(original) (raw)

One Tuesday morning in June 2003

• "F" has been suffering pain in lower abdomen all night, goes to doctor and gets pain pills (? and an antibiotic?) and sent home - things get worse -

• Tuesday night - About 6:00 PM, after checking with her doctor, "F" goes to the Emergency Room at Washington Hospital, here in Fremont, California.

• About 7:00 PM, "F" goes to the CAT scan area, and I am permitted to photograph the activities :-)) (My pictures are pretty good but "F" does not want images of her insides published.)

• Things were going OK - until they lost us in the emergency room system.

  • About 8:25 PM, the doctor gave us the CAT scan report
    - diverticulitis of the sigmoid colon -
    and said that he was prescribing
    - a strong antibiotic
    - a liquid diet
    - a strong pain killer

  and said "F" was being admitted to the hospital.

  • About 9:30 PM I started bugging the nurses about when anything was going to happen - like where is the medicine?.
  • About 10:00 PM a nurse agreed that something was amiss, and started to search for our records
  • About 10:20 she found them, she said that the doctor had placed them face down somewhere.
  • About 10:45 the IV and medicine arrived. IV is "Intravenous" - signified by the bag of clear fluid that hangs over your head in a hospital, connected to a needle in a vein in you, used as a convenient method of getting fluids, medicine, nutrients, etc. into a person. But "F" has very small veins - nurses 1 and 2 failed to get the needle into a vein for the IV.
  • Finally about 11:15 male nurse 3 did the job, and the antibiotic and pain killer started to flow into "F".

• About 11:45 PM "F" arrived at the general nursing room Third Floor, West Wing, Room 8 Bed 2 (of 2).

• About 12:15 AM I am finally able to attract a nurse to come to the room and meet the new guest. Honest to God, they really don't seem to give a *&#@ -

• Soon some Officious Person comes in with forms to fill out, like allergies, phone numbers, medical history, age, ...
  - "F" had just filled out similar but not identical forms in the Emergency Room.

  • I try to tease the Officious Person that the Emergency Room does not talk with the West Wing (where we are now, 2 floors above the Emergency Room).
  • Officious Person is not amused.
  • "F" starts to fill out the forms, leaving out stuff about "Pain Management Counseling" and "Community Help Counseling".
  • Soon Officious Person starts telling "F" about the use for the above Counseling -

• "F"'s identification wrist band was coming off, so they made and installed a new one.

• The past two days have been long, it is well past midnight, I head home ( about a mile away). Wednesday morning -

• I got back to the hospital and "F" about 9:00 AM. "F"'s doctor had already been there.

• I notice that the name and age on the ID tag on "F"'s wrist are for a different named woman about 25 years younger than "F".

• A nurse agrees that the wrist band is incorrect and has a correct one made up and installed.
  "F" was told that is no problem as everything is by Room Number and Bed Number anyway.

  • A few minutes later, Tina (the 33 year old roommate) says that this morning a nurse had tried to give her "privara" or something like that.
  • Tina told the nurse that "privara" or something like that was for much older women, and refused the medicine.
  • The nurse said that it was for Room 8 Bed 1, but Tina refused it anyway saying there must be some mistake. The nurse took the stuff away.

• Lunch comes - it is chicken and rice -
  Hmmm "F" thought the doctor in Emergency said something about a liquid diet.
  "F" asks the nurse - nothing about a liquid diet.

• - OK - what the hell does "F" know? - Thursday morning

• I get there about 8:00 AM and meet "F"'s doctor - Dr. Veronica Watson, a very short plumpish very alert looking oriental appearing lady. She seems an interesting person.

• "F" asks about the liquid diet -
  OH Yes - "F" should be a liquid diet!
  I guess such minor details don't get from the Emergency Room doctor to the West Wing, two floors up.

• "F" is put on a liquid diet. Friday Morning

• I get there in time to see Dr. Watson again, and later leave to walk the dogs and wrestle with a sick computer and Fry's

• I get back about 2:30 PM, and "F" is *NOT* connected to the IV system.
  There had been considerable swelling at the needle site and the nurses had pulled out the needle but could not re-insert it another of B"F"'s veins.
  Several had tried, and given up. 3:30 PM is shift change time, and by 2:45 they all seemed too busy to try to get "F" connected up again.

• About 3:45 the new nurses seem available and "F" tries several times to attract a nurse about the disconnected IV system. It seems low priority -

• About 4:00 Rosa from the Philippines explains that since the other nurses had tried and failed, she did not want to turn "F" into a pin cushion and calls for a anesthesiologist nurse to install the needle. (They are reputed to be more expert.) About 4:15 he arrives -

• About 15 minutes later he succeeds in a vein in the bend of the right elbow. (An immobilizing place but that was the best he could do.)

• Rosa reappears and says that she will start the 6:00 antibiotic IV bag early since the 2:00 antibiotic bag had not been given because of "F"'s small veins.
  What The Heck
  - the big deal about being in the hospital is to get the damn powerful drip antibiotic into "F" - and the day shift just couldn't/wouldn't do the job !!!

• The day shift just didn't seem to give a damn. (Screw the small veins and antibiotic, let the afternoon shift do it!!)

• About 7:00 P.M. I head out for dinner and dog walking.

• About 10:30 P.M. "F" calls and wants me to fix something. I get to the hospital and the nurse in the hall tells me she is calling Dr. Watson because "F" wants to get off the IV.

• I go into see "F" and she says her arm is really painful, and I see a little red line going up her arm. she wants to get her antibiotic by mouth or injection instead.

• A bit later the nurse comes in and says that she is pulling out the IV system. "F" is delighted and we talk about bending over for the injection.

• The nurse says "No" - "F" will be getting antibiotic pills.

• They have been fighting the IV system for three days, missing the afternoon dose, and "F" could have been popping pills instead of this whole *&^%$#@! stupid IV nightmare? ???? ????????

• Then the nurse says the reason the IV hurt so bad is likely the potassium. (The label on the bag of IV fluid they were using indicated 0.5 % NaCl and 0.15% KCl . )
  I assume that a person can live a few days without a shot of potassium. ( And since "F" is active - like eating and going to the potty by herself, I presume that if daily potassium is necessary, and enough is not available in the normal food - the staff could have given her half and half salt (Half KC1) (I'm willing to concede that if a person is totally dependent on IV for a month or so, balanced electrolyte might be important - but 3 or 4 days - come on - )
  I ain't no medical doctor, but I do try to fake that I got at least half a brain!

• About 1.5 hour after the IV got pulled the second time, the antibiotic pills hadn't arrived in the West Wing. I volunteered to go to the local 24 hour pharmacy and get them but the nurses said they are not allowed to give medicines [with unknown history].

• It is after midnight - the pills haven't arrived. I went home - shaking my head, a sinking feeling in my stomach.
  This is worse than fighting city hall!
  - It is too pathetic to get mad!!
  - When my time comes, I want to die in my own bed !! Saturday

"F" leaves the "hospital"

- "F" feels much better

- and we have survived the hospital staff.

Ya know what - the high school kids working at the local veterinarian's office seem more capable and caring than the nurses we saw at Third Floor, West Wing of the Washington hospital. - And the nurses in the Emergency Room didn't shine much either - .

What is the score?
Minus side

1. Emergency Room - long delay (three hours) after diagnosis and prescription before treatment started ("F"'s records got lost and they didn't realize it until I bugged them a lot)
2. West Wing - not being interested in arrival of new patient
3. West Wing - have to fill out the same info into forms already filled out in emergency room (it is the same hospital? or is it? see billing below)
4. West Wing - replacing failed ID band with wrong patient name and age, OK, they got the sex correct -
   OK, OK, You're correct - same chance as a coin flip -
5. West Wing - fed standard food to patient on liquid diet -
6. West Wing - lost and totally screwed up the IV battle, then gave up and went home leaving the antibiotic unadministered.
7. General - it seems the whole IV business (in this case) was based on high billing incentive rather medical need. (In the time delay of getting the IV installed, oral antibiotic would have been completely absorbed anyway.) Plus side
8. Patient survived in spite of the above
9. Hospital got lots of cash flow

Epilogue

The hospital bill(s) totaled $14 thousand for 4 days stay. (They use three different billing centers - maybe to confuse themselves as well as patients and insurance companies.)

I figured that the CAT scan would be a big part of that, but the CAT scan was only $2 thousand for the half hour.

But I did figure why the hospital loves IVs :-))

• - the wholesale price for standard solution IV bag is $13 per dozen - lets say a buck a piece - OK?
• we were billed $84 per IV bag - as a material object
• we were billed $81 per IV bag - labor to install
  including the bag that they couldn't/didn't install. On the other side, hospitals in California have to take everyone whether they can pay or not - maybe this krazy billing is just a socialized medicine tax and should be acknowledged as such?
• Shortly after "F"'s stay, the local newspaper reported that the hospital administrator's salary was raised to over $350,000/year and that she also got a bonus "for meeting business objectives".
• In May 2004, the California Public Employees' Retirement System, CalPERS, removed Washington Hospital from its approved list - citing excessive billing.
• Blue Cross is requiring a higher patient co-pay from about 20% of the state's hospitals - including Washington in Fremont. Stanford Hospital, across the bay, gets caught about every ten years double or triple billing - bill the patients, and the state, and the feds, and who ever. Each time they say they will review their practices ;-))

Maybe this is the reality of the hospital business?

If insurance had not paid for "F"'s hospital stay, Washington Hospital would have had to take me to court to get paid! That way I could have broadcast what a high priced, low service place it is! Talk about "your day in court" - I bet we would have settled out of court for a good deal less to save Washington Hospital from getting a public black eye.

- just dreaming of course -

Ya know - after re-reading the above tale, if a hospital treats me like that, and if I am conscious and mobile, the hospital might have to call 911 - They might have an insanely "mad" old man on their hands

- I'm old and don't have a salary or reputation to protect

- Why the hell not give it a go? ;-)) - yell, scream, throw stuff, ...

- On the Third Floor of the West Wing of Washington Hospital,

they might not even notice :-|

- probably have to pee on a nurse to get attention.

On the other side of the coin, my next door neighbors at the time were a cop and his wife, an obstetrical nurse at that very hospital. My neighbor the nurse was the very model of nurse of the year, caring, cool under fire, observant, (attractive), seemingly highly medically informed, ... , could move quickly carefully in touchy situations, just about every possible positive adjective. A wonderful person, you would trust her with your wallet and life.

(I didn't have the heart to tell them the above sorry tale. They moved to another area shortly after the above misadventures.)

Cheers

Ed Thelen

Another Epilogue - Friends and e-mailers who have read the above, report similar things at their local hospitals.

Maybe I'm sensitized to hospital failings. One of my father's sisters, Rose, died in a hospital (in 1934 I am told) due to some medical screw up with a "minor" operation. Uncle Will, a brother of my father, was doctor in that hospital at the time and was in a position to know.