My seemingly healthy 82 year old father had triple bypass surgery this past spring (we didn't realize he had a heart condition, just some high cholesterol). After a tightness in his chest that led to an angioplasty, he was told at 7pm that night that he needed surgery and said OK to the doctor in the white coat and was in surgery 12 hours later. He had been active right up until the day before surgery, including golf, doubles tennis and bowling. He and my mother, as well as the entire family, were quite ignorant as to the ways of the medical world as we had not had any major health crises in the past.
We had no idea that Rehab Centers actually have reps who visit the hospital room, asking for the patient to consider rehabilitation at their facility. The representative from the rehab facility at the retirement community where my parents have lived for over 5 years was among those who approached my father. Of course, my parents were pleased with the concept of his being at least back on the property where they live (my mother doesn't drive). By soliciting him as a patient, they indicated that they had the manpower and level of expertise to provide him proper care. On its website and in all of its sales literature, the retirement community promotes its ability to care for its residents through their changing circumstances that may present themselves, particularly in the event of changes in health situation.
My father was discharged 5 days post-op to the Rehab Facility at their Retirement Community. Included in the discharge summary from the hospital is a notation that my father should be well monitored with regard to his electrolytes given that he was on a diuretic for post-surgery edema. While it is surprising to me that a reputable hospital would use such a subjective term as "well monitored" and did not define that, what happened next turned into a terrible series of events leading to my father being hospitalized and bed-ridden for over 9 weeks, suffering a frontal lobe stroke during that time and becoming completely deconditioned in terms of his overall physical health.
I just finally got copies of his lab results and daily log from the Rehab Facility. Most importantly, I now know that the rehab facility did labwork after my father had been there for 2 days. His sodium level was 135, just at the bottom of the acceptable range. His blood was not drawn for five days. On that day, his sodium was 121 (clearly below the acceptable range and with a LO indication next to it for ease of reading the lab results). Based on that information, my father's diuretic was ordered stopped and he was put on fluid restriction. It took over 12 hours for that fluid restriction to be put in place. The next day, another set of labs were completed at which point my father's sodium level was 118 with the word CRITICAL in bold capital letters. At that point, he was sent back to the hospital via non-emergency ambulance. His condition deteriorated quickly. He was severely hyponatremic and, as a result, was in an altered state of conciousness for the following 3 weeks.
During those 3 weeks, his body was resistant to return to a normal balance. He was unable to eat. He had a feeding tube. Ultimately, a medication never used by the hospital was used successfully to bring his sodium into the normal range. He was incredibly weak and disoriented and continued to be in an altered state of conciousness. He suffered a frontal lobe stroke and spent a month in a different Rehab facility where he improved only slightly. A GI tube directly to his stomach was put in place and remains today. He developed sleep apnea post surgery and suffered a damaged ulna nerve that has progressed into complex regional pain syndrome. He is unable to even putt the golf balls at the Retirement Community's tiny little putting green, let alone go out and participate in his former activities.
So, my question concerns the terrible mistake that was made in not carefully monitoring my father's electrolytes. While no definite number of labs were specified, I believe that a reasonable level of care would be something quite a bit more frequent than 5 days, particularly given that the first labs showed his level to be just barely within range.
In fact, there were other examples of insufficient care during his stay at Rehab. Here are a couple of other things:
He was terribly short of breath. Couldn't even speak more than a few words at a time. We thought it must have been normal given the surgery. Nurse friends of mine have indicated that a nurse should have known that shortness of breath with absolutely no physical exertion is not normal. The nurses gave him nebulizer breathing treatments. They never had him rinse his mouth (standard protocol for repeated breathing treatments) and he developed a terrible case of oral thrush (which we had to ask them to check for and which took them 24 hours to get the medication to treat). He had no appetite post surgery as can happen. Further, he had pain from the thrush for weeks and only just got his sense of taste back recently. This oral thrush never should have developed and it contributed to his continued weakening state as he couldn't eat, though he tried, in his altered state when he returned to the hospital.
The reality was that the shortness of breath reflected a prominent pleural effusion and one could argue that a reduction in his breath sounds should have been evident when vitals were checked. In fact, his vital signs were only checked once a day for the first several days, only because he was on a beta blocker. Several days into his stay at Rehab, his daily charts (typed up new on a Monday, after having been handwritten for the first 5 days) included a notation to check vitals on each shift, thus thrice a day.
My father saw a doctor once while at rehab. A nurse practitioner was following his case and I'm not certain just how frequently she saw him. On those occasions I was visiting, there were only nurses aides (who didn't speak fluent English) tending to my father. And, in fact, they were very hard to find.
My mother received a call on that Monday to sign admission papers for my father - the person indicating she had been on vacation. Two days later he was transferred back to the hospital via the ER.
Prior to my father's surgery, my mother had heard there had been some upheaval at the medical end of things at the Retirement Community. They didn't have first hand knowledge as they had an existing PCP (he was useless from the day he sent my father to the hospital). However, we assumed that any trouble with the medical staff at the Retirement Community was in the past and also heard some positive reports from some people who had acceptable experiences there. The truth is that the upheaval continues and my mother heard at a recent community meeting that residents were still asking when the proper number of doctors would be on staff. The fact that the company wants to hire doctors with proper knowledge of geriatric medical issues was given as the cause of the delay.
Shouldn't they stop accepting, indeed soliciting, rehab patients in the meantime?
My father is a shell of his former self. The fact he didn't die from complete shutdown of his organs while he lied in bed for all those weeks is a miracle, attributable we believe to his prior excellent health. Previously, he would bop out of the retirement community like a man 20 years his junior. Now, he seems his age and then some.
The months have taken their toll on my mother as well. She spent many long nights alone and awake at 4am crying with the fear that he would not survive. Upon his return home, her stress level has gone through the roof. He was so weak when he went home (visiting nurse, walker, wheelchair at times), resulting in many scary and stressful events for my mother.She manages his medications with a chart I have provided to her. She also has provided his bolus feedings through the GI tube, only now is the number of feedings a day finally being diminished and my father eating somewhat more normally. While I had been planning to return to work (my kids are in middle and high school), instead I take my father to all appointments in at MGH where he is finally getting the care he needs. He has a new PCP specializing in geriatrics, a cardiologist, a G/I specialist, a Pain Specialist, an ENT and a neurologist. His situation is now and forever will be very complicated.
While the owner of the retirement community continues to grow his mammoth operation, my parents lives have changed unnecessarily forever and the Retirement Community continues to promote its ability and desire to provide excellent care during all stages of its residents lives there, which obviously include a deterioration of one kind or another for all of those residents but those who drop dead of a heart attack unexpectedly or peacefully go in their sleep.
Because of so many mistakes along the way (by the hospital and the second rehab facility), folks have mentioned malpractice. Rather than being the sue-ing type, I feel like it would be kind of creepy to upset my parents with having to go through this entire nightmare again. The mistakes by the hospitals were unfortunate but my impression was that they were at least well intentioned. On the other hand, some say it would be wrong not to take my concerns directly to the owner of these many Retirement Communities so that he will not continue to allow for this sub-standard level of care while drumming up new residents on false claims of care through all stages of aging.
Sorry, that's about as brief as I can be without editing through the entire post and I have to go prepare for my father's impending visit to the MGH Pain Clinic to address the chronic pain in his hand. Any thoughtful opinions on this difficult situation are greatly appreciated.

