Wednesday, October 31, 2012

Another View of the US Hospital Care System

This blog entry is not about childbirth.  But it is a blog entry about navigating the health care system.  It is also a confirmation of the statement childbirth expert Suzanne Arms made several years ago (and I paraphrase), Hospitals are not made for the individualized care of individuals, but for the mass care of the masses.

While there is much more to this story, I’ll just summarize some of the inappropriate, unprofessional and idiotic actions during a 3 day period.

Once upon a time, there was a hospitalized elderly gent (88 years old), who after a somewhat sudden revelation of anemia caused by kidney failure, subsequent installation of a fistula for dialysis, and an indwelling catheter, was scheduled to be transferred to the 3rd floor of the same hospital for rehab.  Family received a phone call around noon on a Friday, and were told the transfer to rehab would be at 5 pm that day to room 381 and to bring loose fitting clothes for the gent to ambulate in for the next 7 -10 days.

While gathering said clothes and running some errands (about 2 hours later), the family gets another call from the same rehab unit saying the gent’s admission has been denied and one of his 5 physicians has ordered him to be discharged to home at 5 pm which was in 2 hours.

Now this discharge to home had indeed been the plan all along…until the day before this Friday when it was discovered by family that the gent would need catheter irrigation every 2 hours around the clock – a procedure his 84 year old wife could not possibly do.  In fact, the family had been discussing alternative care options. 

As family members rushed to the hospital with the understanding that he was being discharged at 5 pm to go home, one family member requested that the hospital unit case worker, director of the rehab unit, social worker and patient advocate meet with the family for a brainstorming session.

During the insuing 90 minute heated conversation, the rehab director admitted they may have acted in haste in making the first call to the family about the transfer to rehab before the transfer had been approved by the rehab physician who reviews all transfers.

The rehab director’s reply, “These things happen.”

The unit case worker said that it was the family’s intention to take the gent home all along and didn’t see a problem with his 84 year old wife flushing the catheter every 2 hours x 24 hours each day.  Really?  So now that we are asking for more than 3 hours to make alternative care decisions, the family would have to be billed for any extension of his stay?  Really?

When the question came up by the family to the hospital representatives “So if the gent cannot stay in the hospital, cannot be transferred to a local nursing home (because they “don’t do” catheter irrigations), and cannot be cared for at home, exactly where is this gent to go?  A tent in the parking lot?

The hospital reps reply, “We don’t know.”

a hospital west of Indianapolis
With the rehab director repeatedly stating a prescribed script about how he cannot go to rehab and cannot stay at this hospital, the social worker now arrives to add some sanity.  But before she does, the unit case worker suggests that she can call the physician who ordered the irrigation so he can change his order for irrigation to make the gent more able to go to an alternative care facility.  Really?  Since in the past year when his catheter has only had a PRN (as necessary) irrigation order, clots formed and urine backed up which caused the kidneys to fail in the first place.

Iatrogenic?  I believe so.

Now with the first hour of the conversation complete, the social worker arrives and sheds some true light on the immediate situation:

  1. The family has now until Monday to make plans for alternative care and the social worker states that she will work tomorrow (Saturday) to assist.
  2. The family doesn’t have to incur a cost while all (including the hospital) are actively looking for care for this gent.
  3. The rehab director reminds the one emotionally exploding family member that the family member’s voice mail is full and the rehab director all the rehab director got when calling the family member was the playback music.  Not only was my voicemail NOT full but I don’t have playback music, nor did I have a missed call from her.
  4. A rehab nurse interrupts the last 30 minutes of the brainstorming session saying “I’m ready to transport him to rehab” – the rehab director wipes yet another load of egg off her face.

The rehab director either lied or is incapable of dialing a phone……or communicating with her employees.

Since then, we have also found out that the social worker does not work on the weekends and she did not do any work on this case until Monday.

Now, due to the change in the irrigation orders, the gent was discharged to home on Tuesday.

While there are more absurd situations, I will not bore you with those.  I can tell you one thing: the state of the US health care system, from birth to death, is generally not friendly to humans.  And if that is not an oxymoron, I don’t know what is.

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