Hospital Horror Story: Un-certified Respiratory Therapist misses Baby’s Lung

A baby was born at the hospital and had difficulty breathing and an un-certified respiratory therapist attempted to intubate (the insertion of a tube for the purpose of adding or removing fluids or air) the baby but missed the lungs and put the tube in the baby’s stomach. The therapist had never intubated a baby by her own admission. Eventually, the baby was sent to another hospital and the tube removed. The baby was eventually discharged unharmed by the hospital. The member's of the medical staff were not told of the error but only heard through scrupulous nurses who were outraged at the behavior of the respiratory therapist.

The medical staff leaders made a formal report to the Joint Commission of Hospitals. The Joint Commission investigated the incident and sanctioned the hospital with formal written reprimand. The hospital was required to have all respiratory therapist certified. The medical staff wanted to know why the doctor's in house were not intubating the patients. The hospital would not use the in house specialists who are available 24 hours per day to assist in an emergency but allow the therapist who is less qualified to perform this procedure.

Hospital Horror Story: 75 Year Old dies from apparent Incompetence

A 75 year old patient was evaluated in the Emergency Room (ER) at Henry Mayo Newhall Memorial Hospital and was found to have a blood sugar above 500. Normal blood sugar is around 100. A physician admitted this patient and came to the ER in the middle of the night to evaluate the patient. After evaluating the patient the physician wrote admitting orders. The admitting orders had very exact insulin dosages written in the chart. The orders would say check blood sugar every 15 minutes and give insulin that is written in the chart and call me if blood sugar is not decreasing. The physician gave the nurse in the ER his cell phone, pager and home numbers to contact him if needed. Through out the night the nurse did not check the blood sugar or call the physician. This patient was noted by the nurse to have a cardiac arrest and subsequently died. The nurse who did not follow the orders was a part time nurse that was later asked to be a full time nurse at this hospital. The family is suing the hospital but the admitting physician was not named as part of the suit because his level of care was excellent and the patient expired because of poor nursing care.

Hospital Horror Story: Medication Screw up puts Patient in ICU

A 93 year old home bound senior was admitted to Henry Mayo Newhall Memorial Hospital for dehydration and had low blood pressure that required intravenous medication to reverse the downward sloping blood pressure. The admitting doctor diligently ordered a blood pressure medicine meant to increase the blood pressure. A medicine was started and the physician asked the hospital staff to call him with the new blood pressure readings.

The hospital staff called the physician with the blood pressure reading as the new medicine should be working by now....but the pressure was lower...the physician asked for an increased amount of the medicine and the blood pressure continued to drop. The physician came to the hospital to see the patient and was shocked by what was found. After determining the condition of the patient he transferred her to the ICU as she was becoming critical. What the physician discovered was the complete reversal error by the hospital. Instead of starting the patient on (dopamine) a medicine to RAISE blood pressure the patient was given a blood pressure LOWERING medicine (nitroglycerin). Through the diligence of the physician the patient recovered and subsequently went home.

An Open Letter to HMNMH CEO Roger Seaver

Dear Mr. Seaver,

My wife had a medical emergency that required the services of the L.A. County Paramedics and an ambulance on Saturday night while I was out of town. Once she was checked out by the paramedics, who did a great job, the ambulance took her to Henry Mayo Newhall Memorial Hospital (HMNMH).

Once at the ER at your hospital my wife was left on a gurney and placed in a corridor for over an hour before anyone checked on her. Her blood pressure had spiked dangerously high at home; she had heart palpitations; and she required a CAT scan. Yet your hospital placed her out in a hallway unmonitored!
At one point she need to use the lavatory and the nurse that actually came over to her, after close to an hour, asked my wife if she had shoes because the floors were filthy despite how many times they were wiped and she “wouldn’t dare walk on them barefooted.” Her entire nightmare at your hospital lasted nearly seven hours.
One of the two CT scan machines was out of order and she learned after asking several times that some patients were being taken across the parking lot to another facility where there was a working high contrast CT machine. Her CT scan was not high contrast yet it took over 2 hours of waiting in a room to be taken to the scanner down the hall. This is something that might happen at a third world country hospital but it shouldn’t be happening SCV.
This is just another example of the numerous and outrageous stories that continue to surface about HMNMH. It is because YOU and the Hospital Board of Directors apparently are unwilling to recognize the serious issues plaguing HMNMH including the POOR management of the facility. Instead, senior management has it’s blinders on and continues to snowball the local “gold card” gentry at apparently spurious fundraisers while lining their own pockets.
Your medical facility is a joke for the size of SCV community. Senior management’s style has alienated the seasoned medical professionals and has planted the seeds of mistrust in the community. Who knows what will happen when a large scale disaster strikes our valley. God help us all!!
I promise, in the coming months, that I will do everything in my power to expose the true horrors of your hospital. In doing so, I am calling on the entire SCV medical community and patients to send me their “HMNMH Horror Stories” for publication. Any information provided to us will be in the strictest of confidence and we will not divulge our sources.
Yeah, I’m back!!
Sincerely,
Dave Bossert
Publisher, www.westranchbeacon.com and Community Activist
Dave Bossert is a community volunteer who serves on a number of boards and councils. His commentaries represent his own opinions and not necessarily the views of any organization he may be affiliated with or those of the West Ranch Beacon.

Doctors vs. Hospital: A True David vs. Goliath

A recent fundraiser for Henry Mayo Hospital brought in $295,000, but one must wonder how much of this money is being used against your physician who has dared speak against CEO Roger Seaver and the hospital Board of Directors. This ongoing David vs. Goliath battle is truly one-sided as the hospital has millions of dollars to spend on lawyers, consultants, and public relations, whereas the Medical Staff continues to be stifled by financial crippling attempts to undermine and slander many doctors, especially those on the Medical Executive Committee (MEC). Recently in another swath of their sword to “cut off the MEC”, a letter dated May 10, 2012, from CEO Roger Seaver launches spears, behind the shield of the Board of Directors, against Medical Staff leadership making it seem this poor giant was being unfairly blocked from recruiting new physicians. This is far from the truth.
Twisting information to lift their banner of trying to fulfill “community needs” should shame them as they use your donated money in the takeover of our community hospital. As you read Mr. Seaver’s letter below, and the second letter in rebuttal from the MEC, keep in mind the increasingly outrageous salaries, bonuses, and retirements these Administrators are receiving.
Waving hospital dirty laundry should not reflect the valiant attempt by many physicians to continue providing needed healthcare to this community despite draconian attacks from this bullying Goliath. It should make you consider though there is something terribly wrong when devoted and caring doctors are assaulted and cannot be heard because the local newspaper is financially tied to hospital advertisement.
Aiding the MEC in whistleblowing is our “David” of The West Ranch Beacon, Dave Bossert, who is providing the “sling” for the reality of this Goliath to be toppled and brought back to the people.
Gene Dorio, M.D.- Guest Commentary
Gene Dorio, M.D., is a local physician. His guest commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

  

To view HMNMH Letter clink here: http://westranchbeacon.com/2012/06/guest-commentary-doctors-vs-hospital-a-true-david-vs-goliath/

Medical Executive Committee Rebuttal to Seaver’s May 10, 2012 letter
June 9, 2012
Dear Medical Staff:
In a recent letter to members of the Medical Staff dated May 10, 2012, Roger Seaver, Henry Mayo Hospital President and CEO, uses disputable reasoning when he objects to established Medical Staff dues. This is not the first time this subject has arisen as Mr. Seaver continues to disregard physician self-governance in running our hospital.
State and Federal law requires a physician Medical Staff be independent from a hospital Board of Directors and Administration. Without this guideline of independence sustaining undue influence (especially financial), patient care at any hospital could easily be skewed by unprincipled, unethical, and amoral businesspeople.
Our Medical Staff By-Laws protect us from this undue influence as dues are set and determined by the elected Medical Executive Committee (MEC) of the Medical Staff. The hospital Board of Directors do not, and should not, have the right to set these dues. This is an important distinction in balance we each play in governing our hospital.
Not mentioned in his letter is the new member physician application fee and first year dues were actually increased to $2200 ten years ago under a Chief of Staff who is now a hospital Board member. Since then first year dues decreased to the present $1700.
The increase in the annual dues come from the legal assault against the Medical Staff and MEC from this Administration that other “geographic” hospital Medical Staffs do not face. They continue to hide this fact from the public to thwart MEC members who fight for the rights of physician self-governance.
At our next quarterly Medical Staff meeting, the MEC plans to again substantiate the financial rational for the amount of our annual dues. Your MEC has succeeded to reduce costs by decreasing legal fees and maintaining accounting fees. The Medical Staff must realize though the continued incursion into our self-governance by the Board and Administration, and “Corrective Action” brought against MEC members is legally expensive.
Conversely, the hospital seems to have plenty of money to spend in acting against physicians, especially when they have paid well over six figures to a Seattle medical consultant, and most recently to a survey group, to cast aspersions on the Medical Staff and MEC. Instead, this Administration and Board should consider using some of these monies directed to “recruit and retain practitioners” discussed in Mr. Seaver’s letter.
Whether you are in private practice, a hospital contracted physician, or one who belongs to an HMO, there is a threat to you and your group when the legal balance of structure is skewed by those who do not value the care of patients in our hospital.
The MEC is your last voice of reason to assure our hospital and physicians can provide quality healthcare to this community.
Your Medical Executive Committee

HenryMayo Hospital; that’s Where the Money Is!

Over the past two decades, access to healthcare for patients has become financially onerous, while the practice of medicine for physicians has become exceedingly difficult. Doctors and the public are caught in this chaos of spiraling upward costs and diminishing care, yet there is a slowly emerging link between this debacle and the one on Wall Street trickling down to Henry Mayo Hospital.

Statistically, this country contributes a higher percentage of Gross Domestic Product monies toward healthcare than any nation in the world, yet our ability to provide care to citizens is rated low, just ahead of Cuba (see a,b). Where is all this money going?

The infamous Willie Sutton was asked why he robbed banks, and his response “because that’s where the money is” was classic recognition of the obvious (see c). In the latter part of the 20^th century, shrewd business people realized healthcare, especially hospitals, was another perfect source other than Wall Street banking, to attain high salaries, outrageous bonuses, and golden retirement parachutes.

As powerful hospital lobbyists had greater influence on our Democratic and Republican representatives, and physician medical associations were kept busy with myriad legal hoops doctors had to jump through, a Willie Sutton-game plan was launched to takeover healthcare. This is what has trickled down to our community hospital and, as you have read in The West Ranch Beacon (WRB, 6/9/2011, 2/20/2011), created the ongoing conflict between physicians and the Administration.

An online article written in 2004, revealed the hospital industry game-plan “to decimate the independence of medical staff and take away physicians’ rights to place unfettered power and economic control over doctors in the hands of hospital administrators” (see d). This strategy has been launched over the past 4 years against Henry Mayo doctors.

How does this effect patient care? Most hospital admissions are paid by Medicare and allows them to make more money when stays are shorter. This is great incentive except when discharge decision-making has been wrenched away from physicians and placed in the hands of those where profit, not quality, is the primary motivator.

Hospital greed has overpowered experienced clinical judgement by your doctor and using faulty “criteria”, is forcing our elder seniors out of the acute care facilities before they are ready for discharge. Unfortunately, and statistically, many of these patients face greater pain, discomfort, institutionalization in nursing homes, and even re-admission.

Legally, hospitals have tried to transfer all responsibilities onto the backs of doctors. Too many times we have heard from Administration “ultimately, the physician is responsible for discharge.” Wisely, the hospital leaves no trails as they put notes and letters on the chart coercing discharge, yet later destroys those communications as “not part of the medical record.”

The hospital has recently become openly aggressive in pressing early patient discharge, not only with multiple phone calls daily to physicians, but giving letters to patients and family members stating they might be financially responsible for the hospital bill (even if they are on Medicare). Think about it: Your grandfather is in the hospital with a heart attack, and he and your grandmother are given a letter stating they might be responsible for the bill. Next: Your grandmother is in the hospital with a heart attack!

So, when members of the physician Medical Executive Committee fight back, the hospital and their legal team create “disruptive physician”, “corrective action”, and trumped up charges to convince the hospital Board of Directors these doctors are not worthy to remain on the Medical Staff (WRB 4/8/2011). The flagrant and gross conflict of interest within the hospital Board of Directors (WRB, 8/23/2011) buys their vote to complete the coup d’etat against your physician.

Bottom line (facetiously): They remove outspoken doctors, control discharges at the expense of our elder seniors, give poor quality care by shorting nursing staff and ancillary care, and run with the profits giving themselves higher salaries (remember, our CEO makes about $700,000), outrageous bonuses, and their golden parachute endorsed by the conflicted Board of Directors. This is why, we as a nation, spend more money on healthcare, but get little in return.

Many of us in Santa Clarita want our children and grandchildren to have the same, if not more opportunity than we had, but not stated this presidential election year is how healthcare is directly related to our ability as a nation to compete in the world marketplace.

Almost every competitive country in the world provides healthcare to their people, and since we don’t, many of our citizens face the residual foreclosure, bankruptcy, bill collectors, and homelessness. There is no solution yet, but part of the overall contributing problem is the Wall Street-mentality takeover of hospitals.

Realize, even as a bank robber, Willie Sutton never had bullets in his gun, nor did he ever harm or kill anyone during his crime spree. Unfortunately now, hospital greed is the gun filled with real bullets wielded by CEOs with a clearly defined game-plan that has doctors and patients in their crosshairs.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

(a) http://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_(PPP)_per_capita

(b) http://www.nejm.org/doi/full/10.1056/NEJMp0910064

(c) http://en.wikipedia.org/wiki/Willie_Sutton

(d) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1140733/

No TLC for the Transitional Care Unit

Her grandmother came to California in a covered wagon; her grandfather fought in the war...not World War II or I, but the Civil War; her mother was 103 years old when she passed away and lived in three centuries; and her father suffered from “lumbago” and died from “consumption.”  This was more than just curious information told to me in my first encounter with Emma, as her past painted a parallel picture of our evolving nation.

Emma was the first woman in her family to graduate from college, receiving a degree in English, and periodically she reminded me of her involvement in The Daughters of the American Revolution.  When I first visited her home to see her ailing husband twenty years ago, they proudly displayed an oversized American flag on their porch.  After he passed away, I didn’t hear from her for about five years until a phone call requested a medical visit.

Time did not age her, although because of her infirmities she was now using a walker.  Our discussion noted no life-threatening conditions, yet emotionally she was indifferent except for the roses she tended around the fencing of her small house.  “Roses are fussy and difficult to grow, but I pamper them with gentleness and kind words enticing them to fill my home with their sweet aromas.”

As with many of my senior patients, I encouraged her to find “purpose” and broaden her social community by returning to church, volunteering at the senior center and hospital, and exploring her previous writing talents.  She obliged me, but I knew there was a spiritless shell struggling with internal battles. 

At the same time in early 2006, Robin Clough, Volunteer and Activity Director at the SCV Senior Center, and I learned the Henry Mayo Hospital Transitional Care Unit (TCU) would be closing.  For many of our elder seniors, it served as a stepping stone after discharge from the hospital, allowing them to gradually return to normal health and go home as opposed to going to a nursing home.

Within a few weeks, we organized a steering committee, had a “Rally in the Valley” meeting, then protested the closure with pickets in front of the hospital.  We chose the day and time to coincide with the hospital Board of Directors meetings, which was mid-to-late afternoon.

The call went out to our elder seniors in Santa Clarita to come to these hospital rallies, and I was happy to see Emma on the first day.  It fit her character when she claimed the picket sign that read:  “I’m the Little Old Lady from Santa Clarita”!

Over the next year, seniors rallied at the hospital five times, spoke at City Council meetings, and publicized the plight of the potential loss of the TCU.  One scorching Santa Clarita day, we were forced to bring the rally and our picket signs into the hospital.  We had already discussed the legality of this with the SCV Sheriff’s office, so we knew our rights, yet hospital security came to put us back on the street. 

In the main lobby, as one hundred seniors (some on oxygen and in wheelchairs) lined the hallway and quietly stood with their signs, the head of security came with an entourage of seven other officers and emphatically told us to leave.  Knowing the law, I told him we wouldn’t, and then he threatened to take our signs.  Unfortunately for him, Emma was standing next to me, and this 100 pound, 92-year-old clinging to a walker, shook her sign in his face and said, “You’re not going to take this sign away from me!”  (There were a few extra words I left out which were not a part of her degree in English.)  I knew Emma had not only found “purpose”, but had passionately grown sharp thorns like her roses!

At the third hospital rally, Robin noticed a change in Emma and pointed it out to me...she was wearing makeup!  Curiously, I went over and asked if she was okay.  She said she felt fine, but after a few moments confessed, “I think I’m in love”.  “His name is Don, and he’ll be here in a minute”, as she told me about the kindness and commonality of her 95 year old friend.  In the next moment, she looked worried.  “I am afraid though...”  as I cut her off and said, “You mean of him passing away?”  Without hesitation she retorted, “Of course not...I’m afraid and worried one of these pretty ladies here might take him away from me!”

Later that day as we marched, I noticed them holding the sign together, and the wording was changed to “I’m the Little Old Lady & Man from Santa Clarita.”

Eventually our efforts allowed the TCU to remain open for 19 months beyond the Board’s directive because of community and city protest.  Don though had indeed been hospitalized twice, and in failing health was placed on hospice in the TCU just before it closed.  He passed away with Emma at his bedside.

Emma continued to have purpose and give her opinions.  It was difficult for her to understand how the Board of Directors ignored the plight of the community they serve and look at our elder seniors as only numbers to balance their books, and not as people who have history and emotions.  She insisted the TCU allowed for seniors to stay close to family and friends in our valley, receive care from their longtime local physician, maintain their dignity and hope, and especially not go to a nursing home.  I could only agree and knew the money saved by the hospital was minuscule compared to the financial and emotional stress seniors now face.

For several more years I continued to see Emma at her home, and she continued to tend her roses.  Next to her American flag was the picket sign she and Don carried during our rallies.  Emma became ill earlier this year, and was hospitalized several times.  Finally, she requested in-hospital hospice care which was granted.

Although weak and fragile, Emma was still lucid and clear.  She was comfortable and without pain, and was not suffering.  On a Thursday evening, I came to see her...and she had makeup on!  I told her she looked great, and she told me she wanted to look good when she saw Don. That evening, Emma passed away.

Periodically, I go to Eternal Valley to see Emma...and I bring a rose so she can smell the sweet aroma.  I also make sure the rose has a lot of thorns...I know she would like that.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.