Reform and Improve Discharge Policies (and their enforcement) at New York Hospitals
Reform and Improve Discharge Policies (and their enforcement) at New York Hospitals
The Issue
On behalf of my loved one experiencing dementia and Traumatic Brain Injury (TBI), I had an unfortunate encounter with the Huntington Hospital/Northwell Health Emergency Room and its administration, which carelessly saw tomy loved one's wrongful discharge without proper concern about his safety post-discharge.
The experience was made worse by the condescending attitudes and cruel behavior of the hospital administrators, who were rude and dismissive of me, when all I asked for was our rightful access to the discharge papers.
We were never given discharge papers on the day of my loved one's discharge.
This experience illuminates a concerning issue that is not limited to our case but impacts a troubling number of patients and their advocates in New York hospitals. Current New York State law does not effectively guarantee the rights of patients and their advocates in situations of dispute about discharge from the hospital.
It is high time New York leaders consider reforms in the approach to discharge policies at hospitals. These reforms should include improved procedures for patients and their advocates to appeal and complain about discharge procedures.
Moreover, an outside third party, such as a local health official, the patient's regular doctor, or a member of the police COPE unit, should be provided the legal flexibility to mediate when such disputes arise at hospitals or emergency rooms.
No individual or their family/advocate should be subjected to distress due to questionable discharge procedures or suffer the indignity of inadequate care and dismissive attitudes. It is time our state leaders recognize the inherent respect and concern that patients, especially vulnerable individuals like those with dementia or TBI, deserve in their moments of medical need.
I urge all New Yorkers to join hands in calling for these crucial reforms to be enacted to safeguard our loved ones during their health battles and ensure that similar situations do not recur. Please sign this petition for a just and caring healthcare system in our state.
_________________________
If you have a story about a problematic discharge
from a New York hospital or emergency room,
please put it in the “Why I Signed” comments.
You may also send it anonymously to:
kimberlywilder06 AT yahoo DOT com
_________________________
Background and more information:
Signing this petition will add your voice to a plea for political leaders to reform discharge practices at hospitals in New York State, including reforming the manner and amount of possibilities for patients and their advocates to appeal and complain about discharge procedures. NY State Law must provide for an outside third party (such as a local health official, the patient’s regular doctor, or a member of the police COPE unit) to come to the hospital or emergency room to mediate when a patient or their advocate is disputing discharge. There must be a significant consequence to hospitals and healthcare companies if they violate the rules under the NY State Patients’ rights law 405.7
It is important to protect the patient’s right to receive discharge papers (ie: on paper) as they exit the hospital or emergency room.
New York State’s laws about Patients’ rights are a powerful tool to make sure that hospitals treat all New Yorkers with dignity and proper care. Unfortunately, due to inadequate oversight and channels for complaints, these rights – especially the right to receive discharge papers upon leaving – are often mowed over by enormous healthcare organizations, uncaring hospital administrators, and a faulty mechanism for making complaints and creating justice, after the fact, for wronged patients.
Improving discharge outcomes and upholding these patients’ rights – which are already enshrined in law – could be an important solution for protecting vulnerable populations such as the elderly, long term care patients, unhoused people, and people with mental illness from being summarily discharged from emergency rooms and hospitals.
The Story of Our Terrible, Horrible, No Good, Very Bad Experience
at Huntington Hospital/Northwell:
Have you ever had to beg for your loved one’s life?
Sometimes, when you advocate for a child, elder, or other vulnerable family member, it may feel like you have to do battle with the workers or systems in an organization just to make sure that your loved one can survive. I had to engage in this type of struggle with the emergency room at Huntington Hospital/Northwell Health on a recent holiday weekend, and it was very traumatic for myself and my loved one.
My family member (who I will refer to as “George”, for his privacy) has TBI from a fall from a roof, and also dementia. George has trouble walking. Since his fall, there have been several times that he has fallen out of his wheelchair and been hurt.
Then, recently, on the Friday of a holiday weekend, George fell out of his wheelchair two times on the same day. And, the second time, he needed to go to Huntington Hospital/Northwell Health for treatment, including a CT scan of his head.
Being a concerned family member and someone listed as one of George’s Healthcare Proxies, I grabbed my lime green tote bag of visiting supplies and papers and went to: comfort George at the emergency room, help him communicate with the doctors, and to advocate for him. I was the only person there to accompany him at the hospital.
Among my goals was to let the hospital staff understand that it was unusual for George to have two falls in one day. So, I wanted to make sure the doctor considered possible reasons for the extra falling.
In addition, I wanted to underscore that there was no safe place/safe scenario for George to be discharged to. George needs special care and someone to watch over him 24/7. Because of the holiday weekend, there would not be a way to schedule staff for his needs, nor be properly in touch with a doctor or decision-maker to make a plan for taking care of him after two falls and the possible consequences of the two falls.
I wanted to bring the concern to George's doctor at the emergency room, that the hospital was probably the only safe place for George, until Monday. At that point, the holiday would be over, and staffing and planning would be able to happen. Otherwise, other falls would be likely.
It was clear to the hospital that George could not participate well in his discharge plans. In fact, when we received his medical records, three weeks later, after several certified letters and faxed legal papers, the paperwork showed that instead of having George sign the hospital’s paperwork at all, they had someone write things like “Patient unable to sign due to confusion” and left the signature space for the patient blank.
I did not have George’s official Healthcare Proxy with me, but I did have an old letter from George’s wife noting that she was his spouse and Healthcare Proxy, and I was another primary contact for health issues. All through George’s emergency room visit – as I waited Friday evening of the holiday, went home to sleep, and came back on Saturday morning -- no one ever asked or mentioned a Healthcare Proxy. Though, I finally presented the letter to the Hospital Administrator on Saturday morning as I begged her to stall George’s discharge and/or to give me his discharge papers.
I knew that if they had to give me discharge papers, I could see if there was a reason given for George having suddenly fallen twice and I could see if the doctor had made any suggestions (or plans) for how to keep George safe this holiday weekend.
I also knew that if the hospital had made a hasty mistake, forcing them to provide discharge papers might clarify the situation for all involved.
In the whole time I was at the hospital for George, the only medical staff I had been allowed to speak with were nurses. I was specifically never allowed to speak with a doctor.
The Social Worker and two administrators agreed to a meeting with me. At the meeting, it was clearly “three against one” with them talking over me. I could see that they were stubbornly and arrogantly set on not letting me have one shred of paper and not seeing a doctor. And, the Hospital Administrator told me at the meeting “You will get the discharge papers as the ambulance is taking your [family member] away.” But, in fact, they did not give me discharge papers even then.
When I begged the people in the meeting to either give me discharge papers, or to write a note saying they were not giving me discharge papers, or to let me tape them on my phone asserting I was not getting discharge papers, they all stood up and walked out of the meeting.
Then, I pleaded with the Hospital Administrator to meet with me alone to try to calmly figure things out. At that point, she called over to another person that “It’s time to call security.”
So, as they dumped George from the hospital gurney on to the ambulance gurney, a white shirted Security Supervisor and two blue shirted Security Guards hovered over myself and George.
The ambulance crew that came to take my loved one away were also Northwell employees. (Which I believe could be another problem with discharge outcomes in New York.)
I rode in the ambulance with my family member as he was taken back. The ambulance staff person was uniquely kind. He still had no physical paperwork for me, nor did he give me discharge instructions. Though, he read some of George’s lab results off his handheld tablet and tried to explain things to me that no one had been willing to explain at the hospital.
Neither George, nor myself, nor anyone in our family ever received discharge papers that day.
What should the consequence be for the actions of Huntington Hospital/Northwell Health?
When I contacted someone to ask if any of the pieces of this story seemed to indicate a lawsuit against Huntington Hospital/Northwell Health, I was told that the only mechanism in the law is to report them to the NY State Health Department. Then, the Health Commissioner, New York State Department of Health, would decide if it was worth creating a case. And, then, if the hospital was deemed to have done something wrong, they would pay a small fine to NY State.
Clearly, the small fine that hospitals pay to NY State when they violate patients’ rights is not enough to deter them from violating those rights. And, the fact that that Health Department mechanism exists (as a sort of monopoly on justice) seems to have only emboldened administrators and social workers to arrogantly deny patients and their advocates their basic rights.
NY State Law must provide for an outside third party (such as a local health official, the patient’s regular doctor, or a member of the police COPE unit) to call or come to the hospital or emergency room to mediate when a patient or their advocate is disputing discharge. Having immediate help is the only way to stop an unfair discharge, since the hospital has security and high paid administrative staff to support their position.
NY State Law should not circumvent the judicial systems of our state and federal government by implying (or making true) that the only path to seek justice for unfair discharge is to apply to one office, the Health Commissioner, New York State Department of Health.
If you have a story about a problematic discharge from a New York hospital or emergency room, please put it in the “Why I Signed” comments. You may also send it with your name or anonymously to kimberlywilder06 AT yahoo DOT com
If you are a nonprofit entity or government official (or can flag one of those down) here are some brainstorm ideas about how to support the goals of this petition and make discharge more fair for vulnerable New Yorkers and their advocates:
-In order to examine if discharge policies in New York State are upheld, and if New York State’s process is properly supporting the New York State Patients’ rights laws, someone could:
+Collect data on the number of overall complaints sent to the NY State Health Commissioner, and the number of cases that are “founded”
+Collect that same data on number of cases related to “discharge issues”, and the number of those that are founded.
+Tally the individual and overall fines imposed by the Health Commissioner, New York State Health Department against various hospitals and healthcare entities, and compare them to their annual profits and “bottom lines.”
+Collect data from the NY State Health Commissioner on the complaints on a hospital by hospital basis, and also on a “healthcare network/nonprofit entity” comparison basis, ie: Northwell Health vs. NYU Langone, etc.
-Have NY State public health officials survey hospitals and healthcare organizations about what kinds of rules/policies/consequences/rewards would actually affect their decision to follow the NY Patients’ rights laws.
-Follow the money: Do research to examine who profits from NY State’s loose enforcement of the Patients’ rights law? Do research to see if some of the big hospitals or healthcare agencies are funding NY State officials or their political campaigns.
-Educate the public on ways to advocate for themselves and family members regarding NY State Patients’ rights. Some ideas: Ask to speak to the “Patient Advocate” when disputes arise. Bring any Health Proxies with you to the hospital when you go. Consider standing next to the patient and being able to confer with them and assert that you are communicating their needs.
-Lobby for a NY State Law that provides for a third party (such as a local health official, the patient’s regular doctor, or a member of the police COPE unit) to come to the hospital or emergency room to mediate when a patient or their advocate is disputing discharge.
-Examine how HIPPA privacy laws may currently interfere with someone advocating for a vulnerable and/or nonverbal family member at a hospital. Privacy and the proper seclusion of medical records are important. But, sometimes hospital staff can use them as an excuse to not provide medical records or discharge papers to family members of vulnerable populations. The interface of advocacy and HIPPA is something that NY State elected officials and health officials could study and address.
-Research could be done on how strongly the law should assert giving a PHYSICAL and paper copy of discharge papers and instructions to patients.
Physical printouts provide timeliness, ease of understanding, and evidence that the papers were given. One problem is that some hospitals or health systems encourage and even pressure people to sign off on paperless systems, so that discharge papers are not genuinely available and/or helpful to patients as they leave the hospital
____________________________________
To find a list of your Patient Rights as a New Yorker in a New York hospital or emergency room:
https://www.health.ny.gov/professionals/patients/patient_rights/
Link to the way to complain in the approved of manner, to the New York State Health Department about violations:
https://apps.health.ny.gov/surveyd8/facility-complaint-form
(The above is the complaint system that portends to be effective because it is centralized. Though, it is actually creating an overburdened system, and a kind of monopoly on complaints that protects hospitals and healthcare agencies from other types of legal action)
New York State Codes, Rules and Regulations
Section 405.7 Patients’ rights
effective date 11/13/2019
Under (b) Hospital responsibilities. The hospital staff shall afford to each patient the right to:
(16) “prior to discharge, receive an appropriate written discharge plan and a written description of the patient discharge review process available to the patient under Federal or State law.”
-end background info on petition
Information on the ambulance picture:
Picture is stock by: Mangocove
https://commons.wikimedia.org/wiki/User:Mangocove
https://commons.wikimedia.org/wiki/File:Armstrong_Ambulance_P17.jpg
https://creativecommons.org/licenses/by-sa/3.0/deed.en
Super thanks if you read this far! Hope some folks find useful info among the links!
114
The Issue
On behalf of my loved one experiencing dementia and Traumatic Brain Injury (TBI), I had an unfortunate encounter with the Huntington Hospital/Northwell Health Emergency Room and its administration, which carelessly saw tomy loved one's wrongful discharge without proper concern about his safety post-discharge.
The experience was made worse by the condescending attitudes and cruel behavior of the hospital administrators, who were rude and dismissive of me, when all I asked for was our rightful access to the discharge papers.
We were never given discharge papers on the day of my loved one's discharge.
This experience illuminates a concerning issue that is not limited to our case but impacts a troubling number of patients and their advocates in New York hospitals. Current New York State law does not effectively guarantee the rights of patients and their advocates in situations of dispute about discharge from the hospital.
It is high time New York leaders consider reforms in the approach to discharge policies at hospitals. These reforms should include improved procedures for patients and their advocates to appeal and complain about discharge procedures.
Moreover, an outside third party, such as a local health official, the patient's regular doctor, or a member of the police COPE unit, should be provided the legal flexibility to mediate when such disputes arise at hospitals or emergency rooms.
No individual or their family/advocate should be subjected to distress due to questionable discharge procedures or suffer the indignity of inadequate care and dismissive attitudes. It is time our state leaders recognize the inherent respect and concern that patients, especially vulnerable individuals like those with dementia or TBI, deserve in their moments of medical need.
I urge all New Yorkers to join hands in calling for these crucial reforms to be enacted to safeguard our loved ones during their health battles and ensure that similar situations do not recur. Please sign this petition for a just and caring healthcare system in our state.
_________________________
If you have a story about a problematic discharge
from a New York hospital or emergency room,
please put it in the “Why I Signed” comments.
You may also send it anonymously to:
kimberlywilder06 AT yahoo DOT com
_________________________
Background and more information:
Signing this petition will add your voice to a plea for political leaders to reform discharge practices at hospitals in New York State, including reforming the manner and amount of possibilities for patients and their advocates to appeal and complain about discharge procedures. NY State Law must provide for an outside third party (such as a local health official, the patient’s regular doctor, or a member of the police COPE unit) to come to the hospital or emergency room to mediate when a patient or their advocate is disputing discharge. There must be a significant consequence to hospitals and healthcare companies if they violate the rules under the NY State Patients’ rights law 405.7
It is important to protect the patient’s right to receive discharge papers (ie: on paper) as they exit the hospital or emergency room.
New York State’s laws about Patients’ rights are a powerful tool to make sure that hospitals treat all New Yorkers with dignity and proper care. Unfortunately, due to inadequate oversight and channels for complaints, these rights – especially the right to receive discharge papers upon leaving – are often mowed over by enormous healthcare organizations, uncaring hospital administrators, and a faulty mechanism for making complaints and creating justice, after the fact, for wronged patients.
Improving discharge outcomes and upholding these patients’ rights – which are already enshrined in law – could be an important solution for protecting vulnerable populations such as the elderly, long term care patients, unhoused people, and people with mental illness from being summarily discharged from emergency rooms and hospitals.
The Story of Our Terrible, Horrible, No Good, Very Bad Experience
at Huntington Hospital/Northwell:
Have you ever had to beg for your loved one’s life?
Sometimes, when you advocate for a child, elder, or other vulnerable family member, it may feel like you have to do battle with the workers or systems in an organization just to make sure that your loved one can survive. I had to engage in this type of struggle with the emergency room at Huntington Hospital/Northwell Health on a recent holiday weekend, and it was very traumatic for myself and my loved one.
My family member (who I will refer to as “George”, for his privacy) has TBI from a fall from a roof, and also dementia. George has trouble walking. Since his fall, there have been several times that he has fallen out of his wheelchair and been hurt.
Then, recently, on the Friday of a holiday weekend, George fell out of his wheelchair two times on the same day. And, the second time, he needed to go to Huntington Hospital/Northwell Health for treatment, including a CT scan of his head.
Being a concerned family member and someone listed as one of George’s Healthcare Proxies, I grabbed my lime green tote bag of visiting supplies and papers and went to: comfort George at the emergency room, help him communicate with the doctors, and to advocate for him. I was the only person there to accompany him at the hospital.
Among my goals was to let the hospital staff understand that it was unusual for George to have two falls in one day. So, I wanted to make sure the doctor considered possible reasons for the extra falling.
In addition, I wanted to underscore that there was no safe place/safe scenario for George to be discharged to. George needs special care and someone to watch over him 24/7. Because of the holiday weekend, there would not be a way to schedule staff for his needs, nor be properly in touch with a doctor or decision-maker to make a plan for taking care of him after two falls and the possible consequences of the two falls.
I wanted to bring the concern to George's doctor at the emergency room, that the hospital was probably the only safe place for George, until Monday. At that point, the holiday would be over, and staffing and planning would be able to happen. Otherwise, other falls would be likely.
It was clear to the hospital that George could not participate well in his discharge plans. In fact, when we received his medical records, three weeks later, after several certified letters and faxed legal papers, the paperwork showed that instead of having George sign the hospital’s paperwork at all, they had someone write things like “Patient unable to sign due to confusion” and left the signature space for the patient blank.
I did not have George’s official Healthcare Proxy with me, but I did have an old letter from George’s wife noting that she was his spouse and Healthcare Proxy, and I was another primary contact for health issues. All through George’s emergency room visit – as I waited Friday evening of the holiday, went home to sleep, and came back on Saturday morning -- no one ever asked or mentioned a Healthcare Proxy. Though, I finally presented the letter to the Hospital Administrator on Saturday morning as I begged her to stall George’s discharge and/or to give me his discharge papers.
I knew that if they had to give me discharge papers, I could see if there was a reason given for George having suddenly fallen twice and I could see if the doctor had made any suggestions (or plans) for how to keep George safe this holiday weekend.
I also knew that if the hospital had made a hasty mistake, forcing them to provide discharge papers might clarify the situation for all involved.
In the whole time I was at the hospital for George, the only medical staff I had been allowed to speak with were nurses. I was specifically never allowed to speak with a doctor.
The Social Worker and two administrators agreed to a meeting with me. At the meeting, it was clearly “three against one” with them talking over me. I could see that they were stubbornly and arrogantly set on not letting me have one shred of paper and not seeing a doctor. And, the Hospital Administrator told me at the meeting “You will get the discharge papers as the ambulance is taking your [family member] away.” But, in fact, they did not give me discharge papers even then.
When I begged the people in the meeting to either give me discharge papers, or to write a note saying they were not giving me discharge papers, or to let me tape them on my phone asserting I was not getting discharge papers, they all stood up and walked out of the meeting.
Then, I pleaded with the Hospital Administrator to meet with me alone to try to calmly figure things out. At that point, she called over to another person that “It’s time to call security.”
So, as they dumped George from the hospital gurney on to the ambulance gurney, a white shirted Security Supervisor and two blue shirted Security Guards hovered over myself and George.
The ambulance crew that came to take my loved one away were also Northwell employees. (Which I believe could be another problem with discharge outcomes in New York.)
I rode in the ambulance with my family member as he was taken back. The ambulance staff person was uniquely kind. He still had no physical paperwork for me, nor did he give me discharge instructions. Though, he read some of George’s lab results off his handheld tablet and tried to explain things to me that no one had been willing to explain at the hospital.
Neither George, nor myself, nor anyone in our family ever received discharge papers that day.
What should the consequence be for the actions of Huntington Hospital/Northwell Health?
When I contacted someone to ask if any of the pieces of this story seemed to indicate a lawsuit against Huntington Hospital/Northwell Health, I was told that the only mechanism in the law is to report them to the NY State Health Department. Then, the Health Commissioner, New York State Department of Health, would decide if it was worth creating a case. And, then, if the hospital was deemed to have done something wrong, they would pay a small fine to NY State.
Clearly, the small fine that hospitals pay to NY State when they violate patients’ rights is not enough to deter them from violating those rights. And, the fact that that Health Department mechanism exists (as a sort of monopoly on justice) seems to have only emboldened administrators and social workers to arrogantly deny patients and their advocates their basic rights.
NY State Law must provide for an outside third party (such as a local health official, the patient’s regular doctor, or a member of the police COPE unit) to call or come to the hospital or emergency room to mediate when a patient or their advocate is disputing discharge. Having immediate help is the only way to stop an unfair discharge, since the hospital has security and high paid administrative staff to support their position.
NY State Law should not circumvent the judicial systems of our state and federal government by implying (or making true) that the only path to seek justice for unfair discharge is to apply to one office, the Health Commissioner, New York State Department of Health.
If you have a story about a problematic discharge from a New York hospital or emergency room, please put it in the “Why I Signed” comments. You may also send it with your name or anonymously to kimberlywilder06 AT yahoo DOT com
If you are a nonprofit entity or government official (or can flag one of those down) here are some brainstorm ideas about how to support the goals of this petition and make discharge more fair for vulnerable New Yorkers and their advocates:
-In order to examine if discharge policies in New York State are upheld, and if New York State’s process is properly supporting the New York State Patients’ rights laws, someone could:
+Collect data on the number of overall complaints sent to the NY State Health Commissioner, and the number of cases that are “founded”
+Collect that same data on number of cases related to “discharge issues”, and the number of those that are founded.
+Tally the individual and overall fines imposed by the Health Commissioner, New York State Health Department against various hospitals and healthcare entities, and compare them to their annual profits and “bottom lines.”
+Collect data from the NY State Health Commissioner on the complaints on a hospital by hospital basis, and also on a “healthcare network/nonprofit entity” comparison basis, ie: Northwell Health vs. NYU Langone, etc.
-Have NY State public health officials survey hospitals and healthcare organizations about what kinds of rules/policies/consequences/rewards would actually affect their decision to follow the NY Patients’ rights laws.
-Follow the money: Do research to examine who profits from NY State’s loose enforcement of the Patients’ rights law? Do research to see if some of the big hospitals or healthcare agencies are funding NY State officials or their political campaigns.
-Educate the public on ways to advocate for themselves and family members regarding NY State Patients’ rights. Some ideas: Ask to speak to the “Patient Advocate” when disputes arise. Bring any Health Proxies with you to the hospital when you go. Consider standing next to the patient and being able to confer with them and assert that you are communicating their needs.
-Lobby for a NY State Law that provides for a third party (such as a local health official, the patient’s regular doctor, or a member of the police COPE unit) to come to the hospital or emergency room to mediate when a patient or their advocate is disputing discharge.
-Examine how HIPPA privacy laws may currently interfere with someone advocating for a vulnerable and/or nonverbal family member at a hospital. Privacy and the proper seclusion of medical records are important. But, sometimes hospital staff can use them as an excuse to not provide medical records or discharge papers to family members of vulnerable populations. The interface of advocacy and HIPPA is something that NY State elected officials and health officials could study and address.
-Research could be done on how strongly the law should assert giving a PHYSICAL and paper copy of discharge papers and instructions to patients.
Physical printouts provide timeliness, ease of understanding, and evidence that the papers were given. One problem is that some hospitals or health systems encourage and even pressure people to sign off on paperless systems, so that discharge papers are not genuinely available and/or helpful to patients as they leave the hospital
____________________________________
To find a list of your Patient Rights as a New Yorker in a New York hospital or emergency room:
https://www.health.ny.gov/professionals/patients/patient_rights/
Link to the way to complain in the approved of manner, to the New York State Health Department about violations:
https://apps.health.ny.gov/surveyd8/facility-complaint-form
(The above is the complaint system that portends to be effective because it is centralized. Though, it is actually creating an overburdened system, and a kind of monopoly on complaints that protects hospitals and healthcare agencies from other types of legal action)
New York State Codes, Rules and Regulations
Section 405.7 Patients’ rights
effective date 11/13/2019
Under (b) Hospital responsibilities. The hospital staff shall afford to each patient the right to:
(16) “prior to discharge, receive an appropriate written discharge plan and a written description of the patient discharge review process available to the patient under Federal or State law.”
-end background info on petition
Information on the ambulance picture:
Picture is stock by: Mangocove
https://commons.wikimedia.org/wiki/User:Mangocove
https://commons.wikimedia.org/wiki/File:Armstrong_Ambulance_P17.jpg
https://creativecommons.org/licenses/by-sa/3.0/deed.en
Super thanks if you read this far! Hope some folks find useful info among the links!
114
The Decision Makers
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Petition created on August 8, 2024