Saturday, March 17, 2007

Medical Care And The Buck-Who's In Charge of This Insane Asylum?

My daughter had jaw surgery last week to correct a congenital malformation. Her oral surgeon is the Chief of Surgery and has revolutionized jaw surgery by wrapping the jaw with an ice pack machine to cut way down on swelling. Our surgeon is pathological about insuring that machine is working at all times. Surgically speaking, she was in great hands. I know this surgeon well. I’m a vet with this particular surgery having watched my husband and son go through the same exact surgery a few years ago. They had excellent care back then.

However, things have changed, and not for the better.

After being stuck in Recovery for over five hours because another patient – one patient – suffered some minor post-surgical complications, my daughter was finally wheeled into ICU. I wondered if there was only one Recovery nurse back there.

The crack ICU nursing staff of years ago had given way to casual interest. They failed to plug in the ice machine. The portable battery pack had long since died and my daughter wasn’t receiving any ice. Thankfully the surgeon caught it during evening rounds, and I thought he was going to rip the nurse a new orifice for failing to insure the most important factor of her post-op care was working.

They also allowed the machine to run dry of water hours later. My daughter told me her face felt warm. I said something to the nurse, and she finally added more water. By this time, I wasn’t feeling confident about my daughter’s care and was grateful I was spending the night so I could make sure she was taken care of.

I was told that there was no way they’d allow me to stay. I told them that I was a vet at this and had stayed with hubby and son a few years ago. How nice, but not this time. Rules and all. I left my daughter with a huge knot in my stomach.

I just knew something was going to happen during the night. It did. They failed to give her the timely anti-nausea meds and she proceeded to get sick – a potentially dangerous situation for a jaw case. They let her sit in her own vomit for a while before finally cleaning her up. They didn’t cut her rubber bands to clean out her mouth and stitches, they didn’t change the bandages. Words can’t describe my anger. I did vent my spleen when the surgeon came in for morning rounds, and he was furious. I couldn’t get her home fast enough.

I mentioned ICU’s cavalier attitude to the office manager at the surgeon’s office, knowing she had just had hand surgery. I wondered if her care had been just as shoddy. It had. This hospital used to be so fabulous, what happened, I asked. A single sentence brought it all home. They were bought out by Tenet Corp. First thing they did was to fire all the experienced nurses because they made too much money and bring in less experienced nurses for far cheaper. Gee, great business decision. Wonder if anyone cares about quality anymore. Is this the way America’s medical care is headed? I feel my daughter’s care was compromised and had I not been vigilant, she may have spent 24 hours in ICU without ice on her jaw.

I’m bitter.


Sid Schwab said...

Sadly, I think your experience is being repeated across the country countless times in each day. Not universally -- yet -- but increasingly. "For profit" hospitals only make it easier to see: even in community hospitals, because of enormous financial pressure, nurses are given more and more to do with less and less support. A few years ago I watched as the best (and highest-paid) nurses were laid off, agency nurses hired (hourly wage, don't have to pay benefits) in order to stave off financial collapse. Care suffered enormously, and at one point I wrote to the CEO saying I was a heartbeat (or lack thereof!) away from stopping admitting my patients there. And, of course, in many ways the cost-cutting was self-defeating as word got out that care had declined and people sought alternatives.

As the nurses are overworked and undervalued, it's unsurprising that care suffers. Morale declines. Excellence, unrecognized and unrewarded, becomes irrelevant. Still there are many who keep trying under the worsening circumstances. I don't blame them, or even the hospitals (the non-profits, anyway): payors squeeze them at every instance. I don't know what the answer is: I do believe that at some point there will need to be head-on confrontation with some tough questions. How much do we want to spend, as a country, on healthcare? How much can we afford? Where will the money come from? What will be the spending priorities? And how can we find specifc ways to identify the most cost-effective methods for managing a given illness?

One thing is clearly true: such reality-testing is still a long way off.

Lynn Price said...

"One thing is clearly true: such reality-testing is still a long way off."

Gad, aside from being bitter, I'm depressed. This, from the strongest country in the world, is pathetic and makes me think we're being beaten from within.

911DOC said...

sorry about your experience. i have my own opinion on the state of in hospital care now and it has a lot to do with the beat-downs delivered from a far-away bureaucracy enforcing meaningless paperwork requirements on docs and nurses. core measure scores are followed meticulously while the art is taken out of nursing. as a doc i try to hold the line against the bullshit but my pay is tied to core measure performance and i'm required, after all my training, to follow guidelines that can not possibly be universally applicable. that's one of the reasons i write my blog. most of my bile comes out as i type.

hope your daughter is doing well.