What would you do?

[scroot]

DW just had another surgery. A left hip revision on halloween. The operation went great and her recovery in the hospital was swift and with very little pain. They moved us into rehab so she could continue therapy. After her first therapy session the therapist's assistant transfered her poorly and dislocated her hip. This required going back to the hospital for a "closed reduction." It all resulted in tremendous pain, loss of ability, and a much longer stay in rehab. We filed a report and the rehab says that the employee did everything right! Now, I was there and I know what I saw. Just the fact that she wouldn't use a gate belt. . .

We are waiting to see what sort of bills arrive from the rehab. They did extend a couple of nice things to us like not moving anyone else into the other bed in her room and giving extra therapy on the weekend (which would have been spent at home.) We have had to cancel our vacation in Dec. becuase she can't travel with the brace that she needs to wear now.

What was by far the worst for me was the attitude of the workers who kept telling us how to avoid dislocation. Finally we took to listening to the 'precaution' talks and then saying, "you do realize that her dislocation happend while the people here were handling here?" Then the staff doesn't listen when you tell them what you need.

Any way, I have always enjoyed reading your input and offering my own. Now, what you do about this if it happened (or has) in your family? (sorry for ranting on so.)

 

[teri]

Oh, I am very sorry to hear this. I hope that her recovery is swift and complete. That is really too bad that you have to postpone your trip!

It sounds to me like you need to speak with the patient ombudsman or advocate, and discuss your problems communicating with the staff. You may also need to contact a lawyer. {{{hugs}}} What a dificult time! Our prayers are with you.

 

[SueM in MN]

Sending a load of pixie dust to you.
I agree with teri. The Rehab has someone that deals with patient complaints and they are required to give you information about contacting reporting complaints if you ask. Like teri mentioned, the person is usually called a patient ombudsman or advocate. You could also ask to talk to someone in Risk Management (they are the people who deal with things that might lead to lawsuits, etc.).
The staff are aware she fell, but people who haven't been told won't know it was with a staff member.... You could ask them to put a note on the Kardex that indicates you understand how to prevent dislocation and that the problem occurred with a staff member. The Kardex is like a notecard file that lists basic info about each patient. Hopefully that would keep them from harassing you about it anymore.
Also, if you haven't, start a little log about what is happening. Write down everthing you remember about the events leading up to the injury and your problems afterward. Keep notes of who you talked to and what they told you. This would be helpful when you do talk to a lawyer or in talking to the patient advocate.
Good luck.

 

[scroot]

Thanks for your replies. I asked about an ombudsman but there doesn't seem to be a requriement for one here in AZ. We did meet the risk management folk many times but they are more concerned about shirking liability. She has come home now but we return three times a week for pt. I have kept pretty detailed notes since the accident (on my pda while we were waiting for the ambulance to take us back to the hospital.) As I am a minister I am hesitant to bring legal action but it may come to that. Thanks for your kind thoughts.

 

[SueOKW]

Just want to tell you that you both have my sympathy! What a miserable thing to happen. Good luck to you both.
Sue

 

[SueM in MN]

It's too bad how the Risk Manangement people have treated you. I was hoping they had the "listen to people and try to resolve the problem so they won't need to sue you" classes that most of the hospitals in Minnesota seem to have gone to.
I tried to look up some places that might help you. The best I could find is the Arizona Attorney General's Office . If they don't handle consumer complaints about hospitals, they should be able to give you some other places to contact.
The hospital would also be licensed by the state (whether they tell you that or not) and the state would be interested in all aspects of care at the hospital. Here is a link to the Arizona State Health Department. You could also find out if the hospital belongs to any voluntary organizations like the Joint Commission for Hospital Acreditation (JCAHO) or the or a similar one, CARF, for Rehabilitaion Hospitals. Most hospitals belong to JCAHO and are proud to display their accreditation.
Many areas also have a phone referral number where you can call trained volunteers who have databases of contact information for your area. These phone lines are usually a United Way service and are usually called something like "First Call for Help".

 

[scroot]

Thanks again, that should be most helpful. Things are getting a bit eaiser around the house and we are adjusting to our new circumstances. It is frustrating when we have to put up with the unnecessary. But we all do. I do appreciate your advice and links.

 

[dan-tot]

I would contact a lawyer. I was told when my sister was in the hospital for newmonea that id I had a complaint that I needed to do it then and not later. They put my sister on a general floor when she needed to stay in the intensive care unit. She got worse and almost died. This extended her time in the hospital two weeks. So I would contact the lawyer and see what they have to say.

Dan-tot Sorry about the spelling.

 

[mamajoan]

Scroot, I have seen many dislocated hip replacements. There are many factors which may cause the hip dislocation. Usually one poor transfer won't cause the hip to dislocate UNLESS it was done with the following no-no's: Hip in internal rotation, hip flexed greater than 90 degrees, and surgical Lower extremity planted and twisted during the transfer. Personally, I always used a gait belt. As much for my safety as pts.
I am sure you are tired hearing the repeated " dislocation no-no's", but I will say that when treating THR pts, I will repeat these during each treatment. I also document these instructions.
I am sorry to hear that your dw has had pain and difficulty with her THR. I hope that the rest of her recovery goes smoothly. I am sure that the hip spica brace (just assuming that is what she has) is uncomfortable, but it should be removed as soon as the hip and leg muscles are strong. God Bless you both.
Joan

 

[momejay]

My mom had a total hip replacement. A PT aide transferred her out of bed in the hospital & broke her leg. They told her it was normal post-op pain. She knew something was wrong. She didn't go to a rehab. She saw the doctor a week or so later & found out about the break. They said it must have happened at home. She is fine now but, there were no witnesses or anything. She wasn't even supposed to be out of bed yet. It hadn't even been 24 hours after surgery. They kept trying to sit her up & she wasn't supposed to bend the hip 90º

I couldn't wait to get her home. They got mad at me for bringing food from home. Then they yelled at her for not eating. She is allergic to food dyes & they put her on a liquid diet. Everything on the tray had food dye. (milk substitute for her coffee, the jello, the broth, the orange flavored ice...) They didn't have her bloodpressure pill in stock & tried to sub some yellow colored pill. I walked in & asked if the pill contained yellow #5. No one knew. They could have killed her.

Anyway... she's fine now & everything healed well. She's even had the other hip done now, her knee & her back even has replacement parts. We call her "The Bionic Woman." She uses a scooter when we go out shopping or on vacation.

 

[1Disneyite2]

I can totally empathize as DS has to have a hip surgery soon. We found he had a "dislocated"
hip after his PTA fractured his femur during a session. I was not in the room but heard his cries and went in and realized "something" was wrong. that evening, it appeared his hip was looking odd so he went in. They did x-rays but only of the hip and said "yes it's out, but it's not the PTA's fault". Two weeks, and much pain later, it was discovered that it was actually a femur fracture that was causing the pain and leg guarding although, yes, the hip was out too. I talked to a lawyer about this whole thing, since my son doesn't need to have his legs fractured during PT. Unfortunately, the medical people like to stick together, and the doctor himself missed this fracture for 2 weeks, until my relentless phone calls caused him to do a leg x-ray and finally a bone scan which confirmed the fracture. Then, they covered themselves by saying my son has "weak bones" (no kidding, that's why he is having PT, but there is nothing in his 12 years of medical records indicating any type of "risk for fractures because of weak bones". SO basically, the PTA got away with it, and now he has to have his hip socket totally redone. Six hours of surgery, full body cast, etc. Not to mention the pain and the initial femure fracture pain. It's quite irritating, but because my son has multiple disabilities and the doctor's tend to "stick together" the lawyer said there's not much we can do about it.

 

[SueM in MN]

1Disneyite2, is your son able to stand? If he isn't able to on his own, he should probably be in a stander each day with his weight actually on his legs (once he's all recovered and can do weight-bearing). Bones that don't have weight put on them regularly tend to lose minerals and are more prone to breakage. It happens to anyone (even astronauts) who are not weight bearing. Obviously it can't do anything about what already happened to him, but it might help to strengthen his bones for the future.

 

[1Disneyite2]

Sue, Yes DS is up in a walker and weight bears regularly. He can take steps and walk
with assistance, which is why I was particularly peeved about the femur incident (which was
2 years ago, BTW). The PTA that worked with him weighed about 300+ pounds and was about 5 feet tall. She could barely move herself and I think she fell on him. He has never had any other problems with "minerals" or "weak bones" and this was never mentioned to us, until this incident, when it became a "convenient" explanation that would let everyone off the hook. The lawyers I spoke with said it is common for a disabled person to have the blame squarely placed on them and their disability if they are injured during a service (like PT). The whole point of PT is to make him stronger, not fracture his bones. The ironic part about the whole situation is that his femur and fib/tib bones have always been the strongest, the problem he has with walking has to do more with neuro-muscular issues particularly relating to scoliosis and kyphosis, not his legs He is doing quite well now that I have fired the PT service and DH and I are doing most of his PT work. Again, the main focus is his trunk control, not his legs.

 

[SueM in MN]

I just asked because a lot of people don't realize the importance of weight bearing, even for people after a spinal cord injury who don't have any use of their legs.
My DD can't walk because of cerebral palsy, but she is in the stander every day.

 

[scroot]

Here is what is going on. I have talked to three lawyers all of whom say the same thing. We have a winable case but it won't pay enough for them to take it. The rehab has agreed to pay our portion of any bill that resulted from the dislocation. DW continues pt and is making slow progress but progress none the less.

We are focusing on getting better.

We have filed a complaint with the state and there is supposed to be an investigation.

 

[1Disneyite2]

Scroot.

That's basically what we were told by "lawyers" that it was very difficult and they
would need this and that, and basicaly, in the long run, it wasn't worth it from their
perspective (financially). Good luck with your dw's rehabilitation. Our son is going for a
bone density scan and of course the eventual surgery, so our "case" may not be totally
over yet, round 2, who knows? Depends on what the bone density shows, if there are no
"weak" bones (which is what I suspect) a lawyer may be more apt to take the case. The
issue that bugs me is that these people are sent out without much training (at least in our
case, are supposed to be supervised (She wasn't) and basically "get away" with it, not even
the actual person, but the agency that puts them in the spot and the patient at risk and continues the practice and rakes in the money regardless of the patient's care.

 

[mamajoan]

Just FYI.........Depending on where you live:
Registered Physical Therapist- BS, Masters in Physical Therapy, State Licensing Exam
Physical Therapist Assistant-AS, Cert. Physical Therapist Assistant Curriculum, State Licensing Exam- Requires minimal supervision of RPT
Physical Therapy Aide- On the job training, no licensing, 100% supervision by RPT required.