It’s not terribly surprising that St. Elizabeth’s lied to Tufts and the DPH just like they lied to us.  After all, once they made the decision to evade and lie rather than admitting to having made mistakes, they had to be consistent about it.  What’s surprising is that they weren’t consistent about it — the story they told to Tufts, the DPH and me have different elements and are in some cases contradictory.  Some interesting tidbits:

• According to Tufts, “Dr. L…’s answering service informed [the ER physician] that Dr. L… was not on call that day.”  There are three problems with this claim: (1) Dr. L… doesn’t have an answering service; (2) she’s the only doctor in her practice and is therefore always on call, except when she’s on vacation; and (3) she wasn’t on vacation and has confirmed to my wife that she was available.
• According to the DPH, “Attempts were made to call, fax, and email the lab results to Dr. L……. the email address was unavailable.”  However, the letter St. Elizabeth’s sent to us said nothing about attempts to email Dr. L…, and she has since confirmed that her correct, valid email address is available in the hospital’s records.
• Just as the letter St. Elizabeth’s sent us offered no explanation for why Dr. L…’s staff was unable to obtain my wife’s test results through repeated calls to the hospital, they also made no effort to explain this to either Tufts or the DPH.  This is funny, since this is in fact the crux of our complaint.
  According to Dr. L…, doctors at hospitals fail to follow up with primary care physicians all the time at most hospitals, so although it’s incredibly annoying, there’s no point in making a fuss about it.  Similarly, it’s also common for ERs to fail to send lab results to PCPs.  What is not normal is that Dr. L…’s office wasn’t able to get the results by calling the hospital, and yet that is the only problem the hospital has made no effort to explain.

The hospital may be telling the truth when they claim that the ER tried and failed to contact Dr. L… (however, as noted in my previous postings, they clearly did not try hard enough).  The hospital may even be telling the truth when they claim that the ER tried and failed to fax the test results to Dr. L…’s office because they had the wrong fax number.  However, where the hospital’s story breaks down is in their failure to explain why the test results were not provided to Dr. L…’s office when they called.  There is no possible explanation for this which doesn’t involve the hospital doing something wrong, and this, presumably, is why they’ve avoided trying to explain it at all.

Here’s what I think happened…. The test results were, indeed, sent to the ER and “available at the lab at St. Elizabeth’s on Monday, January 18″ as the hospital claimed in the letter they sent us.  But notice that extremely careful wording: the test results were available at the lab.  In other words, they were available on paper at the lab but were not entered into my wife’s electronic medical record immediately, as they clearly they should have been and as hospital policy no doubt requires.  This is why Dr. L… couldn’t see them even though she has access to the St. Elizabeth’s medical record network.  This is why the hospital couldn’t provide the results to Dr. L…’s office when they called.  Somebody in the lab didn’t do their job.

So, how should the hospital have responded to my complaint?  They should have apologized for not trying hard enough to contact Dr. L…, and they should have apologized for not entering my wife’s test results into her medical record immediately.  That’s it.  If they’d done those two simple things, my wife and I would have been satisfied, and that would have been the end of it.

I have written back to both Tufts and the DPH and asked them to reopen their investigations, starting with speaking with Dr. L… about her version of what transpired, which is clearly rather different from the hospital’s.  We’ll see what comes of it.

Janet Davis
Patient Relations Coordinator
St. Elizabeth’s Medical Center
736 Cambridge Street
Brighton, MA 02135-2907

Dear Ms. Davis,

My wife received your response, dated February 12, to my January 26 letter to John Holiver. When coupled with the problems which prompted our letter, your appalling response is enough to convince us to never again entrust our family’s care to St. Elizabeth’s.

I will respond point-by-point to the claims made in your letter.

“… the physician and secretary made several attempts to contact Dr. L… and were unable to speak with her directly due to timing and her voice mailbox not accepting messages because it was full. We have alerted Dr. L…’s office to this issue.”

At our request, Dr. L… checked her records at the hospital and confirmed that her correct cell number is listed for first contact. There is no record on her cell of the hospital ever calling. Furthermore, you have her home number, office number, correct fax number, and a working email address, and there is no indication that anyone attempted to contact her using any of these.

Dr. L… also says that her office has not been notified by anyone at St. Elizabeth’s of any problem with her voice-mail system.

Dr. L… has been my wife’s and our children’s physician for almost a decade, during which we have called her many times. While we have occasionally encountered a full voice-mail box on weekends, we have never been unable to reach her on her emergency extension, and we have never during office hours been unable to reach the front desk or leave a message which was returned promptly.

Even if it were true that one of Dr. L…’s voice-mail boxes was full and you had an incorrect fax number as you assert later in your letter, you had three other working methods for contacting her, so there is simply no excuse for your failure to contact her in a timely fashion about my wife’s treatment.

“You visited Dr. L… on Tuesday, January 19, 2010.”

That is simply incorrect. As I told you in my last letter, my wife did not see Dr. L… until January 26, because Dr. L… told her there was no point in her coming into the office until Dr. L… had the test results. Of course, if we had known that would take nine days, my wife would certainly have gone in earlier, because Dr. L… could have repeated the same tests and gotten the results back days before the results from your ER were made available to her!

Dr. L… has spoken to the ER doctor who treated my wife. He said he had no reason to believe my wife saw Dr. L… on January 19, nor is such an appointment listed in my wife’s records. Neither we nor Dr. L… has any idea why you think my wife saw Dr. L… on January 19. This obvious, verifiable, factual error is indicative of the shoddy quality of your entire handling of this incident.

“St. Elizabeth’s physicians made several attempts to contact Dr. L…’s office with the results. Unfortunately, the fax number we had for Dr. L… was incorrect – something we have since corrected; and Dr. L…’s voice mailbox would not allow us to leave a message, or verify the fax number.”

As noted above, Dr. L… is unaware of any problem with her voice-mail system that would have prevented the hospital staff from reaching her or her staff. Also as noted above, even if it were true that you had the wrong fax number and were unable to reach her office by phone, there were three other ways you could have reached her that no one from St. Elizabeth’s ever attempted.

“The lab results were available at the lab at St. Elizabeth’s on Monday, January 18, 2010.”

Dr. L… reiterated to my wife that it was nine days before her staff was able to obtain my wife’s test results, and that at no point did anyone from St. Elizabeth’s initiate contact with Dr. L…’s office or return any of her staff’s calls. Every single contact with the hospital was initiated by Dr. L…’s staff. Dr. L… overheard one of the calls placed by her office to the hospital, and her staff’s utter frustration over the issue was verbalized to her repeatedly over many days.

Your letter ignores the repeated attempts by Dr. L…’s office to obtain my wife’s results and offers no explanation for why you were unable to provide them when asked. Do you mean to imply that Dr. L… and her staff are lying about having tried repeatedly to obtain the results? Or do you consider it so entirely unremarkable as to be unworthy of comment for a patient’s primary care physician to be unable to obtain test results despite repeated attempts over many days? Or perhaps you would like to reconsider your claim that my wife’s results were available in your lab from January 18?

As I mentioned above, Dr. L… has spoken to the ER doctor who treated my wife. He informed her that he wrongly assumed that she was still on active duty at St. Elizabeth’s and would therefore be notified automatically of my wife’s discharge from the ER. According to him, he didn’t even try calling her until several days later when he found out that he was wrong about her status at the hospital. Furthermore, he said he knew nothing about claims to the contrary made in your letter. To be blunt, if you’re going to perpetuate a lie to cover up your hospital’s misconduct, you ought to do a better job of making sure the involved parties on your staff know about the lie so they can play their parts properly.

Speaking of transparent lies… I called you on Friday, February 12 to ask why my we had received no response to my letter. You called me back on Monday, February 15 and claimed that a letter to my wife “went out last Friday.” This is odd, because although the letter to my wife was indeed dated February 12, the postmark on its envelope was dated February 17, and we didn’t receive it until February 19. Perhaps the five-day delay was needed for your legal department to review your response to confirm that you hadn’t done anything foolish like actually admitting to having done anything wrong?

“It has been determined that the care rendered based on your hospital presentation was appropriate…”

In fact it was not, and we are not the only ones to think so. Dr. L… has informed us that as a result of this incident and how you responded to my complaint about it, she will now strongly recommend to her patients against using your emergency room. This is especially damning given that Dr. L… has admitting privileges at your hospital and teaches there.

Furthermore, after hearing my story, a physician friend who did part of her residency at your hospital remarked, “From what I saw at St. Elizabeth’s, I’m really not surprised. If you’re ever in an accident and the EMTs want to take you to St. Elizabeth’s, get out of the ambulance!”

“…and the billing will be processed for your care.”

Aha! Now we come to the essence of your view of this incident. Of course you can’t admit to having done anything wrong, because that might compromise your ability to collect from the insurance company for my wife’s treatment! That’s truly appalling.

In summary, it is indisputable that mistakes were made in my wife’s care. I brought these mistakes to your attention with the expectation that you would acknowledge them, apologize, and use them as an opportunity for improvement. Instead, you evaded, lied, and falsely (and libelously) laid the blame on others. Because of this, my wife and I will never again willingly seek treatment for our family at your hospital; we will strongly discourage all of our friends and neighbors from doing so; and we will continue to aggressively pursue any and all third-party avenues of complaint that are open to us.

My wife received a call from someone at St. Elizabeth’s at 3:15 today: “… I just wanted to let you know that we received your letter and are looking into it….”

My letter obviously didn’t make it through the mail from my house to St. Elizabeth’s in six hours, which means that they saw it on my blog.  A review of my blog’s access logs shows someone at the hospital visiting the page at 1:49pm, a little over three hours after I posted it.  Either someone who reads my blog knows someone at St. Elizabeth’s and forwarded a link to them, or someone at the hospital is actively monitoring the Web for postings about it.

I suppose this wouldn’t be terribly surprising — any large business that isn’t doing that nowadays is run by fools — but I do think it’s somewhat interesting.

I can’t resist the urge to point out that if St. Elizabeth’s has to choose between having enough people on staff to process test results in a timely fashion, and having someone on staff to monitor the Internet for postings about the hospital, I’d rather they choose the former than the latter.

John Holiver, President
St. Elizabeth’s Medical Center
736 Cambridge Street
Brighton, MA 02135

Dear Mr. Holiver,

My wife, A… Kamens, was treated in your emergency room (ER) early in the morning on Sunday, January 17.

The doctor who treated her told her to seek follow-up care with her primary care physician (PCP), Dr. C… L…. He said he would call Dr. L… that day, but my wife should wait until Tuesday to contact her, because by then all the test results would be available in my wife’s electronic record, where Dr. L… would be able to access them.

Not only did the ER doctor not call Dr. L… on Sunday as promised, he never called her at all.

Not only were my wife’s test results not available by Tuesday as promised, they were not available until January 26, nine days after my wife’s ER visit.

According to Dr. L…’s office, St. Elizabeth’s never gave them a straight answer about why the test results were taking so long. Not only that, but they seemed to be giving the office the runaround, repeatedly telling them to call the next day at a specific time and ask to speak to so-and-so, only to be told when they called at that time that so-and-so was not available.

To be blunt, this is pathetic. I’d be surprised if it’s not also a HIPAA violation – failing to give a patient and her providers prompt access to medical records required for urgent care. My wife has been walking around in pain unnecessarily for nine extra days, with her PCP unable to initiate treatment because she did not have access to the test results necessary to diagnose and treat my wife’s condition.

Do you think my wife’s treatment lived up to your mission of “delivering the highest quality care with compassion and respect”?

I’ve got a great idea for an improvement you can make to the billboard across the street from your ER:

What do you think?

Here is what my wife and I need from you now:

• confirmation that you have investigated this incident and confirmed the details I’ve related;
• a written acknowledgment that it is not acceptable that:
  • the doctor who treated my wife in the ER never called her PCP as he said he would;
  • it took nine days for you to make the results of my wife’s tests available to her PCP; and
  • your hospital failed to give honest, accurate information about when the results would be available;
• a written apology to my wife for making her suffer unnecessarily and to Dr. L… for making her and her staff waste their time; and
• a written description of the steps you will be taking to ensure that in the future:
  • doctors in the ER follow up promptly with the patient’s PCP when they say they will;
  • results of tests performed in the ER are accessible to patients and their PCPs promptly; and
  • PCPs are given honest, accurate information about when test results will be available.

My wife has affixed her signature to the bottom of this letter and thereby authorizes you to access her records to investigate this incident, to disclose the contents of those records to me, and to discuss this incident orally and in writing with me, without restriction, as if I were her in the context of HIPAA privacy rules.