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Hospital, Heal Thyself

Ever get tired of hearing "Thank you"? I didn't think it was possible until it happened to me. Since April of this year I have been a patient at Princess Margaret Hospital (PMH), to receive my chemotherapy. The hospital is bureaucratic to the point it is inefficient. As I have stood up and insisted on receiving the best health care available and refused to accept excuses for across the board issues and mistakes, other patients and staff constantly say thank you. I've heard 'thank goodness someone is standing up to this place', and other such comments. It's actually gotten old. While I appreciate the sentiments I have cancer too, though something needs to be done.

In our sister publication I have written many editorials praising the medical professionals and hospital that initially found and treated my cancer. I choose to have my chemotherapy at Toronto's downtown Princess Margaret Hospital. April 4th of this year chemotherapy began in the afternoon. That morning I had minor surgery to insert my portocath, the device through which I receive the chemo drugs. That procedure was done at another University Health Network hospital, I add that hospital to the list of the finest in Toronto. PMH is also a member of the University Health Network (UHN).

The PMH Pharmacy

In the first inklings of inefficiency, the prescription for the drugs that I need to stave off the miserable side effects wasn't given to me until after I had arrived at PMH, to receive my first chemo. That limited my choice of pharmacies to the one at PMH. At about noon the prescription was taken to the PMH Pharmacy. By four that afternoon it wasn't filled. One prescription was for 30 pills. The other two prescriptions were for 4 pills each. Learning it would take some time to fill the prescription I told the pharmacy I'd go elsewhere. I was informed, by the PMH pharmacy, that they were the only ones that could fill the prescription. They agreed to rush it claiming the delay was the address on my prescription didn't match the address on file for me and it was inexplicable. I moved! A simple and obvious explanation didn't occur to the PMH Pharmacy. I had my UHN blue hospital card updated at Toronto Western that morning with my new address.

Minor surgery and my first round of chemotherapy were on the day's agenda. I didn't need this nonsense anytime let alone that day. Keep in mind the pharmacy had not filled my prescription despite having nearly 4 hours to do so. As I waited for them to fill it I noticed that everyone who came into the pharmacy following me had each waited longer than I had. The last had waited all day being at the hospital one hour before the Pharmacy opened and his prescription wasn't ready. I heard pharmacy staff make excuse after excuse. I was told one reason for the delay, and why I couldn't use any other pharmacy, was my oncologist had to be called before they could fill the prescription. The pharmacy said the oncologist would answer PMH pharmacy calls first ahead of any other pharmacy, suggesting the delay would be longer if I went elsewhere.

Before leaving the Pharmacy I decided to have them fill the prescription for my second round of chemotherapy. I patiently explained about my address change and received a receipt for this prescription. They were given two weeks to fill it. I didn't need it until April 19th, a red letter day for me at PMH.

During this visit to PMH and my prior visit to meet my oncologist and organize the chemo I noticed that the front line staff were constantly told off and shouted at. Patients and their loved ones verbally took out their frustrations, usually about long waits, on the bewildered front line staff. On Good Friday my first round of chemo ended, as I left the Chemo Day Care unit I stopped off and thanked the front line staff, feeling very sorry for them for the number of times I'd seen someone yell at them.

April 19th: Mistakes Abound

My first stop for chemo round two was PMH Pharmacy to pick up my prescription that they'd had two weeks to fill. They lost it! The first excuse: I hadn't given it to them. I pointed to my receipt currently in one pharmacy staff member's hand. Excuse two: it was a duplicate for my first prescription. No sale. Excuse three. The address they had on file and the one on my blue UHN hospital card didn't match. I'd heard that one before. I pointed to the staff member that had taken the second prescription and reminded her she'd assured me she'd make a note that my address had change so this problem, that had reoccurred, wouldn't reoccur. They rushed in filling the prescription.

My next stop was to have blood drawn, a must before chemo. Until the results are available, which should take one hour but usually takes much longer, the chemo drugs aren't prepared. It's not like PMH uses a mortar and pestle. The drugs are available they are merely labeled and I hope put through a quality/service check at least one time.

Three hours later I was called to the Chemo Day Care Unit. The first words I heard after identifying myself was the heart-stopping, "there is a problem with your blood." Then I learned, PMH lost my blood work.

Is it possible for PMH to be more incompetent? That was my response. At that moment I identified myself as a member of the media and told the Front Line staff the problem was PMH I had nothing but praise for all other hospitals and staff involved in my care and had written as much in my editorials since February. I demanded to have Home Care take over my chemo treatments.

My blood work was drawn again and a rush put on the order. In the meantime I met with my oncologist. My first words to him were "I'm glad to see you, my toe is numb." I asked him to examine it. In the only criticism I will make of my oncologist he insisted on lecturing me for telling off his staff. He said he couldn't treat me if I was unprofessional. I told him he'd treat me.

In our back and forth discussion every time he went silent I asked him to treat my toe. Numbness is a side effect of chemo though this wasn't the case for me and the numbness has gone away though thanks to my fantastic GP who sent me to another specialist this was confirmed. Humber Hospital referred me to my PMH team not my GP. I want to be clear because, as I've written, I have never had a problem with any doctor my GP recommended.

My oncologist told me Patient Relations dealt with complaints like mine. He provided their contact information and then treated my toe. His professionalism during the examination was obvious. Medically I do not have an issue with him.

Patient Relations did contact me and take a list of complaints. I told them I would write about this as I have covered my cancer battle. I agreed not to do anything until after my next chemo treatment in May. I was able to arrange for Home Care to remove the drug paraphernalia from that point forward. PMH organized Homecare and a pharmacy delivery. Both received, incorrect addresses, and in an example of the magnitude of inefficiency each received a different incorrect address. The pharmacy delivered 4 syringes which is usual for flushing my portocath line. One was unusable. Other medical supplies that I needed for this procedure to take place, bandages, tape and a medical waste container weren't provided. My Home Care nurse used an empty pasta jar and through his medical supplies and those I had on hand we persevered.

The following week Patient Relations called me back. The majority of complaints I had made, too numerous to mention here, were ignored. At one point, Patient Relations, response to one specific concern was "I wasn't there, I didn't see it." That's PMH's idea of self-regulation? Every other complaint I'd made, that they addressed was proved valid.

The Bureaucratic Solution

Vasiliki (Vas) Bakas, Patient Relations at PMH, assured me that a protocol had been put in place to ensure that the blood would not be lost again. Guess what the change was: the cancer sufferer has to schlep the blood over to the PMH blood lab. Since I have a portocath another area of the hospital inserts it and does my bloodwork. The idea of informing the Blood Lab of this change apparently didn't occur to PMH. I had to argue with the front line staff member, who couldn't be bothered to lift his eyes from his pc and notice the blood vial in my hand. He demanded my hospital card to set up an appointment to draw my blood. I kept repeating the blood vial is in my hand and wouldn't give him my hospital card. Finally another staff member came over told him about this new procedure and took the blood vial.

I was dissatisfied with Patient Relations response and wanted to climb the food chain to get to someone who would deal with these valid issues I raised. Several days later I received a letter from the Hospital Ombudsman, Sharon Rogers, who ignored virtually all of my complaints focusing only on the reasons why Home Care couldn't take over my chemo treatment. The Ombudsman said I needed to be monitored.

When will the monitoring begin? I called the Patient Relations voicemail, a body to answer the phone would be efficient so not part of PMH's procedures and put my question to them. That call made in May has never been returned. The Ombudsman cc'd PMH's Chief of Staff, Dr. Malcolm Moore and Dr. Robert Bell, President and CEO, UHN. Since May 9th, the date on the letter, both of these men have learned of the issues and yet they continue to occur.

Monitoring Begins When?

Thursday June 14th proved to me beyond any doubt that I am not monitored during chemo. I had the great misfortune to be seated next to a very angry man. Five times I witnessed acts of violence, four of which were also witnessed by PMH staff and nothing was done. I noticed him while waiting for Chemo he viciously shouted at his wife to get away from him while angrily waving his hands. He was standing at the front counter of Chemo Day Care and it was obvious that had anyone been behind him they would have been struck with his arm gestures.

About one hour into his chemo he stood, up there was a machine used to take vitals in his path. He gave it a hard shove and it struck a computer station. Not one PHM employee witnessed this second act of violence. Acts 3 and 4 were directed against me. Usually I read during chemo or chat with other patients. I wasn't about to chat with him. The second time he got up and returned he'd wrapped the IV line around himself. His solution was to slam his drug cart against mine. He went to do it again, this time a nurse was close by and together with his wife grabbed him and put him in his chair. He began slamming his chair against the wall. The nurse left. Shouldn't patient safety be a concern for PMH? Not in my experience.

Hospitals in Ontario are funded through the Ministry of Health and Long-term Care, currently the Health Minister is George Smitherman. Oversight is internal. Self-regulation at it's finest. PMH's Ombudsman's Office is an advertisement for the problems with self-regulation. In my experience PMH is not interested in fixing the problems.

Chemo patient can wait hours before the chemo treatment begins. It is not difficult for PMH to arrange to have the patients, drugs, bed/chair and nurse in the same place at the same time. Businesses perform this function daily or they go out of business. That's what a lot of the yelling at the front staff is about. It isn't the only issue but it is an important one. It is heartbreaking to see patients slumped in their chairs waiting for chemo. From my observation the sicker one is with cancer the worse the chemo experience and then the miserable side effects begin. PMH is full of excuses, I've heard multiple explanations why this or that didn't work.

George Smitherman

Disappointed with PMH I contacted the Ministry of Health who took nearly two months to reply with a pro-form letter refusing to do anything because of the legislation. The Minister of Health, George Smitherman, can alter the legislation and his excuse is he's bound by it? Minister, heal thyself! He suggested complaining to the Ontario College of Physicians and Surgeons. Too late. I already have filing a complaint against the two men I see as responsible PMH's Chief of Staff, Dr. Malcolm Moore and Dr. Robert Bell, President and CEO, UHN. I also filed a complaint against my oncologist. He's the only one of the three that I have had direct contact with so he's a starting point. I insisted on keeping him as my oncologist and continuing to receive my follow-up care at PMH. Only by standing up can any positive changes be made as long as PMH's bureaucracy refuses to do anything but continue the status quo.

PMH's media office was contacted twice to discuss this article and invited to comment. The calls were not returned.

The obvious solution is to allow the Ontario Ombudsman to have oversight over the hospitals. I have brought these complaints to his attention. How many mistakes does one hospital get to make before action is taken. Put the patients first.