"Death in Hospital and associated issues."

About: Box Hill Hospital

(as a relative),

My aunty passed away in Box Hill Hospital.

I am at a loss to comprehend how it could happen, given that when she was admitted it was for a relatively minor problem.

This letter is being written in the hope that no one else will have to suffer the way my aunt suffered in the care of a system that quite plainly allowed her to die, and in the hands of a few professionals who, in my view, found it convenient to use that system to hide behind their professional duty of care. After my first letter to Patient Opinion my Aunt did indeed receive more appropriate attention, as was my hope, but very sadly, tragically in fact, it was a case of too little too late. Her condition had deteriorated so far in the first week to ten days that she had become under nourished, losing way too much weight and with that, not enough energy to survive. And. . . . . . what I believe was less than professional treatment continued all the way through to her dying hours.

As aunty became weaker and weaker, I did inquire on numerous occasions to various staff members, nurses, a dietitian and doctors if she could be fed through her nose, but they all explained that NG (Nasal Gastric Feeding) was reserved for patients who were more critically/acutely ill. It is my belief that subsequently and consequently, my aunt became a critically ill patient. The day before my aunty died I had asked this question, receiving the above response. In the time closer to her dying I asked again. . . . . . . I was told that she was now too ill for NG. . . . . . . I could not believe my ears. I was shocked by the realisation that this hospital, once again, had failed my aunt and that death for her had become a very real possibility.

Less than twenty four hours before my aunty passed away I’d taken in an assortment of food that I knew she liked, sour dough bread, salmon, home made jam etc and we enjoyed lunch together. During that morning the ward doctor came by with his team, we all had a conversation about ongoing treatment and it was both understood and agreed that my aunt wished for and wanted treatment for any problems that might arise. If this meant being moved from the rehabilitation ward she was in, to a medical ward, this is what she wanted and stated clearly. My aunty had been moved to the rehab ward just the day before this conversation. This raises another question regarding appropriate care. Why was my aunt moved to the rehabilitation ward in the first place, given that she was suffering severely from fluid on her lungs, other complications and so incredibly weak?

Later that day, I received a phone call from a doctor who explained my aunty had in fact been moved to a medical ward, and that she had been made comfortable. The doctor stated clearly enough that my aunty was not at all well, but in no way at all did I understand that she might be dying. So I arrived back at the hospital to find her without a drip, through which she had been receiving fluids, and without even a glass of water at hand. I could not comprehend the situation at all. With all due respect to the doctors and nurses with whom I was in communication, the language they all used as far as I'm concerned was not clear, in fact it was fluffy nonsense.

It was not until the early hours of that morning when a nurse and a doctor were able, only after direct prodding from me, to state that my aunt was actually dying. If no professional member of staff can state clearly, what may be obvious to them but may be a total mystery to loved ones, how are those loved ones to prepare for the shock of death? It was explained that there were swabs at hand with which to wet her mouth and lips, but not once did that happen all night and up until my aunty passed away. In the excruciatingly dry climate of the hospital ward, this strikes me as an incredible lack of attention to my aunt’s needs. I cannot imagine how horribly dry she must have felt, and on top of all else she must have been feeling at the time!

It just gets worse! On top of these issues, it is hard to believe but, there is more.

Throughout her stay in the hospital my aunty had complained about being roughly handled by some of the nurses, especially at night when she required moving to prevent the worsening of bedsores (which were yet another problem directly related to her extended stay in hospital). I had mentioned this rough handling to the head nurse on the ward, who assured me she would speak to the staff. However, during the course of that last night with my aunty, as I was resting on the bench seat, two nurses entered the room, flicking the lights on and flooding the room with light, which was a fairly shocking interruption in itself. But what followed shocked me terribly and deeply! One of these nurses was quite obviously not in any way concerned that my aunt was dying; she appeared not to even notice that my aunt was human. The way in which this nurse treated my aunt was an absolute disgrace. I was waiting for them to stop, but it seemed like an eternity and I was frozen in disbelief. It was obvious that the other nurse was quite definitely not a part of this rough handling; I could see that she too was taken aback by the actions of her colleague. They did what they came to do and departed, I got up to hold my aunt's hands and soothe her in some way as she was extremely distressed by what had just happened.

Some time later, they came back. I shot off the couch as quick as lightening, to hold my aunt's hands, almost before they had the lights on. There was no way in a million years I was going to let that happen again. They/she seemed to get the message. In my opinion this should very certainly not be nursing.

Apart from all that has been mentioned thus far, an over-riding trend that has flavoured this whole experience is very poor communications. It became quickly apparent that amongst the personnel from different areas of expertise there in each ward, was an obvious lack of information sharing and possibly even more importantly, responsibility sharing. It was obvious to me that the distance between these many areas of healthcare was such that individuals involved could easily allow details to fall by the wayside. The fact that my aunty was an extremely and frail human, and not just a leg with a haematoma on it, was in no way the least of these details. I know that sounds a bit coarse, but that is as it was through my aunt’s experience.

Communication with my aunty directly and me secondly, as her next of kin, was no less atrocious.

A week after I wrote the first letter to Patient Opinion, my aunt (and I) still had not received any communication from the Plastic Surgery Department. A clear and reasonable explanation as to why my aunty had been fasted to the point where she was struggling to recover and from which ultimately did not recover; had not been given to us. Details of that fasting process to this day remain less than foggy. She needed and deserved information; I had questions and we were both in limbo waiting for answers.

In the interest of open communication I approached the Head Nurse with my concerns, indicating that I had no other option now but to inform the Medical Review Board (or some such independent review forum) of the situation, and ask them for answers.

From there I proceeded directly to my aunt's room and not fifteen minutes later so did the Head Nurse, the Plastics (Surgery) Registrar, and the Associate Program Director of Surgery. Pathetic is all I can say to that response. Who among them is genuine? Who among them is looking after their own back? Which one of them was really in it for my aunty?

Happy (as I was cynical), for the surgeon to appear, it was the Associate Program Director (of Surgery) who had most to say initially. Offering in my opinion, a lame excuse for them having not been in touch sooner. They said they had no contact name and no number; this is a person at the top of the pyramid of administrative activities. (We were not looking for excuses, just answers.) How is it that so many others seemed to be aware, to some degree by now, of my aunt’s situation? During this conversation with my aunty this person told us that there was in fact a review currently underway of the fasting procedures. But did not tell me/us why, nor has there been any follow up communication from them to that effect.

The surgeon then proceeded to explain what had taken place in that first week to ten days of my aunt's stay in hospital regarding the surgery, which in the end did not actually happen. However, they could not explain why, not to my satisfaction at all. They did their best to avoid and gloss over the real issue of why such an elderly and frail person could be allowed to waste away so dramatically that recovery had become impossible.

All this for a surgical procedure that did not need to take place at all! ! !

My aunt's Haematoma was subsequently treated without plastic surgery! Despite her loosing many kilos of weight (I would guess ten to fifteen kilos with a corresponding failing of her strength), despite her developing pneumonia, despite her suffering fluid around her lungs, despite experiencing several severe heart incidents, the Haematoma was healing very satisfactorily.

From a family and community supported at home life, to the grave. I can even now hardly believe it.

I do want answers, I do want those responsible to explain fully, and I would very much like for an independent inquiry into my aunt’s death. All this so that others will not die prematurely and unnecessarily, as did my aunty.

In anticipation of such a response.

Responses

Response from David Plunkett, Chief Executive, Eastern Health

picture of David Plunkett

Dear concerning treatment

Thank you for providing your feedback again on Patient Opinion and I apologise we haven’t been able to provide a suitable response to your first post. I would like to apologise at the outset regarding your experience and your Aunt's care and experience. I hope you can accept my condolences following the loss of your Aunt.

I was very concerned to read of the multiple areas of concern and would like to make sure we follow this up as a matter of priority. I would like to assure you that I am taking your concerns and comments very seriously.

Given you have had some discussion with the Associate Program Director, Surgical Registrar and the ward Nurse Unit Manager, I wonder if you would be interested in contacting Paul Leyden, Program Director for Surgery via email on paul.leyden@easternhealth.org.au so that he can arrange to speak with you, hopefully in person.

I am sorry that we have not provided the high standard of care that our staff pride themselves on and once again, encourage you to contact Paul.

Kind Regards

David

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