DISCLAIMER: NAME OF HOSPITAL AND NAME OF SUPERVISOR CHANGED FOR CONFIDENTIALITY OF BOTH
Presented to St. Joe's on the 18th of July secondary to chest pain, abdominal distension and paresthesias and pain in legs, feet and hands in the setting of a 30 lbs weight loss over the past month. EKG revealed on QTc prolongation with no arrythmias. CT scan of the abdomen and chest times two failed to reveal any abnormalities therefore the patient was admitted to CPCU for further workup and treatment.
Patient was discharged five days later on a Friday even though no diagnosis had been made. CBC clearly showed a moderate to severe macrocytosis and a severe abdominal distension. An endoscopy planned during that admission was not done due to time constrictions and patient was to f/u with GI. She was given a PPI, Carafate and Folic acid along with potassium. Patient was sent home and presented again to SJH ED in the early morning hours of 7/26/22 with chest pain, paresthesias, abdominal distension and the near inability to walk due to swollen legs and ankles and extreme pain.
Patient was seen and examined and discharged to follow up with her PCP on Thursday. However she presented to my office on Wednesday, July 26th in extremis. Blood pressure was 136/91 with a HR of 104. Had to be held to walk.
To this point, the patient who notified SJH at every point that I was her PCP both verbally and in writing, SJH failed to send me either of the two ED reports or the hospitalization.
Therefore, I was flying blind during this presentation having to start from scratch. Several calls were made to SJH asking for her records.
4:23 pm: our office called medical records asking for the Discharge Summary and ED reports. Rather than send them they asked for a written statement that she was indeed in our office. We did so and received nothing.
5:07 pm my MA called against and had to page the nursing supervisor as medical records was now closed. She stated she would get the records and send them. Nothing was received.
5:40 pm: I called CPCU and was told that the discharge summary would be printed and faxed to our office. Nothing.
6:00 pm: Called CPCU and was told they would need a signed release. Release was sent.
6:10 pm Supervisor, Charlotte, received the release but refused to send records as she was at a pediatric office. This AFTER SJH made the appointment with our office themselves.
6:20 pm: Still questioning my being PCP and asking about pediatrician taking care of an adult. Still no fax of records.
6:35 pm: Patient spoke directly with nursing supervisor, Charlotte, and made it very clear that she wanted the records practically pleading for a copy of her records which she had sent a signed release for. Supervisor wanted to know how she could trust she was who she said she was. She told her they were faxing it at the time.
6:55 pm: Still no records.
7:00 pm: As patient's condition was worsening, an ambulance was called and took the patient to the Emergency Department of EMMC.
7:09 pm: Ambulance arrived and took the patient to the ED.
7:54 pm: Received fax from SJH with "discharge summary" which was actually a copy of the discharge from the ED and was the patient copy.
Patient seen in EMMC ED with anemia and macr0ycytosis with a MCV of 112 and question of severe B12 deficiency. Myelodysplasia is questioned. As of this note, she is still in the ED.
From our first request to the receiving of the wrong information, it took 3:31 minutes or 211 minutes, most of the time wasted due to a) medical records closing after promising the records, CPCU's inability to locate the patient in their computer system and then having difficulty printing and faxing and c) the nursing supervisor's refusal to send records.
Her excuse was the pediatric office and the fact that my name was not on ALL of her past records. This had nothing to do that a) SJH referred her hear, b) a signed release was sent and, c) the nursing supervisor, Charlotte, was aware that the patient was here and was very sick. At one point she asked why the patient couldn't simply sign the release at the office and we had to explain she was in a different room unable to ambulate.
Edit: It is clear to me that the patient's medical care was significantly delayed due to SJH refusal and then slow release of the wrong records. Patient deteriorated and was taken by ambulance to EMMC.
This is clearly where the question of HIPAA overrode patient care and was not its intention.
PS: I questioned why I should wait for the records prior to simply sending her to EMMC. First, I wanted to have the two ED reports and the H & P and D/C summary from the hospitalization so I could present a coherent message to EMMC ED and/or hospitalist. With each communication I was reassured they were on their way.
PPS: This patient had received a letter discharging her from the practice and letting her know she needed to find a FP or Internist. But once she presented to my office, she was my responsibility.
