Hospital born infections

trianglejohnJune 7, 2006

Some of you may remember me posting last fall about my father falling off the roof and breaking his neck and back and most of the bones in his chest. Well here it is 8 months later and he is still in the hospital!!! He has become the poster boy for hospital born infections. He's caught all of them at least once and fighting them has taken a serious toll on his health. So far none of them appear to be drug resistant varieties but still...

After his broken bones healed he got to come home for a few weeks before going back in to have a heart valve replaced that was damaged by a staph infection. Ever since that surgery things have gone pretty much downhill. Kidney failure, depression, weight loss and now a pseudomonas infection.

After all this time he has exhausted the amount of paid for care from both his insurance and Medicare (did you know they have life time limits on care?? I didn't). All recovery and rehab work we now have to pay for out of pocket.

I guess my biggest question is has anybody ever heard of someone suing a hospital over these sorts of infections? I would be happy just to have them cover the cost of his recovery from the infections alone but it appears that our system is an "all or nothing" kinda deal. We have to sue for everything and blame them for all of it, which seems harsh when they really are trying to help him.

Anyway, I come from a large family and everyone is not in agreement over how to proceed. And I am not the power of attorney or executor of his estate. When we get together and panic sets in over what are we gonna do next, I am left wondering if people can even take legal action over something so hard to prove. How would you know where he contracted a bacterium - I mean some of it looks like hospital staff sloppiness but some of it could be from him touching something and then touching his wound site.

Any advice???

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Nope, no advice. It might be worth talking to the hospital on the chance that they might reduce the bill. but I doubt it. Remember that if you sue, the hospital can afford BIG lawyer bills a lot better than you can.

Now, to be practical about this. I really, really hope that none of you signed to be responsible for his bill. If you didn't, then the family doesn't owe a dime. It's HIS bill and if he can only pay five bucks a month, then that's it. All they can do is try and recover from his estate when he dies. Even if he is turned over to a collection agency, His family is not responsible....UNLESS someone signed to be responsible.

You don't state what his financial status is, but if he has reached a point where there is little or nothing, you need to see about getting him on the State Medicaid program. (this varies from state to state) It's there to take care of people with no funds and no insurance. Check with the Social Service Agencies in your area.

Good luck!

    Bookmark   June 7, 2006 at 12:30PM
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I had an appendectomy two weeks ago. I got a staph infection in the hospital. I don't think it is going to be a big deal but I have been amazed in talking to people how common this is.

I think you should buy a half hour of time with a medical malpractice attorney. Let him/her tell you if your father has a case and if they will take it on a contingency fee basis.

    Bookmark   June 7, 2006 at 12:38PM
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Since this is all taking place in another (and distant) state I have no idea if anyone has signed anything concerning his bills. He has great insurance and they have covered everything so far. The problem is that the recovery and rehab costs have limits. Unless you buy an extra long term package your insurance has a cap on how many hours of rehab they will pay for. This is for your entire lifetime. Medicare has the same policy. So he has now exhausted that limit. If he should survive and end up in a car wreck or suffer any sort of injury where he will need rehabilitation work, he will have to pay for it. He is only in his mid seventies and could easily need some form of rehab in the future. If he survives this mess. I would like to sue the hospital to recover some of those hours. Just to provide a safety net should he ever need it in the future.

My mother is another health nightmare in and of itself. He was supposed to be her caregiver. She needs lots of assistance just to do basic things. So she is now off in a different state living with my sisters. She wants to come home but there is nobody there to take care of her. She keeps thinking he will recover and be her caregiver but I don't see him regaining that much strength for years to come. I wonder how they can ever live so far out in the country again.

Anyway, the house they own is paid for and not worth a ton of money. I'm sure there is some money in savings somewhere but there probably isn't enough for all the medical care they both will need in the years to come. They keep telling us that he should completely recover and be his old "super-dad" self but I just can't see that happening. He was only supposed to be in the hospital for a month back in October of 2005!! So far all the predictions have been wrong.

    Bookmark   June 7, 2006 at 2:55PM
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I am so sorry to hear about your father's health problems.

Medicare does not have limits on lifetime rehab to my knowledge. There is a per diagnosis limit, but as far as I know, there is no lifetime limit; this is worth looking into. Medicare does limit the number of days at Skilled Nursing Facilities to a certain number of days per calendar year. Care at an intermediate care facility (ICF or ECF) is never covered by Medicare or health insurance except for Medicaid; this is considered a place to live in lieu of home and not rehab. Medicaid DOES have lifetime limits for number of visits or days in some states, but not Medicare which is federally regulated, although there are regional variations in how the rules are applied. Rehab at either a SNF (skilled nursing facility) or inpatient rehab facility is limited both by need and time. E.g. if your policy has (for example) 60 days of acute inpatient rehab, you don't automatically get 60 days unless that's what you need based on your progress and your goals; same for SNF care. But if you have a stroke the week after being discharged from acute rehab for injuries from a fall, rehab should be covered IF YOU MEET THE CRITERIA for inpt rehab (SNF-level rehab may not be if you've exhausted the # of days per calendar year).

Talk to the social worker or discharge planner assigned to your dad for clarification of what level of care he needs and what Medicare will or won't cover. He may or may not also qualify for some social security or other benefits. If your parents will both need long term care, you/they may have to sell or liquidate home/assets to fund long term care until your parents are Medicaid eligible.

Unfortunately, without longterm care insurance, costs for home health aides and unskilled care are not covered, and of course, neither are your mother's. Medicare will pay for rehab in the home if you are homebound, but rehab is "skilled" care (something requiring a license). A physical or occupational therapist comes in for a short therapy session once or more a week. It doesn't include bathing, 24 hour care, overnight care, household tasks, etc. Medicare/insurance pays for a licensed someone to come rehabilitate you or teach your family or caregiver to provide care you need, not to take care of you, if that makes sense.

I agree that it's worth talking to an attorney for a consultation. Huge numbers of patients do acquire infections in the hospital every year which causes deaths and disability, but just because the infection was acquired in the hospital, it isn't automatically a preventable complication. You have to prove negligence or lack of adherence to policies and procedures as well as damages to get a win in a suit.

    Bookmark   June 12, 2006 at 7:00PM
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I hate to admit it, but I have given up.

Dad continues to improve - though slowly. Depending on which doctor you talk to he is either doomed, or just sorta doomed, or expected to make a complete recovery after a long time in rehab.

All five kids got together this past week to celebrate my parents 50th wedding anniversary. I was only able to be there a few days so I don't know how everything is going to be handled, but my sisters seem to have everything under control.

The elements that bother me are when the nurse says that there is a limit to the time a certain thing is supposed to be done - like say a catheter from your bladder is only supposed to be in place for 15 days max. Otherwise you run the risk of infections. And they leave my dads in for 19 days and he suffers from horrible infections after they remove it. The infection migrates to his chest wound from the open heart surgery and he takes a nose dive when it ends up in his heart. When I ask why the catheter wasn't removed on time I get no answer. This sort of thing has happened over and over again. The doctor states that dad is not to be upright or to raise his arms above his chest or else he runs the risk of damaging the wound in his chest (the wound left after they re-opened his chest to clean out all the infected flesh). He is on blood thinners to help his new valve and so he tends to bleed too much. He must be limited to leg only exercises while laying down. In walks two physical therapists who talk him into standing up and they try to get him to walk to the bathroom to practice going to the toilet. Only after I throw an almight hissy fit do they check his chart and see that he was never supposed to upright! After that his chest wound starts bleeding and it takes close to 15 hours before a wound specialist is available to work on it and get it under control. Thats a lot of blood loss and all because someone got confused about the limits of his mobility. It has been one of these types of episodes after another. These things happen everyday to him. It is exhausting riding shotgun. One of us has to sit bedside all the time in order to make sure things get done on time and correctly.

Anyway it is in the hands of my brothers and sisters now. I have heard that there is a service that will take the medical charts and compile a report explaining everything about his medical care in laymans terms. A report like that is what I really want. I don't want to hear it from his doctor nor from my family members - I want an impartial expert to revue his care and health and write it all down so that I can see where things went wrong and why.

    Bookmark   June 20, 2006 at 2:03PM
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It does sounds as if there was some lapse in proper care. One thing that I did notice is your remark about the nurse saying that a catheter should be in only 15 days. This isn't true. Some patients have them in much, much longer, even years, with no trouble. If he developed an infection from it, it would have been likely to have been a bladder infection first and then a kidney infection.

The infection that caused all his problem could have started from all sorts of other things. Trying to tie the infection back to the catheter would be impossible. They would not want to remove it and then replace it. That's just asking for trouble. As it would be much more likely to cause an infection than just leaving it in. Nurses don't always know what they are talking about.

I certainly hope that things go well for him now. It's unfortunate that people that need open heart surgery are usually in a condition that they simply aren't healthy enough to fight off small infections that are not uncommon in any type of surgery. Even very minor surgeries can have unbelievable problems.

    Bookmark   June 20, 2006 at 8:29PM
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but he needed open heart surgery because a valve was damaged by the staph infection he caught his first week in the hospital. He was in the hospital because a roof he was working on caved in - he fell about 8 feet and cracked all the vertebrae in his neck, a few in his back, a few ribs and his sternum. Before all of this he was a very athletic and healthy 76 year old.

One reoccuring problem seems to be that he doesn't display the classic symptoms when he has an infection. His white blood cell count doesn't rise (apparently ever), he doesn't show a temperature rise, etc. By the time they figure out he has an infection he has crashed and is near death. I'd think that after the first couple of episodes they would know to look elsewhere for evidence of an infection. I can't tell you how irritating it is to hear, "but he doesn't have a fever!" or something similar over and over from the people giving him his care. We always suspect a problem when we see him sleeping too much or not making much sense when he is awake. We bring it to their attention and they always have some response like - oh well, that could be the medication....

I'm glad to hear that the catheter isn't really on a time limit. Since he has been in the hospital for so long (going on nine months!!!)and he has so many different problems, he has been on many different floors with different teams working on him. That means that lots of comments get shared with the family members sitting at his bedside (and often assisting with his care because the place is short staffed).


    Bookmark   June 21, 2006 at 9:20AM
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Oh gee!! Staph infections can be horrible. It's easy to see how it could just blow his immune system away. Then even the slightest thing would cause him great trouble. New strains of bacteria are turning up everywhere.

It could be that the whole hospital is not on its toes. It's a shame that the family has to keep such a close watch on the patient, but that seems the way it is now. Understaffing, poorly trained staff and just plain stupid staff are too common everywhere.

    Bookmark   June 21, 2006 at 1:08PM
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Is there a Social worker in the hospital? They can help coordinate care, handle communication, smooth out problems. There was a report on TV about a woman who went in the hospital to give birth, got MRSA infection that went to her brain and killed her. The problems your father had/has are horrible. I hope he can come home soon.

    Bookmark   June 23, 2006 at 3:58AM
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I hope your father will be on his way back to good health very soon.

My husband recently had surgery. Only one nurse checked his incision after the bandage came off. Only one! It's standard nursing care to check the incision (and bandage) of a patient who's had surgery. One of them asked what he was in there for!! Another one gave me a vague answer when I asked her about the medication she was pushing into the IV tube -- she didn't seem to know much about it. The nurse on the night shift -- the one who checked his incision -- knew all about that medication and everything else we asked her. She was really on the ball, an A-1 nurse.

    Bookmark   June 23, 2006 at 10:43AM
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The hospital he is at is large. They have a social worker and a patient advocate for each floor (he's been on several). They have been great about his needs after he leaves their care. They won't offer any medical info or clarification - thats not their job. They don't always do all the homework when they talk to you. I have had to remind them that he has been in the hospital, on a different floor, for a different problem before he was moved to this floor. They might suggest that he needs to be evaluated by a specialist and a test might be needed. Then they look perplexed when I tell them that he has been evaluated and tested, last month when he was under a different doctors care for a different problem. Same test, same hospital just different floors. Isn't this info in his chart? Haven't you read his chart? None of his nurses knew anything about the broken neck and back that happened in October, all they were focused on was his open heart surgery that happened in April. Normally I could understand this gap in communication - but he hasn't left the hospital between the two different crisis! And they really keep quiet once you tell them that most of his problems were due to hospital born infections. Infections he got while under their care.

I like all the nurses and techs that have worked on him so far. They all enjoy him and his sense of humor. They appreciate the constant bedside attention our whole family has given him (they find it amazing) and thanks us profusely when we help them (we do a lot of his therapy, cleaning feeding). It is a shock how they just don't have the time. He has difficulty swallowing after the fall, so getting pills down him can take quite a bit of time. They just don't have that luxury. But it seems unethical for us to take over giving him his medicine - isn't that stuff supposed to be monitored? how would they know we gave him all of the pills?

The whole experience has been an eye-opener.

    Bookmark   June 23, 2006 at 12:41PM
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That's the biggest problem with large hospitals. While a patient may have access to much more high tech treatment, they seem to be more apt to be lost in the shuffle. I worked in a 460 bed hospital for a good while, we had patients, that because of their condition, were known on every floor simply because their case were interesting. But I can see that with staffing cuts and the temporary staff that they use in emergencies, that is no longer true even in the smaller hospitals.

Don't worry about giving the medication. It's as ethical as your giving it if he were at home. Just make very sure that you keep a bed side record of when, howmuch and initialed by who gave it. The staff will appreciate everything that you do. It gives them time to tend to those poor souls that don't have anyone to care for them.

    Bookmark   June 24, 2006 at 8:53AM
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