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 A Patient' Case Study - Medical Records



Physician's Report of Fractured Arm.  Fractured arm occurred shortly after admission to the hospital.  Confirmed by comparison of x-rays.  I was witness to unusual repositioning of the patient.  Three staff members pulling on the arm that was discovered to be "acutely" fractured.  

Bed Pan Complaint Response. Patient was admitted to the hospital because of a wrist fracture and general physical condition following same.  While in the hospital I discovered the patient's metal "fracture" bedpan placed backwards under her.  I filed a complaint with the nursing supervisor who questioned the responsible parties.  They denied that the bed pan had been placed incorrectly.
Discharge Instructions.  The patient is deemed well enough to return home.  Discharge instructions are filled out.  The Patient is discharged. 
Duragesic Prescription.  When the patient is in  her home after being transported by ambulance she complains of pelvic pain.  She in brought to the hospital emergency room where she is not examined by x-ray.  Rather, the physician prescribes a stronger pain medication.  She is returned home via ambulance.  Again the patient complains of pain in the pelvis/hip areas.  She is taken to the hospital emergency room where she examined via x-ray.  It is determined she has a fractured hip requiring total hip replacement.

 

Blank Form For Surgery.  In preparation for surgery a release/informed consent form must be signed.  A nurse insisted that I sign a form which was "blank" and did not have a physician's signature on it. 

 

The Cost Comparison Analysis.  The patient undergoes the operation for a total hip replacement a day or two after being admitted.  She is being readied for discharge.  I ask for assistance from the Social Worker by having her develop a cost comparison between various nursing/rehabilitation facilities.  I receive less than expected and am chided for taking time attempting to find the best facility for her care. 
Nursing Home Was Not Her Residence.  The patient is transported to a Nursing Home\Rehabilitation Center.  This is listed as her residence by the ambulance transport service which is located in the basement of this hospital.  The patient eventually returns home after enduring an questionably managed facility. 
Eye Care Appointment Slip.  While at a branch of this health care system Lasik eye surgery was performed on the patient. During the procedure a nurse kept pushing the patient forward, injuring her eye.  The patient declines further treatment by the physician.  See "Have You Seen This Physician" on the home page.
Another Eye Appointment.  The physicians are aware that the patient can only tolerate sitting in a wheel chair for so long.  Little effort is made to accommodate her.  The patient had to wait so long that before an outpatient procedure was performed that she fatigued and had to return home.  when questioned as to how long it would be before she could have the procedure performed, the nurse stated another hour.
Investigation Request To Department of Health.  After having more than a few conversations with administrators regarding the condition depicted on this web site I seek help through the State Department of Health.  They promise to investigate.  They do.  They say they could find no deficiency.
Department of Health Regulations Obtained.  After many denials from proprietors and nothing found by State Health inspectors I obtain regulations from the Department  Health.  What does this look like to you?
An Invoice for Home Health Respite Services.  When you have to supervise the assistance you get (to keep them from accidentally hurting your mother or vacuuming the lavatory and then your home) it is really not worth it.

 


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