Former patient wants ‘change’ after hospital discharge in middle of night

Audrey Caro

In the last 11 years, the Oregon Health Authority has only received three complaints about Samaritan Lebanon Community Hospital that have reached the level of investigation.

“We had surveys dating from 2005, but none were complaint-related,” said Jonathan Modie, OHA Communications Officer, External Relations Division.

OHA tracks all complaints it receives, and forwards them to the Center for Medicare and Medicaid (CMS), Modie said. “Most do not proceed as far as an investigation; they may be regarding insurance or billing, which we do not regulate – those are referred to the appropriate agencies. Sometimes they are for concerns that are not regulated by state or federal law.”

Robin Swindall, of Sweet Home, was one of the patients whose complaint was investigated.

Swindall went to the emergency room in February of 2016, complaining of abdominal pain. She alleged that she was released from the emergency room at 2 a.m. without transportation arrangements after being given morphine.

She complained to the hospital directly and then filed a complaint with OHA about the way she was treated. She contacted The New Era about her experience as well.

In response to Swindall’s complaint, OHA investigators found deficiencies in an on-site survey of SLCH conducted on June 15, 2016.

One of the deficiencies found is that SLCH “failed to implement policies and procedures it had adopted for ensuring transportation was evaluated, arranged and confirmed for (emergency room) patients prior to discharge.”

Swindall’s record reflected that she was administered 2 milligrams of morphine at 12:24 a.m. and was discharged between an hour and two hours later.

The investigation found “there was no documentation in the record reflecting the patient’s discharge transportation was evaluated, arranged or confirmed; and no assessment of the patient’s ability to arrange his/her own transportation including consideration of the patient’s arrival by ambulance, history of physical and psychiatric conditions, administration of potentially sedating medications in the (ER) and distance from the (hospital) to the patient’s home.”

The OHA document states that, according to MapQuest, the hospital is 16 miles from Sweet Home. The drive time was estimated at 24 minutes, and the time to walk from the hospital to Sweet Home was estimated at 6½ hours.

The OHA report includes corrective actions taken by the hospital, which included a review of its policies to make sure it follows government regulations.

The report reflects the findings of the unannounced, on-site survey of a federal certification complaint and a state licensure complaint.

Swindall did receive a letter from hospital staff acknowledging that she “didn’t feel well cared for on that first visit, and that you were discharged late at night.”

According to the investigation, SLCH “failed to implement policies and procedures it had adopted addressing allegations of patient abuse (and) to ensure that patients/patient representatives received appropriate written responses to grievances.”

In response, SLCH reviewed its policy and procedure for “Complaint or Grievance, Patient/Family” to ensure the regulatory requirements were outlined.

Investigators also found that “written responses to patient grievances were not submitted or did not include all required elements.”

To address this, managers were re-educated on the policy and requirements for responding to a grievance, according to the OHA report and hospital staff.

Sample letters with required elements highlighted were attached to the policy. All letters are to be reviewed before they are sent to patients.

In addition, SHS drafted “Patient Identified Concerns of Inappropriate Behavior – Response Guide” to support current policies and outline the process of when, what and to whom to report patient or family member concerns. Emergency department staff were educated on the process.

Marty Cahill, CEO of SLCH, said that though he was not able to comment on specific cases, he was able to speak in generalities.

He said hospital staff will make sure administrators see any complaint from patients or their families.

“If they were going to send a letter out to anyone, that it came out through this office so that we could log it, see it, make sure that it was taken care of appropriately. So just making sure that people were aware of our policies.”

A complaint is usually verbal and usually something they can fix with a conversation, Cahill said.

SLCH handles most complaints in-house. Staff is required to keep track of them for CMS, but Cahill declined to provide the number of complaints they have received in a given period.

“We log every single one of the complaints,” said Kellye Hildebrandt, manager administrative services and HCTC. “When a complaint comes into this office, I disperse it to the manager … and then they investigate and look into it.”

Cahill said that if a person makes a statement to staff, whether they intend it to be a complaint or not, it should reach his office.

“We need that here,” Cahill said. “One, to make sure that we address it. If someone’s having concerns, issues they raise, of any nature, and if the room’s cold or if the room’s hot, we just take care of a cold room.”

If a patient has a concern about the way they’ve been treated or something that has happened in the hospital, they need to log it, he said.

“I believe the fact that we’re proactive in trying to do that, lessens the people’s dissatisfaction to believe that they have to go any higher than what was the resolution that was taken care of at the hospital for whatever the issue is,” Cahill said.

He regularly hands out his business card, which has his cell phone number on it, he said.

“The idea that we’re available to the public, available to the staff, I think lends to a culture that says we want to know,” Cahill said. “We want to understand what’s going on. We want to understand any grievances or any complaints and that we’ll try to rectify them in the best possible way. I think that leads to people leaving satisfied or at least understanding why they’re dissatisfied or why we can’t do what they think we should do.”

Staff members receive training and the patient’s bill of rights is posted in the hospital.

“That tells them what they can do,” Cahill said. “I could be mistaken, but I don’t think people generally have a problem with finding us with a complaint.”

He said he has never heard that someone didn’t know where to complain at the hospital.

“I think when they come in it’s ‘I’ve got an issue and I want to talk to the administrator, I want to talk to the CEO, I want to talk to someone in leadership,’ depending on the concern,” Cahill said.

Swindall said she was hesitant to come forward about her experience, but she wants to educate people about “how to stand up for their rights.” She has advertised locally in attempts to locate others who have had similar experiences.

“This is the only way you can produce change.”