NY-Presbyterian Hearing Report

8/10/2019 NY-Presbyterian Hearing Report

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Recommendations for Improving New YorkPresbyterians Emergency Department andStrengthening the HospitalsTies to theCommunity

1/14/2015

Office of State Senator Adriano Espaillat

Office of Councilman Ydanis Rodriguez


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Table of Contents

I. Introduction

II. A tale of two hospitals

III. Recommendations

a. Increase staffing

b.Improve space & patient privacy

c. Improve access to urgent care centers

d.Improve communication with local stakeholders

e. Foster inclusive partnerships with healthcare professionals in the

communityf. Investigate billing practices

g.Work in partnership with the community

IV. Conclusion


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Introduction

On December 10, 2014, New York State Senator Adriano Espaillat and other elected officials gathered

healthcare professionals, policy analysts, Upper Manhattan residents, and community leaders to discuss the

quality of care provided by New York-Presbyterians Emergency Department. The community hearing

was called in response to reports of overcrowding, a lack of patient privacy and wait times that are doublethe national average. The hearing provided a platform for members of the community to share their

thoughts, concerns, and experiences and to discuss possible solutions for moving forward.

This community hearing was just the beginning of

an effort to create a more inclusive and responsive

community hospital. We need to make sure our

community has a hospital everyone can rely on,

regardless of who they are or how much money they

have, because that is where people go when they

need help the most, said Senator Espaillat. New

York-Presbyterian is a world- renowned facility

and a major healthcare asset. However, testimonydemonstrated that the Emergency Department

requires more resources to provide our community

with the care it needs. With 5% of ER visitors

leaving before they can even receive treatment, it is

clear that our needs are not being met.

New York-Presbyterians emergency rooms waittimes are double the national average. Evenadjusted for the crowded conditions typical of urbanemergency rooms, which often serve underinsured

populations, New York-Presbyterians wait timesexceed those of hospitals in similar areas.

During the testimony several themes emerged,including most importantly the need for:

Increased staffing levels for doctors, nurses,and allied health Professionals to reducepatient wait times.

Additional space to improve patient privacy so people do not have to discuss personal medical data incrowded waiting rooms.

Additional beds to allow patients to receive sensitive medical treatment out of public view.

With completion of a new emergency room three or more years away, there is an immediate need to increaseresources allocated to the hospitals emergency department. The hospital should also promote alternatives fornon-urgent care to alleviate the volume of patients seeking treatment in the ER.


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Improved communication with the community is essential for ensuring New York-Presbyterians long-termability to meet the needs of its patients. While representation of New York-Presbyterian at the community hearingwould have aided our fact-finding, suggestions on how to foster a continued two-way dialogue between thehospital and Upper Manhattan residents are included below.

Thank you to all who submitted testimony, and to the Malcolm X & Dr. Betty Shabazz Memorial & Educational

Center for providing space for the community hearing.

A Tale of Two Hospitals

New York-Presbyterian is an excellent medical facilityproviding world-class care, and has been ranked forseveral years by U.S. News & World Report as New YorkCitys #1 hospital. The hospital has made a significantinvestment to attract an international clientele, offeringenhanced services for those who are willing and able topay for them. According to its own website, New York-

Presbyterian offers semi-private, private, and luxuryrooms and suites for our patients. Our recently renovatedluxury accommodations and suites feature amenities suchas flat screen televisions, complimentary Wi-Fi access,DVD players, and satellite television with numerous language options. Some suites also offer sleeper sofas forovernight guests and beautiful, panoramic views of the East or Hudson Rivers. Patients staying in our luxuryrooms and suites will also receive complimentary high tea service in the afternoon In addition to the standardmeal service included in your hospital stay, your Regional Coordinator can arrange meals of your choice preparedby the Hospital's chef. A full-service restaurant is also available for patients and family members in the McKeenPavilion. Our Regional Coordinators can recommend and arrange hotels or furnished apartments where patientsand their family members will feel comfortable. During a patient's hospital stay, they can also arrange for familymembers to stay at one of the Hospital's on-campus hotels.

This is in stark contrast to the conditions in of theEmergency Department, which includes crowding,lack of privacy, and the surrounding chaos of medicaltreatment wherever one turns.


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After having been in the emergency

room f rom 10pm to 4am I decided to risk

my chances at another hospital and

in formed the nurse of my leaving, andonly then was the doctor final ly called in

to see me and assess my injuries, six

hours after my arr ival at the ER. At that

time the blood on my wound had dri ed

on my f ace, and my eye was painf ul ly

swollen. Angel Medina, regarding a June2014 visit to the Allen Pavilion ER, where he

sought treatment for a bleeding wound.

On any given day, we are assigned

eight to ten patients or more at a

time. On Mondays, our busiest

day, it is difficult for us to see

beyond the line of patients,

sometimes looped around the

facility, creating backlog of needs

that can seem very daunting.

Whats easy to see, however, it is a

situation that i s out of hand andworsening. Dawn Minerv,

Registered Nurse in NYPs Adult ER

[A] woman whose husband said she

was pregnant and bleeding, sat in the

ER for 2.5 hours with no one dealing

with her.David Tossir, NYP ER patient

Whenever we go to ER, I

always say we need to br ing a

pillow, a blanket, breakfast,

lunch, and dinner because we

get there at a certain time and

are stil l there seven or eight

hours later. - Carmen Rosa

Perez, NYP ER patient

Recommendations

Increase staffingA root cause of the long wait times at New York-Presbyterian Hospital is poor staffing levels. From January 1,2013 to November 30, 2014, there were 320 Protests of Assignments signed on to by over 1,100 nurses, over two

thirds of which were due to inadequate staffing or caseload was too high. An increase in the number ofdoctors, nurses, lab technicians, and other healthcare professionals attending to the needs of patients in theemergency room would reduce wait times and the number of patients leaving the New York-Presbyterian semergency rooms without receiving care, both of which are twice as high as national averages.i

While the hospital has made some adjustments in how it utilizes itsstaff in the ER, including placing a staff member at the front door,more must be done. We have no doubt as to the dedication and

abilities of thenurses, and doctors,and additional healthcare workers who strive to ensure the well-being of the Upper Manhattan community. But their numbers are

not adequate to meet community demand.Nurses at New York-Presbyterian Hospital repeatedly have

complained about the

staffing shortfall in its

emergency rooms.

Yasmin Bahar

(Registered Nurse at

New York-

Presbyterian Hospitals Pediatric ER; NYSNAmember) testified, The

reality is that we are called upon in every shift, every day, to care for

more patients than should be assigned by professional standards. In

acute cases- the most ill children -- caseloads should not exceed four;

there should be three...but everyday RNs are handling more than four

acute cases at our pediatric ER.

The New York State Nurses Association have compiled 320 protests ofassignment dating from January 1, 2013 to November 30, 2014, signed bymore than 1,100 registered nurses. Anthony Ciampa, a registered nurse atNew York-Presbyterian Hospital, testified that there are more than 300documents from the emergency room. Three hundred documents: instanceswhere we believe patient care might be compromised... More than 85% ofthese protests of assignments, the detailed record indicates that there is a

staffing shortfall: not enough nurses to handle the patient load.

Even as nursesstaffing levels are inadequate to support patient need, there arent enough techs to support thephysicians and nurses. A big part of the reason patients spend hours in the ER is because when RN or Dr.collects their samples (blood, urine stool nasal swabs) the specimens get sent to the lab. You can have 100 RNsand Drs. in the ER but with a short-staffed lab the patients are going to sit for hours until the [doctor] gets backthe results and can determine what to do with the patient next, one laboratory technician testified.


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We are so overcrowded that we are

examining people in chairs! So

overwhelmed with patients that sensit ive

matters -the things about which patients

seek and shoul d have privacy-- are hardto discuss. There are stretchers in

corr idors all th e time, sometimes in the

path of equipment. Nora Murphy(Registered Nurse at Allen Hospital with 30 years

of experience)

A needle was left in my arm with no

explanation except that i t was needed. I

began to wonder if they thought I was a

visitor and not a patient. Jay Mazur,regarding his experience at New York-

Presbyterian Hospitals ER, where he reported

staying for more than 10 hours for kidney stones.

There are stretchers incorridors all the time,

sometimes in the path ofe ui ment.

ER space was so congested

that any efficiencies were

negated and there was no way to

pass a fire inspection. DavidTossir, community resident

Improve Space & Patient PrivacyOn a regular basis, there is not enough space in New York-Presbyterians emergency room to serve patients presenting fortreatment. While the number of people utilizing emergencyservices has steadily increased, the hospital has continued toreduce the number of beds in the Emergency Department. The

result is a cramped environment where patients are not affordedeven a modicum of privacy or dignity; treatment being provided inpublic hallways; and patients, many of them elderly, waiting 30hours or more for a bed. This does not meet our standard offairness or decency -- a decency which the people in thisneighborhood deserve, said Councilmember Mark Levine, whoseDistrict, located just south of New York-Presbyterian, is home to many of its patients.

Patients have suffered unnecessary discomfort by revealingintimate, personal medical information in the middle of acrowded emergency room, within earshot of many others. Thislack of privacy also makes patients hesitant to share such

information, potentially leading to improper care provided. Whilefederal privacy laws allow communications as required forquick, effective, and high quality health care that may result inincidental disclosures, it is questionable whether the hospital istaking the reasonable precautions federal regulations require toprevent such situations from becoming the status quo.

While the new facility will provide asignificant increase in the number of bedsand available space for New York-Presbyterians emergency department, ourcommunities cannot wait years for these

overarching issues to begin to be addressed.Immediate steps must be taken to addressovercrowding.

Improve Access to Urgent Care CentersAccording to NYP, over a 16 year period, the annual number of ER visits hassoared from 50,000 to 80,000. While many patients ailments do not requireemergency care and could be better served by healthcare professionals in adifferent setting, a lack of access and patients unfamiliarity with such options arehindrances to the appropriate use of such resources. Increasing outreach efforts(including better signage), having 24/7 urgent care centers, and opening suchcenters throughout the community would significantly reduce the use of an

overcrowded emergency room.

Urgent care centers are part of the solution, but New York-Presbyterian only hasone in Upper Manhattan, and there is minimal knowledge in the community of the

services it provides, in part due to poor signage.

There is a growing demand for urgent care centers, but it is not being met by New York-Presbyterian. As a result,two urgent care centers, including one by Mount Sinai hospital, have opened in Washington Heights and Inwood.Even though a substantial portion of the community is uninsured and many of those who are insured are covered


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There is no communication between

ER physicians and primary doctors.Even when they know who the doctors

are, we seldom get a call to tell us about

the progress of our patients. A localphysician testifying that the ER at New York-

Presbyterian Hospital does not communicate well

with patients primary care physicians.

by Medicare and Medicaid rather than private insurance, there clearly is a market for these services. It seems oddthat New York-Presbyterian would not have capitalized on this opportunity, and has failed to expand into its owncatchment area to meet the needs of its own consumer market.

Improve communication with local stakeholdersCommunication between doctors, patients, and New York-

Presbyterian must improve. As one doctor testified, primary carephysicians are often not receiving notification when a patient visitsthe New York-Presbyterian emergency department, while suchcontact is standard practice at other hospitals in Manhattan.

While New York-Presbyterian has put the onus on patientsprimary care doctors to inform them of the proper instances to use

the emergency room, there is little evidence of the hospital taking responsibility to better inform the community.With thousands of doctors affiliated with New York-Presbyterian, the hospital has the ability to address itsconcerns.

The extent of community input at New York-Presbyterian has ebbed and flowed over the years. In the 1970s,

community activism led to the creation of an ambulatory care network (ACN), improved cultural sensitivitymeasures including translation services, and the formation of a Community Health Advisory Council with twodedicated staff members. While these initiatives met the needs of patients at that time, there currently are nodedicated staff members to support the advisory council. "There has been a lack of public dialogue between thehospital and the community members who utilize these services," Sen. Espaillat said. As a result, there have beeninsufficient means of communication to ensure the hospital is meeting the needs of its patients in the communityin the 21stcentury.

Foster Inclusive Partnerships with Healthcare Professionals in the CommunityWith New York State is accepting applications for its Delivery System Reform Incentive Program (DSRIP),which will allocate up to $6.42 billion in efforts to redesign Medicaid funding and improve health outcomes, NewYork-Presbyterian has the opportunity to make major changes. Presuming New York-Presbyterians application is

granted, we hope the hospital will utilize this new funding appropriately to work with all key community partners,including independent physician associations, to reduce utilization of the emergency room when care can besufficiently provided elsewhere. The image of an island in the community has only been furthered by theshutting out of local organizations from potential shared opportunities," said Councilmember Ydanis Rodriguez,who represents the district in which the hospital is located and many of its patients reside.

Investigate billing practicesHealthcare professionals have raised serious concerns over the billing practices in the emergency room at NewYork-Presbyterian hospital. These range from being billed for seeing a doctor when such services were notprovided, to excessive charges for minimal services provided. A letter has been written to New York CityComptroller Scott Stringer and New York State Comptroller Thomas DiNapoli requesting further investigation.

Work in Partnership with the Community to CreateNew York-Presbyterian is a not-for-profit institution that generated $4.3 billion in revenue in 2013. It has theresources to embark on initiatives that would both improve the health of the community and the hospitals bottomline, and understands the public health concerns specific to Upper Manhattan, but could do improve its efforts tomeet the communitys needs.

In 2006, New York-Presbyterian commissioned a Community Health Needs Assessment by Columbia Universityprofessors. It found a significant number of residents in these communities are Eligible for Public HealthInsurance but Not Enrolled (EPHINE), and in 2008 created a three -year plan to facilitate access.iiBy the end


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of 2011, with one in three Washington Heights and Inwood residents lacking continuous health insurance at thetime,iii New York-Presbyterian was able to enroll a total of 334 people into Medicaid, with no mention ofadditional enrollees in subsequent years.iv

Increasing Medicaid enrollment would improve access to local physicians while reducing the use of emergencyroom for the provision of primary care while increasing peoples ability to pay for services provided in the

emergency room. Even so, New York-Presbyterian has not matched this opportunity with aggressive patientenrollment into available insurance coverage.

Conclusion

New York-Presbyterian Hospital is a premier facility for numerous medical specialties. However, there is a taleof two hospitals. Conditions in the emergency room accessed by local community members remains poor. Thereis overcrowding, not enough staff and a lack of privacy. The recommendations above, based on the testimony of awide array of stakeholders, will dramatically improve the state of Presbyterian s Emergency Department. Byimproving communications with local stakeholder and increasing involvement in the community New-YorkPresbyterian Hospital will be better equipped to address both the current and future concerns of Upper Manhattan

residents.

Summary of Recommendations:o Increase staffingBy improving the patient to staff ratio, wait times can be lowered, and the

quality of care will improve significantly.

o Improve space & patient privacyProviding patients with additional private space to discuss

sensitive matters and information will prevent having these conversations in public spaces.

o Improve access to urgent care centersEnsure urgent care centers and the services they

provide are accessible and well known throughout the community. Opening additional urgent

care centers and increasing hours of operation can provide better utilization of these health care

resources.

o Improve communication with local stakeholdersThe hospital should have strong

communication between the doctors whose patients they treat, and with the community whose

healthcare needs they are trying to meet. Community activism lead to previous improvements at

New York-Presbyterian, such as adequate translation services, a continuing public dialogue is

necessary to meet the communitys 21st century needs.

o Foster inclusive partnerships with healthcare professionals in the communityThe Delivery

System Reform Incentive Program (DSRIP) is an opportunity for New York-Presbyterian to

improve health outcomes. However, this can only be accomplished by including all key

stakeholders.

o Investigate billing practicesEnsure people are only being billed for the services they receive

while in the emergency room. Any miss-billing can cause financial hardship.

o Work in partnership with the community- Itis vital that a community resource as important as

New York Presbyterian has a strong connection with the community and that there is an

accessible conduit available to community members and other stakeholders to voice their

concerns.


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T E S T I M O N Y

FROM 12/10/14 HEARING

on

CONDITIONS IN THE EMERGENCY DEPARTMENT

AT NEW YORK-PRESBYTERIAN HOSPITAL


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Senator Adriano EspaillatOpening Remarks

Public Hearing on New York-Presbyterian Hospital ER Conditions

December 10th, 2014

Good morning, and thank you for being here.

Were gathered across the street from New York-Presbyterian, an undeniably world class facility, and a major

asset for Upper Manhattan. Inside, hospital staff are leading the way in multiple specialties pioneering advanced

techniques that will benefit the entire world.

But local residents are experiencing something radically different: if New Yorkers recognized that our home had

become a tale of two cities, then we must acknowledge thatNew York-Presbyterians treatment has become a

tale of two hospitals.

This tale includes an E.R. overflowing with patientswith wait times more than twice the national average and

higher than equivalent facilities in underserved areas. This problem is so pronounced that 5% of ER visitors leave

before they can even receive treatment.

It includes reoccurring complaints that patients have been asked to detail private medical history in crowded,

public, and invasive settings. And many visitors have been uncomfortable discussing their conditions or

immigration status out in the open.

It includes frustration from partners and advocates in our communitydoctors treating low-income and

immigrant patients, whose patients report horror stories. Or community organizations who hoped to partner with

New York-Presbyterian on federal initiatives like reducing hospital readmission rates but have been shut out

shared opportunities.

And it includes healthcare professionals who have devoted their careers to helping others, but often feel hindered

in doing so. They have complained to me about questionable billing techniques they are pressured to use,

deprioritizing patients based on insurance, and basic issues like access to critical equipment.

Compared to the patients seen by specialists in the hospital, the community members visiting the emergency room

are low-income Blacks and Latinos. They are more likely to rely on Medicaid for insurance; many are ineligible

for their insurance because of their immigration status.

Of course the ER is less profitable than other parts of the hospital. But that doesnt mean we can accept unsafe

conditions.

This is not meant to be an attack on New York-Presbyterianbut there has been a lack of public dialogue

between the hospital and the community members who utilize these services.

Yesterday at a closed-door meeting with New York-Presbyterian and stakeholders, one attendee movingly spoke

of a recent experience at the hospitals emergency room in which a family member did not receive timely


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services, and they walked out to obtain care elsewhere. When the discussion shifts from abstractions to personal

anecdotes, the urgency of the situation becomes readily apparent.

This hearing today provides an opportunity for members of our Upper Manhattan community to openly discuss

issues and experiences that many have been unable to speak out on, and I thank everyone testifying for their

courage.

The testimony heard today is just the beginning of an effort to create a more inclusive and responsive community

hospital that everyone will benefit from. The problems and solutions heard today will be used to compile a report

on how to improve conditions, enhance collaboration between New York-Presbyterian, elected officials,

community members, and additional stakeholders, and result in a local hospital that this community can rely on

without reservation

Testimony by Council Member Ydanis Rodriguez-District 10

As the 6thbest hospital in our nation, and #1 hospital in both New York state and metropolitan area according to

US News, New York-Presbyterian Hospital obviously has high expectations. Over 100,000 patients come from

around the nation and world to receive the renowned medical care from one of our nations best facilities, ranking

in the top 10 in 10 specialties according to the US News and World Report Rankings. Recently, the first hotel in

Northern Manhattan began construction near the hospital to serve those waiting for surgery and their families. The

level of service surgery patients have received is renowned. However, the surrounding community has expressed

serious concerns about not receiving the same level of service. We have received reports of differential treatment;

one hospital serves the elite from around the world with incredible amenities, and another heavily underserving

the surrounding community.

Each year the emergency room at Columbia Presbyterian receives over 275,000 visits. These patients, some with

critical undiagnosed diseases and issues, are then subject to wait times twice the national average. Long wait-times only further exacerbate an already crowded hospital leading to incredibly uncomfortable conditions for

those seeking treatment. Although the emergency room does not provide the hospital with large profit margins, it

must be heavily invested in so that the hospital does not remain an island in the community. Our community

deserves top-tier service from a top-tier hospital, and will not settle for anything less. That will require that New

York-Presbyterian Hospital invest heavily in improving and expanding the services offered in order to better

address the needs of the surrounding community.

We call for increased transparency in dealings with patients as well as local organizations and advocacy groups.

We must have as much transparency as possible to end these practices so that our communities can gain the

medical priority they rightly deserve as patients, regardless of insurance status. The image of an island in the

community has only been furthered by the shutting out of local organizations from potential shared opportunities.

I call upon the hospital to instead reach out to any and all local organizations to partner with, not only to give

funding but also to create and expand much need programming and services for our communities.

In conclusion, though the hospital has provided many economic benefits to the community, it has not provided the

quality of service expected from a hospital of its tier. The communities of Northern Manhattan deserve the best

quality treatment from one of the best hospitals in our nation.


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Testimony by Council Member Mark Levine-District 7

There are presidents and prime ministers who come to seek care from Columbia Presbyterian. This is a hospitalthat serves people not just from around New York City, not just from around the U.S., but globally.

This is the ultimate, world-class healthcare institution. But it is also a neighborhood health institution. This isntlike the Upper East Side, where you have great hospitals every few blocks; this is it for us. Were 200 miles awayfrom other hospitals in Manhattan. This is our first option for medical care. We depend on this hospital, but thehospital that we here in the neighborhood experience is not the same one that presidents [receive] and prime tosupport people who have limitless resources at their disposal to pay for their health care.

But for the average person, someone who may be relying on government insurance, may not even have insurance,they are experiencing something very different: an emergency room where the waits are long, I think the averageis 3.5 hours, where often people have no privacy and are forced to share medical information in public in front ofothers, where something so frustrating that, as the senator mentioned, that they get up and leave. And this isunacceptable. This does not meet our standard of fairness or decency -- a decency which the people in thisneighborhood deserve.

So today is about listening and learning to all the voices of the people who work and receive services in thisemergency so that we can document in a public way what the challenges are, and hopefully that will lead us tosolutions.

Testimony by Sabino Perez

My name is Sabino Perez, I live in the Bronx and I came to share my experience in the emergency room atColumbia Presbyterian. On February 2nd, 2014, I had an accident at my jobsite, picking up demolition debris. Iarrived in the emergency room at 9:30am, at 9:45am I was seen in triage, and at 10:15am I was admitted into the

hospital. At 10:00am and at 10:15am, I asked the nurses for a checkup and something for the pain, but theycompletely ignored me. At 10:30am they told me that they could neither give me anything nor do anything untilthe eye specialist came to see me. At this point, my eye was swollen and it hurt very much; my iris broke.Although I asked for medicine for my eye, no one spoke to me, nor did they check on me. All of the nursesignored me; they were writing documents at the computer terminals and didnt even glance at me. A while later, Iasked one of the nurses supervisors to give me something for the pain, but the gentleman said I had to wait for adoctor, and that no one ever died from an eye injury.

An EMT who was in the ER told me that it would be better if I went to Saint Luke's Hospital instead because atPresbyterian, they wouldnt be seeing me for a while.

Throughout the entire time we were there, we never saw a nurse pay any attention to me, nor take my vitals, nor

ask me about the pain or the accident.

At 11:00am I asked for something for the pain, but to no avail. At 11:45am I left because I didnt receive any typeof attention during my wait. They only said to wait and that nobody could see me at the moment because theywere filling out some documents.

I left and went to Queens to search for a private doctor. When I arrived at the clinic and met with the doctor, shetold me that I had developed an infection from the sliver of wood that I had lodged in my eye. The doctor gave mea note so that I could go to the Eye and Ear Infirmary. There, I was quickly treated; I was given an MRI shortly


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after arriving and I was treated as one should. In the wake of the accident and the poor medical attention Ireceived, I lost vision in my right eye.

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My nombre es Sabino Perez, vivo en el Bronx y vine a compartir mi historia en la sala de emergencias del NewYork-Presbyterian. El 2 de febrero de 2014 tuve un accidente en mi lugar de trabajo, recogiendo basura dedemolicin. Llegu a emergencias a las 9:30 am, a las 9:45 am me vieron en triage y a las 10:15am me entrarondentro. A las 10:00 am y a las 10:15 am le perdi a las enfermeras que me revisaran y que me dieran algo para eldolor, pero me ignoraban completamente. A las 10:30 am me dijeron que no podan darme nada ni hacer nadahasta que llegara el especialista de los ojos a verme. En ese entonces tena el ojo muy hinchado y me dolamucho. El iris se me rompio. Aunque peda medicina para el ojo, nadie me hablaba ni me chequeaba. Todo lasenfermeras me ignoraban, escriban papeles en el espacio con computadoras, ni siquiera me miraba. Ms tarde lepregunt a unos de los supervisores de las enfermeras que me dieran algo para el dolor, pero el seor me dijo quetena que esperar por el doctor, que nadie se mora de un golpe al ojo.Un EMT que estaba en la sala me dijo que era mejor que me fuera al Hospital San Lucas porque en elPresbyterian no me iban a ver por ahora.

Nunca vimos una enfermera darme atencin y tomar mis signos vitales o preguntarme sobre el dolor o elaccidente durante el tiempo que estuvimos all.A las 11:00am ped algo para el dolor pero nada de nada. 11:45am, me march porque no recibi ningun tipo deatencin durante mi espera. Solo me decia que esperara y que nadie me poda ver porque estaban llenando unospapeles.Me march y me dirig a Queens y busque a un doctor privado. Cuando llegan a la clnica, a ver la doctoraprivada. La doctora dice que se me desarroll una infeccin por la estilla de madera que tena incrustada en elojo. La doctora me di una nota para que fuera al Hospital Ear and Eye Infirmary. All fu tratado rpidamente,me hicieron un MRI a poco tiempo de llegar al hospital y me atendieron como se debe. A raz del accidente y lapobre atencin mdica recibida, perd la visin en mi ojo derecho.

Testimony by Francisco W. Matos

Estoy testificando sobre el trato recibido por mi madre Josefa E. Encarnacin (MRN: 201 3524 en New York-Presbyterian Hospital) en la sala de emergencias del New York-Presbyterian, La razn de haber ido al hospitalfue las observaciones que hice, como ameneca con mi madre de noche y la homeattendant la acompaaba de dia,que ella tenia 3 das sin orinar. El miercoles yo llame a la enfermera del plan mdico de ella y la enfermera medijo que no me preocupara, que iba a visitar a mi madre para ver su estado. Mi madre estaba hinchada en suspiernas y tenia ciertas erupciones en la parte interior de las piernas y la parte lateral del cuello, eso mostraba queel cuerpo no estaba eliminando todas esas excreciones. Entonces, yo observaba que a mi madre no le daba fiebrepero cuando vino la enfermera, fue directamente en la parte trasera y le puso un termometro y tenia 101 grados detemperatura y procedi a llamar inmediatamente al hospital para que mi madre fuera ingresada.El 31 de julio de 2013 a las 5:30 pm fue ingresada al saln de emergencia, se le tomaron sus respectivosexamenes rutinarios de presin y temperatura e inmediatamente fue trasladada al rea D de emergencias. Yo

considere unas 2 o tres horas mas tarde, mi madre iba a ser trasladada al Mailman Hospital, pero la enfermera mehabia dicho que no habia camas vacantes. Pase toda la noche hasta el otro dia, al lado de mi madre junto a lahome attendant de ella en el Area D. Llega la maana, considere que en ese lapso de la maana iba a ser traslada,no fue asi, llega la hora de la tarde y mi madre segua en la misma posicin. Luego llega la noche, y yo melevanto para decrile a una supervisora de la sala de emergencia que me iba a quejar porque eran demasiadas horasde no recibir atencin y mi madre era una persona muy mayor y nunca habia durado tantas horas para seratendidos. Despues de 30 horas de espera la subieron a un cuarto al Mailman.


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Cuando llegamos al Mailman pude darme cuenta de que habian varias camas vacias en el piso, porque estuveobservando cuarto por cuarto. En ningun momento vi que le pusieron una sonda para tratar de ver si sus orinespudieran salir. Para mi fue muy dolorosa esa experiencia. No le estaba llegando a los pulmones suficienteoxigeno y por consiguiente a su sangre no estaba lo suficientemente oxigenasa. La doctora me explico esasituacin y me aconsejaron que le iban administrar morfina para aliviale el dolor. Me arrepiento de haberaceptado que mi madre ya en sus ultimas permaneciera en el Mailman, porque si la hubiera trasladado a Calvary

Hospice, su estadia en Calvary quizas le hubiera prolongado su vida, sin embargo ella falleci en el hospitalMailman a raz de esta ultima hospitalizacin.Francisco Matos12/16/2014

Rita McKee

Thank you, Senator Espaillat, for holding this hearing and for pushing our hospitals to be the BEST they can, toserve the people of New York City in general, and Upper Manhattan in particular. I appreciate the opportunity toexpress my own experience with New York-Presbyterian Hospitals Emergency Department.

On August 27, 2013 my 63rd birthday I briefly lost consciousness and fell on my face,cutting my upper lip and hitting my forehead hard enough to raise a large lump. Since I was scheduled forgallbladder surgery within 2 weeks, and I had just eaten a great homemade birthday breakfast of bacon, eggs, andtoast something I hadnt eaten in months because of a strict diet I suspected I had (as my surgeon laterconfirmed) suffered a severe gallbladder attack, triggering a vasovagal reaction and causing me to faint. Mypartner called 911.

The EMTs were terrific. At my partners insistence, and at the urging of the EMTs, I agreed to be taken to theNYPH ER by ambulance. Based on a visit two years previously to the ER of a much smaller hospital inNorthampton, Massachusetts for an unrelated medical issue, I figured I would be in and out in a couple of hoursunless something were really wrong. A few tests... bloodwork, maybe a neurological exam or a head xray...treatment for the facial cut... and Id be out of there, in plenty of time for a birthday celebration. Two hours.Three, if the ER was really busy.

After my initial arrival on a gurney, and a 5 minute conversation with what I found out later was a supervisingphysician, I was ushered to a single chair against the wall in a large, open room a chair my partner and I wouldshare for the next nearly 8 hours.

From that chair, I had a good view of the entire ER: to my left, I could see into an open,Ushaped area in which at least a dozen people sat at computer screens. (I later learnedthese were residents, doing paperwork.) In front of me, stretching from about where thedoctors were sitting over to the wall, were nurses cubicles. They were mostly empty, and the few people sittingthere were also at computer screens. Beyond that nurses area was a line of sometimes curtained, sometimes open,beds on which lay a variety of patients. One of these yelled for much of our stay; when I asked about him, I wastold he was a regular, awaiting mental evaluation.

Very little personal interaction happened with either nurses or doctors, though when they happened, they were allpersonable, pleasant individuals. Mostly, they sat at their computer terminals, in full view of everyone awaitingattention. If I hadnt taken the initiative, repeatedly approaching residents and nurses to ask when I would be seen,there would have been even less interaction; we were left on our own about 90% of the time we were in the ER,sharing that lone chair in full view of everyone in that large, open room.


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About two hours after my arrival, I was given a chest xray; about 4 hours in, I was given an EKG. Bloodwork wastaken at some point, though I was never told results. About six hours in, a sonogram of my gallbladder was doneadministered by a resident who was demonstrating the use of the machine to two students. The resident attemptedto convince me to have gallbladder surgery immediately, but I declined, since I had surgery already scheduled. Bythe way, this was evidently not an official examination; it was never billed for, in any event.

And just before we left a resident used superglue on my upper lip, which was by then quite swollen. Noneurological exam, or head xray, or MRI, was ever done. I may or may not have suffered a concussion. I willnever know, even after 8 hours and $2272.16 of services including $442.12 for the superglue fix.

I am convinced that, had the ER been run more efficiently if more than one supervisingphysician been working; if the residents and nurses had been interacting with patients, rather than doingpaperwork we would have been out of there within my initial estimated time.

As it was, being on public display during this entire ordeal was humiliating; sharing a single hard chair for nearly8 hours was uncomfortable; discussing my questions and concerns in a public setting in earshot of other patientsand staff was embarrassing; and not getting answers about my own health was unacceptable. By the time I left atminimum I should have known the results of bloodwork, and I should have known whether I had a concussion.

The most reassuring interaction I had that long, long day came from my gastroenterologist, whom I called while Iwas sitting around waiting to be seen by a physician in person.

After this experience, I dont know how I will feel if I ever again have to be taken to the ER at New York-Presbyterian Hospital. I hope, as I have recently read, that the hospital is serious about expanding its ER facilitybut I also hope the hospital takes a look at its ER practices to see how they can be improved for all patients, bothcritical and noncritical.

Thank you for your kind attention.

Julissa Lorenzo

Espero todo vaya bien. Te escribo porque estuve mirando un reportaje en las noticias, donde Espaillat denuncia elmaltrato que los pacientes viven en el hospital Presbiteriano. Me da gusto que ste tema se haya llevado a losmedios de comunicacin, puesto que es realmente una situacin bastante denigrante la que se vive all. Me atrevoa relatarlo de esta manera porque visit esa sala de urgencias y la de la sucursal que tiene el mismo hospital en lacalle 232 y fue verdaderamente absurdo el trato y el mal servicio que se recibe en ambos lugares.

A consecuencia de esta experiencia que viv y todos los rumores que se escuchan al respecto, me interesacooperar del modo que sea para que se preste atencin seria al asunto. Si necesitan historias que contar paraapoyar la causa del reporte, por favor djame saber . Con gusto me encantara contar la experiencia que vivi miprima y un amigo, a los que acompa a dicha sala de urgencias. Mi prima est dispuesta a cooperar si necesitanapoyo. Mi madre siempre dice que prefiere morir antes de ser ingresada a esa sala especficamente. Y creme,ahora entiendo a qu se refiere. Es un completo caos lo que se vive all.

Si les interesa nuestro testimonio o necesitan algunas que otras firmas para llevar el tema a las autoridades deinvestigacin correspondientes, cuenten conmigo. Slo avsenme.


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Citations

iCMS Hospital Compare:http://www.medicare.gov/hospitalcompareiiNew York-Presbyterian Hospital's 2008 Community Service Plan,http://www.nyp.org/pdf/communityserviceplan2008.pdf

iiiNYC Department of Mental Health and Hygiene: Community Profile,

http://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-301.pdfivNew York-Presbyterian Hospital's 2013 Community Service Plan,http://www.nyp.org/pdf/communityserviceplan2013.pdf
http://www.medicare.gov/hospitalcomparehttp://www.medicare.gov/hospitalcomparehttp://www.nyp.org/pdf/communityserviceplan2008.pdfhttp://www.nyp.org/pdf/communityserviceplan2008.pdfhttp://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-301.pdfhttp://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-301.pdfhttp://www.nyp.org/pdf/communityserviceplan2013.pdfhttp://www.nyp.org/pdf/communityserviceplan2013.pdfhttp://www.nyp.org/pdf/communityserviceplan2013.pdfhttp://www.nyc.gov/html/doh/downloads/pdf/data/2006chp-301.pdfhttp://www.nyp.org/pdf/communityserviceplan2008.pdfhttp://www.medicare.gov/hospitalcompare

NY-Presbyterian Hearing Report

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