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Safety and Hospitalization Concerns

Expert PhotoMartine Ehrenclou, MA, is an award-winning author, patient advocate and speaker. Martine writes monthly articles for several health websites, regularly publishes articles on the topics of patient empowerment, patient advocacy, patient safety, successful communication in medical encounters, and other health/medical related issues.

We are extremely concerned about a recent situation we have encountered. Our 84 year old mother is in a licensed nursing facility, recuperating from a broken hip. We were getting ready to transfer her to a higher functioning facility (assisted living) when she took a turn for the worse and started having excessive diarrhea. After 6 days of the facility not notifying her primary care physician, we requested a stool sample be taken and tested for C-Diff. Meanwhile, the nursing facility did not hook her up to an IV or do anything to help her with her dehydration, except to "encourage her to drink water." The Air Conditioning in the facility was on the fritz. It was in the 100s in Southern California and it was HOT in her room. We had her transported by ambulance to a local hospital where she was quickly hooked up to an IV and given a saline solution drip. After a liter of this solution and her body temp regulating in the 70 degree Emergency Room, she was much better. She is back in the nursing facility, but our concern is for her safety. Your comments please. Thank you very much. 

Mary from CA

You are right to be concerned and I'm glad you are. C.diff is not something to be overlooked or treated in a casual manner. It is difficult to get rid of and can come back, not to mention the discomfort it is causing your mother. If she tested positive for it, perhaps she contracted it in the hospital or the nursing home she is in now. C.diff is rampant in nursing homes. (If she got it from the current nursing home, she could get it again). But more importantly, your mother is not being well looked after. You wrote yourself that the facility did not notify your mother's PCP after six days of diarrhea and they also did not hook up your mother to an IV or help her with dehydration. The air conditioning is also unstable and it's in the 100s where your mother is. All of this sounds like cause for prompt action. Consider moving your mother to another facility until she has recuperated enough to go to the assisted living facility. The treatment she received is not acceptable. C.diff can be life-threatening. See this from the Mayo Clinic

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Q: After 3 strokes my dad is blind with severe short-term memory loss. My main worry is having to hospitalize him in the future, say in ICU, where family members cannot stay round-the-clock. Dad gets frantic if left alone without family members that are familiar to him. In fact, in his 4 years of blindness a family member has always been with him. Can a hospital absolutely deny us the right of staying with dad round-the-clock due to their policies?
Yochana from LA

Talk to the hospital supervisor (possibly the Hospitalist) at your hospital and bring documentation that your dad has had the three strokes, the short term memory loss and the fact that he panics without a family member at his side in the hospital. Perhaps his PCP will give you a short report. Find the appropriate person in charge at the hospital (it will be different at each hospital) and ask for a meeting. Bring a copy of the documentation and and ask for help before your dad has to go to the hospital. Keep all copies of your dad's documentation, reports, medical records in a file. Also whomever you meet with at the hospital to have it arranged so one of you can stay with him in his room, have this person give you a signed release and business card. One copy of that release should go to your dad's PCP. You never know when staff changes so you'll need proof that this was granted in case the same staff person is not there if your dad should need to be hospitalized.

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Q: My 90-year-old mother was hospitalized with pneumonia and released to a rehabilitation facility to continue intravenous antibiotics. While there, her hip was broken and she had to go back to the hospital for surgery. Now she has been released to a different rehabilitation hospital for therapy to try to get her walking again. Is the facility that was entrusted with her care liable for negligence and responsible for the financial debt, which will be incurred at the end of the Medicare 90 day period?
Jo from LA

From the editor: Both our Safety and Elder Law experts say that you need to contact a local attorney if you feel that the original rehabilitation facility did not adequately care for your mom.

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Q: How can I protect a loved one in the hospital?

Hospital care has become hazardous to the patient’s health. According to the Fifth Annual HealthGrades Patient Safety in American Hospitals Study, 2008, nearly a quarter of a million deaths in hospitals nationwide were found to be preventable.?All of us will at some point have to deal with our own hospitalization or the hospitalization of a loved one—a parent, spouse, relative or good friend, and cope with the realities of what is happening in hospitals today. In a nutshell, there is a nationwide, drastic nursing shortage. Insurance companies require physicians to see too many patients in too little time. Many hospitals are under financial duress because of uninsured patients, patients who don’t pay their bills and demands for new, expensive technology. Because of the baby boomer generation, there are more older patients with multiple medical issues that require hospitalization. Every physician and nurse I interviewed from my book, Critical Conditions, said this: "Hospital care is in crisis. You must have someone with a patient at all times. Loved ones are patients’ best advocates."?

There is something everyone can do immediately to improve the chances of surviving a hospital stay. There must always be someone—a family member or good friend—to act as a sentinel to oversee hospital care in an effort to prevent medical errors. The hospitalized patient cannot do this for himself. If you or a loved one has to go into the hospital, the number one priority is to enlist a family member or good friend to act as an advocate caregiver to oversee and monitor the hospital medical care.
Among the most important steps the advocate can take is to show up during doctor’s rounds. Ask the primary nurses what time the doctors do rounds and simply be present in the patient’s room. Have your notebook handy. Prepare questions ahead of time about the patient’s diagnosis, treatment and prognosis. Ask the doctor how he/she wants to be contacted. Write down phone numbers, office hours, time of hospital rounds, email address and how that doctor wants to be contacted. Provide him/her with your phone numbers and the best times to reach you. If you can’t be available during rounds or if you live out of town, call the patient’s primary nurse and ask that a note be placed in the patient’s chart for the physician to call you. Leave your phone numbers and times available. You can also call the nurses’ station during rounds and ask to speak to the physician. If you still have trouble reaching the doctor, fax a note to the physician’s office asking for him/her to call you—note phone numbers and times you are available.

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