BOCA RATON, FL (BocaNewsNow.com) — //By Andrew Colton, Editor// — FIRST PERSON — If your child is admitted to the pediatric unit at West Boca Medical Center as our infant sadly was this past week, there are three things that you can count on: caring and professional nurses, competent doctors, and possibly one of the worst managed Respiratory Therapy departments in the United States.
I encourage parents to read the following experience which I share to help you make the right decisions during the first chaotic and often traumatic hours that parents face when a young child is admitted to a hospital. There is no political motivation here, although it should serve as a wakeup call to Tenet Health Care (NYSE:THC), the third largest publicly traded hospital chain in the United States and owner of West Boca Medical Center.
Our six month old son was hospitalized at West Boca Medical Center last Sunday with a severe case of RSV, a rapidly spreading flu-like condition that can be extremely serious — and potentially deadly — in infants. Despite ongoing treatment from his pediatrician, our son experienced shallow breathing, moderate fever, and a decreased blood oxygen level.
He was admitted through the emergency room.
While the nurses and doctors assigned to his care were top notch, the key to treating a respiratory ailment like RSV (Respiratory Syncytial Virus) is the division of a hospital known as “respiratory therapy.” These are the people who administer aerosol medication and provide therapies to facilitate a return to normal breathing. They are not doctors. They are charged with carrying out a doctor's orders.
At West Boca Medical Center, this is a department overrun with poorly trained students and their mentors who often present an unprofessional, self-absorbed attitude towards patient care. West Boca Medical Center is not a teaching hospital. It works with area colleges and tech schools to permit students to train there.
Caring Nurses. Undertrained Students. Poor English.
Over the course of four days with treatments scheduled between three and four hours apart — roughly 26 treatments — my wife and I often observed the worst of the worst. Students from schools identified after several formal requests as Palm Beach State College and Independence University for Health Science who were so insufficiently trained in the use of equipment and care of an infant that it raised serious questions about Tenet's oversight of the hospital. Students distracted their mentors and at times had such poor grasp of English that it was unclear what they were asking.
It actually got a point where unbeknownst to us, a charge nurse banned students from our child's care. She was concerned that their presence was distracting the respiratory therapists from providing treatment.
She was right.
A tear jerking example: instead of focusing on the treatment of our screaming six month old in excruciating pain while having a suction tube inserted through his nose into his upper lung, a therapist was focusing on the questions being asked by the students — questions ranging from “what does this dial on the wall do?” to “how do you silence a pulse oximeter?” (The pulse oximeter looked like an alarm clock with an easily identifiable 'snooze' button).
Incredibly, the therapist answered the questions instead of suggesting that a better time to go over medical equipment and its use would be after the completion of the treatment being provided to our infant and in an empty room.
In another egregious example, an overnight respiratory therapist took a telephone call in the midst of performing a nebulizing (aerosol) treatment at 3am. It was from a student who needed help finding notes. The treatment didn't wake our six month old who was finally sleeping after experiencing nasal trauma.
The telephone call did.
In a third example — and one that didn't involve students — our son's doctor called for a treatment to be administered at 8p. The respiratory therapist walked in at 9:10p, 70 minutes late, complaining about work load. With RSV, it is imperative that respiratory therapy be evenly spaced and consistently on time. There are also restrictions on when an infant can be fed in relationship to respiratory treatment. Simply put: a hungry infant can't be fed if certain respiratory therapies are set to be performed.
The “come whenever it's convenient” attitude was so prevalent that nurses repeatedly had to call respiratory therapy over four days to ask where the therapist was. The nurses, I learned, often received no answer from the department.
In a fourth example — a nurse was so disgusted with treatment from the respiratory therapy department that she took it upon herself to provide respiratory therapy to her son. This is not her job.
In a fifth example — a respiratory therapist again decided to take a telephone call and handed the nebulizing equipment to me to complete treatment so she could hold the phone. While any competent parent can help out, parents are not supposed to be providing medical treatment in a hospital. That's what doctors, nurses and respiratory therapists are paid to do.
The respiratory therapy department's attitude towards talking on the phone while simultaneously performing treatment is much akin to texting while driving. It's not a problem until it is. And when it is, it can be a very big deal.
There were a few pleasant, professional experiences. But the vast majority of our infant's experiences with respiratory therapists at West Boca Medical Center were painful to watch and experience.
State Of Florida
Shelisha Coleman, a spokesperson with Florida's Agency for Healthcare Administration points to the patient's bill of rights to understand that hospitals must provide training and education information upon request about anyone who comes into contact with a patient, including students.
However, despite state law, West Boca Medical Center dodged the question several times when asked who the students were and what schools they represented. This question was also posed several times to Tenet spokesman Ryan Lieber who at this writing has not provided that information (update: see below). To his credit, however, Lieber did intervene in a situation when the pediatric nursing staff couldn't find the respiratory therapist on duty and I emailed — at my wit's end — for assistance. As I wrote to him at the time, I was not looking for special treatment, “just the treatment ordered by my infant's doctor.”
There is no situation where a parent should have to reach out to a PR department for their child to receive the care ordered by a doctor.
Upon our son's discharge, I was invited to speak with Chris Apergis who heads West Boca Medical Center's respiratory therapy department. Our conversation was cordial and he was clearly concerned with what we experienced. He suggested changes would be made, and that therapists should be on time, attentive to patients, and not on the phone during therapy sessions.
But he also suggested that he was unaware that these problems existed, which should be of concern to any parent or patient receiving care at West Boca Medical Center. For a unit leader to be unaware that his staffers are talking on the phone during therapy, distracted by students (remember, West Boca is a non-teaching hospital that has agreements with schools to accept trainees) or constantly running late is a problem and points to poor management and oversight.
There is no room in emergency pediatric care for either.
What You Should Do
As a parent, I encourage other parents to read Florida's patient bill of rights and immediately prohibit community college trainees from having any part of your child's care at West Boca Medical Center. As explained to us by caring nurses — and affirmed by the State of Florida — this is your right.
Know that community college technical students are not medical students. This may sound snobbish but it's true. They are not like your cousin at Johns Hopkins or your neighbor's son completing his residency at CHOP. They may mean well, but — at least at West Boca Medical Center — they are students who are apparently not trained to work in pediatrics and should not be there. Do not confuse a student calling your child “so cute” with real medical training. But also realize the students are not to blame.
Tenet Healthcare has irresponsibly placed them in a situation for which they are not ready.
Once the frantic, hectic admission process is over, speak with the Charge Nurse to gain an understanding of what is going to happen and share what your expectations are. The nursing staff — 24 hours a day — was loving, caring and professional. Exactly what you would expect. The nurses have your back.
And when you experience problems, be heard. Do not complain to yourselves and hope it will get better. There is nothing more important than your child's care. Make noise. Wake up a doctor. Take a stand. You may not have medical training, but no one knows your child better than you, and if something doesn't seem right, demand access to the people who will make it right.
TENET: No Stranger To Problems
Tenet Healthcare is third largest publicly traded hospital chain in the United States and its issues are no secret. Tenet just settled a class action lawsuit concerning patient deaths in New Orleans following hurricane Katrina. It settled a Medicare fraud suit brought by the government for $43-million. And Tenet's lawsuit against a competing hospital chain for alleged billing issues was kicked out of court.
Tenet, like most major companies, has problems. But when those problems include a lack of oversight of the people who are providing care to infants, it's time for the company to step in and make major changes.
Until Tenet makes major changes in the respiratory therapy department at West Boca Medical Center, it is imperative that parents be vigilant, assertive and demand to know not only who is doing what to their child, but what background that person has.
At West Boca, when it comes to respiratory therapy, that background may very well be unimpressive — tarnishing otherwise excellent care.
[UPDATE December 5th 1:45p: Tenet now identifies the schools it works with as Palm Beach State College and Independence University for Health Sciences. We apologize, again, to Broward Community College which was misidentified by more than one West Boca Medical Center staffer as providing students to the RT program. Additionally: Tenet says it receives no financial consideration from these schools to take part in clinical training.
UPDATE December 4th 3:45p: We have just heard from Broward Community College. The school says it absolutely has no students at West Boca Medical Center, and the hospital employees who told us so were incorrect. Our apologies to BCC. Tenet, however, has still not officially stated from which schools students are training — in violation of Florida healthcare regulations. Tenet was formally asked again earlier today].
About the author: Andrew Colton is editor and publisher of BocaNewsNow.com which launched as a hobby but is now on the cusp of one million page views, making it the leading Boca-based source of news and information. A former network news correspondent, Colton is heard on the Wall Street Journal Radio Network while running a strategic litigation and crisis communication firm.