Hospital not informing spouse of problems.

[LAWMED]

First, here is a quote from the OP: "My sister had to work the entire day, she has spent the last 6 months doing nothing but work and take care of our mother." AND "On Friday morning when my sister got off work she went to the hospital and went to her room. my mother was not there. She went to the nurses station and was told that they had a problem during the surgery so she had been immediately put in ICU after surgery. So the night before when my step father called she was in ICU but he was told she was medicated and sleeping and that everything had gone well and she was fine.

We still do not know exactly what happened during the surgery to make her have to be put in ICU, no one can or will answer any questions."

actually, there are several.

1. policy does not allow them to disclose the information and they are required to defer to the doctor

WHAT hospital has a policy that says nurses cannot give the family (with patient permission) information on the medical condition of the patient?? Can you imagine the exodus of physicians from that institution if they had to be called every time a patient or family member asked a question? No such policies exist.

1a. the hospital's legal advisors have recommended all questions be fielded by the professional that was directly involved with the situation.

They sure would have jumped on the situation quick. The surgeon would REALLY have to have screwed up for the incident to have gone straight to the top immediately. Regardless, it is STILL NO EXCUSE. Hospital lawyers are in very murky territory if they advise care givers not to communicate with family members and patients regarding their condition and treatment, and the care givers may well violate state practice acts.

"The hospital lawyer says I can't tell you or your family what's wrong with you" won't be a defense if a state board comes calling.

2. since this was apparently via telephone, they had no way to verify the caller was actually the party on the HIPAA release and simply deferred to the doctor (more a stall than anything)

Nonsense. If that were the case then they should never have discussed the patient at all, declining to even acknowledge that such a patient had surgery that day. You don't make stuff up about a patient when unsure the person inquiring has a right to the information...you advise them you cannot give out any information. Since the patient had been there for two days already, the nurses likely had contact with the husband previously. Also, a patient can give verbal consent to release information...it does not have to be on a written release in this situation.

The daughter, who appeared in person at the hospital, has been a primary caretaker for the patient. She was not at the hospital that day because she had to work. As soon as she got off work the next morning she wen to see her mother. Almost certainly she had been to the hospital prior to the surgery based on her devotion to her mothers health care. No one would answer her questions. This is not a HIPAA precaution on the part of the staff. It is a refusal to convey medical information to the patient or the family without a lawful or medical reason. That is a violation of ethical and likely state practice act expectations.

3. there was a problem that, although not of immediate concern, was best dealt with by the doctor since likely questions would be out of the realm of the nurses knowledge or field of practice.

Not of immediate concern, but requiring ICU admission...and the nurses cannot talk about it because, bless their hearts, they just wouldn't understand what happens when the doctor is performing surgery. If questions regarding the medical condition of the patient, the reasons for her admission to the ICU, the pathophysiology of any complications present and the potential effects on the patient are 'out of the realm' of the nurses, they should not be caring for the patient. You are suggesting that it would be acceptable for a nurse to say...and actually mean...'I don't understand what is wrong with your mother, the doctor takes care of all of that. I have no idea why she is in the ICU under my care. You'll have to ask him.'

This is NOT the way things work. Nurses, beleive it or not, are expected to have a very detailed understanding of their patient's medical condition. ICU nurses especially must have very detailed knowledge about their patient's condition...and they are expected to speak coherently to other health care professionals in such a way as to present an accurate and pertinent clinical picture, on which those professionals often rely in determining treatment, often over the phone. The nurse can manage to convey medical information to the family.

apparently the husband was travelling and it is not known if the hospital had immediate contact information for anybody.

from the OP:

That would be another reason the hospital should be ashamed of itself. You NEVER take someone to surgery without having an emergency contact number for next of kin. But you can't have it both ways. Once the husband called in, this excuse is over.

Finally, if the family asks a question the nurse is unable to answer...for ANY reason, the physician should be contacted. When the question is "Why is my mother in the ICU and what the hell happened in surgery?" then the nurse needs to contact the physician IMMEDIATELY. They can have a meeting amongst the staff later as to why the physician did not personally contact the family immediately after surgery.

There are NO excuses here...IMHO.

 

[gasgirl]

Nobody Talks Anymore!

I have a few holes in my view of what OP is saying/asking:

Mom has advanced Breast Cancer. If she was having large amounts of fluid removed from her abdomen regularly, she likely has malignant ascites.
In most cases, a paracentesis (removing fluid from the abdomen) and liver biopsy are performed in a radiology suite with mild sedation, so if Mom was having this done in an OR by a Surgeon, something else was likely up...An open liver biopsy and large-volume paracentesis?

As far as removing what you describe as several liters of fluid, I can tell you, that ANY patient would likely have serious hemodynamic instability requiring careful monitoring and treatment- throw in a heart or lung problem, a general anesthetic, and you up the complexity.

It is completely reasonable that a woman with the problems you describe to require postoperative care of such a nature that the Surgeon (and likely the Anesthesiologist as well) thought the ICU was the best place for her. And for that, you should praise the surgeon.

Sounds like you are not concerned with the quality of care she is receiving, but are frustrated that you and your family members (who were not immediately available in the immediate post-operative period) did not receive adequate and specific communication regarding your mother's status.

1. Did the Surgeon call ANYONE after surgery? This is absolutely what the surgeon should have done if no one was at the hospital.
2. When Husband Called hospital, did he ask for a specific room or just ask the Operator to connect with Mrs. So-and-so's room? Is it possible the hospital operator transferred you to the ICU nurse's station, and the nurse, not knowing you DIDN'T get the briefing from the surgeon just gave you the reassurance she thought you wanted.
3. Did you ask to speak with the surgeon?
4. While I agree that Nurse's can and SHOULD discuss all aspects of care with patients and families, I can also understand that a Nurse would absolutely not want to worsen what may seem like an evolving conflict with family members. Wisely, feeling tension and frustration from multiple family members, he/she wished to have the family speak directly with the Captain of the Ship-the Surgeon.

In the 2-3 days after surgery, did mom get out of ICU? Did anyone speak to the Surgeon? Call his office? Get the nurse to page him?

It is very hard to be the fatigued, vigilant family member at the bedside, and sometimes just as hard being the family member who CAN'T be there, yet WANTS TO.

My advice, as a Physician, is to ask the Nursing Supervisor to arrange a family conference with the Surgeon (and any other attending physician you feel necessary). Make sure the Supervising Nurse is there too. Then, ask all the questions you want (write them down so you don't forget), and get the info- to include a prognosis, short and long-term treatment plan, etc...

If the Surgeon refuses, go to the Administration.