Mother/nurse raises concerns over treatment received at hospital.

I am concerned for the safety of patients who are being treated at the Spectrum Health Ludington Hospital Emergency Room.  On Sunday, Oct. 22, 2017, my young son had a severe reaction to a bee sting.  Within 20 minutes of the sting his lips, ears, and face were swollen and he had hives head to toe on his body. We rushed him to the Spectrum ER where he was given Epinephrine, IV steroids, and IV Benadryl to stop the reaction.  He responded positively and we were sent home within two hours. We were given a prescription for an EpiPen that we promptly filled, to be used in case of a future life threatening reaction.

The next day, I learned that there was a smaller dose of EpiPen (EpiPen Jr.) that may have been more appropriately prescribed and began to investigate.  The EpiPen manufacturer’s website made clear that my son had been given the wrong dosage, double the recommended amount. He should have been given the EpiPen Jr., but was prescribed the adult dosage.  Later, when I looked at the discharge papers I noticed that on the listed medication that he was being discharged with  a completely different dosage which does not even exist in an EpiPen. I called the pharmacy and they confirmed that he likely had been given the wrong dosage and that I should call the prescribing physician.

I immediately called the ER and spoke with the nurse in charge.  As I explained my concern, she began questioning where I had obtained my information.  I explained my investigation and the steps I had taken.  She then suggested I give “half a dose” of the EpiPen.  Anyone who has used an EpiPen knows that due to the nature of the packaging that giving half a dose is impossible.  She asked, “How could you know the dose of the medicine? Where are you reading it on the packaging?”  She was very condescending.  I then explained to her that I am a RN and that I understand how medication works.  I explained the packaging and she told me I needed to contact my family physician.  I told her I wanted the prescribing physician to rectify the situation and she told me he had gone home for the day.   She told me that “I don’t think he will get stung tonight.”  She put me on hold spoke to the physician working in the ER.  After several minutes, she returned and said, “he feels the dose your son was prescribed was appropriate, so that makes two physicians that say it’s fine. You will just have to call your family doctor tomorrow.”  I assured her that I would be doing that.  Her tone throughout the exchange was very rude and condescending.  It was as if I had committed a great error by questioning a medication dosage.  There was no concern or humility in her tone, no indication that the medication dosage should be clarified except when I insisted that I needed an answer from them.  My intent in calling was not to accuse, just to ensure I had the correct strength medication for my child.  I was not trying to cause difficulty for the nurse, I was simply asking a question.

The next day our family doctor confirmed that the dose that he was prescribed was inappropriate.  She also stated that if the EpiPen was used on my son in the future I should immediately report to the ER. His heart rate and blood pressure must be monitored since this is a serious medication.  His blood pressure was never checked during his visit to the ER and his heart rate and oxygenation were only checked two or three times for a minute or so.  She expressed concern that that was not appropriate care.

Sadly this was not an isolated incident. Several months ago we had another problem with the ER.  I had taken my older son in when he had been extremely ill with a high fever for many days.  He was diagnosed with excessive ear wax and constipation (I’m not making that up). I was concerned then that his care was inappropriate based upon his symptoms.  I called and spoke with someone in administration who assured me that she would investigate the case and get back with me.  I received a letter in the mail a few weeks later thanking me for my concerns and assuring me that the care that he received was determined to be appropriate.  I hoped that this was an isolated incident, but I now know that it was not.  After speaking with our family physician, she once again agreed that his treatment was not appropriate.

Mistakes happen.  Doctors are human and make mistakes.  When I was a practicing nurse, I know I made mistakes.  It is scary knowing that lives are in your care when you are just human.  However, when mistakes are made, an investigation must happen and systems put in place to prevent the same mistake from happening again.  Finger pointing and putting down a mother that questions medication dosages does nothing to advance quality patient care.  Owning up to a mistake or even explaining the rationale behind a questionable dosage would be very appreciated.

As a mother and a nurse, I am concerned for patient safety in our community. The care that my children have received did not result in harm to them, but what about someone who has no advocate or someone who has no medical training and would not know to check dosages?  What if I had given my son the prescribed dosage of epinephrine and he had suffered harm?  Why was my son’s blood pressure never checked when he came in with anaphylaxis?

NOTE: I have chosen to make this story public after several attempts to reach out to the hospital. Those attempts left me feeling as if my concerns were being ignored. It is very concerning knowing that the only local hospital is not a safe place to take my children in an emergency.   I feel that I am responsible to warn others in our community to advocate for themselves and their loved ones. I hope to see meaningful changes in the future so that we can have confidence in the safety and quality of care at our local hospital.