Asheville – Mission Hospital used to be called the jewel of the South. Mission was well known for its outstanding cardiac care, and nurses we’ve interviewed have stated that they moved to Asheville from all across the country just to work at Mission.
More recently, several nurses and social workers have said they’ve been forced to leave because they feel they cannot ethically continue to work for Mission under the ownership of HCA. These professionals feel that the patients aren’t getting the care they need because “profits come before patient care.”
One local resident, whom we’ll just call Annie, for her protection, contacted the Tribune Papers and shared a horrifying story of misdiagnosis that she says led to a worsening of her condition and six trips to the emergency room before she was finally given the proper diagnosis.
According to the Agency for Healthcare Research and Quality, an official website of the Department of Health & Human Services, diagnostic errors are not uncommon. In Diagnostic Errors in the Emergency Department: A Systematic Review it states, “Overall diagnostic accuracy in the emergency department (ED) is high, but some patients receive an incorrect diagnosis (~5.7%). Some of these patients suffer an adverse event because of the incorrect diagnosis (~2.0%), and some of these adverse events are serious (~0.3%). This translates to about 1 in 18 ED patients receiving an incorrect diagnosis, 1 in 50 suffering an adverse event, and 1 in 350 suffering permanent disability or death.”
Annie first went to the Mission Hospital Emergency Room after starting to have terrible high blood pressure episodes. She said, “My heart, my head, and my belly were pounding mercilessly. I was nauseous. I would be freezing and sweating profusely at the same time. I had awful chest discomfort and what felt like an electric current running from head to toe. They did an EKG and a chest x-ray, gave me meds for high blood pressure, gave me anxiety medication, and sent me on my way. Two nights later, I had another episode just like the first. We returned to Mission Hospital ER again. They did an EKG, treated me with blood pressure meds, anxiety meds, and sent me on my way.”
Over a period of time, these episodes continued, and a number of meds were tried but didn’t help. Annie consulted with a cardiologist, who scheduled an echocardiogram. Although they both monitor the heart, EKGs and echocardiograms are two different tests. An EKG looks for abnormalities in the heart’s electrical impulses using electrodes. An echocardiogram looks for irregularities in the heart’s structure using an ultrasound. Mission ER only did an EKG.
Before the appointment for the echocardiogram, Annie’s conditions got so bad that she went back to Mission ER a third time. “They treated me like an anxiety patient and seemed just uninterested that I literally had all the symptoms of impending, potentially fatal heart failure,” said Annie. She continued, “When they asked me why I had come to the ER, I stated that my symptoms were exactly the same as my first visit to the ER. I sat in a hard plastic chair all night with my blood pressure raging out of control and wasn’t seen until 9 a.m. the next morning. They sent me home again, saying there really wasn’t anything they could do.”
One of the things the ER doctor suggested was trying to get some exercise for her “anxiety”. “I lasted about 4 minutes before landing on my back, almost unable to breathe. The pressure in my chest was unbelievable. My blood pressure had zoomed up and didn’t come down at all for the rest of the day,” Annie stated. “I had to go back to Mission Hospital ER again, after just having been there the night before. I was feeling frighteningly sick and pretty darn scared too. Mission Hospital ER did not address my symptoms yet again. They talked about anxiety, said there wasn’t anything they could do, and sent me away for the fourth time.”
Doctor Bias and Discrimination
Once Annie was diagnosed with anxiety, each additional visit to the ER was treated like anxiety was the problem. An article called Embedded Bias: How Medical Records Sow Discrimination, by Darius Tahir, quotes Dayna Bowen Mathew, “Discrimination in health care is the secret, or silent, poison that taints interactions between providers and patients before, during, and after the medical encounter,” says Matthew, dean of George Washington University’s law school and an expert in civil rights law and disparities in health care. The shift to electronic medical records and data sharing encourages and can intensify misconceptions.
In the same article Dr. Hardeep Singh, an expert in misdiagnosis who works at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, explained that narrow or prejudiced thinking is simple to write down and easy to copy and paste over and over. Descriptions such as “difficult” and “disruptive” can become hard to escape. Once so labeled, patients can experience “downstream effects…This thing perpetuates,” Singh said. When his team reviewed records of misdiagnosed cases, he found them full of identical notes.
Life Changes Completely
Annie shared what her life was like at that point, “I had begun my new life on the floor of my bedroom, lying on a heating pad, and unable to move without triggering my symptoms even more. I had to stop working. I could barely sit up anymore. I had gone four times to Mission Hospital with all the symptoms of impending heart failure, and on each visit, I was treated as an anxiety patient.”
No longer trusting Mission ER, the next time Annie had to go to the ER her husband drove her to Advent Hospital in Hendersonville, NC. “I was feeling so sick that night that I really thought I might die en route. It was one of the worst episodes I’d had, but they sent me home after observing me overnight. I was shattered that no one would believe me or do any further testing than a simple EKG or chest x-ray.”
One night Annie’s blood pressure hit 196 over 141, with a heart rate of 130. Her husband took her back to Advent, her sixth time going to the ER for the same issue. She saw the same doctor she had seen the last time she was there. Annie said, “I could tell from how she talked to me that she also thought I was an anxiety case. Her personality was off-putting and pretty cold, but I fought hard to make her listen beyond her perception of me, and finally she admitted me. Since I was in Advent on the day of my scheduled echocardiogram, Advent did the procedure. In short order, they found that I had a serious blockage in my left circumflex artery.” Since Advent didn’t do the stent procedure, they transported Annie back to Mission.
Finally, An Answer
The cardiologist who placed the stent in the artery told Annie afterwards that she had a 90 to 95 percent blockage; basically a total occlusion. Annie explained, “Anxiety and insomnia were included as reasons Mission admitted me. This is crazy. It was because of a blocked artery. I really had been walking around like a ticking time bomb for months and months while the staff of Mission’s ER insisted that I had come there for anxiety and insomnia. And they still claimed that throughout my 4-week stay there, and even in the final documents and records.”
The stent procedure took care of the blockage, but Annie’s problems weren’t solved. She explained, “After the heart cath procedure to place the stent, I had a traumatic hematoma. It took three nurses clamping so hard on my arm to stop the bleeding that my arm turned black, blue, red, and “hulk green” all the way from my fingers to my elbow. They basically had to strangle my hand to stop the bleeding. My hand blew up to twice its normal size. They had put two plastic clamps on my wrist to stop the bleed in my radial artery. I needed three rounds of morphine to handle the pain. After three rounds of morphine I began feeling even more sick, and there was some talk about a possible bad reaction. I was discharged in this condition, unable to use my right arm and hand, feeling horribly ill.”
“I’m Getting You A Psych Evaluation.” What?
A few days later, the paramedics had to be called to take Annie back to the hospital. One doctor told her that her heart numbers were good, and he didn’t see any reason to keep her in the hospital. Annie said he wouldn’t listen and was talking over her when she tried to tell him how badly she felt. She said he told her he didn’t have time for her, that he had other patients. As he was walking out the door he told her, “I’m getting you a psych evaluation.” Annie said, “I sobbed for 45 minutes after that, because it seemed that no one would listen and respond to my symptoms. The chaplain came to see me to comfort me. One of the upper-echelon patient reps came to my room and apologized for this doctor’s treatment of me, saying that there was no excuse for it. She said he had been ‘fired’ from my case and that they would do an investigation of the incident. I was also told that there would be an investigation into why the ER never admitted me or tested me properly based on my symptoms. I know now where those investigations have gone: nowhere.”
Few Would Listen
“Anxiety had become the main buzzword. I can’t even count how many times I was told that I was having anxiety; how many times I was told by a nurse that they couldn’t do anything for me because they couldn’t get a doctor to respond,” said Annie. “During the psychiatric evaluation I told the doctor that I had never had this ‘extreme anxiety disorder,’ as they were telling me I had. I told her, too, that I felt horrible, like really, really sick, and she sat there, wooden and unmoved, and didn’t respond. She returned the next day with another doctor; he heard me out and said, ‘I don’t think this is a psych issue. We really need to put our heads together and figure out what is going on.’ Despite that assessment from the doctor, I kept hearing the word anxiety, and I never saw him again.”
One bright spot was a nurse who really tried to figure out what was really wrong. She kept texting the doctor about Annie’s case, but at one point she showed Annie the phone text that told her to stop texting him about Annie. “Day after day I tried to explain how ill I felt to brand new ‘floaters’ who weren’t comfortable texting any doctors and claimed they could not do anything for me; they were just there for the day. I continued to feel increasingly ill, day after day, and it stretched into week after week.”
Not Just An Arterial Blockage
After more tests and treatments that didn’t help, a nurse got Annie out of bed, and Annie collapsed, totally blacking out. The rapid response team was called, and they brought Annie back from the “brink of disaster”. It was the rapid response doctor who realized that Annie’s hemoglobin was dangerously low, indicating that she was somehow losing blood. They began daily transfusions to replace her blood. Annie explained, “Finally, we knew that half my blood was going into my stomach. I was moved to the intensive care unit. Back I went for another procedure where they removed a quart of blood from my stomach, clamped the abdominal bleed, and discovered that I had a ‘baseball-sized’ blood clot near the top of my stomach. I was literally that ill the whole time, and the GI bleed made it obvious that anxiety was not the cause of my problems.”
“After they fixed the GI bleed, I didn’t have a single episode like the ones that had been plaguing me for months and months. That remains true to this day. My ‘anxiety’, as they wanted to call my GI bleed, is miraculously gone,” said Annie. And yet, the final psych report said that Annie had suffered from an extreme anxiety disorder. That will stay in her medical records and could haunt her for the rest of her life. “It was like they just wouldn’t move from their assessment; even though, after getting the GI bleed taken care of, I ceased to have the symptoms I was having.”
After months of trauma to her body, Annie is still not back to normal, nor is she able to work, but the outcome could have been far worse. She is grateful to still be here. Now she and her husband are dealing with hundreds of thousands of dollars in debt, much of which wouldn’t have been charged if she had been diagnosed properly. After being advised about the hospital’s duty to offer Charity Care for those who cannot afford the bills, Annie contacted Mission who did remove part of the charges, but the outstanding balance is still impossible and doesn’t include the bills from Advent or their ER.