My Response to the Hospital

To,
Tish Eller, LSW
Patient Advocate
Edward Hospital, Naperville

Dear Ms Eller

Thank you for your letter. As you suggested in your letter, before bringing the matter to your attention I had indeed talked with my doctors and these were the responses I received:-
1. At the hospital, I was told by doctors that the radiologist has read the report wrong and reported three clots when there were none.

2. Dr Bajaj: Because mine had been such an uneventful and uncomplicated pregnancy, I had never gotten to test the medical acumen of doctor. Prenatal visits were all so routine and I believed that because I was visiting her regularly she would have discovered if something was wrong. At the question of low amniotic fluid levels going undetected unless the day I delivered she told me that “babies in my family always died”. My mothers are six sisters and one of them did had three neonatal deaths because she had an incompetent cervix and her 28-32 weekers did not survived 15 years back in India. She also has two healthy babies after then
All during my 14 weekly visits with her for wound care, the issue of false PE came up invariably and we both bad mouthed the radiologist together and it was she who suggested that I write a letter to Patient Advocate and Head of radiology describing what I had to go through and my complaint with radiologist. However she never told me the name of radiologist. Also my requests were records were denied for a long period of time. I wanted my records for any future pregnancy. During one of my last visits when wound was almost healed, I finally gave a written request for records. She again refused but I insisted I want to. She then opened my dressing to look at wound and then said she can’t dress it back. The single member in her staff will give me a gauge and I can cover it with my underwear. The wound was not fully healed with raw skin at that point. Mine is a bikini cut incision and she was well aware I cant dress it back myself.
I did talk to her on phone once after picking up records. When I asked her that radiologist is saying suspicion and limited motion exam, she said that the in CT reports clots are always reported as suspected and when there are no clots the report reads low probability. When I said that second reports says “no pulmonary embolism” and does not says “low probability” she refused to discuss it further and said that I should talk to radiology if I have any concerns. This behavior not only raises concern about the medical acumen but also about the ethical behavior of the doctor as instead of coming out clean the blame is put on one doctor whom the patient has never met and is unlikely to meet. I was also told by her “That what can you do about it”
3. Radiology: Naperville radiologists says that radiologists talk to doctors directly and rarely with patients
4. Dr Quezada: She says that starting Coumadin was decision taken by cardiology and OB and her job was just to check whether I had some genetic clotting disorder. She says that the decision to start or reverse thinners was to be taken by doctor who operated and couldn’t have been her.
I was also told that I was lucky I bleeded and insisted on CTA and thus second was done. They give long term anticoagulants to patients and if that fails they put in IVC Filters. I am also told that even if there is respiratory motion or an artifact as was in my case, they start the anticoagulation for a year without verifying if medication is truly needed. I am concerned that while Edward is treating many patients who actually need anticoagulation, many others are enduring years of medication without verifying even if it’s needed.
I shudder to think what would have happened had I not bleeded fatally. I would be taking Coumadin even today and getting INR testing weekly , bleeding on slight episodes, having thousands in medical bills and if I get pregnant later, I would have been injecting myself heparin all because I was breathing fast on a Friday Night
And had my husband not refused surgery, I would have been on these blood thinners for life and the havoc this would have played would have had coming me to hospital again and again as long as I lived.
If CTA is equivocal, MRI, VQ Scan, Venus Doppler, d-dimer could be done. I am sure doctors running the billion dollar cancer center and heart hospitals have tests to verify whether the medication is needed. The entire emphasis is on administering treatment not diagnosing whether that treatment is warranted.
5. Dr Davis \ Dr Clark: I haven’t talked with cardiology as I am too exhausted to do so now.
I have also been asked by my doctors not to make a noise about this episode because I did not die.
The point here is that a 27 year old girl with a picture perfect pregnancy and absolutely no health problems is diagnosed with DVT and Pulmonary Embolism, given blood thinners that were contraindicated with her recent surgery, allowed to bleed for 4 days before any action is taken and is later told that there was No DVT or no PE. And while she did not die, she walked around dripping bloody fluid from her abdomen for months, had severe weakness, anxiety and suffering. And during all this, it was her husband who was packing and cleaning her wound twice daily and it was while they both were trying to take care of their newborn baby.
And if the girl did died (which was entirely possible had the lab not come to draw blood since there was no telemetry), doctors could put the cause of death as Pulmonary Embolism and adverse effect of anticoagulants in therapeutic use. Whether that therapeutic use is warranted no one bothers to check. There wouldn’t have been a repeat CTA done on a dead body. Long term anticoagulation should be clinically correlated and undertaken with definitive diagnosis.
Respiration is being reported as PEs and filing defects as DVTs. Patients are being incorrectly told they have blood clots and they are dying. It is a crime to let patients being forced into unnecessary medication by not allowing them to make informed decision. Patients are not allowed to see reports and they have to make decision based on what is being is told to them by doctors. It’s a crime giving false information to patients about there condition. Radiologist is reporting them as suspicions and others are doing no clinical correlation and treating them.
While the physicians are not employee of your hospital, they do have privileges to practice at Edward and I would like to talk with the committee who grants these privileges to doctors or the Chief Executive of Edward or to the peer review\grievance committee. This is a serious concern and requires attention. My Admitting doctor made serious mistakes with my care and treatment and it needs to be warranted that this does not happen again

I am copying this letter to the doctors who treated me and if they would like to explain to me:
1. Why was I lied about my condition. ? Whenever I asked about where and how big the clots were, the answer was elusive as In there own words
a. “You have two blood clots in your lungs and one in your thigh. You could have died but I called the cardiologist and you are safe”
b. “You are going to get into cardiac arrest.”
c. “Be grateful that we caught you else you would have your son with you now, but not 25 years later when he becomes a doctor”.

2. Why was I not made aware of the bleeding effects of Coumadin.
3. There were 3 episodes of bleeding
i. On morning of 01\13, patient was placed on bed rest again with Foley.
ii. On morning of 01\15, entire wound was opened up with wound separation and indurations was noted
iii. On night of 01\15 there was wound drainage and patient was running a fever with increased indurations
b. Why was no affirmative action taken after three bleeding episodes? It was clear that keeping patient on strict bed rest, oral iron and intravenous antibiotics were not working/
c. Why was wound not checked regularly after bleeding and fever on 01\15 night? Why wasn’t a CTA ordered on 15th night. Even a couple of hours would have a made a great difference in my recovery

4. Why was I discontinued from telemetry in spite of very high Heart Rate especially as tachycardia was the only indication of the presumed PE?

The most important thing is that patients need to made aware of the correct facts about there condition. And had mistakes been made, an apology and making me aware of facts was enough rather than lying and putting blames on a doctor whom the patient had not met and was not likely to meet. This even raises ethical concern about the behavior. I did not wanted to bring these issues up unless really necessary and was sticking to plain simple facts about what happened. I am sure all the doctors would attest to the fact that whatever I am saying is true.


Thank you

Copy to:

1. Dr Vimi Bajaj
My ob\GYN
2. Dr Maria Quejada
My heamatologist. I think she actually allowed me to brestfeed when Dr Bajaj wanted to give me injections to dry out milk because of coumadin
3. Dr Ann Davis
The cardiologist who I saw first day and last day
4. Dr Stanley Clark
The cardiologist who treated me. But didnt see me after it was determined that PE does not exist
5. Dr Leonard Sherman
My god, the radiologist who determined no PE\DVT exists
6. Dr Paul Goldberg
The radiologist who said I had PE\DVT
7. Dr Giradot
Head of Radiology
8. Dr David McElligot
Pulmonary MD who was called on Day 7 instead of day 2
9. Dr Todd Singer
A very kind and compassionate doctor. Did second surgery to drain fluid from my abdomen