We certainly would not send them a bill for poor care...or would we?
Last year I was visiting with a friend, a highly recognizable name in healthcare. He conveyed a personal story of a surgery performed that went horribly wrong, leaving his vision in one eye forever damaged. When the surgical mistake was “diagnosed,” it was the surgeon himself that brought to light his shortcomings. In a glib tone, he admitted his “hand slipped” and that this issue was detailed in the consent form. He promptly sent a bill to the appropriate health insurance company as well as to the patient for the co-pay expenses. As a result, the hospital where the surgical error occurred took a negotiated discount from charges as payment in full for the procedure.
The Hospital CEO -- well, he thought the surgical outcome was really “unfortunate.” The surgeon was disappointed; he said this case was one of only three times in his career he had permanently damaged a patient’s vision. No one thought an apology was in order. Both men are extremely well educated and trained, mannerly and respected in their professions. Both men would even apologize if they accidentally bumped into a little old lady in the grocery store. Permanently damage a man’s vision, and no apology is in sight -- no pun intended.
In October, 2006, Newsweek published ten case studies directed toward fixing America’s healthcare system. The first case study was “Facing Up to Mistakes.” A patient of Boston’s Brigham and Women’s Hospital relayed her nightmare of enduring a cardiac arrest when an anesthesiologist injected a routine nerve block and everything went wrong. The patient intuitively knew that something horrible had happened and felt betrayed by the hospital for not being candid with her about her adverse medical event. The anesthesiologist wrote the patient, accepted responsibility for the mistake, and apologized. As a result, the hospital developed a new system of patient safety. The patient offered her forgiveness to the doctor and, more importantly, said, “I felt like I had my life back.”
Not everyone gets their entire life back, even when they survive poor care. In December, I received a letter from a woman who read an article I had previously written and published with regard to hospital-acquired infections.
Mrs. Johnson offered the following story pertaining to her husband’s care (Mr. Johnson) following a laparoscopic colon resection at Alamo General Hospital. Forgive me for changing the patient’s name and the hospital name. Aside from all of the legal problems such a disclosure would unleash, it would also detract from making this central point: Patients are routinely injured or killed in American hospitals; no one apologizes; the hospital, physicians and surgeons bill the insurance company, and, if necessary, the patient or family is sent a bill for co-pay obligations. It is not possible to make up this stuff.
Mr. Johnson opted for a laparoscopic colon resection because the risk of infection was lower. The surgeon informed Mr. and Mrs. Johnson that the surgical procedure was a “success.”
Notwithstanding, Mrs. Johnson was concerned. With no training in medical or hospital care, she perceived the nurses were understaffed and overworked. “There were simply not enough “hands” to cover the surgical floor most of the time.” All hospital personnel were courteous but frazzled.
There were hand sanitizers in Mr. Johnson’s room, and Mrs. Johnson noticed that nurses and physicians frequently washed their hands. They did not always wash their hands; but after all, they frequently washed their hands. Aside from observed hand washing irregularities, Mrs. Johnson noted numerous unsanitary practices; most caused by the sense of chaos on this surgical nursing floor.
Here are several direct quotes from Mrs. Johnson. “In a matter of a few days, there was something not quite right going on in the area of his incision. As his discomfort grew, he began complaining of pain and nausea and was eventually given some medicines allowing him to be able to rest. Since it was evening, I went home for the night. Little did I know that the next day would prove to be the real beginning of the nightmare.”
"By the time I arrived at Alamo General the next morning, my husband was in severe pain and fighting a spiking temperature. Since it was the Easter weekend, staff was really limited. Eventually, the nurse and I had a talk, and I demanded that a doctor look at my husband. I was not going to allow this to go unchecked.”
"The doctor who finally came to check in on my husband (at the nurse's insistence) barely looked at the wound site. He was nice, but he was not as concerned as the nurse and I. He tried to assure me that there was nothing unusual about the situation. He did not convince me.”
"My husband continued telling the nurses of his concerns that evening and throughout the night; but upon standing up from his bed the next morning to go to into the bathroom, he felt that his gown was wet. When he looked down, he watched as a bloody pool formed on the floor at his feet. A nurse who was passing by his door saw what was going on and quickly attended to him.”
"Shortly thereafter, three doctors were in my husband's room, the young doctor from the day before being one of them. With scissors and nothing to numb the wound site, they proceeded to reopen the wound which produced more puss and fluids than they were able to contain with the handfuls of gauze they had brought along. Right there, on the hospital bed, in a very non-sterile setting, my husband's very infected wound was treated. It almost caused him to lose consciousness and almost caused me to completely lose my temper.”
"I became the one who had to pack the wound, administer the medication and change the dressing for the next month.”
"The health care professions are demanding, indeed. But when there are not enough nurses and nursing assistants on every shift, there simply is not time to employ the proper procedures for fighting infections. The visitors to the patient rooms must also be involved and educated on the prevention of spreading germs to the patient. It cannot be left entirely to the nurses and the physicians."
Mr. and Mrs. Johnson finally left the hospital. As Mrs. Johnson started to drive her husband home, they both noted a banner hanging on the front of the hospital proclaiming that the hospital was one of the top 100 hospitals in the nation or words to that effect.
In closing, Mrs. Johnson said, “My husband recovered, though he still suffers with pain occasionally. As he likes to say, "I had to get out of that hospital before they killed me!" His sense of humor is still intact.”
Indeed, Mr. Johnson might be that one unlucky hospital patient in twenty that acquires an infection as a consequence of being admitted to a hospital. Here are several pertinent facts. Mr. Johnson was otherwise healthy when he arrived at the hospital. He did not have an infection when he arrived at the hospital. He acquired a life threatening infection while in the hospital. No one apologized or even offered a single word of regret. All hospital bills were submitted for payment with dispatch. Mr. and Mrs. Johnson have never contacted an attorney and do not intend to sue anyone. They are just thankful that Mr. Johnson is still alive.
Having conducted interviews with several dozen hospital CEO’s (not very scientific or statistically reliable), they think Alamo General Hospital is the norm and that Boston’s Brigham and Women’s Hospital is the outlier. Among other things, they point to the advice and counsel from the hospital attorneys. Admit nothing. In 1970 there was a memorable movie by the name of Love Story. Torturing the most famous line from the film, “Providing poor patient care is never having to say you are sorry.” The American hospital may not always be able to provide the best care. One element of reform that Newsweek had right is we need to be able to face up to our mistakes. While it is easier said than done, it still should be done. If we are to maintain the reservoir of goodwill that the “Johnson” families of America extend to us, we will need to face up to our mistakes sooner rather than later.
Jan Jennings
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