Wednesday, December 26, 2007

A heart attack at PRMC's Emergency Room....8/9

I received this as an email which had the patient's name and a lot of additional information as to his identity. I suggested that he consider it carefully and he agreed to my removing overt identification. However, I'm sure that his friends and the hospital personnel know who he is and who they are.

On the morning of Aug 1, 2005, I awoke about 4am at home with severe chest pain. It was an intense pain I had never had before.

Heartburn is something I almost never have, but I got up and chewed a couple of Alka-mints. The pain did not go away and seemed to gain intensity, so I woke my partner, significant other or whatever you want to call him. We have been living together for over 33 years and we have lived in ____ 22 years. He is also an ex-EMT basic. He had me lie down and administered oxygen. This helped a little bit, but I still had chest pain and trouble breathing. We decided I needed to go to the ER in Paris.

He drove me there and we arrived at 5:46am. Once in the ER, I sat at a desk while a nurse took my name, address, etc. and finally I was laid down and hooked up to a monitor with my blood pressure all over the chart and pulse as low as 37. When my pulse dropped below 40, an alarm went off and no one came in. I had to tell the nurse that it had gone off. She just looked at me with a blank look on her face.

Over several hours, I was given an Xray, an ECG and had blood drawn. I was left unattended all of the time while they worked on a couple of more patients that they said were critical. I was there forty-nine minutes before I was given nitro several times with no let up of chest pain.

I was never given any aspirin or any other drug of any kind. I was never asked if I had a history of heartburn or upset stomach. Dr Hobbs came in only once for a very short visit. He never listened to my heart or lungs or asked any questions about my history. My partner was in the room with me when asked by nurse Debra Crews who he was. He replied that he was my significant other.

After that statement, the atmosphere seemed to change and I was left lying there with only occasional checks on the monitor. Thirty minutes after shift change at eight a.m., Dr. Rowe came and stood in the door. He said I had GERD and gave me a prescription for a prev-pak ($300). He said my sugar level was high at 146. I asked what should it be and he said "140". Then he sent me home.

All the time Dr. Rowe was in the room he didn't come near me. He never examined me or listened to my heart and lungs. He never asked me any questions or medical history. I went home and the chest pain mostly went away late that afternoon. This visit cost the VA over $2,500. I believed the doctor and thought I had GERD.

The rest of the week was spent in agony. My arms hurt, my legs hurt, I couldn't eat, my blood pressure stayed very low and averaged about 70/50 which is really not enough for kidneys to work properly. By Friday morning, August 5th when I went to Bonham to the VA clinic, my blood was toxic and my heart in really bad shape.

They did an EKG and sent me by ambulance to the Bonham hospital to stabilize me before I was sent to Wilson N. Jones Medical Center in Sherman to the emergency room to be sent to a heart cath lab. There I had one stent put in and angioplasty. They left some blockages because I was on the verge of kidney failure, and more dye would have probably shut down my kidneys. I was told by the renal specialist that I came very, very close to death. Fortunately, I have good kidneys and passed the toxins quickly.

I was released on August 7th. Two days stay at the hospital in Sherman cost the VA $140,000. Later the next week, I was charged over $43 for a copy of my medical records from Paris Regional Medical Center to give to my VA doctor. There were no strips from the monitor in the ER in these records or doctor notes.

When I picked up the records, I asked if I was getting a copy of everything in my medical records and was assured that I was. The ECG in these records clearly showed abnormal heart functions.

On August 20th, I had chest pain and it felt as if I had a heavy weight on my chest. I called the Dallas VA hospital and was told to call 911 or go to the nearest ER. I told them I would rather take my chances on the road to Dallas than to go to the ER in Paris again. I went to the ER at the Dallas VA hospital and was admitted and had another heart cath on Monday, August 22nd. They put in another stent and more angioplasty. I was released on the 23rd with medications for my heart and will do follow-up in the cardiology clinic there.

I believe I was denied medical care for the heart attack I was having when I came into the ER at Paris Regional Medical Center for several reasons. First, I did not have the blank check of Medicare or Medicaid. Second, the personnel at the ER seemed to have no training in treatment of chest pain (heart attack) patients which is simply an aspirin and nitro glycerin under the tongue immediately. Third, Dr. Hobbs and Dr. Lowe acted like they really didn't care about me at all and neither listened to my heart, lungs or asked any questions and seemed to have no training in ER procedures.

I truly believe that if my heart attack had been diagnosed properly at the ER at Paris Regional Medical Center, I would not have gone through so much pain and agony and damage to my heart would have been minimal. By not treating me at all, Paris Regional Medical Center has taken years from my life and is liable for all medical expenses, ambulance trips, medicine and all other expenses incurred by the Veterans Administration clinic and hospitals.
So this is the organization that wants to put in a specialty Heart Hospital? Is this the same place that put up the signs for 'The Chest Pain Center'...and then didn't bother to inform the ER, nor staff appropriately?

And the gay all Essent hospitals have a problem with that? Personnel need to park their personal beliefs at the door. A patient is a patient is a patient...and they need your care. If you can't provide that, you need to get out of the medical field.

Yes, patients can have their own beliefs--and we have to respect them. That's part of the job. That's part of your training. 'First: Do no harm.' That includes 'by omission', as well.


Anonymous said...

Amazzzing--no howls of HIPAA! Maybe they found out that dog didn't hunt. What if the VA gets the balls to go after the money? Either from the hospital or the docs.

Hard to say, it would take looking at what was in the ER at the time, what presented, what the EKG showed, the cardiac enzymes, etc.

Triage is tricky, and that's precisely why the most experienced person should be in that hot seat. If symptoms are missed, the patient miss-assigned, then outcomes are not as they should be.

You might think that the experience is needed with the patient, but if the symptoms are missed--or misinterpreted, it won't be matched with the right patient anyway....frank

911, Whats your emergency? said...

So is the gripe towards PRMC or the ER staff. Sounds like to me that it is with Dr. Hobbs and Dr. Rowe and the nursing staff. Just curious.

Anonymous said...

Been reading the Advance Heart Group ads in the Paris News. It says they are here 365/24 hours a day. Family member was in the ER the other night with chest pain and AHG was on call. Never responded to numerous pages. Ended up calling Dr. Hashmi. Thank you Dr. Hashmi for all you did. AHG is a joke.

Anonymous said...

In either case, isn't the ultimate responsibility that of the hospital?

Anonymous said...

Absolutely Unacceptable. Heart Attack/Chest pain patients are supposed to be the ER bread and butter, and they cant even get THAT right. Just IMAGINE how well they handle something they dont see every Friggin day like appendicitis. Yep, I would not bet money on them catching that very often. How the hell do you miss a classic heart episode in an ER? They just keep finding new ways to astound us with their incompetance.

Anonymous said...

The big problem is the turnover in the ER. How many nurses in PRMC's ER have been there more than 6 months? How many have more than a year of ER experience? I know the answer and let me tell you it aint very many. Hell there are several nurses down there right now that were hired without any cardiac or critical care experience at all and some weren't even ACLS certified when they started. Any department is only as good as its people and if you don't hire the appropriate people because you don't want to pay them you are going to get stories like this one. Just one more example of e$$ent putting the almighty dollar before the patient.

Anonymous said...

Both ER and the docs dropped the ball on this one. Not sure if discrimination based on sexual orientation could be proven, but the rest of it is a lawsuit waiting to happen.

And no evidence of HIPPA violations in this post, so E$$ent can't say squat.

Anonymous said...

Hey 2:54 AM
Chest pain / Acute MI Patients are this er nurses bread and butter. Unfortunately I couldnt afford to work for prmc. I have a family to support. Maybe I'll be able to work there again after e$$ent's demise.
P.S. acute appendicitis isn't that hard to diagnose either. Usually has pretty obvious symptoms that are damn hard to miss. Try to stick to your own field (med/surg) when you want to downgrade others. If you dont you just end up looking stupid. Keep changing bandaids and leave the real work to the critical care nurses. Thanks stupid.

Anonymous said...

The author of this letter seems to insinuate that care was withheld due to his homosexuality. I'm calling BS on that. While I wasn't there and didn't witness the events, it seems he went out of his way to 1) inform the readers of the letter he was gay, and 2) make some pretty bold assumptions about the actions or lack thereof from the ER staff.

I'm no fan of PRMC/Essent. But this screams of someone seeing what they wanted to see and painting it as him being treated poorly because he was gay.

Gayness notwithstanding, if care was withheld, for whatever reason, heads should role. But let's keep this in perspective.

Hard to call it second-hand, but it is in the eyes of the patient. When someone is with you in the emergency room, they ask their status (in this case, had medical power of attorney.) If the appearance is that of a change of care, based on orientation, then pursuing a complaint/litigation is the patient's right.

Essent certainly would say that about their rights in what they perceive as defamation...I perceive it as a SLAPP case ....frank

p.s. He wanted recovery of the money for the VA, not for himself. Probably felt that the money should be there for our vets, not to cover an Essent screw-up.

Anonymous said...

To 2:48:

You are correct, it is the perception by the patient that leads to assumptions and conclusions of discrimination. The burdon of proof is on him though. However, he's going to have a hard time proving discrimination due to sexual orientation.

Could this be a case of "I'm gay, so that must be the reason I was discriminated against."? Don't know. But some would use their sexual orientation as the hook on which they hang all their woes.

It is a letigious world in which we live, wouldn't you agree?

Damn Shame said...

I'm really sorry this happened to this patient. Usually chest pain is dealt with seriously--yes it may be GERD, but it can be a heart attack too. So the SOP is to treat all chest pain as potential heart attacks until proven differently. AN abnormal EKG, abnormal labs should've proven that it wasn't GERD.
Alas, it is possible that predjudice played a part in it. To me all patients are "patient colored" and the only time I note gender, age, race or sexual orientation is in differentiating patients (the black John Smith vs the white John Smith) or aiding in diagnosing (ie, blacks have a higher percentage of high blood pressure, etc)Unfortunately, not all medical personnel are so tolerate. I hope that discrimination was the not the cause of the poor care this patient received.
However, poor care he DID receive and that is a real shame. Essent should be busting their arses to right this wrong and prevent it from happening again.

Anonymous said...

When I first wrote the article about the heart attack at PRMC there was no mention of discrimination or of my being gay. After writing it, I came to the conclusion that after the nurse asked my partner who he was, and he said he was my significant other with my medical power of attorney the level of care did positively change to almost none at all. No one came near me or touched me after that. It did not occur to me at the time because I thought I was safe in the ER with Doctors and nurses looking after me. Only when I went to the Bonham VA clinic did I become aware of the fiasco at PRMC ER.

Anonymous said...

"Only when I went to the Bonham VA clinic did I become aware of the fiasco at PRMC ER."

How sad is it when a patient gets better care at the Bonham VA than at prmc?

Anonymous said...

I will never go to a Paris Texas hospital, if anyone is a patient of Jon Plummer find another dr quickly, especially if you are elderly.I know of two patients he has allowed to die because they were elderly.

He comes off as a kindly old country doctor but in reality is only looking at the bottom line.

I was a patient of his for ten years and finally went to another dr and I am finally getting better.

Annonyomus said...

What happened? A patient with chest pain was usually taken right in and evaluated. It doesn't matter what sex the significant other is. A medical power of attorney held by anyone should be honored. What would have happened if the patient became unresopnsive and this other person had to make a decision? Would no one have allowed it or responded to this person? I can't think of anything more frightening than to be a family member and left completely in the dark. Are there not enough nurses to take care other emergencies, and still look in on a chest pain victum? If not this is a deplorable situation. Just a friendly face can ease a lot of tension at a time like that. As to the Docs, I have no answer but am not surprised. Things in ER have not been right from the time Essent came there. Essent better get their eggs in one basket or there are going to be major lawsuits coming their way soon, from the things I hear going on up there.

Anonymous said...

Don't get so high and mighty, you may have to eat those words.

A friend's kid was brought to the Paris ER a couple of years back. He had pain on the left side, so they treated and sent him home. Back the next day, same thing. More severe pain. No relief.

Following day he was brought in, surgeon who was a friend of the family met them at the ER. Hot appendix, almost burst, he had 'reflected' pain, whatever that is, but the ER had missed it twice.

Anonymous said...

Woman I know went into the ER yesteday (01 Jan 08) AM with severe abdominal pain. As of last night around 6:00 or 7:00, she had still not be examined by a doctor.

Anonymous said...

Since Dr. Pranulis last prowled the cramped closet laughingly called an ER, and even while he was, patient care was nothing to brag about. What this hospital needs is a couple of highly skilled docs who specialize in emergency medicine; a nursing staff with a modicum of competence and compassion; better triage procedures; and a bigger ER. What they have now is a joke- there's very little space in either the ER or the waiting area. At least the north campus had both.

My wife was a patient in the ER, and both times was unlucky enough to have Pranulis as a doctor, and a beauty-school dropout as a nurse.

Sheesh said...

What irks me about ER is they did this million dollar revamp and they should've put an xray room IN the ER instead of down the hall...and CT even further away. This is the only hospital I've ever seen that has ER located a mile from Xray.
They have cute little signs up saying how they want to insure "your HIPAA rights and privacy" by keeping your door closed...but you have to be wheeled down the hall thru the waiting area for all to see as you go get your xray or cat scan!

Anonymous said...

In September my husband was having chest pain frequently and using his Nitro spray so frequently that he used a whole bottle in two weeks . Went to the ER and they told him he had gerd never called my husbands cardiologist . Went to baylor and had five bypasses to fix his gerd.

Med/Surg said...

"Try to stick to your own field (med/surg) when you want to downgrade others. If you dont you just end up looking stupid. Keep changing bandaids and leave the real work to the critical care nurses. Thanks stupid."

Alrighty now, Med/Surg is its own speciality, people think its so easy to be "medsurg" because it doesn't have an acronym (ER, ICU, CCU) that makes it feel "special". You might want to think on it some, Med/Surg nurses have to be versed in ALL systems with the ability to recognize decomposition in any and all of they pts systems that allow for transfer to a higher level of care (such as ICU).

Also keep in mind that most Med/Surg units (PRMC included) do not have monitors on their pts. They have to rely on actually VISUALIZING and ASSESSING the PATIENT!! There is no one else, no tele tech, besides the nurses on the floor watching that pts status. Also, that pt that need monitoring might be at the very end of the hallway, not directly in front of you as in ICU. The Med/Surg nurses have to be very aware of their pt status at any given time.

So much more than changing bandaids. Ever tried placing a wound vac on a decub the size of a small melon in a pts a$$ crack? Yea, the dirty work gets sent to Med/Surg. If you can't poop, if you poop too much, if you're VOMITING all goes to med/surg. If you aren't breathing well...sats at best in the 80's...still in med/surg...but yet they don't even have O2 monitors that are not on the dynamaps... that's a great idea. If you can't pee, if your pee is bloody, if it burns when you

Heck. Not too long ago I know of a pt that was sent to 5th floor asking for the "white heart pill, under my tongue"... she did have an accent, but come on people....the ER nurse hadnt even left the room yet and the pt said she'd been asking for this pill to stop her chest pain!! Talk about stupid, the ER nurse said the pt couldnt idenitify her meds!! What RN doesn't know what the "little white heart pill under the tongue" is??!! Needless to say the Med/Surg nurse identified the need, medicated the pt, stopped the chest pain, and initiated a tx to tele.

So when "the REAL WORK" is limited to the critical care areas I as a med/surg nurse will be greatly relieved! But until that day happens some respect for all units would probably do you some good. There is a place and a need for all specialities in healthcare, no one is more important. We all care for pts and want the best for their outcome. Just some people are obviously more comcerned with their own nursing egos that seem to grow substantially and are fostered in "critical care" areas. If every pt weren't "critical" in some way, they'd be treated as outpatients!

Anonymous said...

6:59 PM

"Med/Surg nurses have to be versed in ALL systems with the ability to recognize decomposition in any and all of they pts systems that allow for transfer to a higher level of care (such as ICU)."

So you are saying that you wait for your patients to deteriorate so that you can send them to another unit where they can be properly cared for? LOL we already knew that now didn't we.

"If you aren't breathing well...sats at best in the 80's...still in med/surg...but yet they don't even have O2 monitors that are not on the dynamaps... "

How do you know the patients sats are in the 80's if you don't have O2 monitors? If a patient like this was sent to med/surg it would either be a death sentence or they would quickly (once again) be transfered to a higher level unit by an overwhelmed med/surg nurse that doesn't know what to do. You can try to build yourself up with false stories like this one. It doesn't make you more important it just makes you a liar.

Stick with med/surg it is important, but stop trying to build yourself up with your inaccurate ramblings. You are just making yourself look stupid.

Anonymous said...

Needless to say this hospital has too many incompitant nurses. They got rid of all the experience nurses and settled for the little beauty queen nurses that their only for a pay check and dont really care about taking care of the patients.All they care about is looking in the mirrors combing their hair. These are the type of nurses Administration wants, because they have a certain look they want to send out . I say if PRMC get rid of the whole adminstration and start over even the head nurses and start over we might see better nursing care.

Anonymous said...

Re: Dr. Plummer. If anyone really cares about his patients it's him. He is the most compassionate and caring doctor in this town. What doctor gives out his personal phone number to patients? And if he were about the bottom line, why did he give up most of his practice and leave the hospital. And he hasn't worked at the hospital in over a year. One thing that patients complain about with him is that he doesn't give them everything they ask for...that's not incompetent, that's good practice and ethical.

Anonymous said...

this incompetency is not a gay issue...i have had those waiting room blues for over 30 years and 2 specific incidents...
25 yrs ago my mom was visiting from CA) she told me she she had chest pains and we went to st.joseph, she lay on the table for ages b4 anyone came in, she lay there so long we began to make jokes about it and several times i went to call for someone to see here...they did nothing and the doctor finally came in, did no checking of any kind, then told her it was not her heart...she went home to calif and her doctor said yes it forward about 10 years ago...hubby had severe rectum bleeding from a polyp removal from his we went to mccuiston emergency...he lay there for a long time, bleeding from his rectum and his fingernails turning blue...luckily a friend of his who was a EMT saw how bad he was and got someone to respond
so no, its not a gay issue, its a paris tx issue.

Anonymous said...

oh yeah and almost forgot about my several hour wait in the ER at old st jo about 3 years ago
had severe pains like stabbing in my back went to minor emergency clinic where they took blood, checked BP, EKG and then decided within a short time to put me in an ambulance to the real (slow) ER several hours went by b4 the doc came in and said it was not my then i had already felt like going home since they did nothing and by then the pain was gone. so no, it is not gay issue, it is paristexas issue.

Anonymous said...

Gaaawd. I know this is pretty old but GOSH. Most of the comments are so... Grayson/Fannin county-ish.

I was in WNJ at one point and (totally single at the time, no boyfriend, ever, nineteen years old.) this nurse was like 'Your boyfriend is a methhead.' and I said 'Do what?' and she said 'Yeah, he's been here for two hours, *first and last name*'. So she's smirking, really pleased with herself, explaining this guy had tested positive for an unidentified type of amphetamine and she knows even if there aren't physical signs of it, that definitely means he's on meth! I say "I honestly have never met anyone in my life who goes by that name, and I don't have a boyfriend." she DISAGREED with me and said I'd come to the ER with him before.

I've only ever taken my grandmother to the ER in Sherman. It was my first time at WNJ for anyone but my grandmother.

And she eventually came back and told me she'd confused me with someone else. I absolutely still remember the guy's name, and how now I know he tested positive for amphetamines. I think she was telling me that because I had tested positive for amphetamines, she got really embarrassed when she finally looked at my chart which said pretty clearly that I am prescribed Adderall, which is made of amphetamine salts. Hence, testing positive for amphetamines. Very relevant to my concussion. I could understand how a nurse employed in Grayson county wouldn't know the difference, though. ^_^ No hard feelings, you know?

Since then, I've ended up in WNJ ER three times, and every single time something ridiculous happens. I escorted an assault victim and FIVE staff members asked me on separate occasions if the attackers were black. All of them were surprised when I said "Uh... no? They were white kids." STRANGE pattern there, I'd say.

When my grandmother was dying of cancer, the doctor who came in said "What's the problem?" and it turned out he had NO IDEA what was going on. She said "Well, I'm rife with tumors, but other than that, I'm having difficulty standing up." SO, this doctor asked me if she was senile and what on earth made her think she was able to diagnose tumors in herself. Again with O_O

Another time I ended up there due to passing out at work(dehydration) and this same retarded nurse who told me about some stranger's test results mistook me for a suicidal patient and gave me a ridiculous speech about why trying to kill myself would be really selfish and stupid. It didn't matter how many times I said "I didn't purposefully pass out, what are you talking about? Are you... did you take some pills from a patient? Are you OK?" she just WOULDN'T let up until she AGAIN, looked at my chart to prove me wrong, thereby proving herself wrong.

She might as well have said "Girl, you gotta stop thinkin' with your DICK, you know?"

That whole AREA is poison, bro. Get out while you still can.