What to do when the doctor wants to discharge you from the hospital too quickly
Patients are increasingly being discharged with the same symptoms that brought them into the hospital
One of the interesting things about being a Houston, Texas medical malpractice attorney is that I have the opportunity to spot healthcare trends, based on the type of calls that we receive from potential clients.
Recently, I have seen a surge in calls from patients who were discharged from hospitals before their symptoms and problems were adequately treated. Two examples come to mind.
One of my clients, a man in his late 30s, went to an emergency room three days in a row with the worst headache that he had ever experienced. The pain was so severe behind his right eye that he felt it would pop out. On the first day, he quickly sought treatment at a Kingwood-area freestanding emergency room. The following two days, he went to the emergency room at Memorial Hermann Northeast Hospital, with the same problem, which was getting progressively worse.
By the third day, this man’s condition was much worse. A neurologist noted the concerning sign of ptosis (drooping eyelid), which indicated a neurological problem, but gave no explanation for it. The radiologist interpreting a head CT scan found an abnormality, but wrote in her report that she did not know what was causing it. Despite these problems, the neurologist and emergency physician wanted to discharge him quickly.
The patient’s wife begging the doctors and nurses to do a more significant workup, because she knew that things were getting worse three days in a row. The doctors documented his signs symptoms, but discounted them as being from a severe migraine. The man explained to them that this headache was unlike any migraine he had had before, but the doctors proceeded to discharge him from the emergency room. He went home and, a few hours later, he had a massive stroke that has changed his life forever.
Another new client of our law firm had a similar experience of being discharged from the hospital before her condition was properly addressed.
A lady visited my office recently about her mother’s care at a Houston-area hospital. This patient went into the hospital because she was dizzy, incoherent, and very tired. From other cases that I have handled, I know that incoherence, or altered mental status, can be a significant early symptom of a medical problem that needs immediate attention. She was admitted to the hospital after tests showed that she had fluid around her heart. The doctors started her on dialysis and she was kept in the hospital for 10 days.
At that point, the nursing staff told the patient and her family that the doctors felt it was time for her to go home. Her discharge instructions included resuming normal activity and going to outpatient dialysis three times a week, which the hospital had arranged with Davita.
The patient’s daughter drove her on the 15-minute trip home. As her daughter helped her into the front door, she suddenly went limp and collapsed. Her daughter immediately called 911 and paramedics arrived and worked on her for 30 minutes before getting her stable enough to load into the ambulance.
The ambulance crew took her back to the same hospital, from which she had just been discharged. The healthcare providers told the daughter that her mother likely had brain damage because of lack of oxygen that occurred when she passed out. The daughter was shocked when she spoke with her mother’s primary care provider, who informed her that a cardiologist had assessed the patient before release and noted that fluid was still around her heart.
In both of these cases, it is disturbing that these patients were discharged the exit door with the exact same problems that brought them to the hospital in the first place.
Lack of continuity of care
One of the issues that I believe contributes to premature discharge from a hospital is a lack of continuity of care. In both of the examples that I provided above, the patients were seen in a hospital setting spanning more than one day. That means that there were different nurses and doctors participating in providing care. Every time a new doctor or nurse becomes involved in a patient’s care, there is an opportunity for an information gap that can compromise patient safety.
Some hospitals have what I consider to be excellent policies and procedures concerning transfer of care from one nurse to a new nurse. I saw this first-hand at Houston Methodist Willowbrook Hospital, when a family member was admitted for a minor procedure. At each nursing shift change, the outgoing nurse briefed the incoming nurse on the patient’s status, orders, and test results. I loved that this briefing occurred in the patient room, which allowed the patient to chime in and provide additional information.
In other situations, significant things fall through the cracks. One of my clients was seen in a hospital emergency room two days in a row. On the first day, someone asked the patient to sign a HIPAA medical records authorization so they could obtain medical records from a freestanding emergency room where he was treated the day before. He was discharged before the records were obtained, so the HIPAA authorization to set in his folder. When he returned to the emergency room the next day, those records, and in particular the original head CT scan, would have been very helpful for the doctors and radiologist to see. No one at the hospital had gotten them, though. There was no passing of the baton and it fell through the cracks. The patient ended up paying the price.
What you can do
Now more than ever, I recommend that patients and family members should always be active participants in healthcare, asking questions, taking notes, and following up. Doctors and nurses are busy people, and I believe that healthcare can frequently operate in an auto-pilot mode, moving in a direction toward the most common conditions and treatments. While that may work frequently, it can be disastrous if you are the person who has an uncommon condition that requires a novel treatment.
Patients and family members can help their doctors and nurses by staying engaged in the process. Ask polite questions about why things are ordered and then request details or copies of the results. Keep notes about your condition and how it has changed, including your response to medications. Each time a new doctor or nurse becomes involved in your care, take if you minutes to tell them in your own words what is going on.
If healthcare providers start talking about discharge before you have been adequately treated, speak up. In some situations, it may take more than that, including a request for a second opinion from a physician. Remember, nurses have an independent duty to advocate for proper patient care. You can ask your bedside nurse or the charge nurse for assistance—even use words like, “I need an advocate here.”
We are here to help
If you or someone you care for has been seriously injured because of the inattention, mistakes, or negligence of a hospital, doctor, or nurse, call the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas. You can reach us at 281-580-8800, for a free consultation about your potential case.
Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. His practice is focused on filing medical malpractice and wrongful death lawsuits on behalf of patients and their families.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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87% of strokes are ischemic and 13% are hemorrhagic [...]read more
Academic/teaching hospitals do not consistently supervise still in their training, which can put patients at risk
87% of strokes are ischemic and 13% are hemorrhagic
Published in the July/August 2018 edition of "The Houston Lawyer" magazine
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