Thursday, April 3, 2008

Thursday, April 3, 2008

Northern Westchester Bureau Chief
Catherine Wilson

“World Class Medicine That’s Not A World Away”...Really?

Our nation’s health care system is a hot topic in the current presidential campaigns. The polls show that this issue is split between the two major political parties with Republicans insisting our system is the best in the world, while Democrats believe it is inaccessible to many of our citizens. Unfortunately such polls promote the belief that our nation’s health care system is a political issue. But to anyone confronted with a medical crisis, the issue of our health care system is extremely personal. To view what our health care system is really like, one needs
to look at it through the eyes of the patients and their caregivers, not through a political perspective. This past Easter weekend, I was given a front-row seat with respect to how our local health care system really affects patients.

For the past two and a half years, I have been a full-time caregiver for my mother. Mom suffered a stroke in 2005, shattering her leg and leaving her inflicted with dementia. As anyone who has had to care for a sick or disabled individual can attest, caregivers eventually become experts in dealing with the diseases and handicaps, and the recognizing of symptoms as well as behavioral/physical changes in their charges.

On Easter Sunday, I noticed some drastic changes in mom’s behavior – incontinence problems, severe confusion, and continual sleepiness.
The Emergency Service workers (EMS) whom I called upon, trusting my observations, took my mother to the Westchester Medical Center in Valhalla. I was impressed that they trusted my experience in caring for my mother and equally impressed with their personal attention to her. The EMS workers made sure to speak to my mom directly to tell her what they were doing, addressing her by name and looking at her directly while speaking to her. A trip to the emergency room can be a frightening experience, so their reassuring words were comforting to her. And the calmer my mother was, the more I could concentrate on the situation.

The Westchester Medical Center’s emergency room (ER) was not crowded but we still spent the next four hours in the ER while mom underwent a series of tests. I could immediately observe that my mother’s treatment in the ER would not be as personal as the treatment she received from the EMS workers. Despite the fact that there were available rooms, my mother was left on a gurney in the hallway the entire time. Other patients were also in the hallway, on gurneys or sitting on hard chairs. Even when a patient was in a room, the medical staff rarely closed the doors when treating those patients. Most patients would opt for privacy when treating and discussing their medical needs.

Discussing their medical issues in an open hallway violates a patient’s right to privacy and respectful care. Why would our Medical Center ignore privacy laws? And why would the Medical Center disrespect patients by abandoning them in hallways when rooms are available to
make the patients more comfortable? An ER is an interesting glimpse into human behavior. Contrary to Hollywood movies and television shows, which often portray ER’s as places where people behave at their worst, the Medical Center ER Easter afternoon did not have any
hysterical patients, frazzled medical personnel, or even much noise apart from the occasional beep from a machine. Many of the doctors were Eastern European who both spoke and walked softly. Unfortunately, while this made for a calm atmosphere, their mannerisms and accents were not conducive to testing a dementia patient for signs of a stroke. One of the tests for mental impairment is to have the patient remember and repeat back a series of words. My mother, however, is hearing-impaired and could not hear or understand the doctor, rendering the test
useless. In such situations, medical personnel should ask the caregiver to administer the test since our family members are more likely to understand us when we speak. But the doctors never asked for my help. The alleged divide between doctors and medical staff was apparent to me in how they each treated my position as caregiver – EMS workers trusted my analysis of my mother’s behavior, the doctors rarely acknowledged my experience.

Noticeably, the other family members in the ER appeared very capable of discussing medical issues with the hospital personnel – many, like me, had arrived at the hospital with medical records, power-of-attorney forms, and insurance cards in tow. Speaking to several of them, I learned that most had been caregivers for years – a testament to modern medicine which too often helps patients survive diseases only to linger in deteriorating states devastating the lives and finances of both themselves and their families alike.

Sadly, the atmosphere of the ER changed dramatically with the evening shift change in personnel. Immediately the ER became a boisterous place due to the behavior of one individual – an extremely loud nurse. Nurse “rowdy” began barking orders upon her arrival and swearing to those around her causing a fellow nurse to warn her “don’t fight with me tonight”. Given that most of the patients in the ER were elderly women, and raised to believe that ladies never use the “f ” word, Nurse Rowdy’s behavior was extremely disrespectful of her patients. But her disrespect was not limited to her fellow nurses or the patients.

One doctor attempted to give Nurse Rowdy medication instructions for a patient. Sadly, he had a heavy accent which she made no attempt to hide her impatience with. The doctor seemed familiar with her disdain and did not take the bait – he simply repeated his instructions calmly and slowly. After he left, Nurse Rowdy shouted to her coworkers several times “see what Doctor Liar wants me to do?” Fortunately, her coworkers were too professional to respond. But what of the ER patients, all of whom were within earshot? How would a frightened
patient feel hearing a nurse referring to their doctor as a liar? And what if the patient within earshot was a doctor’s worst nightmare – a lawyer? How would Nurse Rowdy’s unprofessional vents sound in court?

Shortly afterwards, another doctor called the ER to follow-up on his patient. Nurse Rowdy chastised him for not writing his I/V instructions on the correct form and shouted that “you are not an ER attending so you do not have permission to give instructions here and I am not going to follow them”. What of the patient who now had to wait for an I/V to accommodate paperwork? Why couldn’t Nurse Rowdy see to the patient first, and correct the red tape later? Plenty of patients in the ER could hear these rantings loud and clear. Why would the Medical Center allow any of their nurses to say whatever they like within earshot of patients? Why didn’t any of the doctors stand up to her and inform her to either keep her comments to herself or to “take it outside”? Why didn’t her co-workers value their patient’s comfort over their co-worker’s behavior? What kind of sensitivity training does the Medical Center give their nursing staff? Is the behavior of the staff ever audited? Nurse Rowdy clearly did not behave properly in front of patients. But her coworkers also did not know that they should have put a stop to her outbursts for the sake of their patients.

Mom was finally admitted into the hospital for observations and further tests. Every time that evening when mom was transferred, either to a testing area, or to her room, she was assisted by the Medical Center orderlies. Each and every one of them was extremely friendly and caring making sure to address my mother by name. Even when they walked by her gurney on their way to another patient, the orderlies would call out to her. When I tried at one point to sleep an orderly came over and draped a warm blanket around my shoulders. Their simple pleasantries and casual chats broke the monotony of our long wait.

Most hospitals today have case workers to assist patients with their needs. Mom’s case worker met with me to discuss possible alternative care and therapy for her in case her confusion turned out to be the result of another stroke. The case workers are available as a resource to the caregivers and recognize that the entire family is affected by their loved ones’ hospital stay. While visiting mom in her room, her roommate was experiencing extreme pain and was constantly paging the nurses for relief. At no time did I notice any of the floor nurses or orderlies lose their patience with her. On one occasion, while replacing her Depends undergarment, it slipped, spilling the fecal contents on the floor. Both the nurse and the orderly offered continual apologies to the patient for the mishap, realizing the situation was embarrassing for her.

On the third day, I received a call from the Medical Center neurologist informing me that she had discharged my mother. When I told the doctor that I could not come to the hospital immediately, she told me my mother was already dressed and waiting for me. Dementia patients have no concept of time and become extremely agitated and confused when things do not happen according to their internal timetables. So why would a neurologist, a specialist in brain dis-orders, tell a dementia patient that they were being discharged before the family members had arrived to take them home? Don’t doctors take training in the psychological and emotional aspects of the diseases they are specializing in?

When I finally arrived at the hospital to take mom home, she was sitting in the hallway, surrounded by crash carts and computers. Apparently mom had been left there for hours. Despite the fact that I had prepaid for several days of phone and television access for her, mom was tossed out of her bed and her phone and television was instantly cut off. There was a reason why I paid for access to a phone
and a television for my mother – dementia patients need distractions when they are in unfamiliar situations. The more I could keep mom to a familiar routine, the more mom would feel “at home”. So why did the Medical Center deny her of these simple pleasures, especially when her bed was still vacant and there were plenty of available beds on that floor? Once again, why weren’t the emotional and psychological needs of the patient addressed?

The New York State Department of Health (NYSDOH) provides a pamphlet for hospital patients outlining their rights and other important information ( The NYSDOH informs patients that they have the right to:

• Receive equal access to treatment.

• Receive considerate and respectful care in a clean and safe environment.

• Receive emergency care.

• Be informed of the name and position of the doctor in charge of your care.

• Be informed of all names and positions of staff involved in your care.

• Right to refuse treatment, examination, or observation and be told what effect these refusals will have on your health.

* Access to a non-smoking room.

• Receive complete information about your diagnosis, treatment, and prognosis.

• Receive all information necessary to make an informed consent.

• Refuse to take part in research.

• Privacy while in the hospital and confidentially regarding your medical information and care.

• Participation in decisions about your treatment and discharge including a written discharge plan and information on how to appeal the discharge.

• Review your medical record and obtain copies for a reasonable fee.

• Receive an itemized bill with full explanations of charges.

• Complain without fear of reprisals.

• Authorize who may visit you.

• Make your wishes known with donor cards and health care proxies.

The above rights are governed by the New York State Public Health Law 2803 (1) (g) Patient’s Rights, 10 NYCRR, 405.7, 405.7(a)(1),405.7(c). Despite these laws, the Medical Center did not inform either my mother or myself of the name of the doctor in charge of her care or the doctor’s position on staff (even though I asked to speak to her doctor several times during her admission). The Medical Center did not provide me with any information in advance regarding her treatment – I only discovered mom was having “tests” when I came to visit and she was not in her room. Mom was not granted any privacy when she was left in the hall both in the ER and upon her discharge.

New York State law dictates that a patient must receive written notice of their discharge in advance and a patient may call by 12 noon the day after they receive this notice to appeal their discharge if they feel they are leaving the hospital too soon. All patients are also to be notified of their right to appeal their discharge. As a Medicare patient, my mother’s doctor was to have informed her (and me) of her planned discharge date and to have me, as her representative, present to discuss her discharge planning. Yet the Medical Center never gave my mother or myself her discharge notice in advance, or advised me of our rights – all I received was an abrupt phone call after my mother was already tossed out of her bed and sitting in a hallway with her coat on waiting for me. A two-minute “come get your mother” call hardly constitutes the discharge planning and involvement that Medicare mandates I was entitled to as my mother’s caregiver. Is this any way for a “world class center” to treat an elderly patient?

According to New York State law, my mother was also to have been given a copy of the complete “Patient’s Bill of Rights” upon admission. We never received this critical document. I only learned of her rights when I researched this article. Patients need all critical information up front so they can make informed decisions. Without knowing I had a right to appeal, I took my mother home. Despite having informed several doctors of my mother’s persistent cough and her medical history of respiratory problems, the chest X-ray I requested was never done. Had I known my rights at the time, I would have insisted that my mother stay in the hospital until I was sure she did not also have pneumonia.

Laws alone do not guarantee the level of treatment that all patients expect. Medical personnel need to be trained to view their environment from the perspective of their patients. Patients do not deserve to be abandoned in hallways unless there are no rooms available. Patients deserve to have their caregivers listened to and treated with respect. Patients should not be subject to the emotional rantings of hospital employees. And patients should not be tossed out at the whim of a doctor with no regard to their emotional state or the availability of their caregivers. The Medical Center claims it provides “World Class Medicine That’s Not A World Away”. The orderlies and majority of the nursing staff certainly support that claim. But the training of the doctors must include an understanding of their patients and their caregivers. World Class treatment includes providing world class respect. Our doctors, along with the presidential polls, need to view our health care system from the perspective of the patients.

Northern Westchester Round-Up

Cortlandt: Robert Sepe was arrested by New York State troopers and charged with second-degree murder in the bludgeoning death of
his live-in girlfriend, Janette Carlucci. Sepe is the owner of a local health-supplement company.

Croton: Local resident, Dr. Richard Stone, was killed when a tree fell on his car during recent storms. His two children who were in the car
with him at the time survived. Dr. Stone was the Medical Director for the Metropolitan Hospital in New York City.

Mt. Pleasant: Police are searching for three unidentified men who bound and gagged a woman in her home. Mt. Pleasant police believe her home may have been specifically targeted.

Yonkers: Local property owners learned that they will be facing county property tax increases of almost 24% this month. The county
blamed the huge increase on the state property tax formulas and an increase in property values.

Patients’ Bill of Rights

As a patient in a hospital in New York State, you have the right, consistent with law, to: Understand and use these rights. If for any reason you do not understand or you need help, the hospital MUST provide assistance, including an interpreter. Receive treatment without discrimination as to race, color, religion, sex, national origin, disability, sexual orientation or source of payment.

Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints. Receive emergency care if you need it.
Be informed of the name and position of the doctor who will be in charge of your care in the hospital. Know the names, positions and functions of any hospital staff involved in your care and refuse their treatment, examination or observation. A no smoking room.
Receive complete information about your diagnosis, treatment and prognosis. Receive all the information that you need to give informed consent for any proposed procedure or treatment. This information shall include the possible risks and benefits of the procedure or treatment.

Receive all the information you need to give informed consent for an order not to resuscitate. You also have the right to designate an individual to give this consent for you if you are too ill to do so. If you would like additional information, please ask for a copy of the pamphlet “Do Not Resuscitate Orders -- A Guide for Patients and Families.”

Refuse treatment and be told what effect this may have on your health. Refuse to take part in research. In deciding whether or not to participate, you have the right to a full explanation. Privacy while in the hospital and confidentiality of all information and records
regarding your care. Participate in all decisions about your treatment and discharge from the hospital. The hospital must provide you with a written discharge plan and written description of how you can appeal your discharge.

Review your medical record without charge. Obtain a copy of your medical record for which the hospital can charge a reasonable fee. You cannot be denied a copy solely because you cannot afford to pay. Receive an itemized bill and explanation of all charges. Complain without fear of reprisals about the care and services you are receiving and to have the hospital respond to you and if you request it, a written response. If you are not satisfied with the hospital’s response, you can complain to the New York State Health Department. The hospital must provide you with the State Health Department telephone number.

Authorize those family members and other adults who will be given priority to visit consistent with your ability to receive visitors. Make known your wishes in regard to anatomical gifts. You may document your wishes in your health care proxy or on a donor card, available from the hospital.

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