Worried about getting blacklisted if I complain about care - what do you think?

[visionary123]

Okay, I need some advice. First some background: I graduated as an RN with my ADN last year. I had a long-time home care client which kept me adequately employed, and I had a lot of things going on with my family so I didn't actively begin to look for work as an RN until after my client passed away. I have only applied at hospitals since then, and not gotten any calls, so I am planning to start looking into home care again. I am older (49), but I have good references and graduated with honors. I have not been very aggressive because I am only looking for part time work at this time and am planning to go back to college to get my BSN in the fall this year.

Okay, now for my dilemma.

I won't go into the details (unless someone wants them), but basically I just had a situation happen that I would like your opinion on. I brought my 21-year-old into the ED for care on Sunday night because she was ill and rapidly getting worse. She did not get adequate care and was misdiagnosed even though there was heavy evidence of what was wrong (and I told the ER physician she had been very exposed to a highly contagious illness). The ED physician even told me that my daughter was not contagious and that she could go out in public without taking any precautions.

I was very frustrated when I left the ED because I knew that she needed treatment quickly, but then I had to wait until my clinic could get us in the next afternoon. They quickly diagnosed the obvious problem and set things up for me to be able to care for her at home. She is so contagious that they didn't want her in the hospital if it could be helped. She was (and still is) sick enough to warrant hospitalization, but since I am an RN and our clinic can do IV infusions, they wanted to try to have me care for her at home. The delay in proper treatment caused her illness to become more serious and she is now quite ill (but expected to recover). Her own doctor was not happy that the ED did not treat her immediately for what she called 'a textbook case'.

Some people have told me (including a physician and an RN) that I should file a complaint with the hospital and refuse to pay the bill. My husband also wants me to file a complaint. Personally, I am not worried about the bill itself because my daughter has insurance, but I am upset about the way my daughter's case was handled rather nonchalantly. I am especially upset about how ill my daughter is. It is highly likely she would not have gotten this bad if she had been given the proper medication in a timely matter. Also, I think that physician made a foolish error by telling my daughter that she wasn't contagious, didn't have to wear a mask, and could go back to college when she had all the symptoms of the highly contagious illness that she had been exposed to.

I am not interested in getting anyone in trouble, but I would like the ED physician to realize that she potentially put my daughter's health in serious danger, plus could have put the public at risk by insisting that she wasn't contagious. However, I would also like to work at this hospital some day - this is where I've done most of my clinicals and I really enjoyed working on the med-surg floor. Not only that, but all the hospitals and most of the clinics in our area are in this same system and I am afraid that I might get 'blacklisted' if I file a complaint with the hospital. What do you think? I am not talking about whether they should be able to 'blacklist' me or not; I am trying to be realistic - do you think if I make a fuss that it could potentially affect my chance of being hired by them later? I feel like I have a moral dilemma - I want to do the right thing, but I also want a job later!

I don't know if I should file a complaint and potentially risk not being hired to work in this medical system (which is almost the only option in our area besides some LTC facilities)? Or just let it go? Do you think I'm being silly to even worry about it possibly affecting future employment?

[jadelpn, LPN, EMT-B]

And do not be surprised, OP, if in fact your daughter decides not to file a complaint. Sometimes kids who are adults choose not to involve themselves in complaining.

However, if she is covered under your health insurance (and that is probably the case if she is a full time college student), call your health insurance company and ask them how to stop the payment, whatever language that they use. They may tell you that your daughter needs to proceed. However, if you are the owner of the insurance, then you should have a say.

Complaining to the hospital will more than likely get you nowhere. And what is the goal? However, infection control may be interested in this, as your daughter exposed an entire ER to a contagious sickness, staff, etc. So if there's a parent company, and there is an ethics complaint department, then by all means have her use it. You can do this anonymously, the correct people will get the correct information, and your name wouldn't be part of it.

It is tough to ask questions when you are the parent of an adult child. There are a number of facilities who don't allow parents any information, have them out of the room, etc. If this is the case, then be sure that your daughter heard what was said to her and understood it. During finals weeks, the last thing a kid wants is to not finish out the college year. Perhaps that and the fact she was so ill she misundersood, selectively heard what the doctor was telling her. If you heard all of this yourself, first hand, speak with your daughter one on one when she is better. Ask her if she would like to pursue this further. Now if you or your husband end up ill because of the lack of correct information, then that is another story all together.

Good luck and let us know how it goes.

[visionary123]

jadelpn, I was in the room with her the entire time. I have read a lot of good advice on here - especially liked the comment from nurse156 about the mama bear instinct running deep. Haha - that is so true! I think I will wait until my daughter recovers and then talk to her about it and allow her to follow up if she so desires. I've had to contact her college instructors because she was too ill, but they have mainly been supportive; most of them have offered to give her an incomplete so that she can recover fully and then finish up her last week. Poor girl was supposed to graduate this week .

[Anna Flaxis, BSN, RN]

OP, I don't want to minimize your daughter's experience, but something is nagging at me. I guess I'm just a skeptic at heart, and I don't take things at face value without doing some critical thinking.

Was the "textbook case" in this instance meningitis? If so, how do you know your daughter was misdiagnosed? Was a lumbar puncture performed in the ED? If so, what were the CSF results? Did the clinic perform a lumbar puncture? If not, they cannot know she has meningitis- they are only guessing.

I guess none of this has any bearing on your question, but for me, before lodging a complaint of misdiagnosis and substandard care, I'd want to make sure that's what really happened.

[SeattleJess]

Neither you nor your daughter should respond in the heat of the moment. Deal with issues as they come up.

Seems like insurance will be the big issue and the first place where you should raise your concern. I know my insurance company is always looking for any way to cut costs and paying for care that is the result of negligent care and written off by the hospital would certainly be one of those ways.

As for future employment, blacklisting and retaliation is a reality but if this hospital has that culture, would you really want to work there? I know that the hospitals I have my eyes on take patient care very seriously. They would want to know about errors so they could improve and would not retaliate. I worked for an organization that did not have this culture and never, ever again will I do that.

There's also the truth that everyone (you, too) will commit malpractice at some point in their careers. (These words of wisdom came from my first mentor, a talented and top-rate professional.) You may gain some perspective on the situation by consulting an attorney. It may be too soon to tell if your case is worth pursuing through the legal system but you undoubtedly would get better advice about how to proceed from a professional than any of us can give you. (Though there has been some excellent advice, don't get me wrong!) Make sure he or she is experienced in med malpractice and has a good reputation.

Wishing you and your daughter a speedy and complete healing.

[visionary123]

SeattleJess, I honestly don't know if this hospital would have the culture of retaliation or blacklisting - I just didn't want to take a chance. I highly doubt that ALL of their facilities would, but I still want to be careful. I felt much better just by posting it here and getting some opinions. She had to go into the ED again a few days ago (six days after the initial ED visit). This time, I chose a different facility, but it was still the same hospital system. They gave her excellent care - I couldn't be happier with how they handled it. My daughter is now well on the road to recovery, and although she is weak as a kitten, she should make a full recovery in the next couple weeks. We also found out that this hospital system will send out surveys about both ED visits, so my daughter will have a chance to air her concerns as well.

Thank you everyone for your advice.

[visionary123]

Stargazer, sorry, I realize that I never answered your question. My daughter did not have meningitis. She had chicken pox. She had had it when she was 10 months old, and when she was ten years old she broke out in a mild rash after being exposed to a child who had a rash from her varicella immunization. Because of these two earlier chicken pox episodes, the ED physician insisted that it was impossible for her to have chicken pox again despite having been heavily exposed to it by four young children in the past month.

I insisted that she do some blood work, and pointed out how swollen her spleen was. She did the blood work and came back saying that her platelets were low, and her white count was 2.4, so she did have a virus, but that 'the virus was likely caused from her being under stress because of her finals coming up in college' and told her that she was not contagious! I still can't get over the fact that she told her that a VIRUS wasn't contagious.

While my daughter was laying on the hospital bed in the ED, she broke out in approx another 200 pox during that 90 minute period. The nurse came in to give us our discharge instructions and part of it was "bring her back in if she gets very many more spots'. I actually laughed and said "Why bother? She has broken out in at least 100 to 200 more spots in the last 90 minutes and the doctor still doesn't think this is anything to worry about." (This outbreak stemmed from a 2-year-old getting shingles (she'd had chicken pox at 12 months), and both her 13-month-old brother and 2 week old brother ended up with chicken pox. My daughter was helping at their house extensively as she assumed she was safe from contracting chicken pox.)

Her own clinic couldn't get her in before two the next afternoon, and although they prescribed Acyclovir immediately, she had missed the 'magic' 24-hour window they like to start Acyclovir within. Her clinic wanted to keep her out of the hospital because of how contagious it was so they said they could provide outpatient support via their infusion room and since I am a nurse decided to see if we could get through it at home. Before the week was out she had chicken pox over most of her body, as well as on internal organs. She even coughed them up as they shed off of her lungs.

Anyway, I had no idea how horrible chicken pox could end up being. My young granddaughter ended up in intensive care with encephalitis after being exposed at our house. My own 21-year-old did not end up recovering quickly as we hoped she would. It affected her liver and spleen. It was later determined that she had likely also had mild encephalitis. She has had to go into the clinic for several repeat blood tests, and her physician advised it would likely take her all summer to recover fully, which has certainly proved true.

And we never did get the usual survey from the hospital, so my daughter did not have a chance to share her feelings about her experience with that particular physician.

[Anna Flaxis, BSN, RN]

Thank you for coming back to clarify.

Edited to add: Sorry, I was typing up a response when I got interrupted.

I do not work in Risk Management, so I don't really know what I'm talking about, so take this with a grain of salt, but I would think that a well written letter, not emotional but more of an informative letter just letting them know what happened, might not be a bad thing.

Doctors are not infallible and it can be very helpful for them to know when they mess up so they can continue to improve their practice. This doctor could potentially be a better physician having this information. If there were to be an investigation into this, then it could result in more education for the ED staff- which would potentially be a good thing.

A good hospital to work for would take a systems improvement approach to this- they would ask themselves "How can we do better/prevent this from happening again?", rather than taking a punitive approach. Improvements could be in the form of more education/training in areas like infection control, triage practices, and continuing medical education.

But they will not have the opportunity to do this unless you tell them what happened.

If the hospital were to take a punitive tack and/or "blacklist" you, then I would imagine this would give you pause about whether this is a hospital you would even want to work for.

[kanzi monkey]

Thank you for coming back to clarify.

Edited to add: Sorry, I was typing up a response when I got interrupted.

I do not work in Risk Management, so I don't really know what I'm talking about, so take this with a grain of salt, but I would think that a well written letter, not emotional but more of an informative letter just letting them know what happened, might not be a bad thing.

Doctors are not infallible and it can be very helpful for them to know when they mess up so they can continue to improve their practice. This doctor could potentially be a better physician having this information. If there were to be an investigation into this, then it could result in more education for the ED staff- which would potentially be a good thing.

A good hospital to work for would take a systems improvement approach to this- they would ask themselves "How can we do better/prevent this from happening again?", rather than taking a punitive approach. Improvements could be in the form of more education/training in areas like infection control, triage practices, and continuing medical education.

But they will not have the opportunity to do this unless you tell them what happened.

If the hospital were to take a punitive tack and/or "blacklist" you, then I would imagine this would give you pause about whether this is a hospital you would even want to work for.

Agree with everything here. Trust me--that doctor wants to know about this. Most likely she will never forget it and this will help to inform her practice and teach others. I'm sorry your daughter and family went through that experience.

[llg, PhD, RN]

I do not work in Risk Management, so I don't really know what I'm talking about, so take this with a grain of salt, but I would think that a well written letter, not emotional but more of an informative letter just letting them know what happened, might not be a bad thing.

I had a similar situation once -- receiving 2 significant wrong diagnoses within 6 months of each other at the clinic where I went to graduate school. One problem left me 3 permanent disabilities.

A lawyer friend of mine and I had a talk -- AFTER the initial crisis was taken care of and I could reason through the situation calmly. I was a nurse, my father was a physician. The attorney's father was a physician and his wife was a nurse. We had made mistakes in our careers -- and would probably make others in the future.

So we decided just to be sure that they new of the mistakes they had made and did not file any official "complaints" or lawsuits. I even continued to receive healthcare at that clinic. They follow-up well with my care and the team had obviously discussed my case(s) -- and I was satisfied that they had learned from their mistakes.

I hope that the NEXT time I make a mistake (and we all make mistakes) ... the patient is as reasonable as I was.