Ms. Sunitha Rao Annamaneni MD
Attending Physician
Respiratory Department
Kaiser Permanente
Permanente Medical Group, Inc.
1425 South Main Street
Walnut Creek, CA 94596
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Subject:
Respiratory Department Emergency Room Treatment
Dear Doctor Annamanei,
I was treated in the Emergency Room at Kaiser, Walnut Creek beginning on June
7, and then by you in Respiratory Department on June 8th and 9th.
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I am pleased to commend your excellent care, and that by the ER team.
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On recommendation of the Oncology Advice Nurse, I went to Emergency on
Wednesday, June 7th at about 2pm, with a temperature of 104+, I was shaking
with chills, and wobbly on my feet.
The screening doctor commented that I looked fit, and, despite
elevated temperature, standard practice releases patients with no
evident symptoms of disease or injury to go home. After further discussion the
doctor checked patient history on the computer. The doctor followed Kaiser
guidance for treating cancer patients with elevated temperature, and with
cancer marker indicating possible rising metastatic disease for the past
five (5) months.
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Christy and Cellia were timely and professional preparing admitting documents,
taking vitals, and drawing blood for initial assessment. Blood draws with
needles have become problematic for me. I appreciated very much Cellia's
careful work minimizing trauma to the arm.
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About half an hour later, I was admitted to an emergency room. Andrea assisted
me, being attentive to privacy, and comfort, posting the initial work plan on a
marking board, and monitoring my condition while waiting for a doctor. James,
set up another blood draw and IV using the port catheter. This is specialized
work, which he performed perfectly. James was informative and helpful
conveying messages. In sum, nursing staff and procedures in the ER reflect
Kaiser's high standards. I was treated with competence and compassion.
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The attending physician, Doctor Natchak, explained findings of pneumonia in
the lower left lung, shown by xrays, and consistent with blood work showing
elevated WBC fighting infection. This was treated with fluids to bring the
temperature down, and with antibiotics. By about 6 pm my temperature had
lowered. The doctor advised that the blood count rose slightly.
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I was surprised when the doctor asked how long I have had esophagitis.
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We briefly reviewed the record showing that esophagitis was reported in a PET
scan test on January 20, 2006. I received this report in a meeting with the
primary care physician on February 17th. There was no time during the meeting
to read the report. After the meeting, I saw the analyst's comment about
esophagitis.
My letter to the primary care physician on March 20th reported
occasional
symptoms of esophagitis.
Could this be a target for cancer relapse
driving up the CA 15-3 marker? What treatment is needed? A follow up PET scan
test on April 14, 2006 was presented by the doctor during a meeting on April
28. This next test made no comparison with prior findings of esophagitis. No
diagnosis and no treatment was prescribed at that time on April 28th.
Therefore, on June 7th I asked Doctor Natchak the basis for asking how long I
have had esophagitis. She advised that Kaiser's computer says I have
esophagitis.
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Subsequent research seems to show correlations between radiation treatment for
cancer, and esophagitis, and further with pneumonia, which all fit my patient
history.
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I was very pleased that Doctor Natchak consulted with an
admitting team, who
recommended hospitalization for treatment and observation, based on patient
history. I am grateful for Kaiser's Team Care process that supports busy
doctors with multiple views of experts. At approximately, 7 pm Doctor
Natchak said that I would be moved from the ER into a hospital room in a few
hours. About an hour later, I was taken to a holding room for transfer to the
main hospital.
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The next morning on June 8th at 6:30 am I was moved from ER into room 303B in
the Respiratory/Medical/Alzheimer Ward of the main hospital. This 12 hour
delay presaged issues that may need attention.
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Your work was thorough, careful, and competent treating pneumonia, including
analysis of possible correlations with esophagitis, cited by Doctor Natchak the
day before, and further complicated with rising signals of cancer relapsing the
past few months. I was greatly encouraged by Doctor Johnson's visit, even
though this added to his busy day. Team care oversight and collaboration by
the primary care physician provides experience that lends confidence in
treatment decision, which cannot be drawn from computers and medical charts.
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Later that day on June 8th, switches on the bed that enable patients to control
bed elevations, lights, and television suddenly failed. I panicked when the
nurse call button did not work, because there was no way to report a problem.
Eventually, a nurse came by to attend another patient. I called out for
assistance. The nurse said this happens all the time. She made adjustments
that fixed the controls. What a relief. A few hours later, however,
everything failed again. A nurse who came by said she would call the
Engineering Department for repairs. We discussed getting another bed, but the
nurse said we should wait for the engineer. Several hours later, the nurse
came by and asked if the engineer had fixed the control system. I asked again
about getting another bed, because being in one position made sleeping
difficult; loss of the television was inconvenient, failure of the lights at
night, and failure of the nurse call button presented risks. The nurse said I
could not be moved to another bed due a shortage of beds in the department.
She indicated that getting a bed from another department would take too much
time for paperwork, because the staff was busy caring for special needs of
alzheimer patients. She planned to ask someone to call the Engineering
Department again and remind them to fix the problem. She showed me a light
switch on the wall out near the doorway that I could use by getting out of bed
and walking through the other patient's area. At this time, she offered to
turn on the lights so I could read, and she explained how I could use the
telephone to call the hospital and ask for the Respiratory Department to get a
nurse, until the Engineers come by and fix the emergency call button.
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An hour or so later I needed assistance, and so tried the
telephone to call the Respiratory Department. The phone rang
about 10 times. I wasn't sure if I mis-dialed and so tried
again, but no answer. Thinking everyone was busy, I waited for
about 15 minutes, and called again. This time someone answered
and asked me to hold while he located the nurse. After about
10 minutes I hung up in order to avoid tying up the line and
blocking others trying to call the Respiratory Department.
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I got out of bed and walked out to the nursing station. A nurse walked me back
to my cubicle, saying I shouldn't be walking around the hallways at night. She
apologized for no one answering the telephone, and explained that everyone was
busy helping alzheimer patients. She planned to ask someone to call
Engineering again. The nurse adjusted the bed manually and fixed the covers so
that I could sleep. She also brought some water, which was very helpful.
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I asked about the screaming coming from the ward, and shouting by nurses to the
patient next to me. This was unnerving and stressful, and made reading, and
sleeping difficult. The nurse apologized and said that nurses and doctors have
to talk loudly to patients suffering alzheimer disease, and that these patients
are disoriented, causing them to scream about imaginary things. It's just part
of the job. Eventually, things quieted down and I fell asleep, but was
awakened about 2 am by more screaming. Since I could not call the nurse, I
walked out to the nurses station and requested a sleeping pill. The pill was
not effective. I was awake most of the night listening to wailings, and
moaning of other patients, and to staff attempting to communicate with very
troubled patients.
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In the morning, I asked the day-shift nurse about getting the bed fixed. Aida
was very helpful. Her approach to patient care was attentive and highly
professional, reflecting Kaiser's strong reputation. I got the impression that
she is new in the Department.
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I was grateful, when at last you arrived and reported favorable
test results. My temperature and blood counts were both
satisfactory, validating your treatment plan. As you may
recall, I was ecstatic at the prospect of going home. I am
afraid though that I may have left an incorrect impression when
you suggested that I stay another day to treat diarrhea, which
had begun during a stressful night. I did not disagree with
your analysis, and only decided to check out of the hospital,
when you indicated that self-treatment at home was feasible.
Under the circumstances, the level of care in Respiratory
Department justified self-treatment at home to reduce the
burden on overworked nursing and engineering staff. Being
removed from unsettling conditions treating alzheimer patients,
made peace and quiet of home an attractive prescription.
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While I was getting ready to leave, which took an hour or so,
two engineers came by to examine the bed. They said the bed
was broken and I should be moved to another bed, a solution
rejected the night before. Some time later another engineer
came by. He determined that the electrical "cord" was
defective. He went and got another cord. Then everything was
working again, ready for the next patient.
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Again, thanks very much for excellent care. Since leaving the
hospital my condition has further improved. I am back at work
today and everything seems fine. Please forward my letter to
the ER department, so they are notified that hard work and
excellence at Kaiser are recognized and appreciated by
customers. Doctor Johnson has done a good job the past few
years upgrading the Oncology Department. This kind of
leadership is greatly needed in the Respiratory Department,
including a separate unit for alzheimer patients. In the meantime,
patients admitted to the Respiratory Department should be warned
about conditions, so they can participate more fully in the
doctor/patient partnership model at Kaiser.
.. Good luck in your career.
You sent me a letter advising that a blood test was available on Kaiser's
website. However, the website only has results of one (1) test, which was on
the pancreas. I would like to get results of all the tests performed in the
ER, and for your work in the Respiratory Department. The Oncology Department
routinely makes this distribution to support the doctor/patient partnership.
Thanks.