About: Fiona Stanley Hospital Fiona Stanley Hospital Murdoch 6150
My parent spent a considerable amount of time attending outpatient clinics and several admissions at Fiona Stanley Hospital (FSH) which resulted in lengthy hospital stays last year. During these various admissions, my parent was subjected to, and myself and various family members witnessed and experienced significant concerning treatment by various hospital staff. Details of such events are documented below:
Numerous doctors, nursing staff, consultants, etc displayed 'poor communication' with the patient (my parent) on an ongoing and regular basis. My parent was not advised of blood or other test results, despite asking medical staff for these. On several occasions my parent was told: we don't normally tell patient's these. I question why would a patient not be told their own personal results, especially after the patient has requested them? Of concern was the comment of some staff that my parent didn't need to know these. Not only dismissive of a patient's right to be well informed of their medical progress/diagnosis but also extremely disrespectful and void of basic communication with the patient.
Whilst admitted to Ward 4 the nursing staff were very happy to advise of results when asked, however nursing staff on the Rehabilitation Ward, advised that they were unable to pass on any details, advising that the doctor had to do this. When questioned why this was the case, the staff provided no explanation as to why. My parent would wait up to 2 days to receive any information from the Ward doctor on these occasions.
Changes in medical management decisions were regularly made with no explanation to the patient why this had occurred and the reasoning for it. This was a repeated occurrence on Ward 4. I personally, along with other family members, continually raised this with staff on the ward to be told by various staff, that: the doctors had changed their minds after speaking amongst themselves. Whilst it is fully acknowledged that doctors may change the medical treatment plan of a patient after further consultation with each other and other specialties, I ask why there is a complete failure to advise the patient of this change, with an explanation as to the new plan?
On several occasions, my parent was advised that the plan was one thing, to then be told several hours later by different medical staff that something else was now happening. When my parent asked who had decided this and why, my parent was told: I don't know, the doctor has said this is now the plan. To simply tell a patient something different is now occurring with zero explanation as to the change of direction and the reasoning for it is once again dismissive of the patient and disrespectful. This happened repeatedly despite myself and other family raising this as an issue with staff.
Inconsistent medical advice and care from staff
When information was provided to my parent, I feel there was an evident inconsistency with the information provided. The Consultant would advise one thing, the Ward doctor another and the attending nurse another again. How is this supposed to provide any level of certainty to the patient, and any level of confidence in their medical treatment plan or progress? When this was raised with staff, once again, there was either no explanation and the subject changed/avoided or the comment of: this is now the plan.
A typical example of this involved the information given to my parent regarding dressings on their wound. The doctor advised my parent that dressings were to be changed three times a day. The nurse manager disagreed with the doctor and refused to follow this treatment plan, and instructed the nursing staff to change the dressing twice a day. When raised as a concern, my parent’s request for nursing staff to adhere to the doctor’s request was responded to with: we don't have time to do it that often, that is just ridiculous. Of considerable concern firstly is the doctor’s instructions were ignored, followed by the comment to a patient, that the doctor's request is ridiculous and they do not have time. Why are the needs of the patient and their care in this situation not put first? This was an ongoing issue for the duration of treatment whilst at FSH.
Rude/disrespectful communication with the patient
Whilst admitted to the Rehabilitation ward, I feel that the Registrar on that ward displayed a significant level of arrogance and lack of acknowledgment of the patient's wishes and concerns. My parent was being prepared for discharge and was told that Silver Chain was being organized to continue the dressing changes on my parent’s return home. My parent had several negative experiences with Silver Chain nurses, in between admissions to FSH. Typically, the visiting nurse did not dress the wound with the medical material advised by the doctor from FSH and questioned the doctor’s treatment plan. On one occasion the Silver Chain nurse overreacted and called an ambulance to return my parent to FSH. Upon arrival at the hospital, the doctor in Emergency confirmed that the wound was as it should be following the procedure that had just been performed days prior. These experiences with Silver Chain resulted in no confidence in their medical treatment and my parent’s request to return to the hospital each day, for dressing changes for the length of time required.
When my parent explained this to the Registrar they talked over the top of my parent, disregarded their concerns and request, with the statement: well this is what is happening, Silver Chain will be organized and that's it. This behaviour occurred in front of two nurses on the ward who expressed to the family and the patient the disgust they had for the registrar's behaviour and encouraged the patient and family to lodge a complaint. My parent approached the consultant on the Rehabilitation Ward and expressed their concern and the issue was rectified, with the plan being my parent return to the hospital each day for their dressing change. My concern following this incidence firstly is, a medical registrar’s belief that talking to a patient in this manner is ok. A clear lack of empathy and understanding was evident in this situation. Patients are real people with real feelings and real brains. They are not mannequins occupying a hospital bed, and I feel that this treatment by a medical staff member is not appropriate in any situation.
Surgical procedures and administration of medications
During my parent’s eight-month contact with FSH, they underwent several medical procedures. The most significant and life-changing being a below-knee amputation. It is acknowledged that medical procedures were explained to my parent by the respective doctors and also explained to the immediate family. The communication that occurred between the Vascular Surgeons and immediate family was very respectful and done in an empathic way.
Of concern, however, is that on more than one occasion my parent was prepared for surgery where my parent required to fast, with no food or water for a period of 2 days, to then be told the procedure was not going to proceed due to other demands within the hospital. My parent has other medical issues that require them to take various medications, the most serious being anti-rejection medication for a transplant, and daily insulin injections for diabetes. There was no acknowledgement of the risk to the patient’s health and wellbeing, fasting the patient without these medications for this length of time. The implications and possible impact on my parent’s health were totally ignored. To fast a patient for 2 days, on more than one occasion is simply neglectful. When raised with the hospital staff, it was once again met with: we have just been told you need to fast ready for surgery. Where was the best interests of the patient in these circumstances?
On several occasions following a wound dressing change, the wound was left for up to 5 hours undressed waiting for the doctor to come and view it. On some of these occasions the doctor didn't arrive at all and the nursing staff redressed it hours later.
A referral was sent to the Dermatology department for a consult and treatment plan regarding a significantly large scab that wasn't healing on the top of my parent’s head. My parent asked staff several times when the Dermatology department was coming to view the scab, to be consistently told: they are too busy to get to you, so we are unsure. Some eight months later, when my parent finally left FSH, Dermatology had failed to provide the consult and no explanation was ever provided as to why. My parent actioned their request for the scab to be looked at via their own General Practitioner on return home, and a consult occurred at our local hospital. The surgeon providing the consult expressed their annoyance that this was not responded to by FSH when admitted as the scab had increased in size significantly and now required surgery to remove it and a skin graft. A biopsy of the removed flesh etc. showed there was a non-invasive carcinoma. As a result of this finding, my parent is now required to undergo further surgery and possibly radiation treatment. I provide this information to highlight that once again FSH's failure to follow up on the referral resulted in further harm and consequence to the patient. How is this ok?
My parent is very adept at managing the administration of their own medication. On several occasions my parent wasn't given certain tablets and had to advise the medical staff that they were missing a particular medication. The fact that medical staff fail to administer required charted medications, is totally inexcusable. In addition to this my parent’s medication regime was changed on several occasions with no discussion with my parent as to the reasons why. Nursing staff once again provided the standard response of: this is the new plan, with no explanation as to why. My parent often had to wait several days for the doctor to come and explain the reasoning for changes. Where is the basic communication and engagement with the patient regarding their health?
The best and most polite description regarding the hospital food served to patients at FSH is 'slop'. A typical plate of food consisted of mushy, pureed food with excessive water running all over the plate. To look at the food it is far from appetising, and was consistently void of any flavour and taste. The meals my parent ordered were consistently not provided, often receiving items they never ordered such as surgery desserts. Given doctors are very quick to stand by the patient’s hospital bed and lecture them on healthy eating and dieticians are regular visitors to the ward to lecture diabetics on their consumption of carbohydrates, what options does the patient have when this is what the hospital is serving them? A total contradiction in what is preached and then what is practiced by the hospital.
A typical example is the limited food choices given to a diabetic. Menu options consistently provided were, white rice, white pasta and white bread. When the dietician is preaching to patients to reduce carbs and eat whole grains, how is the patient to do this when it isn't even a menu option? The health profession as an entire unit recommend grain breads, and low GI options, however the hospital does not provide these health options. Once again where is the focus on health and wellbeing of the patient?
Social Worker/Occupation Therapist on Rehabilitation Ward
It needs to be noted that both the Social Worker and Occupational Therapist on the Rehabilitation ward were very helpful and accommodating. The support they provided my family and my parent following the below knee amputation is acknowledged and we are very grateful.
Psychological impact of the above issues
My parent’s hospital experience as noted above, evidenced a failure of the hospital to provide holistic care. There was no acknowledgement of the psychological impact the continual changes in treatment with no explanation, and conflicting medical advice my parent was provided with, had on them. I personally witnessed a very articulate, alert, intelligent and confident person, become a quiet, withdrawn and depressed person as a result of their hospital experience. My parent verbalised to myself and other family members on an ongoing basis: what's the point of asking, they don't tell me anything, and it changes in a few hours anyway. My parent expressed not being listened to and their concerns and request for information being disregarded and ignored. I would also support this view, having witnessed this myself.
Whilst I acknowledge my parent’s experience cannot be changed, my request is that action is taken to prevent another patient from being subjected to what my parent and family experienced at FSH.
Responses to this story
Response from Neil Doverty, Executive Director, Fiona Stanley Fremantle Hospitals Group, South Metropolitan Health Service 6 days ago
Thank you for sharing your parent's experience with us. I am sorry to hear of the various concerns you have raised during their care events over the last year and that we have not treated your parent in a holistic, patient-centred fashion, as we work hard to provide this.
I am also sorry that the psychological impact has resulted in your parent being withdrawn and depressed following the experience. I understand the impact on your confidence in the health services to adequately assess and plan their care.
I understand that you are in contact with us and we are currently conducting an investigation into your parent's experience. From this, you will obtain further detail for the issues raised in this story and we will advise you of any changes we have made as a result of the review.
I apologise again for your parent’s experience and the impact to your family.
Fiona Stanley Fremantle Hospitals Group