Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a
doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
My Wife Has Been Declared Brain-Dead in the ICU. Why are They in a Hurry to Withdraw Treatment to Her?
You can check out last week’s question by clicking on the link here.
In this week’s episode of ““YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Breanna as part of my 1:1 consulting and advocacy
service! Breanna’s brother is tracheostomized connected on the ventilator in the ICU and is asking why does the ICU team is telling that he weighs too much for a lung transplant.
My Brother is Critically Ill and with Tracheostomy in the ICU. Why Does the ICU Team say He Weighs Too Much for a Lung Transplant?
Breanna: Hello?
Patrik: Hi, Breanna. It’s Patrik speaking here from Intensive Care Hotline. How are you?
Breanna: Hi, Patrik. How are you?
Patrik: Very good. Thank you. How is your brother doing at the moment?
Breanna: They called Amy today and said that they brought his oxygen down to 35 which is a good day for him but it’s hard to get excited about that because until it sticks for a while, it doesn’t really mean much.
Patrik: Yeah, and the other thing that your sister-in-law mentioned to me yesterday was there is a plan to potentially move him onto sub – acute care, is that right?
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Breanna: Well, that’s what they keep telling us but they also keep telling us that we have to talk to the doctor about it and for as long as he’s been there, we have talked to his doctor zero times. Not once.
Patrik: My goodness. That’s no good. Basically, all the updates you’re getting are through the nursing stuff or how do you get updates?
Breanna: We’re getting updates usually from the case manager or the … what does she call herself? The-
Patrik: Social worker?
Breanna: Patient-
Patrik: Liaison?
Breanna: Yeah. Her name is Katrina. She’s very, very nice. The other one is I think just a case worker and that’s where we get most of our information and then they always say, well if you have additional questions for the doctor, you can tell us and we’ll tell the doctor. We keep telling them that and we never hear back from the doctor and my sister-in-law is just not a very aggressive person.
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Patrik: Yeah. They’re basically putting a wall between you and doctors pretty much.
Breanna: Yeah.
Patrik: Right. The people that you’re talking to, case manager and the other person, they’re probably not clinical people, they’re probably social workers or-
Breanna: Yes, that is correct.
Patrik: Right. And then you have the added on issue that in the long term acute care facility, you don’t have ICU nurses as far as I’m aware so you have to-
Breanna: Well, it is considered a long term ICU facility.
Patrik: Okay, good.
Breanna: The unit that he’s in is called ICU and from what I gather, these are ICU nurses, they better be.
Patrik: What’s the name of the hospital again? Can you just tell me because I’ll just have a quick look to see what-?
Breanna: Sure. It’s called Carefield.
Patrik: Carefield.
Breanna: Yeah, C-A-R-E-F-I-E-l-D Hospital and that’s in Perris California. It’s P-E-R-R-I-S, California.
Patrik: Okay. Hang on. Pellis did you say? P-E-L-L-E-
Breanna: Perris.
Patrik: Oh, Paris like-
Breanna: No. Like Paris France but it’s spelled P for peer E-R-R-I-S.
Patrik: Yeah I’ve got it. Yeah. Let me just have a quick look what it says because-
Breanna: Okay. We’re gonna patch Amy in right?
Patrik: Yes, of course. Can you do that? Might be easier for you.
Breanna: I’m not really sure how to.
Patrik: Okay. Just give me a sec. Hang on. I don’t think I can do it from what I can see because I think it’s not … because I’m overseas I don’t think I can dial somebody in from overseas but if you look at your … Are you using a cell phone?
Breanna: Oh, I see at the top it says add call?
Patrik: Yeah. Add call. If you could do that.
Breanna: Okay. Let me try that. Hold on.
Patrik: Yeah, sure. I’ll wait.
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Breanna: Okay. Alright. Patrik are you there?
Patrik: Yes.
Breanna: Okay. Amy is on the line now.
Patrik: Fantastic.
Amy: I’m here.
Patrik: Fantastic. Hi Amy. How are you?
Amy: I’m fine. Thank you for asking Patrik.
Patrik: You’re very welcome. Breanna, I’m just on this website for this facility Carefield Hospital in Perris. There is no indication that there is an ICU when you look up services, there is no indication but just give me one more sec please so I can … Normally, a hospital who has an intensive care unit or an ICU, they would brag about it on their website.
Breanna: Well, I thought it was listed because it belonged to an ICU facility when I looked it up.
Patrik: Okay. And that might well be the case. I’m not saying it’s not. What I am saying is I can’t find it on the website. That’s all I’m saying. I’m not saying-
Breanna: Okay.
Patrik: It does come up with ventilator care. Tell me, does he at the moment in this ICU, does he have a one to one nurse to patient ratio?
Amy: Go ahead Breanna.
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Breanna: They do tag team nursing. Would you agree Amy, or does he get one nurse per day assigned to him?
Amy: He gets one nurse a day assigned to him and giving him medication.
Patrik: And that nurse is not looking after any other patient on their shift.
Amy: Yes, she is.
Breanna: Yes, they are.
Patrik: Okay. Do you know how many other patients they’re looking after?
Breanna: I think there’s how many rooms in there, I wanna say there’s probably like one, two, three, four, five, maybe like six rooms and one of them is a double.
Patrik: Right. Because normally in ICU, it’s one nurse for one patient, sometimes-
Amy: He’s like in a regular room now. He’s out of ICU.
Patrik: Okay.
Breanna: Oh, okay. I didn’t know that. I thought they moved him back there.
Amy: No.
Patrik: That’s okay. But there is nothing on their website that suggests they have an ICU there. Yes, they’re talking about that they’re looking after patients with prolonged mechanical ventilation but it doesn’t … there’s no sign as far as I can see that they have an ICU but that’s okay.
We deal with what we’ve got. Let me just ask you … and you mentioned that to me Amy yesterday that once they wean down the oxygen, they’re trying to move him to sub- acute care. Is that still the case?
Breanna: That’s what they tell us but his weaning is not working so…
Amy: weaning is down to 35, and that’s the oxygen today.
Breanna: But Amy that’s happened before.
Amy: They should now get him stable enough then they’re gonna move him.
Breanna: But they’ve been tell us this for weeks on end.
Amy: I know that.
Patrik: Who is in charge of his care at the moment from a medical point of view?
Who’s directing the care? Is it the pulmonologist? Is it the intensive care doctor?
Who’s directing the medical treatment at the moment?
Breanna: All they say is his name is Dr. Winston and we’ve never seen him met him or talked to him.
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Patrik: And you don’t know if he’s a-
Amy: that’s a neurologist and I understand its Dr. Chen.
Patrik: Do you know if they are pulmonologists, are they intensive care specialists? Do you know what their qualifications are?
Amy: No, I don’t know.
Patrik: That’s okay. I made some notes when I spoke to both of you on your respective phone calls yesterday and the day before so there’s a number of things to move things forward. This particular hospital at the moment is not talking about lung transplant at all. Is that correct?
Breanna: Well, they’re trying to put us on our own for that. Yeah.
Patrik: They’re not helpful.
Breanna: Well, no. They pretty much just told us who to contact at UCLA but we had already been in contact with them and Amy-
Amy: We were supposed to contact him again and see if the case was still opened.
Breanna: And then Amy was told that he weighs too much but she was given an incorrect weight. Remember I said that it was fifty-something kilograms and you said that would be 130 pounds?
Patrik: Yup.
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Breanna: We don’t even know how much he weighs. We have not been given a straight answer on that.
Amy: I did look at the paper. His weight is 263.
Patrik: 263 pounds?
Amy: Pounds.
Breanna: And he’s 5’10. Do you think in your opinion Patrik that he weighs too much for a lung transplant?
Patrik: Look, the reality is that if people wanna do a lung transplant … if people don’t wanna do a lung transplant they will find a reason why not if they do wanna-
Breanna: That’s what I thought.
Patrik: Right. If they do wanna do a lung transplant, they don’t think about those things. It really comes down to their interpretation of the information that’s available. Look, 263 pounds. It is probably a little bit too much and in all reality, yes it is easier to do a lung transplant on somebody who’s not overweight but as I said to you, if they don’t wanna do a lung transplant they will find a reason and they might say it’s the weight,
they might say something else, they will find a reason. We can ignore that for now because-
Breanna: That’s what I thought, because yesterday they told us that he had to be under 300 pounds. He was 316 pounds and he went down January 25th. He’s lost a lot of weight. He gets down to this and they still tell Amy that he weighs too much. I have a feeling that they’re just making up excuses.
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Patrik: Yeah, absolutely. It’s not a make or break situation. With the facility at the moment, is he being seen by the doctors every single day? Do you know?
Amy: Yes.
Breanna: How do you know that Amy?
Amy: I don’t actually. I’m just told.
Breanna: Okay.
Amy: I just don’t happen to be there when it happens.
Patrik: Right. I think-
Breanna: How is it that you’ve never seen the man? How long has Michael been there?
Amy: Forever.
Breanna: I don’t believe he’s been seen by the doctor every day. I just don’t.
Patrik: There’s two things that make me a little bit suspicious. Number one, I cannot find any information on this website that they do have an ICU and if he was in an ICU, he would be seen by doctors every single day. There is no doubt.
Breanna: Okay, let me explain to you. It’s a very small hospital and they have a unit called “their ICU” and that’s where he was for many, many weeks and we’ve never met … he’s still under the same doctor’s care. We’ve never met him. They have now moved him to a different part of this very small hospital that is not called the ICU. Is that correct Amy?
Amy: Right.
Patrik: Can I just ask, since when … can you just give me the date again since when he’s been in this hospital? When did he go there?
Amy: He originally went there on February seventh.
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Patrik: February seventh. Okay. Let me ask you, what was the reason given to you why he was moved to this hospital?
Breanna: They told us at Hi-Desert that when he was in ICU at Hi-Desert Hospital in Joshua tree California under what we thought was very good care. We know for a fact that he was seen every single day by his pulmonologist and he did have a nurse assigned to him one on one. We were told that it was in him and Amy’s best interest to be moved because … well, he told us that they did not have, and this I didn’t understand it at the time because
they have a respiratory department and he was being seen by a respiratory therapist.
Breanna: We were told that they did not have the resources to wean him off the ventilator and so they had to transfer him to wean him off the ventilator and then they had someone come and talk with Amy that insinuated that if he stayed in ICU at Hi-Desert it may start to hurt her financially.
Patrik: Okay.
Breanna: I’m right Amy? This is what he told us.
Amy: Go ahead.
Breanna: No. This is what they told us, right?
Amy: I don’t remember. I was a little distraught.
Breanna: Yeah, you were honey but she said, I don’t want this to … because they told her that they would not move him without her consent and then they had someone came and talk to her trying to convince her that if he stayed in ICU at Hi-Desert that it could start to cost her money.
Patrik: Let me ask you. He’s had the tracheostomy around the fourth or the fifth of February from what I remember from what you said with me and he was moved to Perris California on the seventh. Now, when he had the tracheostomy, did you know that this move is imminent?
Breanna: No.
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Patrik: Okay. I’ll give you a quick background. That’s why I’m asking such specific questions. Often what happens is a tracheostomy is often being used as a vehicle to get to another hospital because ICU beds are in demand and the other facilities like where he’s probably now, they’re probably more cost
effective from a health insurance point of view. Doesn’t give patients the care they need but it’s often a money saving exercise for the healthy insurances and it’s also an illegal for the ICUs to empty the beds that are in demand. A-
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Breanna: But they are saying to us…they told us that they needed to do the tracheostomy because if they left it the way it was, it was going through his mouth, that that could cause permanent damage to his vocal cords and his oesophagus.
Patrik: I agree with that. I agree with all of that but the reality is if you didn’t know about the discharge to Perris California when they were doing the tracheostomy. Yes, they were giving you the medical reasons and they are accurate but what they haven’t told you is I can’t tell you how many situations I’ve seen like this before.
The 1:1 consulting session will continue in next week’s episode
.
