AND HOSPITALS CULTURE OF FEAR

The catastrophic effects on those stricken with COVID-19, their loved ones, and our frontline warriors are devastating and almost unbearable. However, non-COVID-19 patients have had their rights usurped. Hospital protocols are rife with undesirable tactics marginalizing quality care while limiting physician input and physician oversight. Administrators prioritize profits over pa- tient care. Staff is threatened with retaliation if they voice opposing viewpoints.

Of significant importance is the ability for patients to advocate for themselves or have someone advocate for them, ensuring that information is properly communicated, received, evaluated, and understood. Violating rights has become prevalent as a result of untenable practices implemented during the current pandemic. Following, please review several rights being breached.

There are many examples of non-COVID-19 patients being victimized by unreasonable protocols. Patient W spiked a fever while receiving chemotherapy and was admitted to the hospital. Put
immediately on a COVID-19 floor until tested, the immunosuppressed patient was further compromised. Testing negative, patient W was then transferred to a non-COVID-19 floor, posing additional risks to others.

Patient X was to have follow-up scans and labs in April, 2020, for her six month post cancer treatment. The tests were denied because of modifications made to accommodate COVID-19 patients, resulting in a delay of care. Upon insistence and demands from the patient, the scans and labs were done in mid-June 2020. The tests showed the cancer had spread. On-time scans could have been pertinent in early intervention and more favorable outcomes. It is beyond negligent.

Patient Y required radiation to the eye which involved mapping, designing, and implementing a plan for delivery of the radiation. A visit to New York City during the initial phase of the pandemic added stress and uncertainty. Helped by a wonderful radiation oncology Fellow, the frustration was assuaged, and the visit took place. Most remarkable was the lack of protective gear worn by staff. Physicians were told, by management, not to wear masks in the hallways because of the negative perception it would create. During the course of the radiation therapy, Patient Y did not have the usual in-person weekly appointment. A phone call the first week was followed by a virtual visit the second week. As agreed by the physician, it was less than optimal. Just another example of management making protocol judgments.

Patient Z was urgently admitted to the hospital for a non-COVID-19 related issue. Placed in a room with no visitors allowed caused an immediate escalation of the fear and concern felt by the patient. Having no one to advocate in person, and the staff less than forthcoming with regard to information and transparency, further hindered the care received. Patient Z authorized and vehemently insisted that his/her advocates be privy to all records, communication, and attending physician visits to help facilitate informed decisions with regard to care options, choices, and recommendations. These rights were violated. Eventually, FaceTime visits brought some clarity. However, these visits were fraught with confusion and fragmented facts. At one point, a hospitalist told the patient to get off the phone. The physician on the phone had been called by Patient Z and was listening while remaining silent.

Other attempts to garner necessary information were thwarted by a nurse manager and a hospital-employed patient advocate/navigator. Worst of all, discharge instructions and follow-up recommendations were scant, leaving the patient to fend for himself/herself.

The examples are rampant, it is a systemic problem. Basic rights are being violated. Physicians, not management, need to determine protocols. It is unconscionable.