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Hospital delay has a human cost

June 17, 2007|by BOB MAGINNIS

This week the lawyers doing battle over a proposed location for a new Washington County Hospital went before Maryland Court of Special Appeals to present oral arguments on the zoning and decisions made by local agencies.

Over the years that this project has been debated, there has been much emphasis on the possible costs of the delay in terms of interest rates, construction contracts and the increasing cost of building materials. But we haven't heard much about the human costs of the delay.

To explore that, Herald-Mail reporter Joshua Bowman and I met this week with Mary Towe, a hospital vice president and Chief Nursing Officer. What I saw and heard convinced me that continuing to look at this dispute only as an squabble over zoning ignores the human needs - and in some cases the suffering - of the hospital's patients.

Our first stop was a delivery room reserved for emergency C-Sections, also known as Caesarian Sections. In a C-Section, instead of being delivered vaginally, the baby is surgically removed from the womb. Towe had staff recreate a recent case in which the heart rate of a baby dropped while the child was still in the womb.

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In such cases, said Towe and Heather Sigel, the clinical nurse manager, the team has 10 minutes to get the baby out. Doing that involves wheeling the mother from the labor area to the operating room, passing through a public hallway and entering a surgical space built long before modern equipment, such as a computer-controlled anesthesiology machine, were in the surgeon's tool box.

Such equipment, which Towe said will be lowered from the ceiling on booms in the new hospital, makes it difficult for the 14 staff people needed for the C-Section to fit into the room. They stand literally elbow to elbow as they take their places for an operation that Sigel said is done there more than 30 times per month.

Sometimes there are delays. Towe and Sigel said this part of the hospital is the only one without a backup power transformer. When there is a power failure, the air conditioner shuts off and condensation begins to form on the walls, rendering them no longer sterile. Before the room can be used again, it must all be completely wiped down.

Outside, the halls are not wide enough to meet modern standards, Towe said, and visitors to the floor pass through the same space as patients on gurneys.

Sigel said the "big thing about taking patients through the (public) hallways is privacy."

Sometimes a woman in labor is on her side, or in a position that might leave her partially uncovered, though staff tries to avoid that, Sigel said. But even if the woman is totally covered, her stress during labor is exposed for passersby to see, she said.

Other patient problems include:

· The emergency room, designed to handle 45,000 patients per year, is now treating 70,000. The can mean long waits, Towe said, adding that 8.5 percent of those who come in for treatment leave without being seen. The national average is 2 percent. To deal with that, the hospital had to add beds to the emergency department.

· Admitting patients. Because most of the hospital's rooms now have two beds, the hospital can't use all of them, Towe said.

Asked why, Towe said unrelated men and women aren't placed in the same room and someone with an infection or the flu can't be in the same room as someone recovering from surgery. That means that at any given time, 10 percent of the hospital's beds can't be used, Towe said. In the new hospital, there will be one bed per room.

· Moving patients. Once a patient is admitted, if there isn't a bed on a floor upstairs, Towe said, they stack up in the emergency department. To deal with that, the hospital is building an admitting area. But moving patients repeatedly, sometimes at night, is one of the greatest sources of patient dissatisfaction, Towe said. For a mother who has just given birth, being moved during her short stay is highly irritating, Towe said.

· Inefficient patient care. Every time patients are moved from one floor to another, Towe said, a medical staff person must accompany them. And the way the hospital is arranged now, a patient who needs two different kinds of tests might have to go to two different floors, accompanied by a nurse each time, Towe said.

"It's not a very efficient use of staff," she said.

· Doctor recruitment. Asked how the condition of the facility affects Washington County's ability to attract the specialists a hospital needs, Towe said that because the hospital depends on physicians in private practice to do surgical procedures, some who have privileges in other hospitals, such as those in Waynesboro, Pa., and Martinsburg, W.Va., decide to take their patients there.

"It isn't so much that they (the doctors) don't come to the area, but although they appreciate the staff, they complain bitterly about the facility," she said.

The net effect of these problems is a form of what happened when the hospital's trauma unit closed temporarily in June 2002. Suddenly, patients who needed trauma care had to be flown or driven to Baltimore.

If the impasse over the hospital zoning isn't solved, it won't be hospital CEO James Hamill who will suffer the most, but the local people who need treatment and want to get it without leaving the area. Those who would prolong this fight should consider that when they count up the cost of continuing their appeal.

Bob Maginnis is editorial page editor of The Herald-Mail newspapers.

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