“… If I had a dollar for every narcotic abusing patient who complained of breathing issues after chest trauma… I would not work anymore…”
These are the words of a Locum (a contracted physician who temporarily fills a position)Trauma Surgeon contracted by Ballad Health in November 2019. He’s referring to his patient, Jeremiah, who had died just a few months prior.
Jeremiah had been admitted to Holston Valley Medical Center after a rollover motor vehicle crash where he, the driver, was ejected. As detailed in my previous article, the Tennessee Department of Health Licensure for Health Care Facilities conducted an investigation March 3–10, 2020 following my complaint regarding Jeremiah’s care and death. The surveyor determined that the Ballad Health facility had violated both regulations and laws.
While a health care facility violating multiple laws is concerning, the details of the report and the lack of disciplinary action taken are alarming.
Trauma patients have bad outcomes. More often than we would like, some of them die. While sad and definitely not the desired outcome, this is the reality. So, you may be wondering why the death of Jeremiah Fields is of such importance.
First, you need to know a few critical details:
- Ballad Health is a legal medical monopoly that controls approximately 97% of the inpatient care for the region. Every hospital is owned by them.
- Ballad Health was created by legislators under a COPA, Certificate of Public Advantage, which allowed two robust health care systems to merge and effectively eliminate competition for the care of 1.2 million people.
- Holston Valley Medical Center’s Trauma Center was one of several downgrades to patient care that was vehemently protested by the public, physicians, and even trauma surgeons working there.
Holston Valley Medical Center’s Trauma Center had a Level I designation prior to its downgrade on October 1, 2019. As a Level I, the highest designation, it was required to have 28 specialties on call, 17 surgical and 11 medical specialties. As a Level III, Ballad Health had reduced their requirements to just 4 specialities on call which did not include ortho, neurosurgery, or radiology.
Downgrade aside, nothing excuses the sentiments expressed by the Locum Trauma Surgeon with regards to Jeremiah as a patient who was on prescription Methadone under the care of a physician. I find myself wanting to clarify that Jeremiah was doing great in his recovery. I want to tell you that he was gainfully employed, engaged, and a father active in the lives of his family, and while all of that is true… I shouldn’t have to do that. Even if he had been homeless and addicted to illegal street drugs, he should have still received the appropriate care, the standards of care.
Another section of the 25-page Statement of Deficiencies details part of Jeremiah’s night shift nurse’s interview. The nurse stated that he (the nurse) called the Physician and reported he (the nurse) was “…having a hard time getting his [Patient #1’s] blood pressure… he [Physician #1] said ‘I am not really concerned with low blood pressure he’s [Patient #1] been high all day’…”
These are some of Jeremiah’s blood pressure readings included in the report:
12:00am 139/78
1:00am 116/76
2:00am 104/77
2:15am 74/47
2:30am 76/50
4:00am 86/42
4:15am 73/29
4:30am 54/12
The report also details how the immediate (STAT) follow-up chest x-ray ordered the morning following Jeremiah’s admission was canceled in error by the radiology technician. The x-ray performed during his resuscitation the next day showed his chest was “full of blood” according to the Chief Medical Officer’s interview.
After reviewing the Statement of Deficiencies with a few physicians, including emergency and trauma specialists, I could not find one who said these blood pressure readings were not of concern. None of them stated they would not have checked for the results of a STAT chest x-ray order. In fact, all of them agreed these things were critically important and advised they would have come in to assess the patient in person.
So, why didn’t this physician do that?
In a Nurse Radonda-sounding statement, the “undated facility investigation” reviewed by the surveyor stated that the “RN did not ask MD [Medical Doctor] to assess patient in person”.
So, is it the new graduate nurse’s fault?
Is the nurse also responsible for the facility not having a provider/resident in house?
Is the nurse also at fault because the Charge Nurse had a staffing assignment?
Is the chest x-ray being canceled by the radiology tech also the nurses fault?
At what point does Ballad Health become responsible for its staffing (including contract employees), working conditions, and environment?
Could it be that Ballad Health knows they are responsible and that is why they did not self-report these deficiencies upon completing their “undated facility investigation” and “undated plan of corrrection”?
Modern Healthcare did a 4-part series on the merger, the proposed downgrades, and our protest in 2019. In one of those articles, the then-Chair of the American College of Surgeons Trauma Committee for the region, Dr. Oscar Guillamondegui, was among those to express concerns about the downgrade.
Looking at a trauma case several weeks after Ballad Health downgraded the trauma center where even their own physician and administrators say there were “opportunities missed along the way” and “in retrospect…there was a couple things this guy fell through…”, you might wonder just how much, if at all, the downgrade was a factor.
I am not in a position to make that determination. I did ask a physician familiar with Holston Valley’s Trauma capabilities, pre- and post-downgrade, if the downgrade was a factor.
The answer given: “Yes, absolutely.”
This response reminded me of another part of that Modern Healthcare article when Ballad Health Board member, Julie Bennett was asked about the concerns related to downgrading the trauma center. She stated, “It’s a convenience issue; it’s not a care issue.”
I am not sure that Jeremiah’s fiance, Jennifer, and his six children would agree with Ms. Bennett.
