Patient Support

Medical Injury and Trauma

I took a two day course in New York City called Pastoral Crisis Intervention.    I called ahead to find out that I didn’t need to be a pastor or religious leader to take the course.  Although most of the sixteen participants were clergy of some type, the skills I learned in those two days had very little to do with being a religious leader.

Tragedy and trauma that someone may encounter after an event can be obvious or subtle.  Learning the mental state of a person following a trauma, making an assessment and possibly a need for referral must be fast and accurate.

Patients or family members who have suffered a medical error or anything that causes them to distrust or question the healthcare system can be severely traumatic.  At our most vulnerable, due to illness, injury or just age, we need to trust those who are caring for us and often making life decisions.  Each time we are asked to sign a consent (which won’t happen in an emergency anyway) we are trusting the professionals to do the right thing.  When that trust is broken, then what?  It’s not like we can say let’s do this over. 

There is a cost to not receiving help that goes beyond the patient’s rights.  Patients or their family members may avoid care until an illness needs attention that costs more and takes more time.  Avoiding treatment because a patient is fearful of the healthcare system is a symptom of post traumatic stress.  Not being able to overcome their fear, anger or depression because someone they love was injured or killed by a medical error, medication error or hospital acquired infection can be deadly.

When there is an unplanned outcome with someone’s medical treatment, it is important that they are assessed for trauma.  It can make a big difference in their future medical care and that of the people close to them.

When My Work is Easy

Patient's Safety and So Much About Communication

A man from the north eastern part of the country speaks to a colleague in the south about his brother’s friend in a Long Island hospital.   He feels that the care is below acceptable standards for a variety of reasons.  Knowing about PULSE of NY, the person in the south recommends that I might be able to help.  The man from the north calls me and I tell him he must have his brother call me directly.  It is not my place to call when I hear a story through someone else.  I am not looking for cases and if the patient or family have worked it out, I have no business getting involved.

Minutes later I hear from the brother, Bill (names are changed).  Bill is visiting Long Island when his friend became hospitalized.  He is concerned about the care.   Bill is not being permitted to stay overnight by the nurses.  He feels there is a shortage of nurses and his friends care is being compromised.  He does not feel he is getting a full accounting of his fiends care so he can be helpful.

I offer to go visit but first I will make a phone call.  I ask him to be honest, has he lost his temper?  Who has he spoken to?   Does he have names and dates?

When we finish this conversation I call to management at the hospital.  Explaining briefly what is happening, within minutes of hanging up the phone they are at the patient’s room clearing up misunderstandings.   The patient’s loved one’s received explanations and apology and days later the patient is released with only positive things to say about the hospital and care received.

The problem; The senior level staff are busy running a hospital expecting the people at the bedside are giving quality and patient centered care.  With the possibility of shortages of staff, overwhelming admissions and paperwork, compassion and communication can easily get lost.

A gentle reminder that there was a communication breakdown happening within the hospital is the best service we can offer.  In this case, as with most, there is a legitimate concern that rules and policies are not being followed.  Patients are permitted to have someone at their side.  There was no reason Bill couldn’t stay, but because that’s the way it’s always been done, no one was looking at how they could make this work so the family could feel safe and satisfied.  It took an outside phone call to help build a bridge to better communication.

How do we measure this success?  Would the outcome have been the same if there was no intervention?  There is no way of knowing.  What we do know is that there was a happy ending to this story.  Another day and the patient may have had a bedsore or been given the wrong medication or worse were the friend not at the bedside.  There is no system in place to count the lives saved by an advocate’s intervention.  If there were, we could start counting.

Safe Doctors

Physician Profiles

An article in Long Island Newsday by Reporter Robert Kessler was released on Wednesday March 20, 2013 that Dr. Gracia L. Mayard, a New York physician surrendered his license to prescribe controlled substance in February but continued to prescribe Oxycodone.  There was a warrant out for his arrest.

Mayard’s license was surrendered on February 7 but a pharmacist reported a prescription written on February 28.  Just yesterday, on March 21, Maynard was “captured”.  The report says that he brought in $1.2 million in less than two years.

It’s safe to say that this physician is a criminal and a drug dealer and a danger to the public.  He had been selling prescriptions for $150.00 the report says.

When we look up the name Garcia L. Mayard on the NY State Physician Profile website www.nydoctorprofile.com,  Mayard comes up that he is a licensed practicing physician in New York State.  He is listed as a practicing general surgeon with two offices in Brooklyn, NY and no discipline against him. 

Healthgrades also has him listed as practicing in Brooklyn and Vitals.com has him listed with a perfect rating from a satisfied patient.

It is appalling that this story has completely gotten past our NY State Patient Safety Center that was developed to protect us from unscrupulous doctors such as this giving fine physicians a bad name.  I understand that we can not play judge and jury and he is entitled to his day in court, but there must be a system in place that patients (and their concerned family members) are better aware of these happenings so new people don't fall victim (in case it is true).

Patient Safety Awareness Week - What's your point?

Patient Safety Awareness Week; Where is it?

In just one hour on the radio today I heard commercials for chronic obstructive pulmonary disease (COPD), breast cancer, diabetes, heart disease and more sickness and ailments than I can remember.  Sometimes these commercials are suggesting medication, sometimes it’s just to raise awareness.  Either way, it works. 

As we are now upon Patient Safety Awareness Week again this year, not a word again to the public about patient safety.  Nothing, Nodda, Zip!

For each of the conditions spoken about on commercials, patients need to be made aware of the possibility that the medication that they receive at the pharmacist can be for someone else if they don’t check the label. There are 1.5 million peopleinjured by medication errors each year.  When diagnosed with a new illness, the patient needs to be sure any new medication works with their other medications.  They can go for a second opinion because according to Dr. Mark Graber, founder of Society to Reduce Diagnosis Errors in Medicine, a New York Times article (Oct 2012) the average emergency room physician during his/her career will send home 17 patients who will die an avoidable death within 7 days due to misdiagnosis.

According to The Joint Commission there are still over 2,000 wrong site surgeries each year.  This can be avoided if the public knows how important it is to mark the site of surgery.  That means breast cancer patients or diabetic patients having surgery.

Patients hospitalized with heart disease should know that according to the Center for Disease Control (CDC) one out of every 20 patients will contract a hospital acquired infection and 99,000 peoplewill die each year.

The outcry this week is about the cost of Medicare or government cutbacks.  But who is paying for the care of those Medicare patients who have the second and corrected surgery, are treated after a medication error or when the patient falls in the hospital adding another few thousand dollars to the hospital bill?  If Medicare no longer pays because they refuse now for hospital errors, at some point we are absorbing the cost either financially or with the risk of our safety because hospitals will have to cut back.

There is the  patient with high blood pressure who doesn’t understand the doctor’s instructions and takes his medication incorrectly, doesn’t keep a follow up appointment or doesn’t share all his symptoms so something may be missed.  These problems could easily be avoided if the patient was encouraged through a patient safety campaign to bring a family member or friend with him to the doctor and help take notes and ask questions.

What about those 99,000 patients who died last year from a hospital acquired infection?  Was their life insurance paid out long before it need be?  We know they are no longer paying into their insurance policies.  Isn’t that another economic loss?  Or, were there 1.7 million lost work days because that’s how many people were said to suffer from a hospital acquired infection each year according to the CDC.

So, we try to get a presidential proclamation again this year.  We visit Senator Charles Schumer’s (NY) office, give them the statistics and nothing.  All we want to do is raise awareness.    Patient Safety Awareness Week is an opportunity to celebrate patient safety and all that is being done.  The media doesn’t cover it, the news doesn’t cover it, the politicians don’t cover it, but when the next wrong site surgery happens and the next misdiagnosis happens and they make the news,  I will just sit back and say “What’s your point”?

Call After Call

Following the Prompts

The e-mail I received was about a woman who was going to cancel her medical treatment because she felt she was wrongly billed for her MRI and sonogram while getting cancer treatment. She couldn't possibly afford the continuation of her care. The e-mail came from LIWA, Long Island Women's Agenda, an organization that networks women's organizations and companies of which PULSE of NY is a member.

 

I have no expertise in clearing up billing but I am willing to learn. Especially when someone has other things, such as the possibility of facing a cancer diagnosis or treatment on their mind. Although I don't consider billing to be a "patient safety" issue (of which I try to only focus on) it is part of the patient's hospital experience and every chance I get I like to learn more about it.

I collected the pertinent information from Mary (name is being changed) and started with the insurance company. I followed the computerized prompts, was asked if I would be willing to take a survey at the end of my call and finally got someone who found the file that was denied on Mary's treatment. The woman put me on hold twice and after 22 minutes, the recording came on if I would like to take the survey. I was now disconnected.

When I called back, I was now helped after again following the prompts and explained that because there was other procedures done during the sonogram and MRI, it was billed as another treatment. Something Mary, (like I so often hear) either wasn't told or didn't understand at the time her billing was discussed (or maybe it was never discussed). I have been with enough patients before their surgery or procedures to know that there is a good chance there was no confirmation that the patient understood or was told the details about how the billing would be handled. Her insurance would pay for the radiology treatment but less for the procedures that went with it. Unlike anesthesiology and surgery, this was billed in one lump sum.

I thought I would try to speak to someone at the cancer center where the billing was done and ask how this might be handled to help her. Here is how that played out:

I called cancer center and was told by the woman answering (after following prompts), that the woman could not help me, so I asked for a supervisor who would handle billing. I was transferred to someone who called me "hon" and "honey" who could not find a record of the patient. "Are you a supervisor?" I asked . She said she was not and that I reached the chemotherapy department. She suggested I call radiology and gave me the number. After following the computer prompts, that were plentiful, on 2 occasions the phone said "goodbye". I may not have been fast enough pressing 1, 2, 3, 4 or 5.

When I got a human, she too could find nothing on the patient and suggested I contact another office. I called and after following the computerized instructional prompts to press 1 or 2 and 1 or 2 or 3 or 4 and then 1 or 2, a recording repeated every minute or so that there was a high call volume and I could wait or "visit" them on line at their website. I waited.

When finally connected, (the waiting gave me time to write up these detailed notes) this woman could find no record of the patient owing any money. She said the balance was zero. So I asked about the department I called and she said it was the doctors billing department. She handles doctors billing. When I told her this was not about a doctors bill, she gave me another number to the business office. The number was different but something told me the next call was the same place, different department.

After following the prompts to the business office, which was also called customer service, I was again told that this patient has a zero balance. This person suggested I try another number since it may actually be a doctors bill. I didn't know why I called another doctors billing department. When I tried the doctors billing office and followed the prompts, I was told there was no patient information, but some doctors do their own billing. If this were the case, then they would not have any information about her bills there.

She suggested I try another number, which was the same number I started with. Each call started with the patient's information, address, phone number etc. Exhausting even though I am not emotionally involved.

This whole scenario took just over an hour plus the 30 minutes on the phone with her insurance company and it got me no where. I just could not imagine an emotional patient, facing a life changing health condition such as cancer having to make these calls.

An hour later I called the Westin Hotel reservations and one person was able to make me a reservation anywhere in the country, plus if I had a problem with billing, the Westin Hotel reservations operator would put in a request for someone to call me back.

Maybe we need to follow that prompt in healthcare..........Vacationing people get to speak to a person while the sick get machines and prompts.

The Joint Commission Surveyor

Who is Out to Protect Us; The Surveyor

As I got out of the car at the hotel in Chicago, the man asked if I was “with the Joint Commission”.  “Why”, I asked, “Do I look like I am?”  He said most of the hotel was filled with people from The Joint Commission.  And so I would start my first Joint Commission conference for surveyors.  As a commissioner, I am invited to conferences and meetings to learn what is happening within the organization, participate in events and show my support.

The first night was the awards dinner where surveyors working 5, 10, 15, 20 and 25 years were going to be honored.   A booklet, with the honorees names and accomplishments were at each table setting. .  “These are my people” I told Dr. Chassin, the President and CEO of The Joint Commission, the people who know what happens at the bedside!  Some of the stories between the pages were of the honorees best memories and most interesting survey.  One surveyor told the story of meeting a hospice patient who was concerned that she could not afford a bridal gown for her daughter’s wedding.  The surveyor told the nurse who found a local bridal shop that donated a gown. 

I soon realized that the honor isn’t just that they worked the years they worked, but what they actually accomplished during these years.  At each survey while doing surveys (or inspections) at facilities many surveyors also educate the staff on safer and more productive ways of doing things.

In most cases, best practices are not shared between one facility and another.  One hospital that has a low infection rate is competing for the business in the community with another hospital that may not have as good of an infection rate.  While healthcare organizations are busy within their own facility, surveyors can be sharing what they have learned with other healthcare organizations.  Educating the medical staff on best practices is one way to help keep patients safe.  Learning that these facilities often take what they learn from surveyors and put it into practice is another reason to use a Joint Commission accredited facility.

Who Knows What Really Happens?

Hey You,

Hey, you behind the big wooden desk.  Do you really know what goes on at the patient’s bedside?

When I arrived at the emergency room and visited with the billing department at 6:00 in the morning while the patient was brought into the emergency room, I was greeted by two women who were of another culture.  In between my conversation with one of them doing the billing, they spoke their native language to each other.  It probably would not have affected the patient’s care, but were I the patient, it surely would make me feel uneasy as this is my first impression.

A small community hospital, I was glad to be with a patient using a facility that I would probably use for myself.  Though they don’t have all the trauma needs as a much larger hospital just a short distance away, the fact that it is small, staff are known to be “nice” and this wasn’t a trauma case, I was confident all would go well.  No suspense, it did go well but what I witnessed anyway was still unsettling.

I was asked to sign that I received an admission packet, advanced directives and about 10 items on the list.  When I questioned that we received none of that, the woman handed me a Patient’s Rights manual and explained that everything else on the list is only for Medicare patients.  I wrote “not received / for Medicare only” and signed the bottom information of the form.  It was my impression that the woman handing me the forms to sign may have never read what I was signing.

When I arrived at the patient’s bedside, the nurse treating the patient  was using the light on her phone to check the patient’s throat.  When I commented on this she smiled as she threw her long hair back behind her shoulders and then ran her hands through her hair.

The area between patients was very close.  I can hear what was happening next to us but until the curtain was pulled back could not see.  I do know that next to us was a patient who was preparing to leave.  When she did leave, the curtain was fully pulled back.  The nurse pulled off all the bedding, lifted a nearby bin with her hand and placed the bedding in there.  She then threw over the bed the clean sheets, tied them in the back put a folded blanket on the bed and put equipment out -probably for an IV.  She straightened the bed table and walked away to escort a new patient to another bed, also close by. 

The bed was not washed, the rails were not wiped and the tray table was not cleaned.

I then watched as another nurse pulled bedding off another bed, discarded it and went behind the curtain with another patient.  A pattern I soon realized was quit disheartening.

Still in plain view I watched the nurse go about her duties, never to wash her hands.   I noticed that two sinks on our side of  the room, one right next to me, were dry.   In the short time I was there, they were never used.  As the new patient finished changing into a gown, the same nurse put on gloves, opened the wrapper for the IV and tied off the woman’s arm but before she started the IV she lifted off an IV obviously left from the last patient, opened a bin (I assume this was the garbage) using her foot and hand and dropped it in.  Same gloves, she went back pulled the curtain open and started the IV.

When my patient was ready to leave and was to get a shot, the nurse explained that it will hurt for the day and gave him a shot in the arm that he needed to work with.  She said “I hope you’re not right handed, I should have asked”. She giggled and walked away.

These may not be life threatening conditions.  This may even sound minor, silly or not worth discussing, but it only takes a small amount of germs to cause an infection.  It only takes a small amount of carelessness to start bigger problems and it takes one person to set an example for others.  When one, two or three people in an emergency department let their guard down, we are in for bigger problems.  I'm not sure that the people who are in the corporate offices, make the policies, write the checks and go to the patient safety conferences even know how to start watching for this breach of conduct.   I’m not sure I would feel safe there, and now I don’t know where I would go.

Kate Middleton's Privacy

Royal Privacy

 



King Edward VII's Hospital

Kate Middleton, Duchess of Cambridge becomes pregnant.  The complications from her pregnancy land her in King Edward VII Hospital in London where she is suffering from severe morning sickness.   DJ’s  Mel Greig and Michael Christian from an Australian radio show call the hospital pretending to be Queen Elizabeth and Prince Charles.  They ask the nurse who answers the phone, as a prank for the radio station, if they can speak to Kate. A nurse, Jacintha Saldanha patches them through.

 

Another nurse, who has not yet been identified picks up the call and offers information about Kate’s condition.  Not realizing this is a prank, this nurse tells the DJ’s detailed information about Kate Middleton’s condition, on tape for all the listeners to hear.

Three days later, after most of the world heard the phone call on the news, Jacintha Saldanha, a nurse at that hospital for four years, and the mother of two teens is found dead from an apparent suicide.

Could this have happened here, in the United States?  Aren’t we “protected” by HIPAA so this information would / should never get out?  What did this nurse who answered the phone, or the nurse who gave out the information but didn’t kill herself actually do wrong?

The hospital policy, as one article wrote “forbids employees to patch phone calls through to the ward”.  This is the only place Saldanha committed any wrong doing.  The nurse, who gave out the information to the DJ’s may have gone a bit overboard in the details, but there too committed no offense. 

The privacy we may expect as a patient in the hospital is our right to ask that information not be shared with family or friends. If that request is not made, there is no public policy in place that protects patients from having a family member get information from the doctor or nurse about our condition, were we the patient.  Healthcare workers usually do not freely give out personal information over the phone to callers to protect the patient’s privacy or because it can get to time consuming to share details with everyone who might call.  But, the HIPAA laws do not protect us from that conversation – although over and over again, medical professionals use HIPAA as the reason they won’t share information about a patient with family or friends.

The nurse who did give out the details may be reprimanded for not using better judgment and Saldanha may have broken the rule about passing on a phone call.  But the only tragedy here is that a woman (that I know nothing else about) took her own life instead of apologizing and now her children don’t have their mother.

I hope that this will be used as an opportunity for people to decide now who you want to have your information were you to be hospitalized.  Who will be your advocate or support person and have that conversation with them about your expectations were you to be suddenly incapacitated.   Were Kate Middleton to have a patient advocate at her bedside, or helping her husband, Prince William know their rights to privacy, there is always a chance the outcome may have been very different.

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Registration is now open for Long Island Family Centered Patient Advocacy Training, Registration

See the following links for more information about HIPAA:

LI Patient Safety Advisory Council Information

HIPAA: Everything You Want to Know about Patient Privacy but Are Afraid to Ask! US Department Health and Human Services For Consumers HIPAA Video 

PPAI 2nd Annual Conference

Professional Patient Advocate Institute

I just spent two days in Orlando at the second annual Professional Patient Advocate InstituteConference.  Day one consisted of a certificate program.  The training covered legal issues, hospital visits, billing and reimbursements, direct services, a business plan, marketing and family support.

You wouldn’t go to court without a lawyer someone said, so why enter the healthcare system without an advocate?

According to the PPAI, some facts to justify the need for a patient advocate; 52 million caregivers provide care to adults ages 18 and up with a disability or illness.   26% of employed adult children take care of a family member and the annual loss to American businesses due to caring for aging parents is $3 trillion.

Presently we are in the early stages of professional patient advocacy services.  This service is not regulated so we are in a unique position to begin preparing for what an advocate needs to do and how they could / should be helping a patient.  Whether it is billing or reimbursement, medication management or doctors visits, at the bedside in the hospital or understanding a care plan, patient advocates can play an important role in the future of healthcare. 

Many nurses are becoming advocates because the time spent at the bedside in nursing is diminishing and nursing no longer allows enough time for patient interaction.

The cost for an advocate can vary from a very high daily rate or a retainer to an hourly rate decided by predicting the needed services.

Another way to encourage advocacy is the way PULSE of NY teaches the family and friend of the patient.  This community based teaching is called Family Centered Patient Advocacy Services.  It focuses on the families need to participate.  This way, there is no charge and the people who know the patient best, want to help and be part of the support system are there for the patient with the needed tools learned at one of the half day workshops.

Day two at the conference focused on guest presenters starting with Trisha Torrey as the keynote.  Trisha started Every Patients Advocate a number of years ago following her own unfortunate experience using the healthcare system. 

Lisa Freeman, the PULSE ofNY contest winner attended her first contest with the professional scholarship of $500.00.  Lisa took a Family CenteredPatient Advocacy Training on February 7, 2012 which made her eligible to apply for the scholarship.

Consider becoming a family centered patient advocate and learn about patient safety.  The charge to take this program is minimal and the lessons will last a lifetime.

Register here for the January 12, 2013 training.  Family Centered Patient Advocate Training Registration.  

Hospital Ratings

Leapfrog Group Hospital Ratings

A recent report from the Leapfrog Group has rated hospitals across the country. The Leapfrog Group is an independent, national not-for-profit organization of employer purchasers of health care. The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry about health care safety, quality and customer value.

An A, B, C, D, or F score assigned to a hospital based on expert analysis of infections, injuries, and medical and medication errors that cause harm or death during a hospital stay—looked closely at how safe hospitals are for patients.

Locally, on Long Island, 5 hospitals scored an A and now have bragging rights to being the “safest” hospitals on Long Island, in New York and maybe in the country. 

One of these hospitals was reported by another group last spring as one of the worst hospitals in patient safety while at the same time winning an award for Excellence in Patient Safety from yet another group.

The CEO of a Midwestern hospital that scored low expressed reservations about how the Leapfrog Group compiles and validates the data it uses to compile scores.

A well known California hospital disputes their F score because they say one patient death in 2010 unfairly lowered its grade from a C to an F.

The senior vice president for a 101-year-old hospital, says he "patently disagrees" with his hospital's F grade, saying that's not reflected in current federally reported data.  "Much of what Leapfrog is using is three or four years old," he says, "and is based on some proprietary methodology, capriciously assigning adverse grades to someone."

Hospitals across the country scoring an A have a very different outlook. They boast to their commitment to patient’s safety, quality care and committed staff.

Years ago I went to a meeting and on the plane I read a magazine listing top hospitals.  I didn’t see a hospital that I knew was always winning awards.  When I saw a top administrator from this hospital, I mentioned that his hospital wasn’t listed.  He grabbed the magazine from my hands and sat in a corner reading it.  Upon his return just minutes later, he shared that this magazine is trash and their scoring doesn’t mean a thing.

Using these rating tools, whether it’s about your local hospital or physician, patient safety and quality care is a two way street and by being vigilant as patients or family members we can help control the outcomes.  Going into a hospital with an F rating might even keep you on guard and with good reason.  Ratings are a tool.  I know of too many people who were injured or died in “the best” hospitals.