainees to travel. She stated that she was going to review the information. She tried to clarify that we must call the physician every single time a detainee leaves when there is no provider. For example, today March 14, 2025, ground transportation was waiting for a detainee to be transported to another facility, and the process coordinator asked us to clear the detainee for travel and acquire his medication. We were working on treating another detainee. Also, we were given less than five minutes to retrieve the meditacion, retrieve the patient’s chart and print out the clearance form, the 2501. By the time I could print the 2501, the BP process coordinator informed us that transportation had to leave and that they would be back later. All this happened while we had a provider on site. Ms. Rivera never got back to me to inform me about having to call the physician for each single detainee when working solo. If we are talking about perfection and not making any mistakes, and watching every single move that a person makes, trying to find flaws, and performing tasks that are not part of our duties, then I could mention that the Key Documentation Elements (KDE) Audit SOP on tab 11, has not been updated. The protocol was updated towards the end of 2024, and to this day, March 14, 2025, the new protocol has not been updated or replaced on the SOP, green binder. KDEs are now performed once per shift instead of twice. Ms. Rivera updated two different protocols on Wednesday, March 12, 2025 and that another protocol was updated that same day, thus she was going to go home to print out the new protocol and update it in the binder. Yet, the protocol in question has not been updated for several months. I am not concerned about this finding, I want to point out that we are humans, we make mistakes, or we might miss something. But that does not mean that you have to make an example out of that person, it does not mean that you are going to make sure everybody knows that he or she made a mistake in front of others, and it does not mean that the person is incompetent. Also, there is no reason to wait for someone to slip and make a mistake and report it immediately to the managers, especially when is something that you should be able to take care of without having to report it to management, since it is your job to make sure your assignments are completed on time, that the staff members are on board with any changes regarding her assigned duties, that she rectifies any issues or concerns she might have with the employee, and to educate the staff. If things get out of hand or the employee does not listen to her or follow safety protocols and procedures within her duties, she can go up the chain of command to resolve any issue she cannot decide on her own. Once again, she does that with all other staff members, but not with me. When it relates to me, she will immediately call Mr. Hughes to talk to me about an issue she might have with me. All I can say is that she is very unfair, condescending, and speaking to me in a harsh, authoritative, and belittling manner. Staff members who have seen our interaction will concur with my complaint. Last but not least, when I was sent to New York to assist opening and running the new stations, Mr. Chris Sloan, the Executive Vice President of Medical Operations, talked with the provider and me. He spoke about the safety culture and how he encourages us to report anything inappropriate, goes against policy, or anything else that appears to be wrong. He stated that the information provided would remain anonymous, which I disagreed. He asked me why I felt that way. I informed him that the reporting party was disclosed at the end of the day, and several team members learned about the complaint and who had reported it. Then several things happen afterwards: the victim gets in trouble and written up, the victim gets fired, the other party gets either rewarded, and even if a specific person fabricates information against another person, the case is not adequately investigated. The victim gets written up, transferred, or fired. Also, when we report something on the computer. We have to use our PIV card to log in. We enter our personal information, which gets recorded, and then the reporting party will be disclosed immediately. I also mentioned that key strokes are being recorded as well. Mr. Sloan informed me that he would not check that and to get that information, they would have to contact CBP IT to obtain that information. He emphasized a safety culture, which I was delighted with. I agree with him and believe that the culture needs to change to promote safety in all areas. He stated that his main priority is staff members reporting the information and that he is not focused on who reported it. He stressed the fact that the reporting party will remain anonymous, must since safety was his main priority. His words gave me hope, and it encouraged me to speak up. I felt safe after speaking to him. I have not reported any previous events or conflicts with Ms. Rivera because I feel nothing will happen, especially because she has a higher license than me. I have also noticed that personnel with a higher license always win, issues are not addressed, and the person who loses is the victim or the team member with a lesser degree. It has happened numerous times, and many have experienced it, including me, several years ago. Even if it puts a patient in danger, for that reason, I realized that I have to accept it and get used to it, even if it creates a hostile environment. I have always been professional and polite to Ms. Rivera; thus, I am not sure why she would dislike me so much and why she was trying to catch me making a mistake and talking to me belligerently. I would question her to understand her point of view or information that she would give us, which it appears that she did not like to be challenged or corrected. I hope we can find a resolution to this matter. Once more, this grievance has been so long because I have not spoken up due to fear of retaliation and lack of anonymity. I have lost trust in the system, which has forced me to accept the mistreatment. I also feel it is not worth sending a formal complaint because there is no resolution, the issue continues, or the victim gets punished. After speaking to Mr. Sloan and Mr. Hughes, I developed the courage to file this grievance. I am optimistic that the culture has changed and that we are safe to report any concerns that we might have about creating a secure and encouraging environment.

create a list with 30 different 2-word phrases to use for the ideal research of "navigating the balance of school and a part-time job" in the terms of "issues and controversies". make sure it incorporates BOTH working a part time job while being a student into one word.

a sentient ball of knives kills everyone in the world