My daughter's experience today in a Phoenix Emergency Room

[PeaceonearthRN]

I am appalled at the treatment my daughter received tonight in Arizona while visiting an ER.

She is in Arizona because her fiance is in school there; she was mugged a few months ago and fell hurting her knee, her leg etc. She is unable to see a primary doctor until she has a well visit.

Tonight, she went to an ER with complaints of knee swelling, nausea and an earache. She has had chronic ear issues since she was born. The type that 'there is nothing there' and five hours later she is getting narcotics for pain and the ER doctor sees fungus growing inside her ear! She was mugged two months ago in Phoenix!

Today, she was desperate to get some relief for this knee pain. It is swollen, her hands are edematous , she feels sick to her stomach from the pain etc. Some of this could be from anxiety due to their financial roller coast and trying so desperately hard to find jobs. Some of this, I am certain, is from being in pain.

When the ER doctor 'Ken' saw her, his response was " 'if you want a pregnancy test, you can buy one at the dollar store'. As well, he informed her that he did not want to waste the ER's resources and x-ray her knee.

Unfortunately due to her difficulty in locating a job, she is currently on Mercy Care. I am all too aware of the low reimbursement rates for Emergency Room Physicians as well as ER visits and testing. We are going to write a fact filled letter to the CNO; however, this is unacceptable.

She tried to get treatment at Urgent Care but their x-ray machine being broken.

This is a despicable state of affairs in our Country.

How ironic that I wrote a thesis back in l993 about 'Women, Mental Illness and Misdiagnosis'. How deplorable that this is 2009 and this type of activity is continuing! She realizes at 21 years of age that an ER is NOT a walk in clinic. Unfortunately, she has had a heck of a time getting established in Arizona; the mugging was just one of the many highlights of her last sixteen months of residency.

As a nurse and a mother, I feel helpless. I am thousands of miles from her. My advice 'take 600 of Motrin , put ice on it and find another hospital to treat you'.

Not everyone that walks in an ER is just looking for hand outs!

[Not_A_Hat_Person, RN]

I hate to say this, but if your daughter is (or looks) Hispanic, prejudice may have been a factor.

[PeaceonearthRN]

She is as lilly white with black hair and blue eyes. She is about as hispanic as her Irish Grandmother and Greek Grandfather!

[pererau]

Without having been there, I can't say for sure, but a couple of points:

1. If there was no reason to do a pregancy test, then the doc made the right call: go to the dollar store and get a kit. Both of my wife's pregancies were diagnosed with dollar store kits. The only reason to do a pregnancy test in the ER is if they are going to give certain drugs or if they are going to do an x-ray, which brings me to

2. With knees, the ottowa rules are pretty acurate in determining the need for an x-ray exam. If she did not meet the criteria, then it really is a waste of your money and the hospital's resources to get her knees looked at by x-ray exam. If there is concern about internal knee derangement, then what she needs is a sonogram or an MRI, neither of which should ever be done in the ER except in those extremely rare circumstances where the limb is in true jeopardy if it is not done immediately. In your daughter's case, the injury is over 2 months old, so this obviously does not apply.

3. I'm not sure what you were referring to with the "fungus in the ear" part, but if ear pain is a chronic issue for her, then it is not an emergency condition unless something has changed dramatically.

I don't want to be condescending to your daughter - like I said, I wasn't there - but from what you wrote, it really does sound like she got the proper course of action: an assessment with determination of no emergenent condition. The gold standard medication for such a condition is ibuprofen or naproxen as these will relieve pain and reduce inflammation. Otherwise there is very little that an emergency deparment can do.

Speaking as someone who needed medical attention at a time when I had no insurance and little money, I understand the difficulty that she is facing, but honestly and frankly, what she needs is a primary care doctor, or even better, an orthopod to follow her and get her on some various treatments to help alleviate the pain. An emergency doctor is expert in assessing for emergencies, not in treating non-emergent pain. In the meantime, rest, ice, compression, and elevation along with NSAIDS is the key.

[rn/writer, RN]

I'm thinking the response she got had more to do with youth than ethnicity. Young people are often assumed to be "up to no good." Whether it's sex, drugs, alcohol, or whatever, there can be a presumption that the "problem" is at least partially self-inflicted, and that renders such a patient far less sympathetic than someone brought in from, say, a car crash.

I saw this with some of my kids when they were in their late teens/early twenties and I had to take them into the ED. I had to intervene more than once and call out some folks on their judgmental attitudes. Fortunately, once the matter was exposed, the staff members changed their approach, but I dread to think what might have happened if I hadn't been there. If the kids had gone to bat for themselves, they probably would have been labeled belligerent and treated even worse.

The worst experience? One of my young married daughters was having a baby a thousand miles away. She'd had a c-section (vertical incision) with an earlier pregnancy and a section was scheduled with this baby, too. She went into labor before that date and was in such agony she could hardly speak. Her husband was unavailable, so she went in by herself. She was admitted, but there didn't seem to be much urgency. The doc would come over after office hours. My daughter called me and told me she felt like she was going to split in two and they wouldn't listen to her. I called the hospital and asked to speak to her nurse. Of course, she said she couldn't tell me anything because of HIPAA. I told her that she didn't have to tell me a thing. I was going to tell HER. I said that my daugher was pretty stoic and with her history and what she was describing, it sounded like she might be having a uterine rupture. I promised her that if anything happened to my daughter or that baby, there would be aggravation like she had never experienced.

She got the doc over to the hospital, and that baby was born very quickly. Oh, and my daughter's uterus was definitely in the process of coming apart near the old incision. We could have lost them both because she was young and alone and the nurse made judgments that she was being overly dramatic.

I'm so sorry that your daughter experienced this. You are right to write that fact-filled letter to the powers that be. Include times, circumstances, quotes, and as many names as you can.

In the future, I would encourage her (and any other young person in need) to take an older friend along to the ED, if possible. It's sad that our young adult children may need to "borrow" credibility that way, but if it gets the job done, then they should do it, and make the necessary complaints later.

I hope your daughter feels better soon.

[PeaceonearthRN]

She needed help with the pain until she could find an appointment elsewhere. She is a kid. She did not ask for a pregnancy test nor did she indicate she thought she was pregnant.

[PeaceonearthRN]

"the primary care doctor cannot see her until the end of march'. as well i am certain she needs an mri but no one has done one even when she was mugged. somehow, you missed the point. there is no doctor to see her, she is in extroidinary pain, tried the right route at urgent care. she has chronic ear infections and again, has not been able to get an appointment anywhere. i am just pointing out that not everyone intends or wants to use an er as a clinic but often can no longer take the pain or whatever issues is occurring.

speaking as someone who needed medical attention at a time when i had no insurance and little money, i understand the difficulty that she is facing, but honestly and frankly, what she needs is a primary care doctor, or even better, an orthopod to follow her

' i'm sure this might happen if she ever has real health insurance'. phoenix system is apparently hard for a 21 year old to navigate'. however, if you know a place that is not in the badlands and they will do an mri for her, please email me. i wish i could help her identify the proper resources and in a place that is safe. how do you think she got mugged to begin with? the kid can barely walk on this leg. if you have someone that will see her, please send me the information!

[kmoonshine, RN]

Please don't take offense by what I'm about to say...

Your daughter went in with multiple complaints; some docs say "pick one". The solution to "nausea" was get a preg test at the dollar store. Now, soft tissue swelling of the knee from an injury months ago - an xray wont help. And there's no need to subject your daughter to the radiation. I'm wondering why the urgent care clinic couldn't give pain meds?

MRI's tend to be hard to come by. I've only had one pt in the ED have a stat MRI, and that was for a trauamtic brain injury with some very odd neuro symptoms. I've noticed that its hard to get an MRI even if you have a PCP and insurance! It took my husband over two months to get an MRI of his wrist, and I won't even get into the hundreds of dollars we had to pay out-of-pocket (in addition to what insurance paid). So unless this is a chronic condition or obvious injury that would result in deficit if not corrected, a MRI probably wont happen for months.

Now, I'm not giving medical advice here or anything, but if the pain continues make sure she follows up - even if it is at an urgent care clinic (xray or no xray). I've seen people with septic joints that need to be tapped, and it doesn't look fun. The urgent care clinic may be more compassionate with her symptoms and can do a doc-to-doc call to the ED if her symptoms indicate something more severe.

Sometimes its easier to get in to see a PCP if you call and say "I was in the ED, I'm having severe pain, and I need to follow up with someone this week". Not suggesting to lie or anything, but if someone is in so much pain that they resort to going to the ED, then their doc needs to make the time to reevaluate their condition and plan a course of treatment.

[Vito Andolini]

I hate to say this, but if your daughter is (or looks) Hispanic, prejudice may have been a factor.

And maybe it wasn't.

[Vito Andolini]

without having been there, i can't say for sure, but a couple of points:

1. if there was no reason to do a pregancy test, then the doc made the right call: go to the dollar store and get a kit. both of my wife's pregancies were diagnosed with dollar store kits. the only reason to do a pregnancy test in the er is if they are going to give certain drugs or if they are going to do an x-ray, which brings me to

2. with knees, the ottowa rules are pretty acurate in determining the need for an x-ray exam. if she did not meet the criteria, then it really is a waste of your money and the hospital's resources to get her knees looked at by x-ray exam. if there is concern about internal knee derangement, then what she needs is a sonogram or an mri, neither of which should ever be done in the er except in those extremely rare circumstances where the limb is in true jeopardy if it is not done immediately. in your daughter's case, the injury is over 2 months old, so this obviously does not apply. why should an mri and sonogram never be done in er?

3. i'm not sure what you were referring to with the "fungus in the ear" part, but if ear pain is a chronic issue for her, then it is not an emergency condition unless something has changed dramatically. re-read her op.

i don't want to be condescending to your daughter - like i said, i wasn't there - but from what you wrote, it really does sound like she got the proper course of action: an assessment with determination of no emergenent condition. the gold standard medication for such a condition is ibuprofen or naproxen as these will relieve pain and reduce inflammation. otherwise there is very little that an emergency deparment can do.

speaking as someone who needed medical attention at a time when i had no insurance and little money, i understand the difficulty that she is facing, but honestly and frankly, what she needs is a primary care doctor, or even better, an orthopod to follow her and get her on some various treatments to help alleviate the pain. an emergency doctor is expert in assessing for emergencies, not in treating non-emergent pain. in the meantime, rest, ice, compression, and elevation along with nsaids is the key.

this is a 2 month old injury.

the girl never said she thought she might be pregnant! the doctor bringing it up shows he is an idiot. and that's the nicest word i came up with.

op: why don't you get a list of orthopods in phoenix and start calling them til you find one who specializes in knees and can see her asap? try reaching the nurse manager in these offices to learn who does knees and who has an ounce of sense and will get her in there. i know you're busy and yes, your dtr can probably call around herself if you don't have time. i hope you will write a letter about this to obama, your and your daughters lawmakers (senators, representatives), and any and all advocacy groups you can think of. this is just another example of the ridiculous health care we have in america and it needs to stop. help the cause of health care reform and your dtr at the same time. sorry for your frustration and anguish over your dtr's well-being.

[Vito Andolini]

i'm thinking the response she got had more to do with youth than ethnicity. young people are often assumed to be "up to no good." whether it's sex, drugs, alcohol, or whatever, there can be a presumption that the "problem" is at least partially self-inflicted, and that renders such a patient far less sympathetic than someone brought in from, say, a car crash.

i saw this with some of my kids when they were in their late teens/early twenties and i had to take them into the ed. i had to intervene more than once and call out some folks on their judgmental attitudes. fortunately, once the matter was exposed, the staff members changed their approach, but i dread to think what might have happened if i hadn't been there. if the kids had gone to bat for themselves, they probably would have been labeled belligerent and treated even worse.

the worst experience? one of my young married daughters was having a baby a thousand miles away. she'd had a c-section (vertical incision) with an earlier pregnancy and a section was scheduled with this baby, too. she went into labor before that date and was in such agony she could hardly speak. her husband was unavailable, so she went in by herself. she was admitted, but there didn't seem to be much urgency. the doc would come over after office hours. my daughter called me and told me she felt like she was going to split in two and they wouldn't listen to her. i called the hospital and asked to speak to her nurse. of course, she said she couldn't tell me anything because of hipaa. i told her that she didn't have to tell me a thing. i was going to tell her. i said that my daugher was pretty stoic and with her history and what she was describing, it sounded like she might be having a uterine rupture. i promised her that if anything happened to my daughter or that baby, there would be aggravation like she had never experienced. right on, mom!!! :angryfire :redbeathe

she got the doc over to the hospital, and that baby was born very quickly. oh, and my daughter's uterus was definitely in the process of coming apart near the old incision. we could have lost them both because she was young and alone and the nurse made judgments that she was being overly dramatic.

i'm so sorry that your daughter experienced this. you are right to write that fact-filled letter to the powers that be. include times, circumstances, quotes, and as many names as you can.

in the future, i would encourage her (and any other young person in need) to take an older friend along to the ed, if possible. it's sad that our young adult children may need to "borrow" credibility that way, but if it gets the job done, then they should do it, and make the necessary complaints later.

i hope your daughter feels better soon.

i hope you will or did write a letter to that nurse who had the good sense to let you scare her into action and i hope you will or did write to the don, the ceo, the coo, the doctor, the chief of ob doctor, the risk manager, and whoever else you can think of about how you had to get up-in-arms and in her face to get action. the nurse might have been inexperienced and just didn't recognize that "splitting" could mean dire outcomes. if she hadn't listened, i'm sure you were prepared to phone the doc's office, the nrsg sup, the ob floor manager, the local police, the fbi, and whoever else might have "under butt fire lit."

[rn/writer, RN]

Thanks for the affirmation. After the delivery, my daughter did indeed complain to the doc and anyone else who would listen. She had a whole lot of credibility by then as one of the baby's elbows was poking through the tear that was causing my daughter such pain. The nurse was quite shaken by the near disaster. I hope the lesson has stayed with her. The doc apologized profusely, too, as did the nurse manager and a few others. Everybody dodged that bullet.

BTW, the "baby" is nine years old now and he's a sweet and funny human dynamo.