Another recap of the hospital stay

For anyone new here who doesn't want to go looking for what happened to my husband at Northside, I'm going to repost what happened here:

Wedneday, Oct. 18, 2006

P__ requested that I call 911, as he was having trouble breathing. We wanted him 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 breathing, but when it became apparent that this was not helping, P__ was intubated. P__ was placed on Diprivan to keep him 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 physically had to move 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 “he has white hair and he’s 71, therefore, he’s deaf.” He never bothered to ask if P__ was deaf (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 October 19, 20

Both days are unremarkable. P__ slowly got better, to the point where he was allowed to regain consciousness by Friday morning; the tube was removed several hours later. Nursing care in the CCY was as good as it should be.

Saturday October 21

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, the nurse assigned to P__ seemed very unsure of herself about giving him 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. 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.

Sunday October 22

Before I left home to visit, P__ called and asked if I would call the nurses’ station. When I asked why, he stated that he had gotten up to use the portable commode and that when he got up, her nasal canula had become disconnected from the oxygen supply. He stated that 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.

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. 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? P__ could have been having chest pains, a possible heart attack, stroke—any number of problems.

Monday October 23

I received a call in the morning from P__ that he was to be discharged that day. He also mentioned that his hip was hurting. When I inquired if he had fallen, he denied falling. (He had broken his shoulder after a fall in May, so I was concerned about possible osteoporosis.)I arrived around noon and was informed (by P__) that 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 he had not received any meals that day, as he was diabetic and required both food and medication to keep his blood sugar levels in check. The nurse told me that since he was scheduled to be released, no meals had been ordered. I had to ask several times to have a meal brought up before one was finally ordered.

During this time, P__ continued to complain that his hip was bothering 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 age and the broken shoulder several months before.

Between 2:45 and 3:00 p.m., P__ said he needed to use the bathroom. He stated that he had used the bathroom earlier (with the help of a walker), that his hip had hurt when he had walked to the bathroom, so I asked his nurse if it was okay for him 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, 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 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 P__'s 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 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 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 to leave? Again, I simply wanted him out of there. (By now, she still had not taken another blood pressure--even after giving the still unknown blood pressure medication!)

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. K. stated, "I thought the hospital was supposed to have someone here to help him out!"

At this point, P__ 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 who 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 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 for several hours. Periodically, the nurse mentioned P__’s blood pressure being very erratic.

Tuesday October 24

Shortly after 2 a.m., while still in the ER, P__ suffered a heart attack...After being moved to the CCU, P__ was hooked up to seven or eight 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. He was also in the Trendelenburg position to help bring the blood flow to his brain and heart.

When P__ finally died at 10:44 p.m., the nurse working on him said that when he died, his blood pressure suddenly went haywire.

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

First Anniversary

Tomorrow is the first anniversary of P__'s death. He died at 10:44 p.m., Eastern time. I contacted the St. Petersburg Times's obit department; there'll be a short "In Loving Memory" for him.

If only...if only...

Does the term "for-profit hospital" seem like a conflict of interest when it comes to treating a patient?

For-Profit Hospitals vs. Patient Care...

This is the term paper I put together for an Expository Writing class last semester...

FOR-PROFIT HOSPITALS VS. PATIENT CARE:
HOW THE BOTTOM LINE AFFECTS PATIENT CARE

ABSTRACT
This paper examines For-Profit hospitals and how having a profit margin can, and often does, adversely affect patient care. I will begin by discussing the role of For-Profit health care providers, including hospitals, clinics and labs, and their place in the health care field. From there, I will touch on the larger for-profit health care providers in the United States, with a brief run-down on how they came into existence. Finally, I will explore how for-profit health care affects patient care, along with possible long-term ramifications and solutions.

INTRODUCTION
Aunt Sarah is the epitome of health; at seventy-something, she hasn’t been sick a day in her lively life. Meanwhile, Grandma June, Sarah’s older sister, has been in and out of the hospital all her life: pneumonia, TB, heart attacks, the flu…Not a year goes by without a trip or two to the emergency room. Thank goodness for Medicare; that helps with a good portion of the bills. Not all of them, mind you, but between that, her Medicare supplement, and her drug plan, she’s getting along. Too bad she lives near that For-Profit hospital, since that’s where the ambulance takes her. The last time she went in with a heart attack, she nearly died after waiting an hour to be seen in the emergency room. If only she lived closer to that city-owned non-profit hospital…

Most of us give little thought about the medical facilities in our area, figuring that most hospitals, clinics or labs are the same, that one is as good as the next. True, we may realize that there are facilities that cater to one group of people: a Children’s Hospital is better suited for treating children than geriatric patients; a hospital set up for OB/GYN problems is not set up to deal with general trauma. However, many people are unaware that there are differences in care between for-profit and not-for-profit hospitals. I plan to explore why the average non-profit may very well be a safer place than the average for-profit facility.

DISCUSSION
The main topic for discussion is how for-profit medical facilities’ quest for the best profit margin has the ability to cost patients and their families, in higher medical bills, in poor-quality care, and in lives lost. While there is be a place for for-profits, everything else being equal, the non-profits are a better choice.

Is There a Place for For-Profit Hospitals?
It is simplistic to state that medical care in the United States would be better if all for-profit facilities closed, for while not-for-profit hospitals tend to be safer than for-profit ones (everything else being comparable), there are times when for-profit facilities provide a much needed service.

In many instances, for-profit chains have either brought hospitals to communities that didn’t have medical facilities or bought out facilities which were about to close, up-grading them and turning them around, thereby keeping valuable medical care in places that would otherwise have little more than one or two overworked doctors (Inlander 225).

Given the choice between no medical care or for-profit facilities, there is no contest.
Small community hospitals in rural areas tend to have fewer resources; fewer people mean less revenue for the facility, making it necessary to ration resources: Do we spend money on one piece of equipment that may be used possibly once or twice a year, or spend the same money on what will be utilized on a daily basis? In this case, having a for-profit group take over the hospital can be a blessing; with their additional resources, they can obtain equipment and care that might otherwise not be available.

The Rise of the For-Profits
During the 1960s, Dr. Thomas Frist, Sr. of Nashville, Tennessee, along with a group of doctors, created Park View Hospital. By the end of the decade, along with Dr. Thomas Frist, Jr., and Jack C. Massey, formed Hospital Corporation of America (now HCA) and began building a chain of for-profit hospitals.

The 1970s saw a rapid industry growth, spawning numerous for-profit hospital chains. As HCA grew, it began buying up smaller for-profit chains, until it finally merged with Columbia in 1994. (Prior to the merger, Columbia had bought out the Humana chain.) HCA is now the largest for-profit chain in the United States, though Tenet Healthcare is also growing with 63 hospitals (http://www.tenethealth.com/Tenet-Health/OurCompany), as well as Universal Health Services (UHS) and Iasis, among others.

Realistically, one can expect the growth of for-profit hospital chains to continue, fulfilling a need in underserved areas, buying out not-for-profits where they can.

The Pain of Dealing With For-Profits
On the surface, it can be incomprehensible why anyone would object to for-profit
hospitals, especially in the United States. Since its founding, the United States has thrived as a capitalistic country, with all its strengths and weaknesses; profits are part of this system.

As for hospitals, most of us acknowledge the fact that we will most likely need their services at one time or another during our lives. Add the two together—for-profit and hospitals—and theoretically, you have a win-win situation.

However, there is the problem of the profit margin. According to the University of Buffalo (NY) Reporter (Thursday, June 27, 2002), “A study…from more than 26,000 hospitals…has shown that people treated in private for-profit hospitals in the U.S. have a greater risk of dying than those cared for in private not-for-profit hospitals (Baker).” The report goes on to state that this study appeared in the Canadian Medical Association Journal (CMAJ).

According to the Canadian Health Coalition press release titled, “Higher death rates in for-profit hospitals: Study,” two thousand (2000) more Canadians would die each year if Canada switched over to for-profit hospitals (CHC Press release, May 27, 2002).

In addition, a commentary in the May 28, 2002 issue of the Canadian Medical Association Journal (CMAJ), titled “Your money and/or your life?” states that “the authors have…reviewed…the results of 14 US studies that compared short-term mortality outcomes for elderly patients admitted to private, for-profit hospitals with those for elderly patients admitted to private, not-for-profit hospitals.” After careful study, the authors concluded that there was a “statistically significant increase in 30-90-day mortality among patients admitted to private, for-profit hospitals (Naylor).”

Dr. Naylor, who was the Dean of Medicine and is now the President of the University of Toronto, ends his commentary by asking, “Does anyone still want to contract out large segments of our publicly financed health care system to for-profit US hospital chains after reading this article (commentary)? I hope not (Naylor).”

In addition, according to the American Hospital Association (AHA), when looking into hospitals, a person is strongly advised to find out if a hospital is nonprofit of for-profit. While the AHA admits that “the quality of care varies widely within each of these categories (for-profit or nonprofit),” they report that “a study in the Journal of General In-ternal Medical found that patients at for-profit hospitals are two to four times more likely than patients at not-for-profit hospitals to suffer complications from surgery or delays in diagnosing and treating illness. Previous research found death rates 25 percent higher at for-profit hospitals than at teaching hospitals and six to seven percent higher than at non-profit, non-teaching hospitals (“All Hospitals Are Not Created Equal”).”

Why the problems? Simple bottom-line: it’s cheaper—on the surface, anyway—to pay for two RNs per shift per floor than four. When Medicare and other insurance companies pay a flat rate for a procedure, it makes sense from a financial standpoint to get the patient out of the hospital as quickly as possible to reduce cost.

On a personal note, I experienced this first-hand with my husband. He had been hospitalized on several occasions since we’d been together: twice at a city-owned not-for-profit hospital, once at a for-profit, chain-owned hospital. While at the not-for-profit facility, he received consistently good care. Even when moved to a non-critical floor, his care remained good: the nurse-to-patient ratio remained low, giving the staff the ability to care for their assigned patients; call lights were acknowledged and answered in a timely manor; patients were cared for as though their lives depended on it!

However, during his last hospital stay, the ambulance was forced to bring him to the closest hospital, a for-profit facility. While the care he received in the CCU was extraordinarily—good, caring staff, a 1-to-1 nurse-to-patient ratio—once on the floor, the profit-margin took over: on a wing where 4-6 nurses may have comfortably handled the work load, there were never more than half that number to be found on the ward. These over-worked souls were then put on 12-hour shifts as opposed to 8-hour shifts. Simple math shows us that this gives us 4-6 nurses on a ward for every 24-hour period, as opposed to 12-18 for the same period. Multiply that number through the non-critical wards and you see not just a smaller staff but a much higher profit-level.

Did this figure into my husband’s death, as well as in the other horror stories I’ve discovered about this and other for-profits, due to under-staffing and higher profits? True, a for-profit hospital is better than no hospital, as mentioned earlier in this article. But when a profit-margin is more important than caring for the patient, we need to ask ourselves the hard question of, “What is more important? A life or a dollar?”
Finally, as Jeffrey Kaye states, “The for-profit industry adamantly maintains its
goal is to combine efficiency with high standards of patient care. But as an increasing number of hospitals have been converted nationally, critics have repeatedly questioned whether profits come before quality care.”

CONCLUSION
While for-profit hospitals may be a positive approach in areas where no other medical facilities would otherwise be available, if given a choice between a for-profit or not-for-profit hospital, with everything else being equal, the not-for-profit would be a healthier choice.

Works Cited
_____, “All Hospitals Are Not Created Equal,” Health Pages: The voice of the Health
Care Consumer, http://www.thehealthpages.com/artricles/ar-hosps.html.
Baker, Lois, Hospital Mortality Rates Analyzed, University of Buffalo Reporter, Vol. 33,
Number 29, June 27, 2002.
_____, “Higher Death Rates in For-Profit Hospitals: Study,” Canadian Health Coalition
(CHC) Press Release, May 27, 2002, http://healthcoalition.ca/for-profit-death.
html.
Inlander, Charles B. et al, The People’s Medical Society Health Desk Reference,
Hyperion, 1995
Kaye, Jeffrey, Community Care-Part 2, The NewsHour with Jim Lehrer Transcript,
KCET
McCabe, Justine and John Battisa, “Warning: For-Profit Hospitals Can Endanger Your
Health And Finances,” The Litchfield (CT) County Times, January 26, 2001.
Naylor, C. David, “Your Money And/or Your Life?” Canadian Medical Association Jour-
nal (CMAJ), May 27, 2002.
Schiff, Gordon, MD, “Fatal Distraction: Finance vs. Vigilance in Our Nation’s Hospi-
tals,” Journal of General Internal Medicine, April, 2000.

Laywers, the Times, and writing...

First off, it appears that the attorney I've been in contact with in Jax may very well be taking the case. I spoke with him the end of last week, and things look good. (Thank you, sir.)

Secondly, I've been contacted by several reporters from the St. Petersburg (FL) Times. Very interested in a story. (Thank you, too!)

Third: I started back to school last fall (local University). Writing major (professional/technical writing; planning to switch back to Journalism). This semester, I'm taking an Expository Writing class. The students were instructed to pick three subjects we were passionate about; mine were the environment, homelessness, and healthcare. We were then told to break each down into three subtopics; from there, we were to pick one of the nine subtopics to write our paper about. It is to be well-thought-out, well-researched, well-documented, and should be written with an eye to being published on the national level (read: Time Magazine, NYTimes, St. Pete Times, et al).

My Expository Paper is going to be on For-Profit Hospitals Vs. Patient Care: How the Bottom Line Affects Patient Care. Yes, I already have a stack of books for my paper (14, and that's just a start). I've googled articles on the matter, and found plenty. The articles that I'll be using come from a variety of reputable sources, including medical journals, business magazines, etc. I already have quite a lot of sources showing facts and figures on how the profit line has the ability to hurt patients. (The floors at Northside were horribly understaffed. Heck, if you can get by paying for only 2 RNs on a floor per shift as opposed to 4, what a savings! But at what cost? I wonder where the CEOs from some of the HCA hospitals send their loved ones when they're sick?)

My point is that when a person goes to a hospital when they're sick, they should be assured that they will be given a fighting chance for survival. Nobody should be exposed to substandard medical care that could cost them their life.

Nobody.