This letter is in response to your communication dated November 21, 2001. The review you mentioned on your letter of the medical record of my mother, appears to be flawed and biased. In very few cases does the E.R. have the luxury of a patient arriving within minutes of the onset of an acute cerebro-vascular event (stroke).
My mother arrived at the E.R. within twenty minutes of the onset of the symptoms. She was an ideal candidate for immediate use of intravenous T.P.A.
If the E.R. physician had any concerns about the possibility of rectal bleeding due to a history of “recent” surgery, those concerns should have been totally dispelled as soon as I was consulted. I am the Chief of Surgery I was one of the surgeons who participated in the removal of a rectal polyp, which occurred months prior to this incident not two to three weeks as your letter proclaims. If an attending surgeon informs your resident of this fact, and requests that T.P.A. be administered intravenously, there should not have been hesitation in the timing of the infusion of this medication.
This emergency room physician had been tasked to find as many cases as possible for intra-arterial T.P.A., because your Hospital was doing a study on this procedure. He was frantically paging the ‘team,’ and received no response to his queries. The ‘team’ was in the Hospital performing another procedure and had disconnected or turned off their pagers. A member of my family, my sister, was insisting that there should be no delay in administering the T.P.A., but her frantic requests were completely ignored; in fact, a member of the E.R. team threatened that if my sister continued to insist on this, nothing would be done for my mother. Six hours later, by the time my mother was taken to the cath-lab to receive the intra-arterial drug, the golden period to dissolve the clot had passed, and the procedure was just an exercise in futility.
The Term Paper on Lead And Manage A Team Within Health And Social Care
Explains the features of effective team performance An effective team which performs at the highest level, whilst completing their work efficiently to the best of their ability. An effective team will always consist of certain features enabling effective team performance. Some of these features are as follows; develop goals and plans, i.e. an effective team will always devise a development or goal ...
My family and I will never be able to forget the fact that my mother’s stroke could have been reversed, or at the least reduced in severity had the drug been administered within that crucial period of the first arrival at your E.R.
I do agree with one item your letter, and that is that the decision to withhold and approve treatment was inappropriately and injuriously postponed, this was not a medical decision. It is ludicrous, however, to infer, that “the neurological team acted appropriately.” Had the intra-arterial infusion been implemented earlier, I would have concurred with the possibility that it could offer benefits over the intravenous route. But to waste those early precious minutes is not medically appropriate. In the very unusual event of a stroke patient arriving early at the E.R, to waste time paging a non responsive ‘team’, to proceed after six hours of the onset of the stroke with an invasive procedure, the hope for any positive response is practically nil to none; this is a clear and unforgivable negligence on the part of your neurological team. This is withholding appropriate medical care with complete disregard for the well being of the patient.
Your letter affirmed “that intra-arterial tPA would be a medically safer therapy” and that the “neurological team acted appropriately” in respect to my mother’s initial treatment; how safe and appropriate was it? Was it safe and appropriate for your ‘team’ to turn off their pagers? Was it safe and appropriate to delay a less invasive approach than the more dangerous intra-arterial attack? Certainly after delaying the intravenous injection for six hours, there was no choice then, but to begin proceeding with the intra-arterial phase. Is that what you mean by safe and appropriate? During the intra-arterial administration of T.P.A. the residents tore the femoral artery, she bled several liters of blood and required transfusion of seven units of packed cells, was that safe and appropriate? To add insult to injury, she was required to undergo vascular repair to the arterial rip under general anesthesia, within twenty fours hours of her arrival, as well as evacuation of a huge hematoma of her thigh, was that safe and appropriate? She required to be kept on a respirator for days due to the ‘safe and appropriate’ care she received at the hands of your ‘team.’ She became ineligible to receive proper anticoagulation due to this uncontrollable hemorrhage because of a drain that had to be left in the space the hematoma had formed, was that safe and appropriate? This ineligibility for anticoagulant certainly worsened the cerebro-arterial thrombosis and, in addition, subjected her to a risk of D.V.T.
The Essay on Learning Teams: Shrinking To Fit
Successful teams often have differences among their team members and may sometimes even collapse over these interpersonal conflicts. Teams must strengthen these weaknesses or recruit for the missing competencies if they are to move forward. This case depicts what could and often does happen to a team with no traditional rules of engagement or effective conflict resolution techniques. Alternative ...
and possible P.E, was that safe and appropriate? She consequently developed decubiti ulcers during her hospitalization at Columbia Presbyterian Hospital, and furthermore, she received token and ineffective physical therapy during her stay there. That is how appropriate her treatment was! In my opinion, as a physician, the decision your staff pursued is not within the guidelines of normal and appropriate medical treatment. Where does one make judgments between what would have been safe and what your team deemed appropriate, in my medical opinion your neurological team and the E.R. staff did not act safely nor appropriately with regard to my mother’s medical well being?
Furthermore, when we requested she be admitted to your Physical Therapy Department for early rehabilitation therapy, a great ‘theatrical show’ was made of the need to transfer my mother to a nursing home instead. Basically, my mother was then de-facto evicted from your institution in the form of pressure exerted upon my sister to approve the transfer. Your so- called social workers, coordinators, attending physicians (who invariably almost never visited my mother), all ‘agreed’ that, at this point, she was not an ideal candidate for the Physical Therapy Department. Yet no one admitted that she was in that non-ideal condition as a direct result of the injurious course of events and negligent care she received from the E.R. staff.
The Research paper on Interpersonal Therapy Case Study Of Susan
Interpersonal therapy is short-term therapy for depression and other problems that looks for solutions and strategies to deal with interpersonal problems rather than spending time on interpretation and analysis. In the initial stages of interpersonal therapy, therapeutic goals typically include diagnosis, completing the requisite inventories, identifying the client’s major problem areas, and ...
If you were truly offering ‘the best possible care available’ then she should have been transferred to the Physical Therapy Department and you would have initiated early rehabilitation.
Neurologists I have consulted have concurred that to waste precious time for cases of early arrival of a stroke patient to the Hospital, is not the standard of care in these United States. We all know the benefits of the drug and that it works during early intervention. The only reason one can muster as to why my mother was not provided with an early intravenous injection of T.P.A. was that there existed at Columbia Presbyterian Hospital a clinical trial in progress for cases slated for intra-arterial protocol and my mother became another case for that protocol. There was no response to the intra-arterial therapy simply because of the negligent delay in administering the drug intravenously. There is no compassion in permitting the stroke to continue its natural course when approved, effective, early intervention medication is readily available which would have dramatically altered the chain of events. There is no medical excuse for such treatment!
Unfortunately your response to my original inquiry arrived almost one year from the date of my mother’s admission. Your hospital must have many mismanaged cases for which you need to apologize that it took you almost a year to finally reply.
