DGH ED Experience Letter

Dear Patient Relations for Dartmouth General Hospital,

Preamble: I do not have the names of the nurses and most of the personnel on shift for our night at the Emergency Department, so I will be referring to them as “Nurse #1, “Nurse #2”, etc. REDACTED had his left hip replaced by Dr. REDACTED at the Dartmouth General on Wednesday, May 29 in day surgery, being sent home the same day.

	REDACTED and myself, his wife, REDACTED, arrived at the Dartmouth General Hospital Emergency Department on Sunday, June 2nd, 2024 at approximately 19:00. Nurse #1, a triage nurse in Triage 1 looked at my husband right away. I had to wheel him in a wheelchair because it was too painful for him to walk. We told Nurse #1 about it being difficult for him to breathe at times, the lung/chest pain, the extreme pain in his leg (he said it felt like a rope was tied around his leg and he was being dangled from it) and the inability to control the pain with the narcotics prescribed at the time (oxycodone, 15 mg every 3 hours; sometimes 20 mg), the rashes and urinary retention his medication seemed to be giving him, the colour of his legs not matching, and the coughing up of brown-coloured phlegm. I also mentioned that the day before, REDACTED had burning hot (and red) arms and face, but all his lower extremities were very cold. Nurse #1 checked REDACTED’s oxygen, but did not do an EKG. As he was being sent to registration, I also asked Nurse #1 if REDACTED told him about the numbness, tingling, pins and needles, and coldness in his foot/lower leg. She said, “No,” so I explained it to her.
	After registration, I wheeled REDACTED into the waiting area, and wanted to ask how he was triaged (what level). I could see that Nurse #1 was busy with another patient, so I went to Triage 2 and inquired of Nurse #2 how my husband was triaged. She said that he would go to the “Minor Emergency Treatment Area” (MET). I questioned her about it being considered “minor” and said he had chest/lung pain and shortness of breath and numbness, and she reiterated that it is how he was triaged and that was where he was going. She said that they weren’t terribly busy and that the wait should be about 3 hours. I asked Nurse #2 if REDACTED can have a stretcher or a bed while he was waiting because sitting was causing pressure on the area of his replacement and causing even more excruciating pain. Nurse #2 became short with me and said, “We don’t have beds just lying around here.”
	At approximately 20:20, I notified Nurse #3 in Triage 1 that my husband’s chest pain was getting worse, and his foot was now completely numb, and asked again what he is triaged as, and he informed me that REDACTED was triaged as Level 3.
	At approximately 20:30, REDACTED’s pain was so unbearable that he requested to me that I bring him out to our van so he can sit in a padded, reclining chair. I spoke with Nurse #2 in Triage 2 again, informing her that I was bringing him out to the van because his pain was so severe and sitting in a chair was not helping. She tried to dissuade me, saying that he could be called at any time. I wheeled him out to the van, and helped him in, which took several minutes.
	To be sure that REDACTED’s name was not called during the time I brought him to the van, at approximately 20:40, I asked Nurse #4, who was calling another name, whether he called my husband’s name and I explained that I had to bring him out to our van and why. He looked extremely annoyed by me, and said they are not responsible for anybody outside and that my husband needs to be inside. He refused to tell me whether my husband’s name was called or not. After Nurse #4 brought in a patient with what looked to be several support persons, a woman in the waiting room approached me to assure me that my husband’s name was not called while we were gone.
	At approximately 21:00, Nurse #5 called REDACTED’s name, so I retrieved him from our van and wheeled him up to the doors exiting the waiting room into the emergency area. Nurse #5 stopped me from wheeling me in, and explained that he was going to a “chaired area” (MET 13), and there wasn’t any room for “visitors” there. I explained that my husband needs me with him, since I advocate for him and he is not in the state of mind to be able to advocate for himself. Nurse #5 was firm and insistent that I not go with him, despite mine and my husband’s protests. Approximately less than 5 minutes later, Nurse #5 came back out, called for me, and asked me the last time REDACTED took medication and what the dose was, since REDACTED was unable to answer and referred for the nurse to ask me since I had the necessary information.
	I asked Registration Clerk #1 to be able to speak with whoever was managing/supervising currently, so he made a request for me to speak with the Charge Nurse.
	The Charge Nurse came out and I attempted to reason with her to let me in to the back to be with my husband, explaining everything happening and that he needs an advocate with him. I mentioned that I believe that there are rights for patients to have an advocate with them in at the hospital. The Charge Nurse told me that they are the ones to determine whether a patient needs an advocate with them, dismissed all of my concerns and would not let me go to be with my husband.
	At approximately 20:20, I requested that I be able to bring my husband his phone, and was allowed to bring it to him in MET 13, but must leave the area after. I could visibly see that the area was not full, and there were several empty chairs. My husband was in a recliner, and upon communicating with him, the recliner relieved some of the pain, but he really needed to lay down to take the pressure off, but nobody would provide a stretcher or bed for him. He told me that he “just had x-rays done” (of his chest). I could see that there were unused stretchers along the hallway. Upon communicating with him later, my husband also told me that Nurse #5 became annoyed with him when he said that she needed to ask me about his medication. After Nurse #5 returned from asking me, she asked REDACTED what level of pain he had, and he said that at that moment, it was about an 8/10 (he had moments of 10/10 on and off that night), but Nurse #5 replied, “You do know that you shouldn’t expect to be pain free?” My husband explained that he knows this, and that he would like some pain relief, and that he was there because of his lungs and possible complications from his hip replacement surgery. Some time later, he was able to get a muscle injection of hydromorphone which brought his pain down to about a 4/10.
	While in the waiting area, I was searching on the internet to find NSHA patient rights. I saw some advice to ask for a social worker, so I asked Registration Clerk #1 to speak with one, and was informed that there was no social worker there at the time. I searched more, and came across NSHA Family Presence AD-QR-020 which states:

• Patient Autonomy: The Patient has the right to decide who is and is not part of their
Family Presence care team.
• Patient Access: Patients and Families/Primary Support Persons are welcomed 24 hours
a day according to Patient preference.
• Family Support and Respect: The Family/Primary Support Person is respected as an
essential member of the health care team helping ensure quality and safety.

	At approximately 23:00, I asked Registration Clerk #2 to speak with the administrative supervisor (“bed manager”), and was informed that they don’t work on the weekends. Registration Clerk #2 queried as to why I was asking for one, and I explained how I found that according to NSHA Family Presence policy, my husband has the right to have me in the Emergency Department with him. Registration Clerk #2 said, “I’m pretty sure that’s not true,” and I replied with, “It is true.” He said that the only person I can speak with is the Charge Nurse. So I requested again to speak with the Charge Nurse.
	The Charge Nurse requested I speak with her in Triage 2 area, and I explained about the Family Presence policy that I had found. She told me that my husband is not admitted to hospital, so Family Presence doesn’t apply, and it’s their policy that I can’t go in the back. I asked, “What is the policy? Can you show me the written policy?” The Charge Nurse replied that it would take her a moment to look up the policy, but she would do so and come get me from the waiting area.
	Approximately 10 minutes later, the Charge Nurse came out with a printed paper from the nshealth.ca website regarding Family Presence and showed me the section on Limitations:

We may interrupt Family Presence to provide appropriate patient care and/or to protect the privacy rights of other patients. We will make decisions case by case.

She told me that it is to protect the privacy of other patients. I attempted to reason with the Charge Nurse on why something like this doesn’t apply. The Charge Nurse still would not let me in the back to support my husband and advocate for him.
	I was told that when the doctor sees my husband, that I would be allowed in the back.
	On Monday, June 4th, 2024 at approximately 0:00, I was called by Nurse #6 to come into the back because he was going to be seen by the doctor. REDACTED was wheeled into a room with tarp walls, received a bed, and examined by Dr. O’Brien(sp?). She checked the pulse in REDACTED’s legs and said it was good, said REDACTED’s blood work came back good, x-ray did not show anything of concern, and ordered more blood work (such as lactate) and an x-ray of REDACTED’s hip. She said she would give REDACTED a prescription change for hydromorphone, since the oxycodone appeared to be the reason for his rashes, and also that he would come back in the morning for an ultrasound of his leg to rule out Deep Vein Thrombosis. She mentioned that there was nobody to do ultrasounds after 4 pm. As the doctor was leaving, I asked if I had to leave as well, and she told me “No,” and that it wasn’t a problem and that I could stay. My husband mentioned that we were told that we had to leave the room when the doctor leaves, and the doctor replied and said that we didn’t have to leave.
	At approximately 0:40, Nurse #6 wheeled REDACTED out to MET 13 again. There were only two other patients in the area; nearly all of the chairs were empty. I stood by REDACTED in his chair since the doctor said that I didn’t have to leave, but Nurse #6 told me I had to leave. I brought up what I was told, and Nurse #6 became short with me and said, “I told you that you had to leave after the doctor examined him.” So I left for the waiting area again.
	At approximately 2:00, Nurse #6 came out to tell me that REDACTED was being sent home, so I went in the back with her to get him. He was given a pink paper with his ultrasound time on it. I asked Nurse #6 if he also has a prescription, as the doctor said she would give one. Nurse #6 said that there is no prescription. He was given four 2 mg tablets of hydromorphone to bring home with the instructions to take 1-2 every 4 hours. MET 13 continued to be nearly empty, and the same unused stretchers were still unused in the hallway.
	The next morning, sometime after 7:30, Nurse #7 in Triage 2 checked REDACTED’s vitals and immediately did an EKG (which was normal). He then went to registration and we were told to wait in the waiting area. Nurse #7 came out and told us we can go straight to ultrasound and register. He had his ultrasound done fairly quickly and we went back to the Emergency Department waiting area.
	While in the waiting area, REDACTED’s name was called, and we were both brought into the Minor Emergency Treatment area near the casting room. It was fairly busy at the time. While waiting for ultrasound results in the MET, I received a call from REDACTED’s case nurse, Emily (I had left a voicemail message during the night), and she informed me that REDACTED indeed received a prescription from Dr. O’Brien (that it was in the provincial system for a pharmacy to pull from). REDACTED was eventually brought in to the casting room and given a bed, and examined by the doctor working that morning. He was told that his leg appeared clear from DVT. He was discharged and sent home.

	I have several questions as to why I wasn’t allowed into the back. If the DGH Emergency Department is choosing to implement the Family Presence limitation, how is it being done on a fair and consistent basis? Is it occurring with all registered/admitted patients? I could see that there were support persons or visitors with other patients in the back. Why is my husband expected to be without support or advocacy most of the night, particularly when MET 13 was mostly empty? Why was my husband considered a “Minor Emergency”? Why was my husband denied a bed/stretcher several times when one was available and he very badly needed one? Is the application of Family Presence consistent among all Emergency Departments at this time? Did a health services director sign off on this policy? What are the criteria for letting family in the back? It seems that DGH’s application of the limitations policy is cruel and inconsistent (particularly with certain staff members).
	Procedure Statement 1.1 states:

Patients identify up to two people upon registration/admission to be their Family or
Primary Support Person and define how they will be involved in care and decision making.

The Charge Nurse telling me that they decide who needs family support is false as per Statement 1.1. The Charge Nurse telling me that Family Presence does not apply since my husband was not admitted (he was registered) is false as per Statement 1.1. The Charge Nurse referring to the privacy policy in Statement 1.6.2 “To ensure the privacy rights of other Patients are respected.” does not apply to such a situation. For one thing, my husband himself could hear and see everything happening with other patients while in MET 13, and the tarp room does not dampen sound whatsoever. Interrupting Family Presence in cases like what happened to us in the Emergency Department does not appear to increase privacy, but instead such interruptions are harmful to the patient:

Family Presence results in increased coordination of care, fewer medication errors, fewer readmissions, reduces falls, and a better overall healthcare experience (Patients Canada, 2015).

I kindly request that the procedures put in place the night we were at Dartmouth General Hospital Emergency Department are reviewed, and that patient rights are protected by allowing patients access to Family Presence policy.

Sincerely,

REDACTED