Christmas--Merry or not, here it comes...

Christmas after the death of a loved one is rough.

When it could have been prevented...

Remainder of week

Sunday

Before I left home to visit, P__ called and asked if I would call the nurses’ station. When I asked why, s/he stated that he had gotten up to use the portable commode and that when s/he got up, his/her nasal canula had become disconnected from the oxygen supply. S/he stated that s/he had pulled the cord for the call-light and waited for 10 minutes for a nurse to arrive while trying to reconnect the tube.

An aside: I used to kid P__ about time; if s/he said it was 10 minutes, I knew it would fall somewhere between 9 minutes, 30 seconds to 10 minutes, 30 seconds. Add the word "exactly", and the bracketed times were approximately 10 seconds either way.

I immediately called the nurses’ station and told the person who answered that someone needed to check P__ and why. That person told P__’s nurse, “You need to check room 243. S/he needs help reconnecting to his oxygen,” to which I heard the male nurse reply, “I was wondering why the light was on for the past ten minutes!” Ten minutes—-and the nurse hadn’t checked? S/he could have been having chest pains, a possible heart attack, stroke—-any number of problems.

Monday

I received a call in the morning from P__ that s/he was to be discharged that day. S/he also mentioned that his/her hip was hurting. When I inquired if s/he had fallen, s/he denied falling. (S/he had broken his shoulder in May, so I was concerned about possible osteoporosis.)

I arrived around noon and was informed (by P__) that s/he had had nothing to eat that day. There was a food cart in the hallway, and other patients were observed to have lunch trays. I asked P__’s nurse why s/he had not received any meals that day, as s/he was diabetic and required both food and medication to keep his/her blood sugar levels in check. The nurse told me that since s/he was scheduled to be released, no meals had been ordered. I had to ask her several times to have a meal brought up before one was finally ordered.

During this time, P__ continued to complain that his/her hip was bothering her/him. When I inquired about the possibility of having an X-Ray done, I was informed that one wasn’t necessary. “After all,” I was told, “we can’t X-Ray everyone for every little ache and pain.” This was said after I mentioned my concern over possible osteoporosis, both because of his/her age and the broken shoulder several months before.

Between 2:45 and 3:00 p.m., P__ said s/he needed to use the bathroom. S/he stated that s/he had used the bathroom earlier (with the help of a walker), that his/her hip had hurt when s/he had walked to the bathroom, so I asked his/her nurse if it was okay for him/her to attempt to get up and go to the bathroom and was told it was okay.

However, when P__ attempted to get out of bed, s/he fell. I pulled the cord for the call-light. When no one came, the family of another patient in the room ran out and got the nurse. She came in and stated, “Somebody put the bed too high. That’s why s/he fell.” After she helped me get P__ back into bed, she took his blood pressure, which was elevated. She then reiterated that there had been several tests run on P__ that day and that “one of the technicians must have raised the bed and forgot to lower it.”

Note: The other patient in the room was only there for part of one day and signed himself out of the hospital AMA after P__’s fall. I overheard him tell his family that he didn’t trust Northside.

Around 3:30, the nurse came back into the room with a syringe. When I asked her what it was and what it was for, she told me that it was for the high blood pressure and that I didn’t need to worry about what it was. I told her that she really needed to take another blood pressure, as it had been 30-45 minutes since the one elevated one, and that that one had been taken immediately after a fall, that there was a good probability that the BP had come down enough to either not need the medication at all or, at the very least, a lesser dose of the medication. However, she informed me, “I don’t have time to take another blood pressure right now” as she injected the medication into his/her arm.

At 4:30, the nurse stated she was almost done writing the incident report on the fall and that as soon as she was done, she’d give us the discharge papers. She also told me, "His/her doctor is on the floor. Please don’t tell him about the fall, as then he might want to keep P__ in the hospital longer.” At that point, I simply wanted to get P__ out of Northside so that I could bring him/her to Bayfront Medical.

Around 5:00, the brought me the discharge papers and a wheelchair. She informed me that since they were extremely understaffed, would it be possible for me to please bring P__ down to the main entrance and help him/her to leave? Again, I simply wanted him/her out of there. (By now, she still had not taken another blood pressure!)

I got in touch with a friend of ours who drives for cab. K. arrived at approximately 5:30. I wheeled P__ out to the cab, at which point, s/he stood up and immediately collapsed onto the ground. K. came around to help me pick P__ up but we were unable to do so. I ran inside and told the girl who was working the front desk what had happened and asked that she call for help, STAT. She assured me she’d get help right away. Five minutes later, when no help had arrived, I went back inside and asked where our help was.

“I’ll call Security back and see what’s taking them so long,” she informed me. Security. For a medical problem. Of course.

I then ran around to the Emergency Room and told the Triage Nurse what had happened and that we needed help. She informed me that if I would simply put P__ back into the cab and drive around to the Emergency Room door, they’d help us. At that point, I picked up the nearest phone and dialed 911 to get help. After being assured that help was on the way, I hung up. The Triage Nurse asked whom I’d called; when I told her, she asked me if I didn’t think that was “overkill” (her words).

By the time I got back to the front of the hospital, where K. was still trying to keep P__ as comfortable as possible, a nurse and a woman from Security were out front. The nurse never once made an effort to help, but kept asking why we had P__ on the ground. She then heard the sirens in the distance and said something about someone coming to the ER. I told the nurse I’d called 911. Her response was to ask if I could call them off; the woman Security Officer told the nurse that once 911 is activated, they couldn’t be called off, to which the nurse made a comment about my calling 911 “ridiculous”.

When the paramedics arrived, they were able to bring P__ around to the ER, where s/he was readmitted. It wasn’t until after the paramedics arrived that the nurse who had come out made a show of helping; before then, she wouldn’t call for help or make any attempt at helping.

After P__ was readmitted to the ER, one nurse worked on him/her for several hours. Periodically, the nurse mentioned P__’s blood pressure being erratic.

After, P__ suffered a heart attack...

After being moved to the CCU, P__ was hooked up to several bags of medicine. I was told that four of the bags were for medication to bring P__’s blood pressure back up, and that the medications were being pushed to the limit. S/he was also in the Trendelenburg position to help bring the blood flow to his/her brain and heart.

When P__ finally died, the nurse working on him/her said that when s/he died, his/her blood pressure suddenly went haywire.

My problem with Northside Hospital is that: 1) P__ wasn’t transferred to Bayfront Medical once s/he was stabilized, 2) the care (or lack thereof) contributed to P__’s death. Yes, s/he was in his/her early 70s and had had two previous heart attacks... However, several doctors wrote that the heart sounds were good. The heart attack that figured into the death happened after the administration of the medication to drastically bring his/her blood pressure down—and this was for a one-time BP reading taken immediately after a fall and not monitored thereafter.

The week from H@#L

Wednesday

P__ requested that I call 911, as s/he was having trouble breathing. We wanted him/her to go to Bayfront Medical Center as P__ had received good care there in the past, as well as the fact that Bayfront has the only Trauma Center in Pinellas County. Instead, P__ was taken by ambulance to Northside Hospital, an HCA hospital.

Once at Northside’s Emergency Room, the staff responded quickly, within minutes. Dr. T___ was on-call at the time. (I’m not sure if he is a resident, intern, or if he has completed residency.) Dr. T___ attempted to use a facemask to assist P__ with his/her breathing, but when it became apparent that this was not helping, P__ was intubated. P__ was placed on Diprivan to keep him/her sedated. The RN assigned to P__ (A.) mentioned that, since many people are sensitive to Diprivan, he would keep a close watch on how it affected P__, which he did. As soon as P__’s blood pressure started to bottom out (at one point, down to 52/35), A. backed off the Diprivan to bring P__’s B.P. back, saying that once the BP came up, he’d try to find a happy medium.

Meanwhile, P__ started to regain consciousness, becoming combative. Dr. T___ came in and, with his face literally inches from P__’s, started screaming at P__ to calm down. At that point, A. came in and moved Dr. T___ out of the way to administer medication. Later, when I asked, Dr. T___ said that he yelled at P__ because “P__ is deaf.” When I asked how he figured that, he stated that he “knew” this because “s/he has white hair and s/he’s 71, therefore, s/he’s deaf.” He never bothered to ask if P__ was deaf (s/he wasn’t), just assumed. This assumption was not a big deal, but it begs the questions: What else does he assume about his patients? How does this affect their treatment?

P__ was brought up to the CCU later the same day.

I requested both in the Emergency Room and the CCU that P__ be transferred to Bayfront Medical as soon as possible for two reasons: (1) it was our preference (due to better care), and (2) our insurance, United Health Care (Medicare Complete) didn’t have a contract with HCA hospitals at that time.

Thursday, Friday
Both days are unremarkable; not needed here.

Saturday

I visited for 1 ½ - 2 hours in the early afternoon, then went home for 1 ½- 2 hours. During this time, the hospital called and said that P__ had been transferred—-NOT to Bayfront Medical, but to room 243, bed 2 (B?). When I came back to visit him/her, the nurse assigned to P__ seemed very unsure of herself about giving him/her some medication by inhaler. It was a type of inhaler that we were unfamiliar with. P__ has used what is referred to as “rescue inhalers”, as well as a nebulizer in the past, and had received breathing treatments in the CCU as well as when he’d been in Bayfront. We were not familiar with the kind that the nurse was getting ready to use. According to the nurse, it was supposed to crush a pill so that P__ could inhale it. The nurse kept asking me, “Do you know how to use this?” When I told her I didn’t, she said that she would figure it out. When I suggested she find someone on the floor who knew how to use the inhaler, she stated that she didn’t think anyone on the floor knew how to use it. I then mentioned that maybe she should contact Respiratory Therapy and get a Respiratory Technician up to the room either to administer the medication or to show her how to do it. At that point, the nurse stated, “No, that’s alright. I’ll figure this out." After having P__ breath twice into the inhaler, the nurse opened the inhaler, looked inside, and stated, “The pill is gone. I guess it worked. While this nurse was in the room, I discovered through small talk that (1) she’d been an RN for 20 years, and that (2) she was nearing the end of a 12-hour shift.

My point is that if she was unsure of how to use this inhaler—or how to do any procedure—she should have asked for help. The pill in the inhaler may have been inhaled properly—or it could have lodged in any part of P__’s air passages.

Remainder in the next post.

Most nurses are good...

I read (and reread) a comment on my first post and I feel the need to clarify one or two things. Here they are:

First of all, I honestly feel that the majority of those in the medical field are in their chosen field for all the right reasons. Most of them want to make a positive difference in this world by making a positive difference in their patients' lives. Granted, the pay is better than in many other fields, true. But in many cases, the pay is not nearly what it should be, especially for those working as nurses (both RNs and LPNs), nurses' aids, paramedics and EMTs.

Example: In the early 1980s, I had left a local fire department as an EMT. Loved the job. I seriously considered putting in an application with the local ambulance company. (It is not the same company that currently serves Pinellas County.) However, upon finding out what EMTs were paid with the ambulance service at the time, I decided against it: the pay was slightly above minimum wage; I could have made more flipping burgers at a fast food restaurant. Thankfully, paramedics and EMTs are paid better now--as well they should be. As well as most people in the medical field should be.

My sister is an RN, and worked in Pinellas County for approximately 20 years. She absolutely loved her job. She has now moved out of state and is weighing her options to either get licensed in her new home state or to retire. It's a call only she can make.

Which brings me to my next point: In every job, one can point to people, both male and female, who should not be working in their field. Either they're in the wrong field completely or they have been in the field to the point that they have burned out. In the latter situation, sometimes simply taking a leave-of-absence is all that is needed: three to six months of recharging one's internal batteries and they're "good to go". Other times, though, it is best to simply admit to yourself, "That's it. I've given all I've got. Time for something else." Maybe teaching skills to a new generation is a good call; other times, a more drastic change is needed.

Also what may have been a problem in Northside (heck, "may have" nothing; I saw it as a definite problem) is not enough staff. While the CCU amazed me in Northside, with their 1-1 nurse to patient ratio (2-1 patients to nurse for the "better" pateints) and the caring the CCU nurses showed, the floor was nothing short of atrocious. Okay, so Northside, as with other HCA hospitals, is a "for-profit" hospital. To increase the profit margarine, costs have to be trimmed somewhere. But to trim costs by not hiring enough nurses and other medical personnel is unconsciounable.

I truly feel that most nurses would not treat P__ as s/he was treated at Northside. But the fact that even one or two did makes me question what is more important in the eyes of the personnel and CEO of the hospital as well as that of the entire HCA system: money or people?

You decide.

Next time, I'll include the beginning of the notes I sent an attorney who is considering taking the case. (Enough people, it may become a class action suit. But that may be getting ahead of myself.)

Not the only one...

Several years ago, I was having chest pain. It was a Friday evening and I was getting ready to fix dinner.

"How 'bout we go to the ER?" P__ asked. I agreed and told my younger two, both in their 20s, that they shouldgo ahead and fix themselves something to eat.

Since Northside Hospital was the closest one, P__ drove me there. As soon as I signed in, I told the triage nurse that I was having chest pain.

"Okay. Go have a seat. We'll call you."

"But I think I may be having a heart attack."

Not even a look up as the nurse reiterated, "Fine. Now, go sit down. We'll call you."

Several minutes later, a young man on crutches was called in. I looked at P__ quizzically. Someone on crutches called in before a possible heart attack?

An hour passed, during which time, P__ and I talked to the triage nurse several times; we were told we had to "wait your turn." One woman, who'd arrived before us, mentioned that an elderly woman had waited an hour and had been taken in just before we arrived. The elderly woman had been brought in by ambulance for a heart attack. "According to someone who was here when she came in, she only had to wait an hour before being brought back," the woman told me. The elderly woman later died. Did the wait kill her? Possibly; we'll never know.

In the end, I waited an hour-and-a-half. It might have been longer, but several people ahead of me, angry that a possible heart attack had to "sit down and wait", told the triage nurse to take me next. Pathetic that several lay-people had more medical common sense than a triage nurse in an Emergency Room.

At the other end of the spectrum, I brought P__ to Bayfront Medical Center for a heart attack in early 2005. I took P__ by cab, as I didn't want him/her to wait forever in Northside. From the time I signed him/her in and the time s/he was brought back was less than five minutes. Was Bayfront's ER empty? Hardly. There were probably 10-15 people waiting to be seen. But while Northside ER's protocal seems to be a "what-your-turn" attitude, Bayfront's is truly one of Triage: critical patients are seen ahead of less critical ones; chest pain trumps sprained ankles any day of the week, any time of day.

Since what turned out to be my non-heart attack, I have become a magnet for horror stories about Northside.

1. Jack P., one of my neighbors, went to Northside by ambulance for a heart attack. He went into full cardiac arrest twice on the way to the ER. There, a nurse put a shunt into Jack's arm and gave him some morphine. "As soon as you wake up from this, we'll take care of you," she told him. When he woke up an hour later, he was laying in a pool of his own blood; the nurse had forgotten to cap the shunt. When he managed to get her attention, she came over and stated, "Oh, it's a good thing I saw this. A little while longer, you might've died!" It was another hour before they started work on him. This, on someone who had two cardiac incidents on the way to the hospital!

2. Jack's mother also was a patient in Northside. She went in for relatively minor problems and came out with, among other problems, a systemic staph infection and pneumonia.

3. A cab driver who picked my son and me up a year ago stated he was back after being in the hospital for several weeks. "My doctor sent me to Northside. I guess they were okay. Of course, I did have to wait six hours in the ER." What was he in for, I wondered. "I was throwing up blood. They had to empty one of their trash cans a couple of times while I waited in the ER because of the blood." While he waited six hours!!!

4. Another driver who knew both P__ and me told me last week that his father went into Northside with breathing problems; N.side's incompetence nearly killed his dad.

Little wonder that I wanted to take P__ to Bayfront instead of Northside.

I did contact the Florida Agency for Health Care Administration. They were able to confirm most of my complaints from P__'s stay there. On one of the two complaints that they could not confirm, I have witnesses: the cab driver who came to pick us up when P__ was discharged, and the run sheet from the responding Fire Department (as a result of calling 911 when P__ collapsed).

I will not be silenced. I will be heard. And I will do so legally, as that is the way to see a moral win here.

But then, I'm sure that, as a for-profit HCA hospital, Northside knows nothing about morals.

P__'s death

It has been almost 2 months since P__ died at Northside Hospital (Tampa Bay, FL). Here are the facts:

1. After being transported to Northside, P__ spent several hours in the ER before being shuffled off to the CCU. I was assured that s/he would be transported to another hospital after being stabilized; however, instead, s/he was sent to another ward.

2. The first day in the new ward, the assigned nurse kept asking me, "How do you work this inhaler?" She literally had no clue, yet, rather than call in another nurse ("No one else on the floor knows how to use this one, either") or calling Respiratory Therapy to send up a Respiratory Tech, the nurse insisted, "I'm sure I can figure this out myself." This, from a nurse who stated that she'd worked as an RN for 20 years. First thing she should've known was that if she wasn't sure how to use a piece of equipment, CALL FOR HELP!!!

3. Another incident: P__ came unhooked from his/her oxygen and pulled the call light. After 10 minutes, I recieved a call from P__, asking me to call the nurse's station. When I did, explaining what the problem was, the nurse stated, "I was WONDERING why the light was on for the past 10 minutes!"

4. After P__ fell, the nurse on duty took one blood pressure reading and found his/her BP to be elevated. Half an hour - 45 minutes later, the nurse came back to give an injection. When I asked what it was for, the nurse stated it was for P__'s elevated BP. I asked what the medication was and told, "It doesn't matter; you don't need to know, except that it's for his BP." When I said that she needed to take P__'s BP again before giving the injection (figuring the BP had probably come done), the nurse stated (as she gave the injection), "I don't have time to take a blood pressure on him/her." I was then asked, "Please don't tell P__'s docter, as he'll want to keep P__ in here longer."

5. An hour and a half later, the same nurse handed me P__'s discharge papers and a wheelchair before asking, "Can you please bring him/her out? We don't have enough staff to help with the discharge."

6. P__ then collapsed outside. When I could get no help from anyone in the hospital (security was called!), I had to call 911 and have a local Fire Department and ambulance come to help pick P__ up.

Obviously, I'm leaving out quite a few details, while giving you, the reader, enough to realize how bad this hospital is.

My next post will discuss several other people who have told me their horror stories about this hospital.

Horror Stories

For anyone who may have stumbled onto this blog (maybe via Google?), I have set this up to address problems at a specific Florida HCA-affiliated hospital.

Many of us have had to go to the hospital and/or emergency room at one time or another. What do we expect when we go to said hospital/ER? To get better. However, I seem to have become a magnet for horror stories for Northside. Why? The death of a loved one.

Originally, I had not wanted P__ to go to N.side. However, as it was the closest hospital, that was where P__ was taken. Would've been fine--if P__'d been transferred after being stabilized. But instead, upon leaving the CCU, s/he was sent to one of the floors (after getting surprisingly good care at their CCU--more on that in a future post). That was where s/he was given horribly substandard care, which subsequently led to his/her death. (I'm purposely being ambiguous on P__'s gender, as I have heard numerous horror stories from an amazing amount of people on the poor quality of their loved-ones at the hands of N.side. Therefore, if anyone from Northside checks this blog out--I doubt that they will, but stranger things have happened--they'll have to sit and wonder, "Who the heck is this?" Let them sweat...All horror stories relayed over the next few days/weeks are medical horror stories that honestly happened at the hands of this hospital.)

Stay tuned: More will be posted tomorrow.