Wednesday, December 29, 2010

Duke Medical Orthopedics & HIPAA violations ("Elopement Report")

September 10, 2010.  It was my birthday.  It turned out to be the beginning of one of the worst weeks of my life.

I was sitting in the Duke University Emergency Department.  It is not a place I like to be.  Too many memories of being there with my dad before his death.  Too much sadness.  Just too much.

Two physicians (whom I trusted) convinced me that I had a horrible and serious infection (osteomyelitis) and I had no alternative but to get to the ED immediately.  And so there I was.   

The surgery was September 13, 2010.  Two days later the stitches were popping out, I was vomiting every piece of food I tried to eat.  I felt worse.  The hospital was very noisy. At night, I took my pillow and slept in hallways.

Saturday September 18, 2010, an anonymous resident came into my room and said "there is nothing more we can do for you" and I was discharged.  I told him that my wound was open.  He refused to look at it and refused to get anyone else to look at it.  

My Chicago orthopedic surgeon telephoned me while I was still in the hospital and I told him the wound was open.  The Chicago surgeon told me that he would call the surgeon and talk with him.  I had absolutely no problem taking antibiotics.  I just wanted the wound healed.

I made plans to return to the Duke surgeon's office 4 days after the discharge.  I explained to the nurse that Duke orthopedic surgeon Dr. Mark Easley told me to not take IV antibiotics unless and until the wound was healed.

My mom was in the circle driveway downstairs crying (her husband recently died from the same infection and under Duke's care).  I left with a copy of the discharge summary, no prescription for pain medications, never having worn TEDs or SCDs --- all before 11:00 am.

Duke's response:  Duke resident Karl M. Schweitzer, MD wrote an "elopement report" and forwarded it to UNC Orthopedics and Cleveland Clinic.  Dr. Schweitzer did not have my authorization to release his fantasy report.  Only Dr. Schweitzer can know his reasons for sending the fantasy report.  But the fact is it incorrectly portrays me as a non-compliant patient and violates HIPAA (a federal law).  Not a great start for a new physician.

The typos are left as Dr. Schweitzer and Dr. Bolognesi approved them
ROI - Browser Chart - ROI Request #: 278702
Patient: HAHDY, CHERYL AHH     H54252
Dictated Hpt:     Final 09/18/2010     00:00 Discharge Summary
DATE OF ELOPEMENT: 09/18/2010.
MRN: R54xxx
Admitted: 09/10/2010
Discharge: 09/18/2010
DOB: 09/10/19xx
Discharge Summary Attending: MICHAEL PAUL BOLOGNESI, MD 
BRIEF HISTORY AND PHYSICAL FINDINGS: Ms. Handy is a white female who has had a prior left tibial osteotomy done by Dr. Easley in 2004. Unfortunately, she had chronic problems related to painful hardware, and this past July, she had her hardware removed in Chicago. Unfortunately, she developed some slow serous drainage from the inferior aspect of her wound a few weeks postoperatively. The patient did not return back to Chicago for a postoperative follow-up. However, she did arrive at the Duke emergency department on 09/10/2010, after she had been seen by the cardiologist, Dr. Biasing, in his clinic. He advised her to the emergency room, as he was concerned about a softtissue or bone infection at her surgical site. She had an MRI of her left lower extremity completed, showing an increased T2 signal in the proximal tibia, and it was concerning for osteomyelitis. The patient was admitted to Duke University Medical Center under the Orthopedic Surgery Service. Antibiotics were held in anticipation of surgical irrigation and debridement.
HOSPITAL COURSE: The patient was admitted to Duke University Medical Center to the Orthopedic Surgery Service. We had her evaluated with the Infectious Disease team and in collaboration, we deemed her an appropriate candidate for surgical irrigation and debridement of her left proximal tibia and suspected osteomyelitis. She was taken to the operating room on 09/13/2010 for this procedure. Postoperatively, the patient was in the ICU, PACU, and then transferred to the floor, where she remained on the Orthopedic Surgery Service, and was followed by Infectious Disease. She was maintained on IV antibiotics, and further recommendations as we awaited the operating room cultures to speciate. 
She eventually grew out a rare Staphylococcus, coagulase- negative species sensitive to nafcillin, but due to home infusion difficulties with that dosing, it was deemed appropriate for oxacillin on discharge. The patient was maintained weightbearing as tolerated on her left lower extremity, and underwent daily dressing changes postoperatively. She was maintained with TEDs and SCDs for deep vein thrombosis prophylaxis while in-house. She had a nutrition consult, and their recommendations were implemented. The patient was fitted with the PICC line with the provision of setting up with home IV infusion for antibiotics. This was completed without difficulty. 
On 09/18/2010, the patient was afebrile, with vital signs stable, ambulating, voiding, tolerating oral diet without difficulty. The pain is being controlled with oral pain medication. The Orthopedics team in collaboration with the patient resource manager and home infusions at the appropriate antibiotic set up for home, be delivered and started at 4 p.m. on Saturday. The patient was set for discharge on this day. She was set up with the appropriate Infectious Disease follow-up and Orthopedic follow-up, as well as the weekly labs to be faxed to the infectious Disease office. However, on Saturday 09/18/2000, the patient advised the Orthopedics team and staff caring for her, that she had made a phone call to the home infusion company and cancelled her IV antibiotics. She stated she was interested in a second opinion of whether or not these antibiotics were necessary. We offered her further evaluation by the Infectious Disease team, who have been following up closely to consider possibly an oral antibiotic, if she would be more agreeable to this. However, she refused this as well. She was advised of the risks of stopping antibiotics, given her complicated history and recent infection that has grown out the bacteria as listed above. However, the patient was adamant that she was going to leave the hospital, and refused all antibiotics. Dr. bolognesi was contacted and made aware of the situtation. He indicated that she would be leaving AMA and that Risk Management needed to be notified. Risk management was called for further consultation. 
On the afternoon of 09/18/2010, the Orthopedic team presented again back to the patient's room, to have her reconsider her choices, and to present her with AMA paperwork to be filled out. If she was going to leave against medical orders, we were going to have her PICC line removed for her own personal safety. However, we found her eloped and off the floor. All of her personal belongings were removed, and she was given elopement status on the day. The patient was never given any discharge instructions, although these were clearly available in her chart, and the nurses were prepared to provide her with our discharge instructions. A copy of our intended patient discharge instructions are available in the eBrowser. However, clearly the patient due to her elopement, never received these and refused any further treatment, she left prior to completing AMA forms.

KARL M SCHWEITZER, MD Department of Orthopaedics 

September 19, 2010 AT 4:14:47 PM
Michael P. Bolognesi, MD 
Department of Orthopaedics ELECTRONICALLY SIGNED ON

September 22, 2010 AT 3:27:17 AM

DD: 09/18/2010 DT: 09/18/2010 MEDQ/JOB: 249256/435034243

So why the HIPAA violation?  Why sabotage my ability to get medical care? 

When I presented to Dr. Michael Bolognesi's clinic three days after the discharge (September 21, 2010), my wound looked like this: 

And Dr. Bolognesi signed off on the Elopement Report (that never mentions the open wound) and faxed it to UNC Orthopedics on September 22, 2010.  Why?

This open wound was what I wanted Dr. Karl Schweitzer or any physician to examine while I was still at Duke Hospital.  Nowhere in Dr. Schweitzer's fantasy "elopement report" does he mention my open osteomyelitis wound.  The stitches were popping out and I was scared and in pain.

What was the end game for Duke?  Why were they ignoring the osteomyelitis and the open wound?  Why would they risk a federal HIPAA violation by sending UNC and Cleveland Clinic a ridiculous and unauthorized "elopement report"?  

Is it that Duke does not want me to get medical care?  That seems cruel.

Is it that the hydraulic oil issue from December 2004 also included surgical patients at Duke University Hospital?  Maybe.

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