CONTACTS
SUBJECTS
Bob Visit Arroyo Grande Community Hospital Recover Knee Replacement
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 30 0000. ref SDS 29 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040507 -
040509 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Washed bedding in spare room for Allen.
040902 -
040903 - Moved the extra matress in the spare room that elevated one side of
040904 - the double bed, and put it in the garage. Placed it behind the
040905 - entertainment center, so it does not take up more space. This gives
040906 - Bob more room taking his normal route through the garage with a
040907 - walker. This change eliminates the odd difference with one side of
040908 - the bed 5" higher than the other. The bed now looks normal now.
040910 - ..
040911 - While bedding is in laundry, organized the garage to provide wider and
040912 - unobstructed path to facilitate Bob's knee surgery rehab status for
040913 - next 6 - 12 months.
040915 - ..
040916 - Investigated garage...
040918 - ..
040919 - To make room for more storage, rearranged the area along the back wall
040920 - of the garage and between the 2 vechicle.
040922 - ..
040923 - Moved cardboard laying on the garage floor to underneath his car,
040924 - which he uses to trap leaking oil. This cleared obstructions for
040925 - using a walker when Bob gets home in a few weeks.
040927 - ..
040928 - Moved wood cabinet doors from next to the water heater to the other
040929 - side of the car along the back wall where other wood materials are
040930 - stored.
040932 - ..
040933 - There were more empty cardboard boxes filled with dust and cobwebs,
040934 - and so give appearance of not having been used for 10 years. Broke
040935 - theses down an put in large blue waste basket, following up on prior
040936 - similar work on 111031 0800. ref SDS 15 ID42
040938 - ..
040939 - There is a box of world war II history books, the kind people buy as a
040940 - set. These were previously in the house next to the East wall of the
040941 - dining room. They were moved to the garage on 111031 0800.
040942 - ref SDS 15 W59I Today, moved them from the West wall near the door to
040943 - the breezeway and the house, to the left side of the car and in the
040944 - new space created per above. ref SDS 0 PP4P
040946 - ..
040947 - There is a grey or beige plastic box with a sealed lid, which Bob has
040948 - been using to store dog food.
040950 - ..
040951 - Dumped the sack of dog food for Sandy, into the large grey plastic
040952 - container, which Bob normally uses for the dog food. Because of his
040953 - injured knee, but had lef the dog food in the large sack, as purchased
040954 - from the store. Moving the food into the normal container made more
040955 - room for walking from the door to the breezway through the garage
040956 - door, which is Bob's normal route, and so facilitates his movement
040957 - without obstructions.
040958 -
040959 -
040961 - ..
0410 -
0411 -
0412 - 0910
0413 -
041301 - Bob called from his room 211 at...
041302 -
041303 - Mission View - Room 211
041304 - 1425 Woodside Drive
041305 - San Luis Obispo, CA 93401
041306 - 805 543 0210 ext 311
041308 - ..
041309 - He asked what time Allen will arrive?
041311 - ..
041312 - Reported telecon with Allen yesterday saying he is leaving LA between
041313 - 0900 - 1100, and so should arrive between 1200 - 1400.
041315 - ..
041316 - Will bring the paper for Bob to read.
041318 - ..
041319 - Bob has not yet done physical therapy today.
041321 - ..
041322 - Bob said he is feeling much better again today compared to last week,
041323 - after doing a lap with the walker around the ward by himself on
041324 - Saturday, and doing 3 laps assisted by physical therapyst yesterday on
041325 - Sunday, reported previously on 111113 1004. ref SDS 30 FF4N
041327 - ..
041328 - Bob indicated that his progress so far 2 weeks after surgery on
041329 - 111031, indicates he may need 2 or 3 more weeks getting rebalitation
041330 - services at Mission View in order to function adequately for living at
041331 - home.
041333 - ..
041334 - Asked Bob about treatment for his infection?
041336 - ..
041337 - Bob said that is all cleared up. His temperature is down, and the
041338 - staff has removed the IV pole from his room because the antibiotic
041339 - was a 10-day treatment.
041340 -
041341 - [On 111118 1005 Bob advised he is still getting IV
041342 - treatment with antibiotics to recover from infection,
041343 - ref SDS 32 PT48; diagnosed on 111031; there was a mistake
041344 - saying the IV pole was removed from his room today.
041346 - ..
041347 - He asked about my schedule?
041349 - ..
041350 - Explained getting medical procedure tomorrow, and then a blood draw on
041351 - Thursday. After that, if needed, can spell Allen again at Bob's place
041352 - in Nipomo until next Monday. Have to return for flight to New York,
041353 - visiting friends in Connecticut for Thanksgiving.
041355 - ..
041356 - Bob said he will coordinate with Allen on his schedule and let me
041357 - know about returning to Nipomo on Thursday, so Allen can go home
041358 - again to take care of personal business.
041359 -
041360 -
041362 - ..
0414 -
0415 -
0416 - 1116
0417 -
041701 - Received call from Debbi with Apria Medical Supply...
041702 -
041703 - 805 783 7413
041705 - ..
041706 - Debbi advised that Arroyo Grande Community Hospital shipped a walker
041707 - in the ambulance that took Bob to Mission View Health Center on 111104
041708 - 0952. ref SDS 19 P560
041710 - ..
041711 - Apria maintains an inventory of medical supplies to the hospital that
041712 - are only billed when actually used. When a patient needs something
041713 - like a walker, it is taken inventory. The patient is asked to sign
041714 - for it. At that point, the hospital notifies Apria that the hosptial
041715 - has sold a walker to a patient.
041717 - ..
041718 - The hospital also submits the patient's Medicare account and any
041719 - secondary insurance the patient may have.
041721 - ..
041722 - Apria bills Medicare and the secondary carrier directly for payment of
041723 - the walker. She advised that Medicare pays 80% of the cost for the
041724 - walker. Debbie believes Bob's secondary insurance will pay the
041725 - remainder. She indicated that some secondary health policies have a
041726 - deductible, so Bob may get a bill from Apria for any residual.
041728 - ..
041729 - Asked Debbi how much Apria has billed Medicare for the walker?
041731 - ..
041732 - Debbi advised that Apria has not yet billed for the walker.
041734 - ..
041735 - Debbie suggested that after Bob recovers so he does not need the
041736 - walker, he should not throw it away, because Medicare will not pay
041737 - for another one in the next 5 years.
041739 - ..
041740 - Debbi's dad had knee replacement surgery. His experience was similar
041741 - to Bob's with the first 2 weeks being very difficult, and then he made
041742 - good progress on rehabilitation. Her dad fully recovered to enjoy
041743 - many years of normal mobility.
041745 - ..
041746 - Debbi said the years helping her dad were very difficult dealing with
041747 - hospital billings and Medicare. She related getting long detailed
041748 - billing with things like kleenex, floor polish.
041750 - ..
041751 - Explained similar experience working with UCSF, shown by the record on
041752 - 070830 0807. ref SDS 3 1G4H
041753 -
041755 - ..
0418 -
0419 -
0420 - 1243
0421 -
042101 - Allen arrived.
042102 -
042103 - He said the drive through LA this past Friday was difficult due to
042104 - rush hour traffic. The drive today was easier.
042106 - ..
042107 - Showed Allen where Sandy's dog food was moved, per above. ref SDS 0
042108 - 5F6N
042110 - ..
042111 - Explained the $250 check was put in the white plastic sack, with Bob's
042112 - checkbooks and other documents. This was stored in the top drawer of
042113 - the locked filing cabinet in the laundry, and is changed from Allen
042114 - using the bottom drawer last Friday, reported on 111111 0802.
042115 - ref SDS 27 NB5O
042116 -
042118 - ..
0422 -
0423 -
0424 - 1315
0425 -
042501 - Driving home visited Arroyo Grande Community Hospital.
042502 -
042503 - Went to the Control Station where Bob was in room B29.
042505 - ..
042506 - Asked to see Jeff, who called and reported Bob was sent to Mission
042507 - View Health Center on 111104 0952. ref SDS 19 05HB
042509 - ..
042510 - The nurse said that Jeff is another nurse, and that he is off-work
042511 - today.
042513 - ..
042514 - Gave the nurse a message for Doctor Fow.
042516 - ..
042517 - The doctor does surgeries on Mondays, and so is onsite.
042519 - ..
042520 - The nurse took down the following...
042521 -
042522 - Bob Welch doing much better since Sunday.
042523 -
042524 - Great Work.
042525 -
042526 - Rod
042528 - ..
042529 - The nurse said she will see that the doctor gets the message.
042531 - ..
042532 - Asked for Medical Records Department.
042534 - ..
042535 - Was directed to Medical Records Department.
042537 - ..
042538 - Walking to Medical Records, past Surgery Orientation Department.
042540 - ..
042541 - Another woman was at Tanya's desk, and she was talking to 2-women
042542 - customers. Probably one a patient and the other a friend, relative.
042544 - ..
042545 - The woman behind the desk looked up. Asked her to give Doctor Fow the
042546 - message per above. ref SDS 0 U670
042548 - ..
042549 - The woman smiled, because this was an endorsement for quality care by
042550 - Doctor Fow and the hospital, and so likely reassuring to her new
042551 - customers today. One of the ladies turned and smiled.
042553 - ..
042554 - Found Medical Records.
042556 - ..
042557 - Talked to records clerk, Kimbeny....
042558 -
042559 - 800 489 4261
042561 - ..
042562 - Asked to see the discharge report for Bob, sending him to Mission View
042563 - Health Center on 111104 0952. ref SDS 19 05HB
042565 - ..
042566 - Kimbeny asked for identification. Showed driver's license.
042568 - ..
042569 - She checked the hospital computer and said Rod is listed as Bob's
042570 - contact.
042572 - ..
042573 - At this point, an older woman came from the back office and consulted
042574 - with Kimbeny
042576 - ..
042577 - The woman assisted Kimbeny using the computer to look for the
042578 - discharge form on Bob's transfer to Mission View, as reported by Jeff
042579 - on 111104 0952. ref SDS 19 ZF40
042581 - ..
042582 - Kimbeny then said the doctor has not yet prepared the Discharge form
042583 - on Bob's release from Arroyo Grande Community Hospital and transfer to
042584 - Mission View.
042586 - ..
042587 - Kimbeny suggested filling out a Request for Medical Records form.
042589 - ..
042590 - This explains why Mission View was unable to find the Discharge form
042591 - and instructions for Bob's care 2 weeks ago on 111105 0853,
042592 - ref SDS 20 NU4J, and again last week on 111111 0802. ref SDS 27 TD3T
042594 - ..
042595 - Filled out the form requesting...
042596 -
042597 - Medical records on Bob's case from 111031 - 111104.
042599 - ..
042600 - Kimbeny said the doctor will be notified to submit the discharge form
042601 - to meet request for patient documents.
042603 - ..
042604 - Kimbeny said there is no charge for the hospital submitting medical
042605 - records.
042607 - ..
042608 - Left hospital and drove to
042609 -
042611 - ..
0427 -
0428 -
0429 - 1404
0430 -
043001 - Arrived at Mission View Health Center in San Luis Obispo.
043002 -
043003 - Went to Bob's room 211. He was not yet back from the Ultrasound test
043004 - scheduled for 1200, reported on 111111 0802. ref SDS 27 YZ4F
043006 - ..
043007 - Visited the Control Station #2.
043009 - ..
043010 - The clerk showed results of Bob's CBC lab this morning.
043012 - ..
043013 - HGB has increased from 9 to 10 for a range........... 13.5 - 17.5
043015 - ..
043016 - This range of 13.5 - 17.5 is different from range 12 - 14, which Misti
043017 - reported on 111111 0802. ref SDS 27 YU8F Bob's test result of HGB 10
043018 - seems like a greater percentage below the target range, than when
043019 - Misti reported HBG 9 for a range of 12 - 14, this past Friday. Thus,
043020 - Bob's blood counts may be worsening.
043021 -
043022 -
043023 -
043025 - ..
0431 -
0432 -
0433 - 1413
0434 -
043401 - Visited with Ken, manager of Physical Therapy Department at Mission
043402 - View, and following up meeting with Laura last week on 111111 0802 at
043403 - 1822. ref SDS 27 B96J
043405 - ..
043406 - Ken said he reported Bob's progress on Saturday, and again yesterday
043407 - on Sunday walking 3 laps with the walker around the ward with the aid
043408 - of a physical therapyst, shown in the record on 111113 1004.
043409 - ref SDS 30 FF4N
043411 - ..
043412 - Ken indicated that, because of infection, Bob is behind schedule for
043413 - most patients getting knee replacement rehabilitation at Mission View.
043414 - This aligns with Bob's report that Mission View staff notified him
043415 - that rehabilitation will extend beyond Thanksgiving because infection
043416 - delays recovery from knee surgery, show on 111109 1032. ref SDS 24
043417 - U48O
043419 - ..
043420 - Ken said the past few days have begun to show improvement. He feels
043421 - Bob will likely need another 2 - 4 weeks of care at Mission View in
043422 - order to be ready for living alone at home.
043423 -
043424 - [On 111118 1005 at 1252 Ken reported that since Monday Bob
043425 - has made remarkable progress much better than expected, so
043426 - he feels Bob is ready to be discharged and go home tomorrow
043427 - on 111119. ref SDS 32 FE8N
043429 - ..
043430 - He explained that patients living alone need more time to gain
043431 - strength for manuevering at home, because there is no one to prepare
043432 - meals and maintain things. He gave common examples of getting up from
043433 - "easy" chairs at home is not easy; getting into and out of bed is
043434 - difficult for knee replacement patients for many months. If a spoon
043435 - falls to the floor, picking it up presents risks of falling over
043436 - without sufficient rehabilitation to build strength and mobility.
043438 - ..
043439 - This aligns with Laurie's comments that Bob's infection delays
043440 - progress on rehabilitation, reported on 111111 0802. ref SDS 27 W54O,
043441 - and that standard of care for elderly patients who live alone requires
043442 - more rehabilitation to function independently to avoid risk of falling
043443 - and suffering injury without help at home. ref SDS 27 574F
043445 - ..
043446 - [On 111118 1005 at 1252 Ken advised that Bob's expert use
043447 - of the walker shown since Monday, 111114, indicates to
043448 - Mission View staff that Bob is ready for discharge to go
043449 - home. ref SDS 32 6R5L
043451 - ..
043452 - Bob's difficulty getting up from a sitting position on the edge of his
043453 - bed to shake hands, this past Saturday, reported on 111112 0838,
043454 - ref SDS 29 N25F, illustrates simple requirements for regaining
043455 - sufficient mobility and strength to live alone at home without risks
043456 - of falling and injury.
043458 - ..
043459 - Asked if Mission View is aware of Bob's dog Sandy, a large, young, and
043460 - very frisky German Shepard?
043462 - ..
043463 - Ken said that Bob has not discussed Sandy, and Mission View's records
043464 - do not disclose this issue.
043466 - ..
043467 - Ken said that having a frisky big dog presents a significant risk for
043468 - an 84 year old knee replacement patient living alone while
043469 - rehabilitating from surgery, and for at least 6 months or more. Ken
043470 - explained the biggest risk for knee replacement patients is falling.
043472 - ..
043473 - Falls can cause fatal injuries to the head, cause broken arms,
043474 - internal injury, and also can break loose the artificial knee joint
043475 - placed during surgery. This would require that surgery be performed
043476 - all over again.
043478 - ..
043479 - Ken asked if the family has discussed with Bob arranging for Sandy to
043480 - live somewhere else when Bob comes home.
043482 - ..
043483 - Explained these discussions have been presented to Bob. He feels
043484 - very strongly that Sandy does not pose a risk. He loves the dog.
043486 - ..
043487 - Ken said that Mission View can explain to Bob medical risks Sandy
043488 - presents. He said that Medicare will send a nurse to perform inhouse
043489 - rehabilitation 3-days per week. The nurse will survey Bob's home and
043490 - determine changes needed for safe, effective rehabilitation. Ken
043491 - indicated the nurse will also tell Bob the dog is a high risk.
043493 - ..
043494 - Ken said again that he is very encouraged today by Bob's progress,
043495 - and expects he will be ready to go home in 2 - 4 weeks.
043497 - ..
043498 - Thanked Ken for great work.
043499 -
043501 - ..
0436 -
0437 -
0438 - 1500
0439 -
043901 - Left San Luis Obispo for drive home, reported in another record.
043902 - 111114 1500, ref SDS 31 EV5G
043903 -
043904 -
043906 - ..
0440 -
0441 -
0442 - 2038
0443 -
044301 - After arriving home and getting setup for work again, called Bob at
044302 - Mission View, per phone number above. ref SDS 0 8430
044304 - ..
044305 - Bob sounded tired. He said this was a long day.
044307 - ..
044308 - He had a blood draw in the morning, and then left the hospital at 1230
044309 - for the ultrasound test. He did not get back until after 1700.
044311 - ..
044312 - Bob's brother, Allen, came to Mission View to see him this afternoon,
044313 - and when Mission View said that Bob was taken to another hospital for
044314 - the ultrasound test, Allen drove there to see Bob. By the time Allen
044315 - arrived at the other hospital, Bob was on his way back to Mission
044316 - View.
044318 - ..
044319 - Allen finally caught up with Bob back at Mission View. They had a
044320 - short meeting, and then Allen went back to Bob's place, and without
044321 - staying for dinner.
044323 - ..
044324 - Bob was very pleased saying that the ultrasound test earlier today
044325 - showed "everything is okay."
044327 - ..
044328 - Bob explained he was told the test was ordered to look for blood clots
044329 - blocking his lungs. This aligns with Doctor Fow's call last Friday
044330 - asking if Bob was experienceing shortness of breath, reported on
044331 - 111111 0802. ref SDS 27 L78H
044333 - ..
044334 - Explained Millie's patient history getting tests for blood clots
044335 - causing pulmonary embolism, shown in patient history on 060722 0810.
044336 - ref SDS 2 6G6O
044338 - ..
044339 - Bob said nobody talked about pulmonary embolism today; they told him
044340 - "everything is okay."
044342 - ..
044343 - Bob said all they found were small blood clots in his lower left leg
044344 - resulting from knee surgery 2 weeks ago on 111031, and which are
044345 - causing inflammation and swelling, reported on 111111 0802.
044346 - ref SDS 27 TE31 Bob was told the medical team will provide treatment
044347 - to recover from the blood clot problems in his lower left leg.
044348 -
044349 - [On 111119 0933 Bob discharged from Mission View, observed
044350 - at home lower left leg has much less to no inflammation,
044351 - indicating response to treatment. ref SDS 33 NP8J
044353 - ..
044354 - Bob said he got a card from Kathy.
044356 - ..
044357 - Told him Kathy is taking me to the VA tomorrow for the EGD Dilation
044358 - procedure.
044360 - ..
044361 - Bob seemed to say he will be going home this week. Hope that was a
044362 - misunderstanding, because earlier this morning, Bob seemed to say he
044363 - expected to be getting rehabilitation care for another 2 - 3 weeks,
044364 - per above.
044365 -
044366 -
044367 -
044368 -
044369 -
044370 -
044371 -
044372 -
044373 -
044374 -
044375 -
044376 -
0444 -