18

NOVEMBER, 2018

Private cardiac surgery
Post operative infection ignored
Rude, unskilled nurses

People tend to think that if they ‘pay more’ for private healthcare, then their treatments will automatically be ‘better quality’.

In the normal commercial world, private enterprise is reasonably transparent about cost and quality. Customers are free to choose from a range of companies. Competition causes poor services to fail and better services to succeed.

In private healthcare there is no transparency about cost and quality. So bad services remain open, along with good ones.

In 2010 Marian developed chest pain and shortness of breath. She went to see her GP, who, seeing that she had private insurence, referred her to a private cardiologist.

Marian had kept up private insurance all her life, thinking it would provide a safety net if she became unwell.

The cardiologist ordered  a stress test. This involves sitting on an exercise bike while having heart rate and blood pressure monitored. Marian’s stress test only seven minutes, as her blood pressure quickly reached 217/100 while exercising.

Marian had a history of high blood pressure, or hypertension. She was currently on class of drug called a beta blocker for high blood pressure, aspirin to thin her blood and a class of drug called a statin for high cholesterol. Marian had a history of vascular problems. She experienced pre eclampsia with her second child and experienced a mild stroke called Transient Ischaemic Attack.

Marian was sent off for two other tests, a Tranthoracic Echo and a CT coronary angiogram. The results showed that Marian had a 60% blockage of the left coronary artery. Marian was told she had angina.

The cardiologist prescribed Marian a blood vessel dilator medication. However the severe chest pain and shortness of breath continued. Marian began to use the medication more frequently. The cardiologist increased Marian’s medication dose. However the symptoms still persisted.

Marian ended up in a hospital emergency department several times over the following nine months. Each time she required morphine to get the chest pain under control.

Due to severe vessel blocking, inserting a stent was not possible. Marian was not allowed to go home and was told she had substantial cardiac issues. By this stage her angina was so severe it felt as though ‘a cement block had fallen on her chest’.

Marian’s cardiologist attempted to regulate her angina with new medication. Her symptoms still could not be controlled. He then referred Marian to a surgeon who worked at the same private hospital.

Despite having top private health cover, Marian was asked to sign an agreement about paying out of pocket costs, before she even saw the private surgeon. The agreement stated that she would pay $1,500 above the private insurance rebate for a Coronary Artery Bypass Grafts operation. She was surprised, but signed the consent.

The private surgeon’s consultation lasted a maximum of ten minutes. He did not review any of Marian’s history, her ECG’s, blood tests, stress test or angio results. The cardiologist had recommended CABGS and the surgeon simply agreed.

During this brief initial consultation the surgeon advised Marian that would take the vessels to graft on to her heart, from the mammary vessels in her chest. Marian told him, “I’ve had a left mastectomy and reconstruction surgery”. She queried whether it was a good idea to go back and re- operate on an area that had already undergone extensive surgery. The surgeon dismissed her concerns.

Surgery was booked for five days later at a nearby private hospital. Marian only found out about the $500 out of pocket cost for the private hospital, when she actually booked in to the hospital.

The anesthetist came and introduced himself before surgery. Once again Marian was asked to sign an agreement that she would pay him an extra $500 in out of pocket costs, over and above the private insurance rebate. She had not been previously advised of this out of pocket cost.

The private surgeon didn’t come and see Marian before surgery. When she came out of theater she was transferred directly to Intensive Care. Marian later found out that the surgery which was meant to take one and a half hours, actually took four hours to complete.

Marian was in Intensive Care for a day and a half. She had an agency nurse looking after her, who didn’t know the hospital or correct procedures.

The agency nurse took out the urinary catheter then went to take out the large chest drains. Marian asked to go to the toilet before the central drains came out.

She was told “there are no toilets in Intensive Care” and wasn’t offered a bed pan.

Marian was not given any pain relief before the chest tubes came out. When they were being removed Marian screamed with pain, and wet the bed. She was humiliated and in pain.

During her recovery in hospital, Marian felt she had an infection developing in her chest, underneath the scar area. Her chest was getting redder and the skin felt tight and hot.

Every day Marian told nurses “I think I have an infection in my sternal wound”. The nurses dismissed her concerns. No doctor was called to review her wound. Once again, most of the nurses were from an agency.

Marian stopped eating, feeling unwell. She started sweating continuously. Her temperature rose to 37 degrees. The nurses still told her she was “fine”.

Marian’s boyfriend even said to the nurses ‘I think she has an infection in her wound.’ Still, no doctor was called to review her wound.

On the fifth day after surgery it was decided to take out the cardiac wires out. Marian was told this process would not hurt. Once again, no pain relief was given. It was early afternoon,1 pm.

Marian found the procedure extremely painful, and jerked away during the removal of the wires.

She was reprimanded by the nurse who told her was “your fault that she had pain, because you moved”.

During the removal of the wires one of the nurses also pulled off the main surgical dressing on her sternum.

Another nurse admonished her, saying “don’t tell the surgeon you have removed the main dressing or you will be in trouble”.

Marian was told to stay still for an hour after the wires were removed. At 3pm the nurse came in to check on her. The nurse announced that she had finished her shift and dropped Marian’s file on the bed before walking out.

An hour and a half later the ward manager came in. She asked Marian if she had a a friend who could drive her to the rehab building. Marian asked if she could stay in hospital for a couple more days.

The ward manager said “no it’s the Christmas period, we have to get everyone out”.

Marian rang a friend who came to collect her. He carried all her possessions down to the car. Marian then walked to reception to check if she still owned any money.

She was not even offered a wheelchair by the ward nurses. A nurse just walked her out to the front of the hospital, and waited until her friend drove up in his car.

Marian rang a friend who came to collect her. He carried all her possessions down to the car. Marian then walked to reception to check if she still owned any money. She was not even offered a wheelchair by the ward nurses.

A nurse just walked her out to the front of the hospital, and waited until her friend drove up in his car.

Marian’s boyfriend even said to the nurses ‘I think she has an infection in her wound.’ Still, no doctor was called to review her wound.

Marian was not able to properly wear a seat belt, due to the pain it caused across her chest.

Marian continued to tell the nurses that she felt she was developing an infection.

The nurses would have a quick look at her chest and say “no dear, it’s just the recovery process”. Like the private hospital, the private rehab nurses were mostly agency staff.

On her forth day in the rehab unit Marian suddenly lost control of speech and mouth and right arm. The episode passed after a couple of hours. Marian alerted the nurses as soon as she had recovered.

Despite the fact that Marian knew from past experience that she had experienced a Trans Ischaemic Attack the nurses did not take any action. Even though Marian told the nurses that she had suffered from a TIA in the past, they did not call a doctor to come and review her.

The following day Marian told the rehab doctor what had occurred when he came on his rounds.

The Doctor just said “do you feel OK today?” When she said yes, her told her “fine, you can go home”. No neurological observations were done after her stroke episode.

After five days in rehab and ten days post op, Marian was sent home. The rehab doctor finally agreed to looked at Marian’s surgical wounds.

He said “I think you might have a bit of an infection there”. Before she left the rehab, the doctor wrote Marian a script for a general antibiotic. The wound was not swabbed.

The cardiac surgeon did not come to see Marian all the time she was in the private rehab unit.

A friend of Marian’s drove her home in the afternoon. He stopped off on the way so she could get the script for antibiotics. He carried her bags into her house, stayed with her for an hour, and cooked her a meal. After he had gone Marian had a shower and went to bed.

When she woke up three hours later, she got up to clean her teeth. In the bathroom she leant over the sink and her surgical wound suddenly ‘snapped’ open. Pus poured out of the wound. It was like toothpaste (6 inches) was bright green and smelt foul. The wound then oozed continuously.

Marian rang the rehab center straight away. They did not answer the phone as it was after 9 pm. Marian then rang the Nurse on Call service. She was just told her to put a dressing on the oozing wound. The nurse referred her to the Doctor on Call service. The doctor told Marian to see her GP the following day.

Marian had not been given any dressings from rehab, so she put clean face washers over the wound. She had to keep changing them as the wound kept oozing.

The following day Marian rang the GP clinic and made an appointment. A doctor looked at the wound, put a dressing on it and gave her a script for more antibiotics.

He didn’t swab the wound to find out what kind of bacteria was growing in it.

The local GP saw Marian every day, and the wound always needed to be redressed.

Because the wound oozed so badly, the wound was redressed twice a day, sometimes three times. Marian had to buy her own dressings from the chemist. The wound smelt very bad. Marian would wake up in the morning to find pus on the bed sheets.

By day six post post discharge from rehab, day five after being on antibiotics and day seventeen post surgery Marian developed raging fevers. She sweated continuously. She rang the surgeon’s rooms, and explained to the receptionist what had happened since her discharge from the private rehab center.

The secretary asked Marian to take photos of her wound and send them in. The private surgeon was shown the photos. Marian was then told to report to another private hospital the following day, by midday.

Neither the private rehab doctor or the General Practitioner had told the surgeon about the post operative infection.

When Marian went in to see the surgeon, she was told unexpectedly that she would have an operation. She had no idea what sort of surgery she would have, or why she was having surgery. Marian was not given any explanation or asked to sign a consent form to sign.

Marian was however told she would have to pay another $500 in out of pocket costs.

After surgery Marian awoke she found out that the surgeon had done a debridement and washout of her sternal wound. She work up on the ward with a VAC dressing (vacuum assisted closure) across her chest. The nurse had to explain to Marian, that this was because she had an infection in her sternum. The VAC dressing was about 6 inches by 2 inches.

Marian stayed in this hospital for eight days.

She had several different types of intravenous antibiotics. The surgeon took a swab during the surgery (this was the first swab that had been done). This swab showed golden staph in her wound. The surgeon explained that the previous antibiotics were inappropriate for this type of infection.

The VAC dressing was removed on what was to be her second last day in hospital. Marian was taken back to theater and as before, there was no discussion about the operation and no consent was signed. The anesthetist always signed a consent.

This was twenty seven days post the initial surgery.

Marian was discharged home the following day, after nine days in the private hospital. She was sent home with a course of oral antibiotics. In total Marian had eight courses of oral antibiotics and two courses of intravenous antibiotics.

A series of large, thick blue sutures were left in Marian’s chest after the removal of the VAC dressing. Each suture was about five inches in length.

Marian saw the surgeon three days after discharge for a review. She waited an hour and a half to see him. He saw her for less than five minutes, glanced at the wound then said “it looks good”.

She saw him seven days later at another private hospital. This time Marian waited for three hours to see him.

The private surgeon spent several minutes reviewing the wound and said to one of his staff “you can take a couple of the sutures out now”.

A woman took Marian taken into a small storage room at a private hospital and sat her in a chair. Surrounded by boxes and medical equipment, two of the sutures were removed by the receptionist.

The woman  did not wash her hands or put on gloves before the procedure.

The removal of the sutures hurt Marian considerably. The second suture was difficult to remove. The woman had to go and find a nurse to give her advice on how to remove it. In the next room the receptionist explained that she was having difficulty removing the suture.

A nurse in the next room yelled out “just use brute force and it will come out”.

The receptionist still could not remove the suture. Finally a nurse came into the room to supervise. The receptionist pulled the suture as hard as she could.

The nurse commented “this doesn’t look like a normal suture”.

After the procedure was over, the receptionist commented to Marian “I probably should have washed my hands and put on gloves before I did that”.

Marian’s sternal scar did not heal properly.

A year after surgery, the scar is eight inches long, very pronounced and sticks out half an inch to one inch. It runs down her chest in an ugly, raised, mottled scar.

Where the infection had burst out at the top of her sternal scar, the skin is visibly damaged. Where the long, heavy blue stitches had been removed, the skin pokes out, half an inch in a series of sharp spikes. She can’t wear low cut tops.

Marian did everything she could to try and fix her wound. She used ointment on it. She bought dressings. Nothing reduced the ugly raised, red scar.

Six months after the initial surgery, Marian began to feel increasing pain around the scar area. She could feel lumps under her skin. Wearing a bra was almost impossible but not wearing one caused significant pain in her chest.

Marian is now facing plastic reconstructive surgery, to fix the disfiguring scar.

Ten months after the initial surgery Marian went to new General Practitioner, working in a government clinic.

The Doctor was horrified when she first saw Marian’s large, raised scar and felt the lumpy tissue around the scar. The Doctor sent Marian for an ultrasound of her chest and a range of blood tests. She also spoke about the need for plastic surgery to repair the scar.

The results of the ultrasound were two cysts, one 4mm one 6mm pf unknown pathology and pockets of fatty tissue around the sternal scar area.

Marian wrote a letter to complaint to the private hospital about her poor treatment. She received a letter from the private hospital management, brushing her complaints off.

Marian is now facing plastic reconstructive surgery, to fix the disfiguring scar.

Marian is not sure if her sternum has actually been rewired after the removal of the VAC dressing. She has heard of another patient of this surgeon, who’s sternum actually split open after four years, as his chest was not rewired.

Marian is wondering why she has payed so much money for private insurance over the years, to receive such poor treatment. Her total out of pocket costs have come to over $7,000.

© Wikihospitals 2015