As a medical negligence lawyer and healthcare advocate, I am frequently critical of healthcare providers for medical errors that have caused grievous harm or wrongful death to my clients. Recently, my father was hospitalized at a large Ohio hospital and, sadly, passed away during the hospitalization. The experience afforded me a rare opportunity to watch physicians, nurses and therapists at work in the hospital setting. For the most part, I thought that his care was excellent despite the bad outcome. But there were several areas that raised concerns.
First, the good:
- The ICU nursing staff was experienced, knowledgeable and diligent. They are really the key to good care in an ICU.
- There were several experienced physicians involved in my father’s care. At one point, four physicians (two pulmonologists, a cardiologist and a nephrologist) met at the foot of my father’s bed to discuss his plan of care with me. The physicians were open about their differing opinions, frank about the risks and uncertainties, and they allowed me to participate in decisionmaking. I saw each of them frequently in the ICU and had several occasions to speak with them.
- I thought that we received special attention by virtue of maintaining a constant bedside vigil and having family members, including a retired R.N. and a physician, asking good questions and prompting action. We were always courteous and respectful towards the caregivers, trying to make their jobs easier and encouraging communication.
- The hospital bent its rules for visitation, particularly at the end of life, allowing my large family to comfort my father until the end.
Areas of concern:
- Early on in my father’s admission, it was apparent that the hospital’s electronic medical record had failed to alert one attending physician to my father’s past medical history, including a significant recent hospitalization at the same hospital. It was mind-boggling to realize that my father had been in the hospital for almost two days without any attending physician getting the whole story down and committing it to the medical record for subsequent physicians to review.
- During the admission, my father was obviously short of breath, yet the electronic monitor recorded a normal respiratory rate. Plainly, there is no substitute for bedside evaluation by an experienced floor nurse.
- Early in the admission, my father was placed on a low-acuity med-surg floor. It required hours of advocacy by family members before he was transferred to the ICU where he belonged.
- My father was initially admitted to the hospital on a Friday. The attention that he received from attending physicians was sporadic over the weekend until Monday morning arrived.
- At one point, a rather arrogant young attending physician jumped to conclusions in diagnosing my father with a bronchial infection, rather than the life-threatening cardiopulmonary complications that he was experiencing. There really is no place for big egos in the healthcare setting. In this case, the self-impressed attending missed the boat entirely and overlooked an obvious test that led to the correct diagnosis the following day.
While none of these lapses caused any harm to my father, under other circumstances, they would have. Overall, I thought that my father’s care was excellent. But I left the hospital, after two weeks of close observation, with renewed concerns about hospital safety. I could see firsthand that hospital care is decidedly spotty and can vary based on such random factors as who the attending physician is, what unit the patient is in, what day of the week the patient is hospitalized on, and whether the patient’s family can intelligently advocate on behalf of the patient. Harkening back to the many medical negligence cases that I have handled, I experienced for myself how communication, continuity of care, careful and personal attention by caregivers, and proper staffing are critical components of good care.