"Feedback on ED experience"

I’m writing to let you know I’m quite unhappy with the overall treatment I had in Emergency (ED), that I now see as being inefficient, in the identification towards fully investigating the injuries I come in to have diagnosed.

I am a pensioner in my 70s, living by myself, and up to this freak accident I had, was a fully functioning person able to care for myself.

Early last month I had a fall onto a cement slab at my home. I took one step and went down, falling onto my felt side. I didn’t lose consciousness or have any bleeding only noticeable scraps on my knees, elbows and bruising on all the impacted sites. I also hit my face which I worried I may have had damage to either my eye socket or jaw. My left upper arm was extremely painful and I had a small chip on my eye tooth. I managed to roll over onto my right side to assess my condition and was able to get up and call 000. There wasn’t and ambulance available to attend, all were on the other side of Sale, so the decision was to organise a taxi to take me to ED, which was rather busy and noisy, plus I felt the triage nurse was rather testy due to the influx which I could understand their plight. 

I was seen to in the later afternoon and then admitted to a bed in ED, I had about four doctors seeing to the necessary procedures of BP, bloods and ECG etc. I did on several occasions’ mention my left arm was 10 out of 10 for pain area when asked by the medical team. Other than having a medic test the function of my arm in trying to observe the rotation sequence, nothing else was done.

The treating doctor said they were going to seek the opinion of the senior doctor on that night, however this senior doctor never reviewed to my arm nor did either of them return with any further information re my arm. I did have a CT scan on my face and my arm was over looked as not being too important or serious to have further investigation. I am also left hand dominant impacting my daily use of this arm.

I also had an issue is asking someone to contact my relative, who lives in another suburb and is listed as next of kin. I had assumed the reception nurse would have notified my relative, as I do not own or use a mobile phone and they are listed in my contact details. I asked at every opportunity if someone could call my relative but there was nobody that responded to my requests.

Eventually in the late evening a lovely nurse let me loan their personal phone to inform my relative, who came in and I was discharged into their care a couple of hours later. Who stayed with me that night, otherwise I was staying in short stay for the duration required. If I was able to contact my relative earlier they may have been able to advocate for me and my arm pain, but this was not the case.

My daily mode of being independent has now diminished leading me unable to function as usual which is a frustrating hindrance and restrictive. Through the following week, even though I was on pain medications my arm was in extreme pain and I decided to go to Melbourne to see a pain specialist in the middle of the month. They assumed I’d had an X-ray or MRI to see what was damaged had occurred and was shocked that nothing had been organised from the ED admission. I was still having 10 plus pain (Scale used in ED) they stated these images where a priority to be attended to. So after a cost of $240 I was still no further ahead.

A few days later I saw my personal GP and requested a referral for MRI, which they were reluctant to see that I needed one and offered an X-ray as being suitable. I still insisted to have an MRI even though I had to pay $300 fee. The MRI referral was put in the next day by my relative and advised an appointment would be before the end of the month.

I had the X-ray later in the month which showed nothing at a cost of $143, I am now more than $715 out of pocket not counting medication, fuel and time. A few days later I had to go to ED again, due to the unbearable pain in my arm. I was attended by the same doctor as my first admission at the beginning of the month, who remembered me and the injury to my arm.

In this consultation I was reviewed by the senior doctor and advised to have ultrasound of my arm, in which I was provided an urgent ultrasound referral as there was conversation I may have torn a muscle. I advised them at this time I had a referral in for a MRI and was awaiting this scan; I was advised an ultrasound would be a better image to have taken. I was also advised to see my GP, in which I made an appointment. I was given morphine tablet and pain injection and sent home on oxycodene.

The ultrasound referral was submitted by my relative who works at the hospital the next day and they were advised there was large amount of urgent ultrasounds referral made over that weekend and this would not be attended to in the near future as the Sonographer was unwell and not working on the next week day. My relative spoke of the MRI referral being in and what would be seen more promptly in which they were advised MRI. We never did hear back re an ultrasound we assume this was trumped by the MRI scan.

Finally a couple of days later I had the MRI, this proved to be very revelling, the report stated tiny joint effusion, large reverse PASTA lesion, large amount of fluid, please see report on file for full details. I believe this was a huge oversight and a serious mistake, in my opinion even verging on some negligence in not reviewing my injury, due to the seemingly possible volume of patients attending ED.

I also saw a private physio at the end of the month to see if they could be any release of the muscle tension or exercises to help. This was another cost. My relative needs to transport me as I’m unable to drive with my arm constraints and this impacts their work and commitments, we have both spent a month trying to find out about the pain I am experiencing. Which I knew was more serious than first suspected and thankfully I was right to keep seeking answers.

I believe the mere fact I was not listened to is a negligent in attention to patients care. I feel perhaps the junior doctors need to improve their understanding of what constitutes 10/10 pain and consider older people justify a more intense judgement, when I did raise my concern on the pain, we may be elderly, but not unwise.

There is a still ongoing physio and doctor appointments, which now involves an orthopaedic surgeon’s review in Melbourne which I am unable to see until mid-March due to my preferred Dr becomes available then.

I believe the injury I have by no means is a simple one, being that this is the arm I use daily. I believe the infraspinatus tendon tear, should have been picked up by the medic when I could not raise up my arm without causing pain when elevated. This was not a known factor when I did this injury, but I feel some precautions and scans could have been done at the time to have this attended to in a timely manner, I am 3-4 weeks behind in getting my arm attended too/repaired and reduced pain due to this apparent oversight in ED.

I would very much like a response and some resolve to what action would be appropriate towards restitution the lack of attention in duty of medical care that was an oversight on my first presentation.