When Kelly Williams Brown was driven to Salem Hospital Emergency Room one cold night in January 2017, she expected to find relief from excruciating pain. The New York Times bestselling author and former Statesman Journal columnist was visiting Salem, and had woken up disoriented and confused, and with intense pain radiating from her arm. She had had a seizure, dislocated her shoulder and cracked her humerus nearly in half.
But the emergency department staff at Salem Health only ordered an elbow x-ray and an ultrasound, and discharged her with a prescription for 600mg of Ibuprofen. They suggested she follow up with her primary care physician – who she could not see for two days because it was a national holiday. The ER staff thought Brown was a “pill-taker” and were, she says, more concerned with, “recording my behavior, saying that I was in no apparent distress when unaware I was being watched, then ‘hysterically crying’” when she saw a member of the staff, than with her reported symptoms.
When Brown begged for more care and resisted leaving the ER, she was threatened with arrest.
Had the staff understood that Brown’s confusion indicated her being in the postictal stage of a seizure – something that checking her hospital records would have suggested – they might have explored her symptoms more thoroughly and found the dislocated shoulder and shoulder fracture.
“Never, ever go to Salem Health’s Emergency Room,” Brown cautions, “unless you will ‘bleed out’ in the time it takes you to get to Silverton.”
Karla Martin reached a similar conclusion after an experience several years ago. “If I had an emergency now, if I had a choice at all,” she says, “I would go to Silverton Hospital instead of Salem Hospital.”
Martin arrived at Salem’s ER when she experienced nausea and strong heart palpitations. She was put in a curtained exam room, given an injection for nausea, had blood drawn, had an IV and heart monitor hooked up. After several more palpitations, Martin was unhooked to go get a urine sample.
She provided it. Then she waited.
“My nicely packaged urine sample, my heart palpitations and I waited on the exam bed there alone for an hour and a half,” she says. “I was no longer hooked up to a heart monitor, and was hidden from hospital staff behind the closed curtain. Nobody entered, or even looked into my exam room in all that time.”
After an hour, Martin opened the curtain and asked a passing nurse if she had been forgotten. Her response was a very formal, ‘Someone will be with you shortly.’ She didn’t even break stride as she – believe it or not – closed the curtain again.”
Another half hour passed. “I realized that I should have stayed at home,” Martin says, “I came in because I didn’t want to have a heart attack at home. However, behind this curtain, I could just as easily have one, and die alone there as I could at home, and my bed would be a lot more comfortable than this slab they had covered with a sheet.”
Martin decided to leave. “I had taken out IVs many times, so I found a cotton ball and tape from a supply cart and began to remove the IV. A man came in – but only to get some supplies. He was very offended when he saw what I was doing. He told me that I couldn’t take the IV out. I told him that I wasn’t going home with an IV in my arm. He left quickly with a very sour expression on his face.”
Martin was dressed and about to head out when a nurse arrived, “and in a very disapproving voice, demanded that I sign a form confirming that I was leaving against doctor’s orders. I signed it but also added at the bottom that it was difficult to leave against doctor’s orders when I hadn’t seen a doctor – or any other staff – for an hour and a half.
Martin’s charge for the experience was more than $2,000. Her own bill, after insurance, was $700. She fought the hospital for four months. “During this time,” she says, “not one person responded to my letters or phone messages. They just kept sending the same bill, indicating 30 days past due, 60 days past due, and so on.” Finally, Martin reached a woman in patient relations and had the matter resolved.
When John Prohodsky’s wife suffered a painful “C-diff,” an inflammation of the colon, her doctor sent her to Salem Hospital’s ER. “She waited at least 7 hours before she was seen,” Prohodsky recalls, “and while she was waiting, she was in and out of the bathroom with diarrhea. By the time she was seen she was so denigrated they had to rehydrate her intravenously.”
A few months ago, Vere McCarthy took his 98-year old mother to the ER at a physician’s direction, to be tested for blood clots. When the two entered the ER, McCarthy specifically asked staff if his mother needed an appointment for the test. He was told, no – they would just have to wait. They waited five hours.
The first thing the nurse who tested McCarthy’s mother asked them was, “Why didn’t you just get an appointment?”
McCarthy says, “It seems that everybody involved was just too busy to deal with information that would have saved time and money.”
Salem Weekly asked the hospital about experiences such as these. “First and foremost,” says Kyla Postrel, spokesman and Content Specialist in Marketing for Salem Health, “Salem Health is committed to quality patient care.”
Postrel notes that Salem Health has the busiest emergency department in Oregon – in fact the busiest between Seattle and LA. Though the average number of emergency department visits per day fluctuates seasonally, Postrel says, “It’s normally between 300 and 310, and is steadily increasing.”
Postural also says that negative experiences in the ER are comparatively rare. On average, 0.2 – 0.4 percent of visits result in expressed complaints, “but only about 0.1 percent result in the filing of formal grievances.”
In fact, she says, “Salem Health emergency department providers rank in the top 14 percent in the nation, according to patient feedback, and 21 are actually in the top 10 percent nationally.”
Non-profit hospitals like Salem’s are considered charities by the IRS. They receive financial breaks that most corporations, including “for-profit” hospitals, do not, including being exempt from most federal, state and local taxes. These considerations are given for the benefits the hospital provides a community, such as uncompensated care (services that are delivered to patients who do not pay in full.)
The Oregon Health Authority (OHA) notes that since the Affordable Care Act, non-profits like Salem Health have become sharply more “profitable.” In its most recent report, analyzing data through the third quarter of 2016, OHA says that while Salem Hospital provided more than $62 million of uncompensated care in the first three quarters of 2012 and $70 million in the first three quarters of 2013 – those figures have dropped; in the first three quarters of 2016, Salem Hospital provided far less, $39 million.
The OHA also says that while Salem Hospital’s ER visits have risen in the last five years, from 70,864 in the first three quarters of 2012 to 83,413 in the first three quarters of 2016 – net patient revenue for its services (profit after expenses, reimbursement to contractors and uncompensated care) have risen dramatically as well. In the first three quarters of 2012, net patient revenue was $372 million. It was $494 million in the same time frame in 2016.
“Why can’t this profit money be spent so we don’t have to wait so long?” asks Salem’s Maria Flores, who brought her daughter in for a painful infected ear this spring, and waited three hours to be seen.
Postrel says that patients who are the sickest or need the most immediate care are seen first. “We don’t want any of our patients to have to wait, but an acceptable wait time for someone with a broken finger may be substantially longer than for someone who is having a heart attack.” The emergency department uses a ‘triage system’ similar to other hospitals, in which medical staff evaluate patients and decide which are most serious.
“On some days, if a patient needs to wait for an hour or two, it is because there are other people who have more significant health issues at that time,” Postrel says. “Salem Health’s emergency department has nurses and medical technicians who make rounds in the lobby for patients who need to wait to be seen. There is always someone at the triage window [next to the waiting room] noting changes in patient health conditions.”
Postrel notes that the ER should be used in times of life-threatening illness or injury such as:
• Difficulty breathing, shortness
• Chest or upper abdominal pain
• Fainting, sudden dizziness,
• Changes in vision
• Confusion or changes in men
• Any sudden or severe pain
• Uncontrolled bleeding
• Severe or persistent vomiting or diarrhea
• Coughing or vomiting blood
• Suicidal or homicidal feelings
• Stroke symptoms
“Patients who are not experiencing life-threatening symptoms may wish to go to Salem Health Urgent Care,” Postrel says, “where appointments can be made online or by phone. That way, they can wait in the comfort of their own homes rather than our waiting areas. Primary care providers and nurse advice lines may also help tend to non-emergent needs.”
Though she wouldn’t comment on Kelly Williams Brown’s case or the frustration of patients who recommend their friends drive the half hour to Silverton Hospital, Postrel says all patients are given printed materials that outline the process for filing complaints and grievances. “If a patient or health representative expresses a concern, all Salem Health employees are trained to take immediate steps to promptly resolve the issue. If the concern requires additional investigation, the Salem Health Board of Trustees has designated the Patient Advocacy office the oversight of the complaints/grievance process.”
Postrel also says that in an effort to reduce wait times, Salem Health’s Board of Trustees recently approved funding for a $3 million rapid assessment unit due to begin operations in December of this year. “This new unit will take a team approach to triage and will separate patients into three different tracks depending on urgency and their needed level of care.”
After being forced to leave Salem Hospital’s ER in January, Kelly Williams Brown waited 36 hours to see her primary care physician. She found relief when she did so.
“He was very, very surprised,” Brown says, “that I hadn’t had a shoulder X-Ray.” By this time, her shoulder had been dislocated from the socket for nearly 48 hours, “causing severe soft tissue damage that will likely require surgery. I headed back to the ER, was put under general anesthesia, and the shoulder was reset.”