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A QUICK TRIP TO THE HOSPITAL

 

THIS IS A TRUE STORY, I HAVE JUST REMOVED ALL NAMES.

My wife’s record of care while being a patient at Some Hospital Medical Center.

I believe that my wife’s trauma and resulting medical condition on 1/31/2011 was a completely preventable injury.

Introduction

My wife was admitted to the hospital after being treated in the ER for a duadinal ulcer on 1/21/2011.

Tuesday 2/1 I received a call from Some Hospital and was told my wife stopped breathing last night and she had not arrested and was on life support medication. I spoke with Dr. ONE at Some Hospital MICU and she had stopped breathing last night and they had to put her on a ventilator. Her BP was too low to measure and her pulse was high and her kidneys had failed and as it turned out, she was also septic. Nobody knew how long she had not been breathing.

I find this and other things that were either done or not done by the staff of Some Hospital unacceptable, irresponsible and below the level of minimum care for any person unable to call for help in any way and known to be having trouble swallowing and breathing.

A patient in her condition should never have been allowed to be kept on a floor where the attending nurse has 8 to 9 patients scattered throughout the floor to attend to.

I believe that Some Hospital Medical Center’s policies and procedures are in direct conflict with their Nursing Staff’s alleged mission, leading to the failure to ensure proper patient care and safety, further leading to my wife’s disfigurement, severe physical pain and post trauma emotional distress and short term memory loss (possible brain damage due to oxygen starvation) as a result. For example, regardless of the number of patients a nurse is charged with, be it 2 or 9, they are rarely in a local area, rather scattered widely throughout the floor making it impossible for the nurse to care for the patients efficiently. In rooms that have 2 patients, it is rare to have the same nurse for both patients and when there is a problem, a nurse will tell you OK, I’ll let your nurse know and in about 20 minutes, if you’re lucky, the nurse will show up.

I have personally told a nurse that my wife is in distress and her lungs need to be suction and as previously described, “I’ll let your nurse know”. This type of thing happened several times for various reasons. Why couldn’t the nurse that you spoke to, that was doing nothing anyway, at least check on the welfare of the patient, rather than what amounts to, sorry, not my patient?

As a result of this incident, I felt compelled to insure that I, our son and on occasion her son stayed by her bed side to insure her safety and the following log is what we were either told by medical staff or witnessed in person.

As proof of neglect, reckless misconduct and necessity for family oversight, I offer the following log:
This log was created on 2/1/2011 and the entries from 1/21/2011 to 1/31/2011 have been logged from memory of events and might not show correct dates and times, but did occur on or about that date and time.

I am making no medical statements. All medical references I am using are based on information from hospital nurses and/or doctors. Other statements are based on my own or our son’s actual observations of care or lack thereof.

All medical conditions treated: Duodenal ulcer, kidney function, liver cirrhosis, pneumonia, pleural effusion, respiratory arrest (stopped breathing in hospital), low blood pressure, sepsis and hypothyroid.

Treatments Received: Several IV treatments, respirator, feeding tube, thoracentesis, and dialysis.

Tests: Brain MRI & multiple CT Scans of head, chest and abdomen, Breathing Test, EKG, Upper endoscopy & Ultrasound.

Events from admission to discharge

Friday 1/21/2011 16:40 – she was walking with walker and talking clearly when Paramedics arrived and transported her to Some Hospital with stomach pain. ER gave her morphine for pain as she cannot tolerate any other pain medication.

By Saturday 1/22 Diagnosis, duodenal ulcer and was transferred to a room.

I tried to feed her dinner collard greens, meat and mashed potatoes and she ate about the volume of 2 tea spoons of food total (visitor for the next bed told me she had not eaten today). She was noticeably sedate, unable to use her limbs or speak. The floor was aware she had been eating very poorly in the past, about 2 tea spoons a day of baby food. Endoscopy showed duodenal ulcer.

Monday 1/24 all pain medication was stopped due to lethargic state and incoherency “altered mental state”. Any time I asked why she is now in a virtually nonresponsive condition, nobody could tell me, not even by 1/31, only that she might have some kind of infection.

Tuesday 1/25 our son had insisted on oral and suction care as her tongue was very dry and hard and was having trouble breathing and this was finally done. After several protests that she had not eaten in days and was in poor nutrition prior to hospital, I was told they would do feeding tube tonight. I was told feeding treatment would be introduced that evening.

Wednesday 1/26 Morning, Feeding Tube not in and again I was told tonight and CT scan was pending. While getting the CT scan, she received a skin tear about 2 or 3 inches long on her right wrist. Our son noticed it as soon as she was returned to her room. He noticed a dry washcloth covering her wrist and when removed it an untreated skin tear was clearly visible and could have been untreated for long as an hour or more. One of the Doctors I spoke with told me that this could have been the source of the later identified sepsis, which is a clear breach of sanitary care.

Picture taken 2/20/2011 11:40  Picture taken 3/08/2011 09:55

Evening, a mild stimulant was administered in the feeding tube to attempt to arouse her and then started feeding.

Thursday 1/27 She's still in the hospital as they still are not able to wake her up. They are starting antibiotics today in case she has an infection that they do not see.

Friday 1/28 we convinced nurses to start oral care and throat suction.

Saturday 1/29 Noticeable improvement, She was responding and able to open eyes wider (about ¼ inch) and communicate more clearly, but still incoherent and resisting suction.

Sunday 1/30 She is still improving and starting to fight suction as she was getting stronger.

Monday 1/31 Condition still improving. Towards evening, she complained she needs suction. RN ONE suctioned her mouth and upper throat. I told her she needed to go deeper and I was told she had already been suctioned 3 times and it was uncomfortable. I asked her if she still needed suction, as I could still hear gurgling sounds in her throat and she indicated yes. Again suction was requested and a different nurse came and suctioned her throat. Shortly after, she started gurgling again and indicated she was still having discomfort. I had told both nurses that if she was asking for suction, something was wrong. At this point, she should have been considered a choking risk as the staff was aware of our concerns with her breathing and should have been watched more closely or moved her to ICU or IMC at that point for breathing assistance. At the very least she should have been considered a high risk patient her full time on that floor, as she could not call out for help or even push the nurse call button if in trouble.

Transferred to MICU.

Normal MICU breathing stats for Jody

Normal MICU module hookup          Normal MICU monitor display

Tuesday 2/1 I received a call from Some Hospital and was told my wife stopped breathing last night and she had not arrested and was on life support medication. I don’t recall my response, but it was not pleasant. I was told to come to MICU. I was greeted very pleasantly and given reasonably good information by TWO the nurse manager. Getting CT scans with contrast on her abdomen, chest and head.

I have talked with the Dr. at Some Hosp. and she had stopped breathing last night and they had to put her on a ventilator. Her BP was too low to measure, her pulse high and her kidneys had failed. She is on 3 vasoconstrictor IV's to increase her blood pressure and protect her kidneys. Nobody knew how long she had not been breathing. I find this and other things unacceptable, irresponsible and below the level of minimum care for any person unable to call for help in any way and known to be having trouble swallowing and breathing.

She is still minimally responsive. She responded to Dr. squeezing her finger and did not like it. Pupils are responsive. I learned when leaving that she had squeezed (barely), when asked, our son and her daughter’s fingers.

Skin tear on right wrist from 1/26 photographed and documented by MICU along with a serious irritation from knees to buttocks from improper cleaning on previous floor. Our son notified respiratory that she cannot use albuterol.

Wednesday 2/2 I was told that her liver damage was significant, contrary to what previous Dr.’s had told me and the kidneys are functioning poorly.

Informed of concerns: Sepsis, liver cirrhosis fairly significant, poor kidney function, low blood pressure, not measurable with cuff (was on 3 IV's to increase her blood pressure yesterday and now is only on one), pneumonia, thyroid and Peptic Ulcer.

Thursday 2/3 Sepsis - Fever is gone (98.6 = 37 C and her temp is 36.9 C) not sure if infection is gone, but better temp is a good sign, liver cirrhosis fairly significant (don't expect much improvement but is controllable), poor kidney function (function has increased today, but still have a ways to go. The Nephrologist came in today for an exam and is holding off on any kidney treatment due to current improvement), low blood pressure (blood pressure has been within normal readings for a while now her only BP IV is vasopressin), pneumonia - lungs are clearing, oxygen support reduced from 100% to 40%. Machine still breathing for her so the lungs can strengthen thyroid and Peptic Ulcer (not a significant concern at this time, but is curable).

The feeding tube was restarted about 18:30.

Friday 2/4 Her condition is improving.

Saturday 2/5 Respiratory test - 30 min out of 60. Urine output has increased from about 6 ml per hr. to about 20 ml per hr. her condition is still improving.

Sunday 2/6 Respiratory test - 60 min out of 60 – CO2 level issue 40 to 60. Her condition is still improving.

Monday 2/7 Respiratory test - 45 min out of 60. Ultrasound on lower left lung and thoracentesis preformed to remove fluid. Her condition is still improving.

Tuesday 2/8 Respiratory test - 60 min out of 60. Kidneys not filtering toxins out properly and Dialysis was conducted. Her condition is still improving.

Wednesday 2/9 Respiratory test - 60 min out of 60. Moving head and left arm some and opening eyes. Her condition is still improving.

Thursday 2/10 Respiratory test - 60 min out of 60. Respiratory rate at 30 per minute and would like 20. When I arrived in the morning around 1000, I had to ask RN THREE to arrange her bowel catheter tube so she wouldn’t be lying on about 2 feet of it blocking her ability to relieve herself. Later, I noticed a syringe laying on her leg attached to her IV. It had been unattended for about 20 minutes. I was told it was only saline. I pointed out what it really was, was a lack of attention. Nebulizer treatments are frequently left on breathing tube far after completion, leaving the O2 readings from the extra Nebulizer oxygen (6L) to allow the blood oxygen to reach 99 to 100% for long periods of time when they should be 95 to 97. I find this unacceptable, irresponsible and below the level of minimum care.

Sometimes the nebulizer gets accidentally knocked off the breathing tube and just lies on her chest. I would think the nurse would notice this. I find this unacceptable, irresponsible and below the level of minimum care.

CT scan on the head found no abnormal findings. Today moving right arm some. I arrived again at about 1530 and noticed her temp was 36C (96.8 F)

and has been routinely very close to 37C (98.6 F). I brought it to RN THREE’s attention and was told it was fine. At about 1635, an alarm went off when the temp went to 35.9C (96.62 F). The alarm sounded for over 20 minutes at 35.9 and possibly still dropping, down from a consistent 37C. 35C is considered life threatening.


There was nobody in either hallway. Her respiration rate had also been elevated to between 27 and 32 since I got there at 1530.
1640  1738  1811

At about 1655 RN THREE came in and turned off the temp sensor and unplugged the module and for some reason turned the auto BP monitor off. I find this unacceptable, irresponsible, negligent and below the level of minimum care.
No temp or BP display. Left module is temperature and unplugged after alarm sounded for over 20 minutes at 35.9C and possibly still dropping, down from a consistent 37. 35C is considered life threatening. The power to BP module is off.

I mentioned her breathing and the nurse gave her something to calm her down at about 1710 and left the catheter cap off (potentially a source of contamination). I find this unacceptable, irresponsible and below the level of minimum care.
There is a cap to protect the line

At that time, I mentioned that the automatic BP should update in a minute or 2. She told me it’s OK I can do it now.

She pushed a button on the BP module a couple of times and the green light came on, indicating the module was back on now and the BP was read again (129/81) and on auto for each hour after that. Still no temperature reading. At this time, RN THREE realized I would notice if the BP was not taken, so she took action before time for the automatic cycle was due to start. I find this unacceptable, irresponsible and below the level of minimum care.

Around 1900 (2 hours later), I mentioned her breathing to the floor respiratory therapist and she gave her a nebulizer treatment and her breathing went back to between 12 and 18 breaths per minute. Tech showed up for dialysis.

Friday 2/11 Respiratory test - 60 min out of 60 rate at 30+ per minute and would like 20. Tomorrow respiratory test - 120 minutes and dialysis ordered daily to reduce fluids. Blood sugar measured at 400+, insulin administered. Blood pressure is now being measured at 15 minute intervals.

Upon entering the room at about 0930, I noticed that there was a lot of fluid seeping from her right arm onto the pillow under it. The wet stain covered an area about 12 inches in diameter. I placed a dry wash cloth folded in half between the fluid and her arm and told RN FOUR about it. I was told OK she would check it and redress it. By 1750, there had been nothing done to the arm and the now stained wash cloth was still in place from this morning. I find this unacceptable, irresponsible, negligent and below the level of minimum care.
1636

I left around 1300 and returned at 1630 and upon entering, I saw the upper guardrail was down and the pillow that was supporting her left arm was on the floor as if it had fallen and her arm was at the edge of the bed. There was nobody around. I re-supported her arm and returned the guardrail to the up position. I heard some deep gurgling and pressed the call button and expressed my concern and asked for suction and was told OK, I’ll get your nurse. I continued to check her lines and comfort when I found the rectal tube had been leaking under her.
Temp 35.8C (96.44).

1710 when RN FOUR returned, I expressed my concerns and was told she had to lower the guardrail to reach her, which I felt was no problem as most nurses did, but why was the pillow where she would have to have stood to do the work? And why was she unattended for so long when things are actually falling off the bed? Jody is in an inflated bed and I have seen them deflate both by section and completely many times for no apparent reason, so “she cannot fall out of bed” when unattended is not valid. I find this unacceptable, irresponsible, negligent and below the level of minimum care.

As for the rectal catheter I was told she is about to clean her up. I was told she was going to give a dose of fentanyl and I stated I thought the doctors had switched to Haldol because of the CPAP tests. RN FOUR then started a litany of reasons why she was using fentanyl and then looked in the book and saw Haldol was also an option, but stayed with her original decision. My thought was, OK you know better than I.

Blood sugar checked at 393, insulin introduced.

From the time I made the nurse call at 1630 until sometime after I was asked to leave, the only thing that had been done is to have her blood sugar checked. I find this unacceptable, irresponsible, negligent and below the level of minimum care.

For the first time since she’s been in MICU, I was asked to leave the floor until 2000 by RN FOUR at about 1750. I am pretty sure that this was retaliation for to me questioning her care of my wife and I don’t think she liked it.

I talked to the respiratory staff and let them know I and/or our son wanted to be there for her 2 hour CPAP in the morning and one mentioned that 6 to 8 was a no visit period and the other stated, yea, but it is something we never enforce as long as the visitor is out of the way. I was told that they would let the necessary people know we would be there.

Saturday 2/12, I arrived at about 0600 approximately 0730 to 0930 CPAP breathing test after which, all blood gases were all marginally within normal parameters. I flat out asked one of the doctors what her condition was, moderate or serious. I was told she is in serious condition. Once they get the infection under control, they start having trouble with the kidney, once they get that under control, something else goes wrong, until they get back to an infection (for example).

I left at about 1000 and returned at 1300, another problem that appears to be a common one as I have mentioned it several times, at least 4 is when the patient is turned or whatever, they are left laying on their bowel tube, making it virtually impossible to relieve themselves. I noticed that this was like this from 1300 when I came back until 1800. I find this unacceptable, irresponsible, negligent and below the level of minimum care.

Another issue I have seen a few times is the circulation cuffs on the legs are not aligned properly.

For example, this cuff side support is covering most of her knee causing unnecessary pressure on her knee when inflated. A lot of these things may seem pretty simple and meaningless, but I’m pretty sure they were made the way they were for a reason. And it was the simple stuff like frequently checking on or transferring a patient that was incapable of summoning help on her own that kills and cripples people.

I left at 1500 and returned at just before 1800 so I could be with her during the treatment. The tech arrived to start the dialysis treatment and as he started to hook her up, he had me put on a face mask. Shortly after that RN FOUR told me it was time to leave and I became furious and remarked to her “are you gonna start that shit with me again tonight”? At this point I was emotionally and vocally hostile at this point, it might be worth mentioning that I have PTSD and it was everything I could do not to respond physically to this RN.

I tried to speak to the Charge Nurse, but she was on her way out for an emergency. I talked with RN FIVE outside the building and she was very nice and comforting and offered some good advice. I waited for the Charge Nurse on the MICU waiting area and she returned very soon after.

I spoke with the Charge Nurse and she also, was very understanding, comforting and helpful. I discussed my concerns and issues with her and she assured me that my issues would be addressed. I felt much better after talking to her and felt I should leave for the night to avoid another flare up with RN FOUR. I have asked that RNs THREE and FOUR not provide care for her in the future.

Sunday 2/13 CPAP started at 0700 to 1000. Test completed so well, the CPAP was left on. I left just before 1200 and returned about 1420. Some time prior to 1420, the CPAP was switched back to support mode and nobody knows who, when or why as there is nothing recorded on the respiratory chart to indicate a change and nobody was there when it was done. I find this not only unacceptable, irresponsible, negligent and below the level of minimum care, I believe it is borderline criminal.

The tech is prepping for dialysis at 1600. 1620 I needed to leave.

Monday 2/14 I spoke with Nurse Manager RN TWO and expressed my concerns about the breathing machine changes and wanted answers.

Tuesday 2/15, she received a tracheotomy this morning. She was moved from MICU to IMC. An EEG was ordered and another dialysis was conducted. She has a slightly elevated HR, 120 and Temp. 38.4C (101.12).

Once her temperature was under control, around 1830, she became increasingly more responsive.

Wednesday 2/16, Respiratory Dr. told me he wanted to start weaning her off the tube.

She expressed extreme fear and started to cry when she learned that they want to eventually reverse the tracheotomy. She indicates the fear is related to when she choked and stopped breathing on 1/31 and nobody even knew it. I asked her if she ever wanted it removed and she indicated no. I asked if she remembered choking that night and she indicated yes.

She complained of what she indicated was heartburn as an issue for a while now (I asked and she nodded yes), indicated by her continuously placing her hands between her abdomen and ribcage. Also indicates tenderness to the touch on lower right abdomen.

Renal Dr. says her kidneys are pumping and removing toxins.

Abdominal CT scan with contrast and ultrasound guided Paracentesis ordered.

About 1730, she started running a fever and excessive gurgling from her throat, not her breathing tube.

Thursday 2/17, 0100 Abdominal CT scan with contrast conducted.  Dr. told me she still has pneumonia. 1115 to 1415 dialysis was conducted to remove fluids 3L.

Left 1130 returned 1430. Paracentesis cancelled at 1600, no fluid to remove from the stomach area.

Friday 2/18, Jody was taken for a HIDA Scan to check her Pancreas and Gall Bladder.

Saturday 2/19, Physical therapy stopped by and want to start therapy. Set up for dialysis, 3 hours. Neuropathy has spread from feet to legs and thighs, RN SIX asked Dr. about treatment with Neurontin. 2300, 1 time shot of morphine for pain and rest was administered. Dark hard gauze stitched into the top of her tracheotomy for some unknown reason. A few nurses have expressed concerned about its purpose, but have received no answers.


Sunday 2/20, her condition is improving.

Monday 2/21, Dialysis was conducted to remove fluids 4L, but now spitting up blood in her cannula tube (morning).

Tuesday 2/22, she is still spitting up blood in her cannula tube. Breathing machine mode changed from 12 BPM to 6 BPM partial assisted breathing. The trach flex tube setup was changed and about 5 minutes later I heard a pop sound and when I looked, the flex tube had popped off and was lying on her chest, I reattached it.

Wednesday 2/23, Jody is still spitting up blood in her cannula tube. 0900 Dialysis was conducted to remove fluids 4L.

Thursday 2/24, Jody is still spitting up some blood in her cannula tube, showing signs of coagulation. 0800 breathing machine mode changed from 6 BPM to 2 BPM partial assisted breathing. 1000 breathing machine mode changed from 2 BPM to 0 BPM CPAP. 2300 dialysis was conducted to remove fluids 2.5L. Pneumonia is still present and unchanged.

Friday 2/25, 0800 breathing machine Supply Pressure mode changed from 15 to 10.

1330 dialysis was conducted to remove fluids 3.5L. Infectious medicine signed off on her care. Her heart rate has been elevated for a couple of days now, average heart rate 117 to 124. Her breathing has been elevated (in the 30s) all day. At 1930 the telemetry meter went into HR Alarm showing a heart rate of 138 to 141 and at 1940 when nobody responded, I set the EMERGENCY nurse call and at 1950 when nobody responded and the meter still alarming, I went and got a nurse and asked what’s going on? I told her, I nearly lost her once in this hospital and will not do it again. She came to look in on her and decided to administer a dose of Haldol to calm her down. It was my understanding that the telemetry was constantly being monitored on this floor and that does not seem to be the case.

Saturday 2/26, 0300 breathing machine mode changed from 0 BPM to 2 BPM partial assisted breathing over our son’s concern for her breathing. 0630 a temperature of 102F was reported to me by phone from our son. Tests are being done to find source of fever and cooling is being administered. 3 antibiotics have been ordered. The trach flex tube setup was changed, about 30 minutes later I heard a sucking sound and when I checked for leaks, the flex tube popped off and I reattached it. 1200 she was taken for head CT scan. 1830 dialysis was conducted to remove fluids 1.5L. 2300 temp starting to slowly rise.

Sunday 2/27, 0915 dialysis was conducted to remove fluids 1.5L. 1400 abdominal ultrasound was conducted.

Monday 2/28, 0930 dialysis was conducted to remove fluids 2L. 1145 breathing machine mode changed from 2 BPM to 0 BPM CPAP, Supply Pressure mode changed from 10 to 8.

Tuesday 3/1, about 1030 to 1100 physical therapy sat Jody on the side of the bed for about 10 minutes. 1100 to 1135 She used Passy-Muir speech valve and was told they would be back tomorrow to try again. 1135 A/C breathing machine removed and replaced with 12L O2 into a T device with no other support. 1700 breathing switched back to CPAP.

Wednesday 3/2, 1130 dialysis was conducted to remove fluids 2.9L. Speech therapy was no show.

Thursday 3/3, 0300 the trach flex tube popped off and our son reattached it. I signed authorization to place a permacath. 1000 physical therapy sat her on the side of the bed. Speech therapy was no show again. 1815 took her to place the permacath.

Friday 3/4, 1130 dialysis was conducted to remove toxins and fluids 2L. Speech therapy was no show again. She started writing on white board today.

Saturday 3/5, 0900 spoke with the Charge Nurse about Speech Therapy neglecting her therapy. 1030 RN SEVEN told me she had put in an order for the therapy and we could straighten out any issues when they come. Spoke with the Dr. for an update on her and learned nothing new. 1130 physical therapy sat her on the side of the bed for about 10 minutes.

Sunday 3/6, 2100 dialysis was conducted to remove toxins and fluids 2.5L.

Monday 3/7, the Dr. and Nephrologist have both assured me Speech Therapy will continue soon. The Dr. told me the pneumonia appears to be clear according to last X-Ray.

Tuesday 3/8, RN EIGHT told me the Dr. ordered Passy – Muir Valve trials. 1030 Physical Therapy sat her on the side of the bed for about 10 minutes and attempted to stand with walker. 1400 Speech Therapy, Passy – Muir Valve trial went very well and lasted about 1 hour.

Wednesday 3/9, 0930 Speech Therapy (ST) instructed me on how and when to attach the PMV and when and why to disconnect it. Valve was on for 1 hour 20 minutes today before her O2 level reached 91 and I removed it. A/C breathing machine removed from room and replaced with O2 into a T device with no other support.

I spoke with the Charge Nurse to express my concerns about telemetry monitoring and the fact that she now has no breathing support and the only way anybody will know if Jody is in distress is the telemetry. I referenced 2/25/2011 1930 when the heart rate monitor was in alarm for 20 minutes before I had to go get someone myself. Charge Nurse answered the best he could, but could not properly address this issue.

1615 I placed the PMV so she could talk to her visitor. 1830 while preparing to leave I checked the telemetry and her O2 was still 96 and the meter indicated it needed its battery changed. I removed the valve and before leaving at 1840, I checked the meter one last time and discovered that the battery had died. I went to get the Charge Nurse and he was not available, so another RN came in and changed the battery and I demanded to know why that was allowed to happen. She had no answers; she “was just the messenger”. I noticed when she changed the battery; the light was still yellow so I pressed the call button. RN EIGHT, Jody’s nurse for the day, came in and fixed it. I expressed my concerns to her and she advised me to talk to the Telemetry Manager tomorrow for answers. 1900 I left for the night while her son waits for our son to come in.

Thursday 3/10, 0930 I hooked up the PMV. I saw the Telemetry Manager outside the doorway, so I expressed my concerns with Jody not having any backup breathing support and the unreliability of telemetry. He assured me he would look into it and that there are several safeguards in place to prevent such things from happening.

1000 Physical Therapy sat her on the side of the bed for about 10 minutes and left some instructions for self-therapy techniques. Started using spray Ionic Silver to mouth and any external sores.

1245 I let RN NINE know that I would be leaving at 1400 so I would be removing the PMV from her trach. This led to a confrontation over RN NINE refusing to allow me to do anything with the PMV that I had been instructed on and authorized to apply yesterday by Speech Therapist. Even when I showed her the written instructions by ST. She kept insisting that it was her license on the line; she did not once reference the patient’s welfare. This seems to be a trend with just a few nurses. She could have just made a call to Speech Therapy as I did to resolve the issue.

I returned to the room and left a message with ST. Within just a few minutes, ST came to the room and spoke with the Dr. about writing an order for me to administer the PMV for her chart. ST also told me she is doing so well on the PMV that they would do a swallow test tomorrow. By 1330 the referenced order by the Dr. had been written and placed in the chart.

1400 after 5.5 hours, the O2 was 95% and I removed the PMV and I left for lunch.

1600 She is too tired for the PMV this afternoon.

Friday 3/11, Speech Therapy preformed the swallow test.

Saturday 3/12, feeding discontinued for Swallow Test scheduled for 1100 – 1200. 1300 feeding restarted, Swallow Test was no show.

Sunday 3/13, she seems very tired today.

Monday 3/14, she passed the Swallow Test, but still needs to pass one more with barium and X-Ray tomorrow.

She needed to be cleaned below and pressed the nurse call at 1500 and shortly after, it was reset at a remote location. At 1530 she attempted a nurse call and again it was reset. At 1550 a third attempt was made and the RN arrived.

Tuesday 3/15, 1200 she was taken to X-Ray for the Barium Swallow Test and passed. 1830, she was presented with her first meal since 1/22/2011.

Wednesday 3/16, When I arrived, she was very upset and reported to me that last night, RN TEN inject insulin without an alcohol swab and when she complained, she was told to write it down then. On another occasion last night, RN TEN instructed our son, who is now just a visitor and no longer co-attending her care, on how to install and remove the PMV when it clearly states in her chart clearly states that I am the ONLY family member authorized to do this and I don’t even mess with the balloon. Further, she showed him how to inflate the balloon in her throat. The balloon in Jody’s throat should never be inflated at this time and if it is, it needs to be done by qualified personnel with appropriate equipment, not just a syringe full of air. These incidents were brought to the attention of the IMC Manager who agreed with our concerns.

2220 She called me after drinking something to boost her blood glucose level, which was 54. 2300 I spoke with RN ELEVEN, who confirmed Jody’s standing order for insulin and I advised her of her condition concerning blood glucose levels and suggested that any further doses of insulin could be dangerous now that she is no longer on tube feeding and a Dr. needs to be consulted and speak with her prior to any further doses of insulin. 2315 I called IMC and asked to have Resident call me. The call was never returned.

Thursday 3/17, she spoke with the Dr. and expressed her concerns about the standing order for her insulin. Insulin discontinued. Started Ionic Silver orally and spray to any external sores.

1000, The Dr. ordered tracheostomy capped.

1200, Physical Therapy has her sitting on the side of the bed for several minutes.

1240 She ate lunch and was having a little trouble breathing and I asked a nurse to ask RT for a breathing treatment. 1300, the telemetry meter alarmed at 90% O2 and dropping to 84%. After 10 minutes, I increased the O2 from 2L to 3L and finally to 6L which helped for a little while. After 15 minutes, RN TWELVE came in with no idea there was an alarm, so I believe she contacted RT and at 1320, the desk told me that RT was just below in ICU and would be right there. 1330, the Dr. came in room and was also unaware of alarm, but explained to me that they were only concerned when 88% or below and the finger sensor was possibly faulty as it was out of alarm at that moment. 1350, the RTs came in and administered a breathing treatment. 1420, the meter was still in alarm at 90% when I left the floor and still no call from telemetry. The meter came out of alarm a few times for a few minutes each time, but for the most part, it stayed in alarm.

If it was an actual alarm, why didn’t anybody respond to it until I sought out help? And even the response was very poor at best. If it was a faulty sensor, why wasn’t it investigated and replaced immediately?

1400, the breathing treatment was removed and O2 set for 3L by RT.

1900, Cap removed and T piece was reattached for the evening.

Friday 3/18, RN apologized for taking so long to answer the call button, but pager did not alert her as it was supposed to. We tried again in the room and it in fact did not go off. Several nurses have mentioned this problem. When equipment does not work as intended in a hospital, people suffer and some die. 1030 RT removed the T piece and capped the trach. Physical Therapy scheduled for 1000 to 1200 sessions. 1715, T piece was reapplied by RT.

Saturday 3/19, 1030 trach capped.

Sunday 3/20, The Dr. orders Blood Sugar test 2 hours after meals. Insulin for any reading over 250. 2300, she called me to let me know that she needed chest suction and RN 13 tried to suction through the PMV, which is impossible and must be taken off to suction. Due to language barrier, she was unable to communicate to the nurse the proper way to do it and had to call for an RT to do suction.

Monday 3/21, The Dr. orders Blood Sugar test prior to each meal and on request of patient.

Tuesday 3/22, PT sat her on the side of the bed for about 10 minutes and she is doing very well. Tomorrow PT wants to try to stand her up. I signed authorization to remove her PEG tube tomorrow. 1700, she was taken for CT scan on her neck for tracheostomy check.

Wednesday 3/23, 0700 RT came into room announcing she was from respiratory and she expressed her concerns over her low O2 level and the RT said OK, I’ll get your nurse. I asked, aren’t you from respiratory? Reply, yes. I asked then why are you deferring an oxygen problem to nurse? Reply, I’ll just get your nurse. I made a complaint to the floor supervisor. Her RT for the day showed up and gave her a breathing treatment. She is preparing for G PEG removal. RN 14 administered 3mg of Haldol per her request to calm her down.

1245, surgical team removed the G PEG in her room. PT cancelled for today.

Thursday 3/24, She started using the trach. cap again. PT attempted unsuccessfully to stand her up.

Friday 3/25, She was moved to another Rm.

Saturday 3/26, No noteworthy events.

Sunday 3/27, No noteworthy events.

Monday 3/28 1700, She was moved from IMC to the Tower.

Tuesday 3/29 2030, I was hospitalized.

Wednesday 3/30, I received a call from her. As I understand it, she called twice for help and then called me in my hospital room across town and told me her oxygen levels were getting down around 81%.

After getting off the phone with her, I called the Charge Nurse and told her she better damn well get somebody down there to check on her. I also understand that my wife in desperation told someone she would call 911 if she did not get help soon. For some background on the breathing issue, my wife almost died on the 3rd floor for this very reason on 1/31/2011. She had indicated she needed suction earlier and nobody bothered to check her again and she aspirated into her throat.

Now all of a sudden, her sputum looks a little funny and she is in isolation.

On 1/22/2011 while in Some Hospital, she became virtually quadriplegic, could not speak and could barely open her eyes.

On 1/23 when I asked why she was in this condition for an ulcer, nobody could tell me anything other than she might have some sort of infection. This lasted until 1/31 when she was transferred to MICU and during the whole time on 3rd floor, never once was she isolated.

While in MICU, I was told she had sepsis and never once was she isolated. Doctors suspected lung infections and tested sputum and never asked for isolation.

During her stay in IMC, not isolated once, not even on at least 2 separate periods where she was being followed by Infectious Disease Doctors.

I want to know who ordered isolation and why now after 2.5 months of suspected infections and what are the results of the alleged tests? And what is the purpose of the continued isolation?

Thursday 3/31

Friday 4/1, 1200 I was released from My Hospital.

During physical therapy, she received a ¾ inch round skin tear on her left wrist from too tight of a grip by the therapist. About an hour after being reported, wound care simply covered the wound with gauze and tape, no medication or cleaning of any type.

Saturday 4/2, no PT.

Sunday 4/3, no PT. I spoke with and addressed my concerns about Jody being in isolation with RN 15. She checked her chart and told me that she had been isolated on concerns of MRSA infection, but the culture now shows negative for MRSA. I still don’t know why this was suspected in the first place.

Monday 4/4, no PT.

Tuesday 4/5

Finally out of the hospital

Thursday 4/21, 1700 Transferred to Rehab Facility.

Saturday 4/23, I was told physical therapy evaluation could not be done due to payment issue.

Sunday 4/24, I spoke with a lady in admissions about physical therapy’s issue with payment and referred to the agreement Some Hospital told me they had with the Center. She spoke with Rehab and the issue was resolved.

Friday 5/13, She was told she had been removed from the physical therapy roster as of Wednesday 5/11 because she had already completed the 6 sessions.

When the Some Hospital Case Manager spoke with us prior on deciding where she was going to go, we had narrowed it down to either The X a few miles away from our home that only provided 10 physical therapy sessions or This Center, 23 miles away from our home. We were told that Some Hospital had an agreement with This Center that would allow her to receive the physical therapy she needed. There is no other reason we would have located her so far away from home.

Tuesday 5/17 Rehab informed me that she was taken off rehab due to her abilities and transferred to Restorative Therapy. Evaluation conducted today with recommendation to change from range of motion upper and lower to something a little more strenuous due to her abilities. PT had been very much hit and miss, very poorly regulated schedule. RA is supposed to be 15 minutes a day, 6 days a week.

Finally going home

Monday 8/01/2011 She was discharged from HHC, still without proper physical therapy.

After a month or so, we were able to get started with physical therapy and a home nurse once weekly each.

We did find out that the rehab center had a contract with the nursing home and the reason for reassigning her to restorative therapy was because the RAs worked for the nursing home directly and RT was afraid they would not get paid. This is contrary to what the hospital had told us, but they probably get a kickback for all they send to the nursing home.

Is all this not grossly negligent & actionable?

All this unnecessary suffering & nobody is held accountable?

Can somebody explain why no attorney will touch this?