Friday, February 27, 2009

Joint Commission on Duke University Hospital

Today I received an email from the Joint Commission. The organization that accredits hospitals concluded that Duke University Hospital acted properly in September 2007 when they discharged my dad the same day he had a fall.

DUH acted properly despite the fact that dad was admitted with subdural hematoma and no one at DUH checked the status of the hematoma after the subsequent fall. DUH also apparently acted properly when they refused to provide my dad or any family member with discharge instructions. That conclusion is frightening.

We still have a few hospitalists at Duke that have not been held to account. The Hospitalists are:

Veshana Ramiah, M.D.
(2) Hope Uronis, M.D.

I am less concerned about the specific, individual hospitalists. In fact, I feel somewhat sorry for these physicians. I spculate that they have jobs as hospitalists because they lack the personal skills and clinical abilities to create and maintain a patient base.

My concern is with the hospitalist program model as a means of delivering medical care.

I reminded the Joint Commission that the September 2007 incident was by no means isolated. My email to the Joint Commission requests confirmation that all incidents regarding my dad have been investigated:

Ms. Legaspi:

I emailed you to ask which date of service this complaint encompassed.

Unfortunately, I have informed the Joint Commission of several incidents. And I do this because I don't want to sue Duke, I want Duke to stop hurting people. Because I have a blog on patient safety (, other patients at Duke tell me how their loved ones were actually killed while an inpatient at DUH (as recently as last Fall 2008). I know of a family who lost an elderly patient at Duke Hospital last Fall 2008 because the Hospitalist did not communicate with the treating surgeon. He died less than one hour after he was given the wrong medication! The family asked Duke for medical records, including nursing notes. Not surprisingly, the nursing notes were not provided to the family.

Specifically, in my situation, I find it hard to believe that your commission would have concluded that DUH acted properly during my dad's August 2008 admission. During that admission the Hospitalist (Veshana Ramiah, M.D.) flat out told me she refused to communicate with dad's primary care oncologist. The result, because he Hospitalist did not talk to the treating doctors, no one took a culture of the infection in my dad's foot. That infection was different than the infection on the remainder of his body because dad had metal in his foot.

No one figured out why the infection did not heal until November 2008. At that point dad had a tragic infection in his foot, lost a large portion of his foot and now and now risks losing his foot.

Dad has one more anticipated surgery for his foot. It is so unnecessary. This man has suffered so much because DUH Hospitalists refuse to communicate, cooperate and coordinate with Duke treating physicians.

Is that really acceptable hospital practice?

In addition, I informed the Joint Commission about an incident in November 2007. Dad's oncologist had dad admitted to DUH and specified that dad should receive 3 days of IV antibiotic for his severe skin infection. The Hospitalist (Dr. Hope Uronis) did not communicate with the admitting oncologist. On her own and presumably as a cost efficiency decision, Dr. Hope Uronis refused to treat dad's celluitis and discharged him without any antibiotics (except one single pill at the time of discharge). The day after discharge, dad returned to the treating oncologist’s office with continuing infection and pain. At that visit, the oncologist’s physician assistant was horrified that Dr. Hope Uronis did not administer any antibiotics to dad.

Three days later, dad was readmitted to hospital ED with very serious pneumonia. It took months for dad to completely recover from pneumonia.

Is that really acceptable hospital practice?

I want DUH to do a better job at treating patients. I do not want my dad to die like the other patients at DUH that have died because the Hospitalists do not communicate with Duke clinic physicians.

Please protect the public. Please.

Thank you for the anticipated response.

We will wait with baited breath to learn what treatments of hospital patients (especially elderly patients) are acceptable to those that accredit hospitals.

More later.

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