A Broken System – The Elderly and Hospital Care

   According to the Chicago Tribune, in 2011, the Illinois Department of Public Health received 560 hospital complaints for inadequate services. Allegations ranged from patient abuse, inadequate infection control to more serious violations such as death. Of those 560 complaints, Illinois officials declined to investigate 85 percent due to a lack of funding. Many of these complaints also failed to reach to a federal level, thus many of these allegations were not further  investigated by the U.S. Department of Health and Human Services. So who is ensuring the welfare of hospital patients if hospital staff/administrators and state/federal officials fail to investigate allegations or complaints?  When someone is admitted to a hospital, it is expected that they are safe and given quality medical care.  It also is expected that nurses, physicians and other staff effectively communicate with one another to ensure adequate care is being provided. Recent events that have occurred with my elderly parents have in part contributed to writing this article. The objective of this article is to increase your awareness of inadequate patient care and encourage you to speak up and not remain silent if something similar were to happen to you.

   In December 2013, my father required emergency hospitalization to a hospital in the western suburbs of Chicago. The hospital he was transported to was not our first choice. However, paramedics don’t transport you to the hospital of your choice. Right from the start, I questioned if the ER nurse was adequately trained on how to communicate professionally to patients. This incident though appeared to be the least concerning of the many incidents that occurred during his hospitalization.  The one incident in which I am still trying to understand is how my elderly father who happened to be hospitalized for disorientation, fall in an intensive care unit? Is it not common knowledge that the intensive care unit specializes in treating severe and life threatening illness thus requiring the patient to be closely monitored? Unfortunately the poor care did not stop in ICU. Other serious incidents which occurred were the overuse and misuse of a highly potent benzodiazepine. The reasons for the use of this drug were never documented, nor were we informed that the drug was being administered. Despite our numerous requests to nurses and directors to have the drug removed, the drug continued to be administered. We were informed by one nurse that  staff administered the drug because my father was agitated and restless. Restless and agitated?  Is this enough to administer a highly potent benzodiazapine to an elderly patient with a history of dementia, pulmonary disease, heart and kidney failure?  If restlessness and agitation were sufficient reasons to administer this drug, then the entire world’s population would be on it at some point. At one point we were told that he may become dangerous, thus they administered the drug for everyone's safety.  The humor with this is that my father is a 5 foot tall, frail, 87 year old man, weighing 120 pounds when wearing his dentures.  How dangerous can he be? If there was concern about his safety maybe they should have been proactive and used the bed alarms which commonly are used with dementia patients who wander. Better yet, maybe they should not have administered as many doses of benzodiazepines as they did. 

   In a healthy individual, the half-life of the drug used (the amount of time it takes for the body to excrete at least half the drug) is 12 to 15 hours. For my father, that number is substantially higher due to end stage renal failure. The number of times in which this drug continued to be administered despite communicating with directors and nurses was quite alarming. Even more alarming is that they used this drug despite it being contraindicated in individuals with a history of pulmonary disease and kidney failure. Could the known side effects of this drug i.e. strong sedation/hypnosis, dizziness, drowsiness have contributed to his fall? Despite speaking to the patient liaison department, 3 different nurses and 3 nursing directors; the drug continued to be administered without consent.  It is quite alarming that my fathers records failed to specify our requests nor did anyone bring our concern to the doctor. No matter whose attention our concerns went to, no one seemed to take the matter seriously. I cannot count the number of times I was told someone was looking into the incidents. While we were trying to manage all of the above and get some answers from doctors, we were concurrently dealing with my mother having been transferred to hospice. Well, hospice is what they called it but obtaining the services appeared to require an  act of God.  We waited three days to transfer my mother to hospice and only were given a room when we went up the chain of command. The time we waited for the room was alarming however, what was disturbing was that we were told by one of the nurse administrators that they did us a favor by placing both of my parents on the same floor.  How compassionate of her!  What about addressing your staffs failure to communicate with not only the family but also with the physician and other hospital staff?  Unfortunately,  many people receive below average standards of care while hospitalized. Millions of people worldwide are harmed by poor hospital care each year. Despite one’s deep involvement with a family members care, significant negligence and inadequate care continue to occur. I can’t imagine what happens to those who don’t have advocates or family members involved in their care. Is it worth it to pursue a concern about quality? For many of us, it's not easy to act on a concern about the quality of care we or loved ones receive. The process can be stressful, frustrating and quite honestly emotional exhausting. And in the end, it's possible that others may not agree with the way we see the situation. Is it worth the time and energy to take action on concerns about the quality of hospital care?  Only you or your loved one can decide. In making the decision, think about the continued harm that might take place if you do nothing.  And think about how the actions you take might lead to better care for future patients.