Would you File a Complaint?

cyc0sys · Oct 9, 2018

Ground level falls are considered minor trauma with exceptions of the geriatric population which constitute the largest amount of fractures. The information you provided regarding the fall was very limited. So I'm assuming he didn't take a fall down a flight of stair, off a balcony, or from a height 3 times greater than standing.

The paramedic assisting your father probably took into account such information aka obvious mechanism of injury, how he landed when he fell, direct trauma to head and torso sustained, as well as many other things only experienced paramedics are aware of. In addition to the basics like loss of consciousness, nausea, vomiting, sensory deficits, limitations of ROM, and absence of spontaneous respiration which are all common in primary spinal cord injury and most nurses know.

Sometimes rigid C-collars and backboards cannot be applied without the risk of increasing injury. These devices may actually do more harm than good especially in the elderly e.g. spinal arthritis, kyphosis, hyperlordosis, risk possible increase of intracranial pressure if a head injury was sustained, airway management complexities etc.

Secondary spinal cord injury often occurs en route due to swelling, bleeding, and tissue ischemia so time is very much a factor. Again, I don't have enough information regarding your father's condition but the medic has less than a 'Golden Hour' to decide whether to stay and play or load and go.

It is doubtful the ED would place him in a collar unless something occurred to lead them to believe otherwise e.g. failed neuro check, swelling or bulges on the C-Spine. A CT scan of the C-spine may be appropriate but that depends on the protocol and the ordering ED doctor.

Professional courtesy goes right out the door when you start impeding care. The last thing the ED staff needs, is someone second guessing what they do every day. Even if you're a trauma nurse, you know there are ways to handle things if you think someone is being medically negligent. I'd urge you to consider, what would you do if someone came onto your floor and started making the same demands before you continue your course of action.

What was the final outcome? Was a fx to c-spine sustained?

Trauma Columnist · Oct 9, 2018

We are very sorry for this experience. However, we can't answer your questions. We ask that you consider discussing your concerns with the Patient Relations Dept at the hospital.

everchangingRN, ASN, BSN, MSN · Oct 9, 2018

I did speak with patient relations - didn't get anywhere.

everchangingRN, ASN, BSN, MSN · Oct 9, 2018

He had a fall from a top a hilltop, rolled down 50 feet. He sustained 8 broken vertebrae, 13 broken ribs, a left broken arm, a head injury, a left brachial plexus injury, of which he can not move his arm now. I was not demanding in anyway at all - I was simply asking them if they had done a neurochecks because his pupils were unequal. My mother said he landed in the ditch on their property and his head hit the driveway.

llg, PhD, RN · Oct 9, 2018

I don't think the Board of Nursing is the place to go with this. If you can't get the hospital's attention by filing a complaint and talking with the Patient Advocate, maybe it is time to talk to an attorney.

elkpark · Oct 9, 2018

I'm sure your state healthcare licensing agency has an office that takes and investigates complaints about care received at hospitals across the state. I used to work for the state licensing agency in my state, and we investigated all complaints that we received (and sincerely, thoroughly investigated them), cited the hospitals for any violations of state and federal rules/regs that we found, and followed up to make sure that deficiencies had been corrected. That would be another option for you.

The agency gets called something different in every state; it's usually a division of your state Department of Health and Human Services (or whatever that gets called in your state ... :))

Sorry to hear about your father. Best wishes!

JKL33 · Oct 9, 2018

I agree the BON is not the proper direction for this. I'm sorry to hear of what you and your father have been through, but I'm going to be blunt: You had concerns about the care rendered by EMS personnel, medical personnel, a general ED/hospital, and the care rendered by an RN. You haven't described how the care rendered by all of these entities has resulted in damages, but you feel it's appropriate to air your grievance by reporting to a licensing agency the one of these individuals that you identify with as an RN and know how to report. I think that is unethical, myself.

Contact patient relations again and tell them you insist on a meeting to discuss your father's care - with his permission, which I assume you have. If you don't get a timely response, consider reporting them to the division of your state's DOH responsible for hospitals. Contact CMS if you want. Contact the EMS agency to discuss your concerns with their care as well. There are a number of ways to reach out.

Secondly, run this by an attorney if you believe there are damages involved.

cyc0sys · Oct 10, 2018

Sounds pretty serious. Stabilization can be very difficult with the geriatric population, especially with head trauma, broken bones and possibly multimorbidities. Tensions were probably high for all parties involved which means they're possibilities things could get missed.

The procotol where I used to work, stated the neurologist must perform an evaluation prior to treatment if the patients is stable. Scans may or may not be ordered by the ED Doc. Usually they did for CYA, otherwise the Pt has to wait. Our neurologist was contracted with several hospitals and hours would pass before he even laid eyes on the patient. Unless he happened to be onsite @ admit.

Was the cause of the fall determined?

morte, LPN, LVN · Oct 10, 2018

I think the BON was perhaps inre to the cursing, which was not appropriate.

JKL33 · Oct 11, 2018

I think the BON was perhaps inre to the cursing, which was not appropriate.

Oh I get that. And of course I think using profanity in this manner (and possibly some of the other described behavior) is egregious.

Reporting to a BON for something like that is egregious in its own right; it is upping the ante significantly. It, too, is unprofessional. It is nothing more than, "You have offended me and I will be *sure* to make you pay."

I have seen at least a couple of posts lately where there was interpersonal difficulty and BON reporting was being considered. Neither post mentioned any harm to a patient whatsoever.

This is not okay. Is there nothing out of bounds any more? I just can't wrap my mind around such a disturbing reaction. My opinion is that completely losing sight of any bigger picture and becoming hell-bent on a vindictive action involves serious emotional instability.

allnurses Guide · Oct 11, 2018

Why in Heaven's name would you file a complaint with the BON? If in fact this nurse cursed at you it should be brought up with the hospital who is not required to let you know what actions they took in the matter.

Otherwise what you describe was inappropriate behavior on your part. I get that you were worried about your loved one, but your actions were impeding the assessment and care the nurse was trying to perform. It is not uncommon in these cases for family members who are getting in the way to be banished to the waiting area until assessments are done and the patient is determined to be stable or not stable.

I'm not sure what kind of nursing you do but imagine yourself in this same situation where you are trying to render care and a family member is in your face telling you how to do your job. I'm not trying to make you feel bad because emotions run high in these situations but I encourage you to look on this with a bit of perspective.

I read nothing in your original post that would be actionable by the BON. You would likely be wasting your time filing a complaint. You do have a right to ask the hospital what the outcome of your complaint was but they are under no obligation to tell you.

Most hospital's will only respond with something like "We are sorry this happened and we are taking measures to make sure it doesn't happen to someone else."

At the end of the day if no additional harm came to your dad in the ER then you need to put this to rest. Otherwise your anger will be like the old proverb ; "Holding on to anger is like grabbing hot coals and expecting the person you're angry at to get burned."

Hppy