Emergency Room Error: Could Have Lost My Life 9/29/2014

This weekend I could have lost my life because of terrible emergency room care, a Registered Nurse not Doctor making a diagnosis, short staffing and a hospital putting the all mighty dollar ahead of my life.

I am one of those people that has a hard time taking no for an answer, I'm also really lucky to have a supportive husband who will advocate for me until he is blue in the face. Thankfully we didn't let the ER turn me away as they tried multiple times to do on 9/29/2014

In 2003 I was diagnosed with Addison's Disease. It's an autoimmune disease that has completely destroyed my adrenal cortex and I have to take life long steroid replacement to live. Stress can exacerbate the condition and send me in to what's called an Addisonian Crisis (Acute Adrenal Crisis) and the symptoms are very severe:
•nausea or abdominal pain
•vomiting
•fever
•joint pain
•loss of appetite
•dramatic changes in blood pressure
•weakness
•chills
•rashes of the skin
•an irregularly high heart rate

With all the stress in my life from the South Napa Quake and being laid off as a result, I've been majorly stressed out and went in to an adrenal crisis. I was treated in the local ER on 9/25 twice and 9/27 for that Addison's Crisis. The doctors gave me no discharge instructions on my steroid dosage and instead of doubling up on my dose (as I should have been instructed) I tapered down. Meaning I took 625mg of hydrocortisone when I should have taken 150mg over the weekend.

Needless to say I was not feeling good and went to the ER again on Monday September 29th at 11:30am with:
•chest pain
•heart palpitations
•visual hallucinations
•hadn't slept in 48 hours
•couldn't quench my thirst
•auditory hallucinations

By 2:30pm, I still hadn't been called back in to the ER and everyone that came in before me had and almost everyone that came in after me had. I asked the nurse how much longer it would be. She replied to me:
We see you for these "fits" all the time. By fits I guess she meant Addison's Crisis's and I'm not seen all the time, they're quite rare and I haven't had one in over a few years. She made me feel like I was being seen for a mental breakdown and this was said in front of the 12 other people in the ER waiting room. Unacceptable.

So I left the ER and walked to the administration department to get some assistance. One of the admins that handles "complaints" came back to the ER with me, explained that I needed to be seen and suggested an EKG. About 20 minutes later I was hooked up to the EKG and it was given a quick 5 second run. I was instructed to sit back in the waiting room and wait to be called back to see a doctor.

At 3pm a nurse came out to me in the waiting room and said:

Look around you, we are busy, you are stable and can go.

I couldn't understand how they could deem me stable without a blood draw since I had taken so many of my hydrocortisone (steroids.)

My confusion and steroid overdose had not been addressed, they simply gave me the EKG.

So I called my husband told him that a Nurse had deemed me "stable" and had told me they were "busy and I could go." Understandably he was angry and told me he'd be right down, and he was there in like 10 minutes. We went back to administration to complain. They again brought me to the ER and told me I had to re-register since I had been discharged. So I did. It's 4:00pm at this point, again I had been there since 11:30am.

At 4:30pm I was finally called back in to the ER and put in the back corner room, they closed the door and again forgot about me. At 5:30 I asked WTF was going on. I was so confused and was having visual and auditory hallucinations, I though it may have been from the high dosage of steroids and not the fact I had been awake for 48 hours. They finally ran my bloodwork and at 7pm I was told that my potassium was a level 2.6L. That is life threatening levels.

Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). A very low potassium level (less than 2.5 mmol/L) can be life-threatening and requires urgent medical attention.

Symptoms of low potassium:
•Weakness, tiredness, or cramping in arm or leg muscles, sometimes severe enough to cause inability to move arms or legs due to weakness (much like a paralysis)
•Tingling or numbness
•Nausea or vomiting
•Abdominal cramping, bloating
•Constipation
•Palpitations (feeling your heart beat irregularly)
•Passing large amounts of urine or feeling very thirsty most of the time
Fainting due to low blood pressure
•Abnormal psychological behaviour: depression, psychosis, delirium, confusion or hallucinations.

The doctor then told me if I was concerned I could go to the local urgent care clinic and they could admit me to the hospital. Again, I was confused and didn't understand why the ER couldn't admit me and I would need to be seen at a low income clinic. My husband was never called, as he should have been due to my hallucinations and confusion as he's my emergency contact. I was not in a state of mind to make that decision as a physician should have known.

The next day I called the hospital to voice my concerns about the quality of care and HIPPA violations. My call was not returned. I called the next day, again no call. So I went to the hospital to talk to someone about it. I was told the doctor thought I should have been admitted but I had told him "I want to go home and go to sleep." And I had told him that after I was told "if you're worried about it go to the clinic and they can admit you. I explained to the admin that my husband should have been called as I was suffering from delirium from low potassium and didn't understand why the ER couldn't admit me to their own hospital.

My husband should have been called to make the decision about me being admitted, not a patient suffering from confusion with auditory and visual hallucinations.

So basically they were busy and a nurse decided I didn't need to be seen, not a doctor. Unacceptable.

Had I not stood up for myself and/or didn't have my husband to advocate in my behalf, I would most likely be dead right now because of their incompetence.

I've got a complaint pending with the hospital, they're going to use it as a "training opportunity." Are you kidding me? Training? That angered me so much that I've also got a claim pending with my insurance, will be calling the state on Monday and also filing a HIPPA complaint, formally.

Don't ever let the Emergency Room push you out, legally they are not supposed to refuse service.

I feel I was refused service and almost lost my life because the hospital is so short staffed. If it happened to me, it's happening to other people and that is something I will not stand for. Would they push out my grandmother, my friend or neighbor who is afraid to speak up for themselves? Not on my watch! This hospital pushed out the wrong patient!

*Mods: I wasn't sure if this was a rant or a medical issue. I put it here because Emergency Rooms are not supposed to refuse service in the US. If it's in the wrong forum feel free to move it.

a reply to: Jennyfrenzy

Don't ever let the Emergency Room push you out, legally they are not supposed to refuse service.

I think I would be afraid they would not give me the best care under those circumstances. It sure would be great if we could all have a caring Doctor of our own to call who already knows our health issues.

I was recently reading about Addison's Crisis strange I came across it in reading something else, but it said something about the dose of steroids needed constant and careful monitoring because too little or too much could be really bad.

So sorry this happened to you. However, you were wise (and brave) to stand up for yourself and lucky to have a supportive husband. Excellent that you are going forward with your complaints!

I remember reading that JFK also had Addison's Disease, and struggled with it while he was in office.

Take care. My best to you.

a reply to: Char-Lee

That was my fear too and I expressed my fear of resentments to the admin. Unfortunately the next closest hospital in about 30 minutes away and we have a 1961 Lincoln Continental that is having issues. There was no other choice at the time.

That's why I feel I wasn't admitted, because of the resentments and that's unacceptable for a hospital. If they don't want angry patients don't refuse service. Most likely I'll never be returning there, that day unfortunately, they were my only option unless I wanted to pay $135 and we don't have that right now.

a reply to: ladyinwaiting

Thank you!

I worry for others that don't stand up for themselves, the healthcare system has really gone downhill since ObamaCare.

JFK did have it and had to lie to the American people about it otherwise he may have never been elected president. I think his sister Eunice had it too, she has the dark/tan skin tone that comes along with Addison's.

Addison's disease seems to run in families, my paternal aunt has it too.

I have seen the emergency room blow my daughter off a few times. I have seen doctors here ignore what is said to them about your symptoms and do no tests at all and come up with the wrong treatment. Half the time my granddaughter goes to the ER or a doctor for her asthma, the doctors give her medicines she can't take because of side effects. Corticosteroids. They keep saying this is different, and the reaction is never different. That is four times in the last six months that pills were bought and then tossed after a couple of days because of the side effects. Then you are back in a couple of days because they did nothing to solve the problem. I'm not sure what is going on, the doctors can't be misdiagnosing that much up here, if they were, they would occasionally get a diagnosis right. This all started when they started typing symptoms into a computer. I don't know what they are typing, but it is blocking their ability to properly diagnose. They ask a question and then they type something in and then they look at the screen and ask a nother question designed to lead a person to answer in a desired direction. Leading the patient is not good, they ignore listening to the patient or asking questions outside of what the program leads them to. I think this is a problem, the ones that use this program are way off base, they are ignoring most of the symptoms.

That computer program should be made illegal. Anyone could use that program to diagnose, you do not need a doctor for that. I can't understand why the doctors can't see this program isn't right. They need to pay attention and think on their own.

I take my granddaughter here and everything gets better. I feed her foods that do not trigger asthma and am trying to tell her that she does not need to have these events. Certain sulfur foods trigger her asthma. Pizzas and stuff with tomato trigger her breathing problems. But she believes the doctor because they do not tell her she has to keep away from eating anything she desires. This is compounding chemistry, overconsumption of some things cause the asthma. If she wants to eat a bowl of pickles, she has to make sure they don't contain alum.

I have had lower potassium levels then you and felt fine. but the doctors wanted to admit me right there.

I have sarcoidosis another autoimmune disorder that causes my low potassium.

But its only in the summer i never have had the problem in the winter. I live in the desert and sweat off potassium due to the heat.

I now take potassium supplements every summer just so i don't annoy the doctors.

I have learned to fix all this, hubby with heart problems and 82 year old mama. Call an ambulance, you will go right into a room. Buzz word chest pains and heart problems history and I don't know. Works every time and I have been doing this for 12 years with both.

I am like you not going to let it go. One visit mama was in ER room for 5 hours not sure what was wrong she has so many health problems. I got a little miffed and started looking on the walls for phone numbers, found one that said let them know if you have a problem, I did, mama had a room in 30minutes.

The nurse tried to lie her way out of it and I called her out as a lier. She shut up and went to work. When we were moved to the room, we had never had such good care. I said to the nurse I guess you heard what happened downstairs, she said the whole hospital had.

I really don't like to be this way, but what do you do when a loved one is sick?

Irregular heartbeat and weak means pottasium may be deficient. Irregular heartbeat and strong may mean potassium levels may be too high. Drinking alcohol causes sodium to be excreted and conserves potassium. I am not telling you to start getting drunk though, but it would relieve your stress.

a reply to: Jennyfrenzy
I don't know if it would help, but you can file complaints to your health insurance company (if your using one) about your treatment

I'm sorry you had to go through this but I'm glad you finally got taken care of. I've worked emergency department many times (I'm a critical care nurse) and have noticed this attitude from the nursing staff on more than one occasion.

When my youngest daughter was going through her "goth" phase she had an adverse reaction to a prescribed medication so I took her to the E.R. They assumed she was a druggie and treated her like a crack whore. Seriously, I actually wound up performing any nursing duties for her because the staff was abusive, condescending, rude and grossly unprofessional. She was a straight A student (AP courses) with a 142 I.Q. All that aside, she was in obvious distress, unable to even sit in her wheelchair without falling out of it. I tossed the staff out of the room when they began to physically hurt her (she weighed all of 100 pounds and had FOUR grown men wrestling her down to put her in 4-point restraints!). They changed their tune when her toxicology drug screen came back negative for any recreational drugs (8 hours later!). I called the poison control center and told them the E.R. doctors name and they called him and told him what to do for her since his treatment option was totally ineffective and inappropriate. When I told them I was a critical care registered nurse and a certified legal nurse consultant, they backed off and let me care for her in the E.R. Btw, this is also inappropriate since I was there as a concerned mother and not as additional nursing staff.

Having worked E.R., I know what it's like to constantly have to deal with stupid people who do drugs and drink too much in addition to all the mental patients who have nothing better to do on any given evening than to seek attention from those obligated to provide it. That said, there are admit/triage protocols in place to avoid exactly the situation you encountered and it sounds like they were not followed. If you seek legal action against this facility, I would recommend an attorney who utilizes a legal nurse consultant (not me) since lawyers know the law but they don't necessarily know hospital procedures, protocols or how things work or are supposed to work in hospitals. A nurse consultant can pick those things out quickly from the records and direct a lawyer to ask the pertinent questions about how things should have been handled. Best of luck to you and if the facility is going to use your incident as a training event make sure they learn the lesson well.

You've gotten a lot of good advice here but I'd like to simply add that your condition is complicated and chronic, with infrequent critical incidents; you need a doctor who knows your history and YOU when you're normal, so they can see when you're having a crisis what abnormal looks like for you, and follow you through it. If you had called that doctor before heading to the ER, things might have been handled differently.

The drugs you're on are dangerous if not followed closely; I realize it's not easy to figure out financially but being too many minutes away from a hospital that is competent and well staffed could kill you. The death rates in rural communities are high for that very reason - too far away from help when it's needed, and the staff is not going to be all that stellar either.

All the people who think Ebola will be no big deal (or even think day to day things are being handled effectively), go to your local hospital's jobs/careers site, and LOOK AT THE NUMBER OF OPENINGS, ESPECIALLY FOR NURSES BUT ALSO DOCTORS. They just added 50 million people to be covered, but they didn't just spit out 5 million nurses, technicians and doctors to do the work... that's what 'we're busy' means. If you're not bleeding or having an active heart attack, two things that are obvious and/or easily diagnosed, you're not likely to get much relief. If you have a beard, or tattoos, or are dressed 'differently', it's likely you'll be considered a druggie, not an ill person. The people you are dealing with at the ER are overworked, understaffed, and see the dregs every day. It's only human that they would react sometimes the way they do. Suing the hospitals will only make the hospitals fewer and farther between, and that's not gonna help anyone.

a reply to: Jennyfrenzy

Oh Jenny, I am so so sorry you had to go through this and thank goodness you are alright. I want to hug you both. You must be exhausted.

I can't tell you how many times my husband has been through this exact same situation. Not only is it an astounding lack of knowledge when it comes to Addisonian crisis, but also the way the medical professionals seem to treat those suffering.

Not only is it a real and urgent state but they seem to expect the sufferer to essentially coach the ER staff and be coherent while doing so. Only then to be treated like a pain in the a%$ whiner when attempting to convey the seriousness of the situation.

The last major crisis my husband had, after heading straight to the ER for an emergency injection was sent out, to catch a bus. No one bothered to call me to say that they had just sent a person in crisis out into the world. So he manages to get the bus to the next town to the pharmacy to pick up an injection to self administer and the pharmacy tells him that the ER sent the wrong papers, and that he needs to go back to the ER. So now in full crisis he heads back outside to try to catch another bus. He never made it back to the ER, he just sat down thank goodness by the side of the road which is where I found him after calling the ER to see when I could pick him up. I wish I could say it was unbelievable but it was not the first time we experienced something similar.

What I do know Jenny is that it takes a lot to live with it day in and day out. You are strong in ways that many can't really understand. I'm so so glad you're ok.

Penny

a reply to: Jennyfrenzy

I'd like to know the name of that hospital, if I may.
(U2U me if you want to keep it private)

If it's in the same group of hospitals where I work, heads will roll.
(I'm on the Leadership Team)

You go girl! I'm so glad you're okay and were able to overcome the stupidity of those folks.
I often wonder how many lives are lost due to this type of behavior by practitioners of mainstream medicine---or how much misery is caused by their inaction.
By the time I left the medical field, I had lost almost all respect for that field in dealing with anything except emergencies like bloody trauma or broken bones. I now avoid them like the plague if at all possible.
For those who are making excuses for medical professionals acting in this way----I'll say the same thing I say when folks stand up for misbehaving cops by pointing out the stress of their jobs---they need to find a different profession. I've seen dozens of people who have done just that. When I worked at our local hospital my department had 14 employees. Within five years of the time I left the job 12 more left the job and 10 of those left the profession. That included my boss, the chief pharmacist, who left the field when he came to the same realization I had reached---that we were doing more harm than good in many, many cases.
There were many times when I had to stand up to a doctor who had written a prescription incorrectly. Some would thank me for pointing out their error before it caused problems but the majority were rude and several times I heard, "I'll have your job." when I told them that it didn't matter what the drug rep had told them, the manufacturer of the med would not support use of that med under the circumstances so I could not dispense it.
Those experiences with the white-coated demi-gods have made me more likely to call out sloppy work when I see it and to do as you did, contact the administration in order to get things moving along.
And for those saying you should have had your own doc, etc....that's fine as long as your own doc who knows your history never takes a day off or a week off for a vacation in the middle of nowhere. Because you can be sure that if you have a crisis, it will happen when the doc is unreachable.
Good on you, Jenny for being able to handle this. May it never, ever happen again---to anyone.

a reply to: rickymouse

I hope your granddaughter grows out of asthma. She's a lucky girl to have you in her life! How frustrating it must be to have the doctors uninvolved in her eating habits. What we put in to our bodies is so important and like you said, effects the rest of the body and current medical conditions.

This all started when they started typing symptoms into a computer. I don't know what they are typing, but it is blocking their ability to properly diagnose. They ask a question and then they type something in and then they look at the screen and ask a nother question designed to lead a person to answer in a desired direction. Leading the patient is not good, they ignore listening to the patient or asking questions outside of what the program leads them to. I think this is a problem, the ones that use this program are way off base, they are ignoring most of the symptoms.

Such a good point and so true! Computers have really taken away the bedside manner of doctors. Computers can't see the patient, talk to the patient or have a complete understanding of how someone feels, only another human can really understand. My endocrinologist uses the computer but she also takes 1 hour with me when I see her. She is an excellent endocrinologist because she cares. It's too bad many physicians are starting not to, especially for patients with low income insurance.

Since my insurance doesn't cover her office visits because she's Kaiser, (I have another type of insurance ) I pay out of pocket to see her. Luckily I made an appointment with her last month and the adrenal crisis happened to fall on the weekend before seeing her. It's weird how things work out like that.

I hope everything works out for your granddaughter too

a reply to: judydawg

I have learned to fix all this, hubby with heart problems and 82 year old mama. Call an ambulance, you will go right into a room.

It's funny that you mention that because I was just talking to a friend about it. She said the same exact thing, next time this happens I'll call 911!

I really don't like to be this way, but what do you do when a loved one is sick?

I feel the same way, it's unfortunate that we have to demand, yell or be stern to get treatment for ourselves out a loved one. If it was my mom, I would have done the same, demanded treatment if there was a number, luckily admin and my hubby were there.

One thing that will always get me is being lied to, especially by a professional. Just be honest, everyone makes mistakes and lying about something always makes it worse.

Glad your mom was seen and treated!

a reply to: rickymouse

If I drank I would have needed a drink for sure, lol!! They gave some potassium seltzer pills to drop in water, a vodka cranberry sounds much more appetizing

No booze for me unless it's a special occasion Total lightweight, lol!

a reply to: gmoneystunt

Thanks for the advice! I filed with insurance today and I'll be filing with the state and HIPPA Monday.

They're just lucky they messed with me, had it been my mom....I would have been in the CEO's office in two shakes of a lambs tail raising a stink!!

a reply to: Jennyfrenzy

I dread going to the emergency room. It takes forever to be seen and by the time the tests and everything else comes back, the entire day is shot.