Horrible care given to SIL post accident!!!

[barefootlady, ADN, RN]

Yesterday afternoon my SIL, a mail carrier in N.C. was hit by a car. In fact the lady who hit him did not even look to see what was behind her, backed into him as he was putting things into his car trunk, and pinned him between his car and hers. This SIL has a previous injury, 13 pins and a rod in his hip. Once the police got on the scene, took the information the EMS took him to the local hospital. No one asked him his pain level, took his vital signs, checked his history until an xray was done and they saw the pins in the hip. They immediately discharged him on crutches, without pain meds, or any type of teaching. They told him to call his regular doctor. In fact, during this whole incident a physician did not see him, a PA did, one who was very green. AM I wrong or does this seem like an act of "lack of prudent care by a facility"?

My daughter is in shock. She said even some of the worst facilities here would have done a better job. At least they would have called the regular ortho's office to check if a transfer or further instructions were warranted. My SIL did not want pain meds, he has an aversion to them and almost needs to be in ICU prior to taking anything, he did not ask for pain meds but he said the staff acted like he was there, under false pretense, to obtain meds. This after the EMS specifically told the triage nurse he was hit by a car. To top it off, the ER was not busy. He was the most serious of only 3 patients in the ER.

Tell me, since he is hurting, on crutches, and cannot bend over today does anyone besides my think he needs to call the PCP for further care and make a call to the ortho for further checking?:

[NewWayofLife]

He absolutely should follow up with his PCP and/or Ortho. Especially since he is hurting, but has so many issues with pain meds... that's something best managed by someone who already knows his history.

I'm sorry to hear he wasn't treated well in the ER. Getting X-rays done quickly is obviously a priority, but they should, at the very least, do a quick triage first (history, vitals including pain level, etc), but given that he came by EMS, maybe they took his history, etc from EMS? Not that it's an excuse to treat someone badly, but does he list several pain meds as "allergies" d/t the problems he's had with them? I find this makes many ER docs/nurses skeptical that A-the patient is looking for something stronger "i.e. I'm allergic to everything but my drug of choice" and B- that the patient has been on multiple narcs in the past, and therefore may have an issue.

I hope he does follow up with his PCP or ortho soon, and that he makes a quick recovery. Many of us just don't realize what our mail carriers go through, and we should be more grateful to them.

[Diary/Dairy, RN]

Next time.... head to NC Baptist up in Winston-Salem..... They have an awesome trauma team there..... do TONS of trauma cases..... I worked on the trauma med-surg floor there for 3 months so I know whereof I speak....

As for the other hospital... perhaps a letter of complaint to the board of directors and the medical board are in order.....??

[Altra, BSN, RN]

given that he came by EMS, maybe they took his history, etc from EMS?

This seems likely. And even when this is done, I, and every other ER clinician I've ever met, will still approach with the patient with, "tell me what happened today." This is to correlate information, gain additional information, and to assess the patient. Patients/families do sometimes interpret this as Clinician X didn't know anything about me! Word choices such as, "I have heard about your accident today, but I'd like to you tell me about it too so that I can hear it first-hand" can go a long way toward helping patients/families understand the assessment process.

Not that it's an excuse to treat someone badly, but does he list several pain meds as "allergies" d/t the problems he's had with them? I find this makes many ER docs/nurses skeptical that A-the patient is looking for something stronger "i.e. I'm allergic to everything but my drug of choice" and B- that the patient has been on multiple narcs in the past, and therefore may have an issue.

I agree that this may have played a role, though this is purely speculation as I do not know (and do not need to know) exactly what the patient's "issues" with pain meds are.

I do think the mechanism of injury warranted eval by a physician. I'm not sure what to make of the statement that no vital signs were obtained shortly after arrival -- what clinician will see a patient without knowing the VS or obtaining them?

I hope he does follow up with his PCP or ortho soon, and that he makes a quick recovery. Many of us just don't realize what our mail carriers go through, and we should be more grateful to them.

Absolutely, follow up with PCP ASAP.

[birdgardner]

If he was on the job at the time he was hurt, he should go through all the necessary steps that would let him get disability if he should need it.

[barefootlady, ADN, RN]

My SIL does not take narcotics. He did not ask for narcotics. He was not asked for allergies in that ER. EMS took the only vitals taken. This whole story seems like a comedy of errors unless you are the one involved. No physician saw him, only a PA. He has gotten in touch with his ortho at Baptist, will see him next week or told to come to the ER there if any problems occur. I was amazed as this story unfolded. The whole thing is a mess.

[Roy Fokker, BSN, RN]

No physician saw him, only a PA.

This isn't unusual.

All PAs/NPs in my ED run their cases by the attending but the attending doesn't see all patients.

This includes some trauma cases as well. I know of at least 4 other area/regional centers that have similar practices in their ED.

ALL that being said - your case does seem like a few balls were dropped along the whole process. Would definitely write letter to Manager/Director of ED with your concerns and complaints.

Good luck.

[barefootlady, ADN, RN]

Hi Roy,

Clearly, I either expect a higher level of care than is given today, or I am so old fashioned in my nursing I do not see the forrest for the trees.

I have dealt with PA's and NP's. I have no issue with being treated by them in routine circumstances, but this was a little more than routine. I am not stretching the truth in any way. When he contacted his boss at work, his boss had a fit, and told him to talk to a lawyer, clearly there is something wrong here.

I am amazed that this PA did not take his own vitals, did not ask for allergies, did not ask about home meds, did not bother doing any teaching about crutches. My daughter, who has lived with nurses and has a BIL doctor, ended up getting the crutches the right length for her hubby.

One thing that is interesting, they forgot to give him that famous excuse of returning to work, on crutches, as a mail carrier, after one day off. When his boss called the facility, after he called and requested the excuse be faxed to his job, the nurse there told his boss, "this must be a mistake, I think they meant more than 1 day off, I will make it for 5". LOL! Who gave her this authority to just change the orders?

Yes, clearly someone dropped a few balls here.

[barefootlady, ADN, RN]

Oh, I forgot, there will be a letter sent to the Director of the ED, DON, and chief

medical director. That is for starters.

Funny thing is, yesterday morning the facility called about billing this visit. SIL told them to call the police and get the information, he was too sore to be bothered. LOL!