Monday, November 10, 2008

Let me be specific - Hospitalists (i.e. Veshana Ramiah, M.D.) at Duke University are dangerous

I hate being specific about a medical facility that is treating my dad. God me the strength to avoid using their names.

1. Dad was hospitalized at Duke University Hospital for two (2) weeks in August 2008. The presenting issues were (a) extreme acute weakness, (b) severe infection (UTI) and skin lesions and (c) horrifying mouth sores caused by strong chemotherapy agents that made it impossible for dad to speak or eat without pain.

Dad was recent post complete left ankle fusion (i.e. metal was in the left foot). One of the very serious lesions was on the left foot. The other lesion was on the right elbow.

Who is in charge of the case? A hospitalist. Her name is Veshana Ramiah, M.D.
I use her name because she made some serious errors - starting with telling me that she "refused" to contact or cooperate with dad's treating oncologist or orthopedic surgeon. I told her that I would prefer that the clinic oncologist have input into dad's treatment plan. She told me (and this is a quote "I will not do that. I have the final say on everything."

Had this person ever known my dad prior to the admission?

What about consults? Hospitalists like to get consults! But the skill in the hospitalists rests with his or her ability to order the proper consults. There is also some need for the hospitalists to communicate with the patient's family, especially to the extent that the physician does not know the patient.

And, so what consults did
Veshana Ramiah, M.D. order?

1. Oral surgeon since the initial internal medicine fellow recommended and dad literally had not skin on his upper mouth? No. Remember, Dr. Ramiah has the last word and she attributed the sores to my father's "decades" of dental neglect.

2. Infectious Disease? No. Seemed odd because dad had an obvious irretractible infection. He had a skin lesion infection in November 2007 that Duke University ignored and dad was readmitted four days post discharge with serious pneumonia.

3. Psychology? Yes. Because all old men with infections act wierd. The group of psychiatrists, fellows, residents all agreed that dad was just stressed about being in the hospital and his quirkiness is "just him."

Of course, before psychiatry could make that conclusion,
Veshana Ramiah, M.D. literally snowed my dad on Ativan because of his agitation. Dad was agitated and confused because of the severe infection and extremely low blood sodium.

4. Wound management? Yes. He had wounds. And the wound management para-professionals have swell cameras.

5. Was dad in good shape when he was discharged from Duke University Hospital? Ha-ha-ha

Dad was discharged to home via ambulance because he still could not sit up. The fancy Duke Hospital never thought he would stand up again.

Mom and I worked with dad every day. We changed his bandages on his wounds twice a day. I carried my dad from the house to the car and drove him to rehab three (3) times a week.

It was *me* who realized there was something wrong with the left foot. I got dad to his orthopedic surgeron because dad was having trouble exercising.

2. Dad is hospitalized at Duke University Hospital for last three (3) weeks.

Veshana Ramiah, M.D. (the hospitalist from August) failed to order an orthopedic consult or even remotely think that an infection near fusion hardware may pose a significant infection issue.

Dad's Duke clinic orthopedic surgeon is great and got dad back into the hospital. But I made doggone sure that dad would be followed by the clinic orthopedic surgeon -- no hospitalists allowed. (I should have made a sign for his room that said that.)

Oh, hospitalists tried to get involved. They would come in and recommend that dad have a full Internal Medicine consult and the a full medical work up by Psychiatry to make sure that he did not have any other infections.

I told psychiatry to leave my dad alone. He had an in-depth analysis during the August 2008. Dad was taken off of the anti-depressant and put on Ativan prn and Sonata prn.

When I was away from the chair in dad's room, a junior psychiatry type evaluated him. And then she called me. "Acute delirium caused by hospitalization." The junior psychiatrist wanted to do a full medical work-up to make sure he had no other problems?!

In the last year, dad has had the most medical work-ups of his life! Everything has been tested over and over.

Dad is looking at IV antibiotics until late December 2008. Then the orthopedic surgeon will decide whether to apply external fixation devise or amputate the foot.

And my dad (who just finished the fight against colon cancer and then met to liver) is being dragged around by hospitalists such as
Veshana Ramiah, M.D. and Duke University Hospital.

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