Hi All - I know this is very long but I'm brain tired and tryed best as
I could to write what I've been going thru with Mom and this hospital.

Mom was sent home from the hospital Tuesday night. I don't know if any
of you know how Medicare has certain rules about how long you can stay
in the hospital.  Apparently, the hospital decided Mom didn't meet
Medicare guidelines last Friday and started working on getting the
doctor to agree to dismiss her.  He told them he wanted new labs and
would dismiss her on Saturday. Well, on Saturday when he came in, Mom
was very swollen from the tips of her fingers, up her arms, neck and
face. The kidney specialist order more labs on her blood and urine. By
Monday, the swelling in her arms hadn't subsided and he ordered a
Doppler on her arms thinking blood clot. In addition on Monday am, I
ask for a second consult from a seizure specialist to adjust Mom's
seizure med as she was still sleeping all the time. Even ate with her
eyes closed.  The family dr, 2nd neuro and kidney specialist all wrote
in Mom's chart that she was medically unstable and should not be
discharged.  I talked the family dr and was told if things continued to
improve he would discharge her on Thursday. That was at 3:30 Tues
afternoon.  At 4:25 I get a call from the social worker stating that
Mom was being sent back to the nursing home, that the family doc and
all others had signed off.  A message was left on my machine telling me
this.  When I  phoned back, a short 5 minutes later, of course, the
social worker had gone for the day. The nurses station refused to page
her telling me that she always leaves at 4:30. Now a little
background.....

On Monday, I was called by a case manager for the hospital who informed
me that since Mom's dr and I refused to agree to discharge her, they
were sending her medical records to be reviewed by a state Medicare
Quality Assurance person. Basically, they would copy and send Mom's
file to them and after Quality Assurance interviewed me, a physician
would review her records and determine if Mom met Medicare guidelines
to stay in the hospital.  If not and the doctor still wanted Mom to
stay there, she would still be able to stay but without Medicare
paying, we would have to pay the bill for anytime after that ourselves.
I had never heard of this before and as you can imagine I was totally
caught off guard. The case manager told me that Medicare would call me
tomorrow. I had to have a witness on the phone that she read me some
jargon and it sounded like they were getting the dr in trouble!

On Tuesday, from  4:30-5:00 I was interviewed by the Quality Assurance
person in the independent program. (It was just prior to this time that
the social worker left me the "we are discharging your Mom at 6:30
message) I explained what had been going on with Mom and why I thought
Mom should have stayed in the hospital.  I emphasized that it was the
DOCTOR'S decision that I supported but understood fully why he felt
that way. When Mom entered the hospital she was in acute renal failure.
With the type of swelling she had on Saturday, it was right for the
kidney specialist to rule out kidney failure. With the only guideline I
had been given being, "nothing we are doing for your Mom can't be done
in a skilled nursing facility" I told the Quality Assurance person that
the labs ordered by the kidney specialist could be done on a timely
basis in the hospital to rule out kidney failure while it would take 48
hours in the nursing home. I further pointed out that the swelling
hadn't been resolved yet and that since her diuretics and heart meds
were on hold waiting for her kidney function tests to lower, it would
seem prudent to get her back on track while in the hospital in case of
bad reactions.  The Quality Assurance person told me that Mom could
stay in the hospital until 12 noon the next day by which time we would
have an answer on who they agreed with -- the doctor or the hospital.
Did I want a call back with the answer? Well, no, discharge was in the
works. The doctor had caved and I said no, feeling it was emminent
anyway. Why not just go with the flow at this point.

Today I received an FED X letter from the Quality Assurance board.
Anyone want to guess what they said?????  Come on....guess........
THEY AGREED WITH THE DOCTOR!  In fact, the physician stated that Mom
was medically unstable and should remain in the hospital!  Too late for
that!  ARGGGGGGGG!

Now a little more of the story. When I got copies of Mom's hospital
records from the nursing home, I find out that the social worker had
been working on Mom's discharge with the case management person since
11:15 in the morning. They know how this review process works and I
didn't. She knew if she called me at 4:30 I would have no way of
fighting it since the social worker and case manager were both gone.
It's also more difficult to get ahold of a doctor that time of day. I
could have had Mom in the hospital until I was given the review
decision which was today.  But then they really really needed beds for
er patients.

When they started on Friday afternoon, I felt as if they were just
trying to get a bed freed up for the weekend. I told quality assurance
basically the same thing and ya know what they said?  That's not the
only hospital that does that! And when Mom was still there on Monday,
its seems as if they were going to prove a point and get the doctor to
discharge her thru threats of reporting him to Medicare Quality
Assurance which ultimately worked.

There were several other things the nurse on the floor did this week as
well. The neuro wrote orders for Mom to be transferred to the neuro
floor in the hospital next door for a 24 hour eeg monitor. The nurse
told the social worker that the neuro wrote for Mom to be discharged to
Lucerne TTC instead of EEG. TTC or Transition Care Center is a high
lever rehab center. She had the social worker from TTC come over and
evaluate Mom who is basically unconscious.  Of course, they refused her
and said send her back to the SNF she came from. So this nurse then
calls the neuro and tells her Lucerne refused to accept her because
they don't have a private bed and she has to be on isolation because of
the 3 different types of UTI bugs she picked up while she was there. So
Mom didn't get her 24 hour EEG. She also called the neuro who had
signed off last week and told him that Mom was swelling. Of course, he
said take her off the anti-seizure drug while the new neuro we had
brought in on the consult had kept Mom on the drug with a different
dosing schedule. I ask the nurse why she called him for swelling when
swelling isn't a side effect of the drug. She claims to have looked it
up on the internet and it said to call the dr immediately if there was
swelling of the lips, tongue, or face; or hives so that what she was
going on and since neuro #1 prescribed it, she called him. Well I'm
still now sure how it was decided which neuro to listen to but Mom was
put back on Keppra and is sleeping all the time. I really think she
should be on something else. Too much for her.

Ok - So now I'm falling asleep but wanted to tell you what's been going
on the past few days. Been at the SNF 2-4 hours at a stretch so I can
be there when she wakes up.

I'll write more tomorrow.  Very tired now.....