SCARY: What Parents Must Know About West Boca Medical Center

west boca medical center problems

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.

Emergency Room

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.




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18 thoughts on “SCARY: What Parents Must Know About West Boca Medical Center

  1. Get an attorney and sue the hospital for corporate negligence. This will force Tenet to “do the right thing” in regards to changing policies and procedures in the critical care units, and most importantly, improve patient safety and patient care in the hospital, and throughout all of tenets hospitals. You should be congratulated for being “detail oriented” in every aspect of your childs medical care! You are your child’s VOICE!!!

  2. Oh boy; where to start…
    January 2005: my 80 year old mother was admitted to Boca West’s ICU with sudden respiratory collapse. She remained intubated for almost 3 weeks while the treatment plan to raise her then-inadequate blood oxygen levels played out and failed. She was described to us as the most seriously ill patient in the facility. We had thought this would result in attention being paid and compassion being shown. The opposite resulted. We complained. Wrong move. I won’t belabor the many errors, process failures, systemic and cultural problems, snafus, and insults except to close this portion with this: as Mom was dying staff failed to notify family, including my sister, who needed extra time to arrive due to her own medical challenges; when Mom died staff ignored monitor alarms for 15 minutes until my sister (who’d be alerted to Mom’s impending death by our cousin who happened to be there) turned them off herself.
    Our miserable experience at Boca West was the earliest of several that actually led me to write a book on how to effectively advocate in-hospital. One lesson: beyond the poor management/oversight Andrews cites, the more root issue is, in my estimation, that management *is* the cause of the problem. When we met w/the Director of Nursing she exclaimed, like they all will every time, “that is not who we are!” and promised remedies. Well, that was who they were, and culture is shaped from the top, and no remedies arose because she couldn’t change the culture under her leadership on a dime and maybe not a the miles of bills the government paid for Mom’s (mis)treatment.
    Nonethess I kindly abstained from naming in my book Boca West (and the Jayco 100-Best facility down the road that my father, a year later, contracted fatal nosocomial MRSA in). It’s striking that, 8 years later, albeit in a pediatric unit, similar systemic failures exist (I do not know if Tenet owned or controlled Boca West in 2005).
    Another tip for effectively advocating: make friends early on with the hospital chaplain. S/he manages by wandering around and will welcome your outreach to place your patient-family on his/her radar. Do this proactively and prophylactically to prevent potential problems. Medical chaplains know the medical system and can help us cut through all the stuff we don’t know about. Since the chaplaincy developed decades ago to serve providers first grappling with ethical conundrums advanced by life support technology, they are well-poised to help patient-families and trusted by staff.
    Lastly, advocacy requires that we proactively act to sniff out systemic impediments to timely, correct, successful treatment. So spend those hours between events discovering, through determined questioning, exactly how this or that process actually unfolds or works in the facility. Monitor it in advance and as it unfolds. Be several to many steps ahead of the game.

  3. It’s not like your child was at John Hopkins’s, Children’s Hospital of Boston, or Children’s Hospital of Philadelphia either. You have to be the best advocate for your child and you did the best you could. Ask West Boca for their outcomes in patient care? That says everything about care. Tenet Healthcare maybe the third largest publicly traded hospital chain in the United States, but they are not on any best hospital list like the U.S. News Best Hospitals annual report. Unfortunately, what you uncovered is probably what the oversight is like in most other departments in that hospital. Saving money by using students as staff is not new. Tenet Healthcare is about the shareholders and not the stakeholders. Again, you did the best for your child, sorry for your experience, your child is lucky to be alive, some have not been so fortunate; and please, don’t go back.

  4. While I can appreciate the many concerns you’ve mentioned, I feel compelled to comment on some of the issues. Firstly, I don’t think it helps when people say things like “you’re lucky they didn’t kill him” or “get a lawyer”. The litigious system is the cause of rising healthcare cost! Not to mentioned, why hospital employees are understaffed, overworked, untrained, and underpaid. You are absolutely right about administration being the root cause of abysmal healthcare. As a 15 year ER/ICU RN, I’ve seen many egregious fatal mistakes, as well as powerful life-saving events. I’ve worked at all the Tenet hospitals in South Florida (including West Boca, St. Mary’s, Good Sam, Palm Beach Gardens, and FMC). Believe it or not they are comparable (if not better) to non-profit hospitals like Boca Regional and Bethesda. Because they are for profit, they have fiduciary responsibility to supplement staff with agency as opposed to non-profit, which pretty much works with a short staff. However, this presents the perpetual problem cycle. Agency staff get paid more, but care less. (For profit hospitals prefer disposable staff). I would not be surprised if the RT you had was agency. That is down right appalling and unacceptable behaviour! I’m sorry for that, and you did the best thing for your child and other children by sharing your experience.
    Still, no hospital is perfect. Therefore, “YOU MUST BE PROACTIVE AND YOUR CHILD’S ADVOCATE”. Question everything, document names of RN, MD, RT (Respiratory Therapist), meds, times, dosages, and vital signs. Good RN’s recognize that teaching is an essential part of discharge planning to prevent relapse and readmissions. Be leery of people who are either defensive or sensitive to any line of questioning. These are signs of ignorance, apathy, or vice. You do have parent/patient rights!
    Secondly, I want to mention something about nursing students. I recognize the concern about the language barrier. But all nursing and medical students must have hospital training somehow (and contrary to belief, they are not used as “supplemental staff”). If not, then how, where, and when can they get clinical experience. I am grateful to the patients that allowed me such inexperience courtesy. Like you, I would also insist on an experienced RN (don’t get me started on the new, inexperienced and ill-prepared RNs). That said, all nursing students are to work under the direct supervision of the primary RN. So standard of quality care should be comparable. Unfortunately new students are so fearful of looking ignorant, that they make the crucial mistake of not asking, especially when they get stumped by family, patients, and doctors. Remember to ask, ask, and ask some more!
    Although I have great empathy for your experience, I want to emphasize that I’ve worked with many wonderful, competent and intelligent doctors, nurses, and respiratory therapist at West Boca. I am truly horrified and sorry for your experience. I thank you for bringing light in the hopes of improvement. I wish there will never be a next time. But if there is, I am certain that what you have already done proactively will make a drastic positive experience for your family and others as well.
    Kind regards,

    1. Very nicely written comment. And no one is threatening to sue anyone, just raise awareness of what appears to be a very serious deficiency in Tenet’s West Boca operation.
      As mentioned several times in the article, the nursing staff was absolutely great.

      1. Change at WBMC needs to start at the top. The community should ask themselves ,why the union was voted in by the staff of WBMC? The employees are aware of the issues but the public is not.
        Ask questions, check what medications they are giving your child, question their experience .
        As parents you have the right to quality care
        As anRN at WBMC I can assure you errors are made every day.

  5. Research the history of tenet healthcare. Enough said….the company has no morals or ethics. They just have the worst quality and the highest billing charges. That is what drives up healthcare costs…..

  6. I am very sorry for your experience with the respiratory therapists at the facility your baby was at. There are many great RT’s out there. Like as some of the other comments said, do be the advocate. Whether its your child, yourself or another family member. Being a 30 year respiratory therapist, I always explain who and what I’m doing to and for the patient. This is what I would want for myself and family. Good luck and glad everything turned out well for your little one.

  7. While the inattentiveness to the patient is inexcusable,I would be curious to know what this facilities staffing practises are .Obama panic has resulted in many hospitals tightening their budgets at a staffing level.AN unsafe nad unfair practise for both the patient and the therapist.Just sayin!

    1. Staffing is based on the census of the hospital , numbers not the acuity of the patients. If they staffed by acuity there would be more experienced therapist working. But remember Tenet is only concerned with the almighty dollar. It does not matter if you 5 stable kids or 5critical kids, the staffing is the same.
      This is a hospital wide practice at West Boca, Directors are penalized if they go over budget.
      Bottom line demand quality care, it is your right

  8. I’m very sorry to hear about your experience. Our daughter has had 6 surgeries at WBMC and I agree that the staff is wonderful. BUT – the hospital policy does not allow the parent be with the child when the anesthesia mask is delivered. This created increasing trauma for our daughter. I now understand that other children’s hospitals DO allow this, and the next time she needs surgery we will NOT be using WBMC. I only wish I had made this decision much earlier.

  9. This is poorly written, unsubstantiated, and defamatory “journalism” at its best. More like a failed novelesque attempt. Did you get sued yet?

  10. Mia,
    Working for tenet will challenge your morals and ethics as a healthcare provider. And the company forces af will employees to sign contracts-i mean what tenets legal department calls at will conditions of employment to be an employee.
    Only wayto nullify tenets administration, is to get unionized , like the employees did in St.Louis.Tenet cares aboutshareholders first, before patients. Its a corporate culture. At some poj

  11. I suppose you would rather the students get out of school without ever having experienced “live patients” then be assigned to your child? You complain because you therapist was 70 minutes late? Your lucky he got there. Maybe, someone down in ICU or the ER wasnt breathing at all. While neb treatments are very important, chances are your child didnt suffer, since I would hope that if he was in distress the nurse would have assessed him herself, and she probably should have since she is there with your son for the full shift she works, however, the RT has to see multiple patients on multiple floors scattered everywhere. Hence, the reason for phone calls. Did you know that medication delivery(yes a neb is medication as well as o2) can be delivered and hour before or and hour after its due time? Your lucky that your child had the benefit of having and RT as many hospitals have cut their staffing of RT’s to save money, and try to pile on more stuff on the nurses back.Instead of complaing simply about the RT, why not complain to the hospital that more may be needed? Sounds to me like that RT was overworked and trying to handle 1000 different things as best as he could. Having both Asthma and COPD, I depend on neb treatments,and also as a former healthcare provider understand the workings of a hospital. Your nurse has approx.6-10 patients. The RT hits the floor with about thirty patients to treat. Due the math.

    1. I am an RRT, and while I understand your concerns, the problem you encountered will become more pervasive in our increasing “bottom-line” driven hospitals. Most patients and their advocates don’t know, that while there are staffing guidelines for nurse to patient ratios, no such guidelines exist for Respiratory Therapy. While a nurse may have 6-7 patients, a Respiratory Therapist may have 40-50! On any given night-shift, I alone, cover 2 entire floors, the ER and maternity…I MUST be at EVERY rapid response, trauma team call and CODE BLUE….I work 12.5 hour shifts, oftentimes, without EVER getting the chance to eat, re-hydrate or take a bathroom break….ask how many RT’s are on each shift….at our 200+ bed hospital, we have 2 overnight RT’s to cover EVERY in-patient, every new baby born during our shift, and EVERY patient that strolls into to the ER….I recently had a 15 day old infant that came into the ER unresponsive, I never left her side for 2 hours!!!what do you think the chances are of getting to a call for a nebulizer treatment? Do you think I don’t feel badly about not getting to your child? Of course I do. We are forced to triage our patients, not because we want to, but because we have to. On any given shift, I respond to 50+ calls that is in addition to my assigned 50+ patients that require treatments every 4 hours, that means in a 12 hour shift I’m suppose to see them 3 times. Understaffing is the problem, if you don’t think a Respiratory Therapist is important..ask yourself this…If the patient is not breathing, does anything else really matter?

  12. Sincerest apologies about your experience with Respiratory Therapy. It is difficult to see your child ill and suffering, and understand your feelings of anger and frustration. Yet, as a Registered Respiratory Therapist and speaking on behalf of our profession, the majority are very dedicated, hard-working, knowledgeable, and give 110%. Unfortunately, due to many complex issues, health care is profit driven, which has diluted and compromised the care a patient receives. Over-budget? Cut staffing. Have 40-60 pt.’s? Deal with it and forget about taking a restroom break, eating or drinking anything during a 12+ hour shift. We must cover more than one, two, or three floors at a time and the ED. If it is a code blue, we drop everything else to attend to the pt. who has stopped breathing and who’s heart has stopped beating. Subsequently, it takes priority over a breathing tx. Yes, I carry a phone – but it is to receive notifications regarding new pt.’s, a pt.’s deteriorating condition, calls from RN’s and Dr.’s who want are assistance and expertise, etc. There are many aspects to our profession. I wish you were able to observe a competent and compassionate RT – who truly cares about their pt.’s health and well-being over the course of a day or a night. It would be nice to see an article about RT’s who perform their duties well. There are two sides to every story.

  13. I’m very sad to read this message. While my child was treated for something other than RSV, my son was admitted into the pediatric unit at West Boca Medical Center. As parents, we felt rather alienated from pretty much the time that we arrived at the hospital with the exception of some attention in the ER. Nurses seemed distant and uninterested, not to mentioned hovered as group around a PC to monitor, or work, on Facebook. When I notified the Patient Relations after discharge, not as a complaint, but as constructive criticism, I received no response whatsoever.

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