Photo

In case anyone wanted to see who died at the hospital...This is who we're fighting for, as well as everyone still alive.

Re-Mediation

Last week, my attorney and I were in a second mediation with N.side hospital. We had gone through one mediation process last summer. At the moment, we're still set for trial this fall.

Before signing with my current attorney, another attorney advised that I could go several routes (besides finding someone to take the case). The routes advised were: Contact the Agency for Health Care Administration (AHCA); protest on the sidewalk in front of the hospital (as long as it was not on hospital grounds or interfering with traffic or business); and start a blog. I was advised that if I did start a blog, I should simply state the truth without any embellishments.

So...I contacted AHCA. They were at the hospital in a relatively short period of time; what they found was not good.

As far as protesting in front of the hospital, that did not appear to be an option I was willing to do. While it may have turned some people away, gotten approval from "the common person" (you and me) and aggravated those in charge at the hospital, I didn't think at the time that it would get the message across to the widest number of people.

The blog idea, though, is a good one. Throughout this blog, I have simply stated the truth. I know what I observed. I have had no reason to embellish or misconstrue the truth. Embellishments and outright lies would only harm my case in many ways: it would damage my credibility; it would make the rest of what I said suspect; it would hurt those who the lies were against; it would be 100% wrong. Add to that that the facts of this case are bad enough...Why would I do that?

The truth has been told all along and needs to be heard. I'm sure that those who have contacted me with their own horror stories of N.side would agree.

Trial Date changed

This past week, I learned that the trial date has changed: Rather than over the summer, the trial is now slated for the fall of 2010.

Yes, this means that it will be that much longer that my life is on hold. But I have no intention of leaving before this is over. I have every intention of seeing this through.

Will it make me stinking rich? I doubt it. Will the hospital admit guilt? I doubt that, too. Will the truth come out? You'd better believe it.

Ya can't go around treating people like garbage and think that it's okay.

The past two years

Northside Hospital temporarily closed to ambulances after license expires, found at http://www.tampabay.com/news/health/article992788.ece and http://www.sptimes.com/2008/02/23/Southpinellas/State_threatens_North.shtmlhttp://www.sptimes.com/2008/02/23/Southpinellas/State_threatens_North.shtml, found at http://www.sptimes.com/2008/02/23/Southpinellas/State_threatens_North.shtml . Both articles were from the St. Petersburg Times.

Moving forward

At the moment, the trial (The Estate of P___ Lastname v. Northside Hospital) is slated for next summer. When the time is closer, I'll see about posting about.

In the meantime, I keep hearing that we have to keep things legal. This is how it should be. If we start talking in mistruths, then nothing good can come of this. We also have to keep things within the confines of the law. Again, this is how it should be.

The only problem I have is that sometimes we can't get into ethics. We can only litigate against a medical person or facility when they legally or medically have screwed up. We technically can't go after them when their ethics harm or kill someone.

At USFSP, if a student majors in journalism, they must take a semester of Ethics. How about for medicine? Are there no ethics classes for doctors, nurses or hospital/nursing home administrators? If not, why not? And if so, how many who took the class forgot what they learned? If there aren't classes in ethics, shame on medical and business schools. If there are and people have forgotten their ethics, shame on those who forgot.

Karma's a boil on the butt of those who forget the Golden Rule.

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.

Un-flippin'-believable

After being out most of the day, I just got around to checking my email about half an hour ago. One of the emails was from the attorney. Turns out N.side hasn't sent them the requested medical records.

"Why?" you might ask.

Turns out they need a copy of P__'s death certificate!!! The man died in their hospital at their hands, and they need proof that he's dead!!!

Now, there are those who will rightfully say that a sense of humor is not needed to live, at least not the way breathing and a viable heartbeat are. But it sure helps. That, and a true appreciation of warped irony.

Another little tidbit

There is always something to be said about telling one's story. Especially important is when, in the telling, we are able to put our thoughts in order.

Sometimes, when we tell our story often enough, as has happened with P__'s death, someone will mention, "You forgot to put this down," or "But what about that?", as in "I'm not quite following this, can you clarify this point?"

Several relatives and friends (in some cases, these are one and the same) have pointed out that I neglected to add one point in the diary of what happened to P__. I intend to add that here.

On the afternoon of P__'s death, his primary care physician came in to check on him and to talk with me about P__'s prognosis. The last time I talked with Dr. ___ face-to-face was shortly before 6:00 p.m. on the 24th. I was getting ready to head home. The visiting hours in the CCU ran until 6:00 p.m., then resumed from 8:00-10:00. This way, the staff could finish charts, do end-of-shift care while the new shift came on and everyone could get a complete run-down on the patients. Very necessary, somewhat time-consuming (I imagine), very hectic. Also, I had only gotten an hour's worth of sleep the night before, so I figured I'd forgo coming back in that evening, opting for seeing P__ the next morning.

Dr. ___ arrived shortly before visiting hours were over. Around this time, a technician came in to run an EEG on P__ which a neurologist had ordered. The technician told me that he would run the EEG after I left, then immediately get the results to the neurologist. The tech was kind, asking me if I had any questions, giving me a brief run-down on the procedure.

Meanwhile, Dr. ___ proceeded to tell me, "We need to pull the plug on your husband."

"Why?" I wanted to know.

"He has no chance at all of any kind of recovery or meaningful life. He is brain-dead. We need to pull the plug now."

Hey, wait a minute. Who let him into this nightmare?

"Excuse me," I told him. "You're expecting what from me?"

"Well, we can't pull the plug without your permission. And we need to pull the plug on him now. Tonight."

I informed him that, first off, I wanted to see what the EEG showed.

"That won't change anything. He's brain-dead."

"I want to check with the neurologist."

"That won't change anything. We need to pull the plug. You need to give me permission to pull the plug." Meanwhile the two or three others (I really don't know who they were) pulled closer around him. There's strength in numbers, they seemed to be stating.

I pointed out that I needed to sleep on this and to talk with P__'s sister. Also, I was going to talk with the neurologist first. Also, if Dr. ___ couldn't pull the plug without my permission, he was not going to get it that night. End of discussion.

Sometime between 7:30 and 8:00, I called the CCU and talked with P__'s night nurse, C__. C__ mentioned that Dr. ___ had made more noise about pulling the plug. "However, the neurologist did look at your husband's EEG. If you'd like, I can page her for you so you can talk with her." I thanked C__ and told her that I wanted to talk with the neurologist.

"Good," she told me. "I promise, we won't do anything except to continue our care for P__ until after you talk with Dr. (neurologist)."

I only had to wait a few minutes for the neurologist to call back. While she said that the EEG showed little, if any, activity, she did offer me this much hope: four (4) days. As she relayed to me, "After an incident like your husband experienced, it's not uncommon to see very little brain activity." However, in her experience, the first four days after such an incident held the key: either the patient would expire on his or her own (frequently within the first 24 hours), or they would stabilize, after which it would become clear that the patient was being kept alive by machines (in which case, letting the patient go was probably the kindest thing to do), or there would be some sign of improvement. She likened it to stories most of us hear on the news during the winter months: a person will fall through the ice, remain submerged for half an hour before being pulled out, and walk out of the hospital a week later, missing only the memory of that week. "Personally, if it were my loved one," she stated, "I'd give him the four days."

After being assured that she would call the CCU immediately, I thanked her. Five minutes later, I talked to C__ in the CCU; she had just hung up with Dr. (neurologist) and agreed that I had done what she felt was best for P__: given him a chance.

Of course, he passed away at 10:44 that evening. But what really makes me angry about this is that Dr. ___ wanted to pull the plug immediately several hours earlier without hearing from the neurologist, and kept pressuring me to give him permission to do so.

And while it didn't affect the end result--P__ still died that evening--I'm still angry that Dr. ___ didn't want to at least discuss options or talk with Dr. (neuro) first.

lawyers and papers and blogs (oh, my)

Well, looks like there are 2 more lawyers interested in working with the lawyer in Jacksonville on the case against N.side; one of them is in Tampa. I'd write more about this, but on the off-chance that anyone from the hospital is reading this, that's all I'll say at this point.

Will add more here in the next week or so...

Does it ever end?

Yesterday, I stopped by the grocery store I usually shop at; most of the people there know me, if not by name, at least by sight, and well enough to stop and talk for a few minutes. Most of them know P__ died, many of them know where he died, and quite a few of them know about the article in Sunday, March 18th's St. Pete Times.

Anyway, as I was paying for my items, the cashier casually informs me, "My mom went to Northside Hospital."

"Really? How is she now?" I asked him.

"She died." (Not sure if it was in the hospital or her death occurred later.) "But Dad got an itemized bill for her stay there. It came after she was cremated. By that time, it was really too late to check anything."

Check anything? "Like what?" I asked.

"Well, the insurance was billed for a pacemaker. Dad and I never heard anything about a pacemaker. The doctor never said anything about it, Mom never mentioned one, nothing. Seems to me that if you have a pacemaker put in, you'd know it. That's the kind of thing you'd mention to your family or your patient's family."

Exactly. "Did your dad ask about it?"

"He was still pretty torn up about Mom. Besides, he wasn't sure he'd get a straight answer from the hospital. And since she was already cremated, we weren't sure that we'd be able to find out anything there."

Which made me wonder. So I googled HCA -fraudulent billing. Here are a couple of links:
http://www.usdoj.gov/opa/pr/2000/December/696civcrm.htm . This appears to be from the Department of Justice. The December 14, 2000 paper states: HCA - THE HEALTH CARE COMPANY & SUBSIDIARIES TO PAY $840 MILLION IN CRIMINAL FINES AND CIVIL DAMAGES AND PENALTIES; Largest Government Fraud Settlement in U.S. History. It goes on to talk about fraudulent billing practices.

And from our local St. Pete (FL) Times (you beautiful people!): http://www.sptimes.com/2004/01/05/Business/The_inside_story_of_H.shtml . In a quote from the January 5, 2004 article (titled "The Inside story of HCA's 'giantkillers'" by Kris Hundley), "It's been a year since HCA, the nation's largest hospital chain, agreed to pay a landmark $1.7-billion fine to settle government claims of Medicare fraud."

Another site about the 2000 case: http://www.againstcorruption.org/briberycase.asp?id=841 .

And another: http://www.billingprecision.com/Medical-Billing-Compliance-Qui-Tam-Whistleblower-Fraud-December42006pharma.htm . This article also mentions Tenent Healthcare's $900,000,000 fine (July 2006) under the False Claims Act, as well as fines against HCA, the Swiss biotech company Serono, Abbott Labs, SmithKline, et al.

Anyone having family members who have been hospitalized, etc., it would behoove you to make sure you get an itemized bill and read through it. If you have questions, you have the right to call and ask about something that looks wrong.

You wouldn't go to the store, come out with a gallon of milk and a loaf of bread, and expect to pay for someone else's 10-pounds worth of $6.49-a-pound meat, would you? Oh, heck, no. No matter how it happens--whether at the grocery store or in the hospital--it's wrong.

And that's my point.

We've got a name...

Anyone who has commented on this blog and who has a complaint against Northside hospital, if you are planning to send along said complaint to AHCA and to Northside, their CEO is Ward Boston, III. But please, if you send a written complaint to Northside (which is preferrable to a phone call), remember three things, please: 1) send a copy to AHCA (after calling AHCA), 2) BE POLITE!, and 3) keep it honest. I can't emphasize these three things. Sending a copy to AHCA assures that it won't "get lost". Being polite and truthful are absolutely imperative to getting heard and helping us change the system. I don't like being screamed at or having people calling me names or threatening me; I imagine neither does Mr. Boston. If we keep what we say truthful, we stand a better chance of being listened to than if we're rude or not fully truthful.

Let's face it, anyone following this most likely wants positive change here--for all of us and our loved ones. Let's all go about it the right way.

Addressing the comments...

Here it is, Monday, March 19. I had almost figured on hearing from Northside today. But then, I may be contacted later in the week. I'm not planning on going anywhere.

Now, first things first. Thank you, Paul Swider and anyone else at the St. Petersburg Times who helped with the article. I personally feel that health care is an important issue. We are all our brothers' (and sisters') keepers; we're all in this life together.

Now, to address some of the posts:
Southlady (who posted back in December): Yes, I agree; nurses (the majority, anyway) are dedicated, decent, hardworking people who got into the field for the right reasons. Unfortunately, as with any profession, be it anyone in the medical field, lawyers, cab drivers, what-have-you, it's the bad ones who give the whole profession a bad name. The fact that you brought your ex- home rather than subject him to the floor at N.side speaks volumes.

Beth: expect an email within the next 24 hours.

Deb Fab: I'll try contacting you, too.

PeoplesSmartAss: Thank you for your kind words and the blog-roll.

Vox: Thanks.

NHpoorcare: I thoroughly sympathize. (No offense, but I hope never to see you ditched!)

Janet, ol14, Edward Ringwald, Alane, another widow, Joanner: I am so sorry for your losses. Part of me wanted to say, "No way." But I believe what you've told me; I've seen it, too. N.side stinks, yes? (And Joanner, mail that letter! It is important!)

Allison: Glad you're now doing well. I should not have read that "deathside" comment with a mouthful of coffee! (But I can forgive you for that!)

Rachet: Thank you; right on.

For all of you who've commented, thank you. For all of you who've read this blog, thank you. For all of you (and I include myself here) who've wondered, "What can I do? I'm only one person," I offer this advice: Keep it legal, keep it honest. Otherwise, we lose our credibility and our power. You're only one person? So was Rosa Parks. So was Martin Luther King, Jr. Jesus started with a band of 12 scared disciples.

In the words of Margaret Mead: "Never doubt that a small group of thoughtful committed citizens can change the world: indeed it's the only thing that ever has."

I will keep everyone updated on how this goes. And, kind readers, keep me posted, too. I have a sneaking suspicion that we all want to see better healthcare. We know we'll all die someday, but it shouldn't be at the hands of those who should be helping us get better.

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.