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My mother has been in hospital care for just over a month due to a bacterial infection caused by an abscess that cannot be surgically drained because of her current condition requiring vent support right now. I need to transfer her to a different hospital because of an extreme visitor ban that has kept her out of contact with me and my family, and she's not in a position to advocate for herself. The hospital she is in is the only one in the area that has closed to visitation, and several serious safety issues have arisen from this lockdown, as well as the toll of her isolation on her that has led to the need to move her for treatment elsewhere, where I as her surrogate and other family members can have access to her. The hospital I wished to transfer her to has said no because it would be a lateral transfer, but the transfer can only be initiated physician to physician, so I could not be part of the discussion to request it based on health and safety concerns, and poor communication with the current hospital. The hospital she is in has been terrible at communicating about safety complaints and providing any alternate means to visually check in on my mother's well being. Not responding to complaints about serious safety issues, such as a procedure performed without gaining my informed consent, a missing tooth front tooth that occurred there with no explanation as to how it was lost, which is serious because she is on a trach, as well as someone doing maintenance work directly above her head, while she is bedridden and connected to a vent. The last several things are what I witnessed when the doctor was good enough to get me in to check in on her. Her infection goes up and down, and at this point, she needs a family member with her for support, and the hospital refuses to provide alternate means for her to be in contact or for a special exemption because of her support and advocacy needs. Communication, without having a direct line to a doctor is abysmal, patients families have had to spend hours obtaining updates and sometimes going days not getting one unless a doctor is good enough to give them a direct line. She needs to be moved where I or one of my family members can be in contact and advocate for her needs, as well as safety. How do I make this clear to the hospital that I wish to accept her?

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It's very difficult to get a transfer to a lateral level of care. The attending doctors change once per week at my hospital and I would imagine it could be similar at your hospital, so talking with the doctor may not be as effective as talking with other members of the team. If you get in contact with other members of the team, then they can badger the doctor on your behalf or tell you bluntly that a transfer will not be happening.
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GGordonLizzy Dec 2020
I've been talking to other members of the team, and in all fairness, they go above and beyond, they're over-extended and stressed too. The missing component here is family support for the patient in a situation where she needs it, and the ability to provide it elsewhere. The main problem is the obtuseness of the hospital itself. In all fairness, the resident and the attending tried on my behalf, and after talking to them further, have understood where I'm coming from on requesting this transfer.
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GGL (your moniker reminds me so much of the Watergate Scandal), when you write that you wish to accept your mom, are you referring to home care?   If so, I don't think it's likely that you could bring her home as along as she's trached and on a ventilator.

But if there's any possibility of step down care for vent weaning, you might want to investigate the possibility of a long term care hospital such as Select
Specialty.    That was the route the hospital chose when my father was intubated and required vent weaning.  There were other issues as well, but they could be addressed at that long term care level.

You might want to ask the doctor who actually was cooperative if that's an option.   My father was unable to stand or speak when he moved to the step down hospital, but he was eventually able to stand with help and do minimal PT.  He was still intubated though.  

The second change occurred when he developed MRSA for a second time and was moved back to an ICU unit.

Are you close to other cities with multiple hospitals?   That might also be an option if the only other one in your area refuses to consider a transfer.

I wish there were better suggestions; this is such a difficult time to get care.  It seems that the crux of the issue is the failure of the existing hospital to cooperate.    I assume you've tried contacting the Administrator?   

Another possible long shot, and not one I'd consider as a first option, is publicity through a local news channel.    Just explaining that the hospital refuses to even discuss issues with you might be enough for a feature story.   They certainly don't need negative publicity at any level during these challenging times.
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GGordonLizzy Dec 2020
I meant the receiving hospital. She was actual at a skilled nursing facility for over a month precisely for vent weening, and further possible rehabilitation since she was slowly, but making progress, recovering from a cardiac arrest in August. She's been intubated since then, now with a trach for over three months. The good thing is, she has the capacity for full movement. Her leg movement has increased in the bed, and she stretches herself out, and can self-adjust very slowly in bed, but she needs range of motion exercises, and PT as well from the long bed rest, to stand and walk again. She still can't move the arms with co-ordination but they can move.

Edit: The name is a play on G. Gordon Liddy and Thin Lizzy. Good catch!
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GG, I am also in Brooklyn.

Have you gone through the patient advocate office at the current hospital?

Have you considered contacting the Borough President and other local elected officials to advocate for a compassionate transfer or allowing of family members to be there to advocate for mom?
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GGordonLizzy Dec 2020
Barb, thank you for the reply and the suggestions. I've spent weeks trying to go through the patient advocate/patient relations office over the safety issues, plus compassionate visitation with at least just allowing me, so I could face time other family members, they're abysmal at responding or simply don't care to. At this point, Monday I was going to call the safety officer, but I'll definitely try your suggestions as well.
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I cannot know how much Covid-19 your area is dealing with at present, but if it is anything like California Hospitals you are likely going to continue to have a good deal of problems in finding anyone to communicate with during pandemic times.
I wish you good luck as you move forward attempting to advocate for your Mother. My brother lost his life in May due to septicemia from a leg infection; he chose to go home on hospice; in fact he begged to do so. And he passed quickly thereafter on hospice care.
On another note, your mother's tooth was most likely lost in an emergency intubation prior to trach placement for chronic ventilator she is now on. This is very common and often not even recognized in the flurry of placing intubation devices.
Sorry for all that you all are going through.
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GGordonLizzy Dec 2020
I'm in New York, Brooklyn to be exact, where there are zones with upticks and outbreaks, and neighborhoods with rising numbers. Though the majority of hospitals in most neighborhoods across the city have not been overrun, thanks to protocols in place from the painful experience of the past spring, and are maintaining screened visitation for all other patients with protocols of limited visits that have been working. This is the only hospital in the area that went to this extreme but hasn't planned out any service to maintain contact with a patient that cannot do so for themselves. Meanwhile, a hospital less than a mile away has maintained safe, limited visitation. The majority of hospitals in the borough have been able to maintain this. Across the city, it's less than 2% covid-patient occupancies, with the major exception being the hot zones where people have refused to comply with safety guidelines whatsoever like Staten Island and several neighborhoods in Brooklyn.
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