Early in the morning of the 2nd, my brother arrived on the shuttle from New York City. He is an architect and a contractor, and used to negotiating for what he wants and needs in a firm and pleasant way. He was appalled at the story we told him, and even though he understood that it was desireable for me to find an elbow surgeon as soon as possible, he agreed with Clara that the best thing to do now would be to get me out of the Baptist as quickly as possible.
He got out a clipboard and legal pad, called the case manager into my room, and began quizzing her intensely and in great detail about the status of my progress to Spaulding, what she was doing to contribute to this process, and where we were. Peter and I were astonished to see the difference in her demeanor when she was dealing with someone she could not intimidate and over whom she had no power. She was pleasant and almost fawning to my brother, and when in his presence, she and the other staffers were much more pleasant to me and my husband. She waited until my brother had left the room to make a phone call or get something to eat to threaten me. My physical therapy sessions were mysteriously resumed, and I received my pain medication for that morning.
With my brother watching over me, my husband felt it safe to go home for the first time in three days, and he took the morning off to go home, check in at his office and shower. A hitch had developed with my transfer, though, as the morning went on, which my brother was forced to deal with: according to the case manager, my insurance company had initially refused to pay for my stay at Spaulding, partly, I think, because I had not yet received the surgery I needed. Meanwhile, the insurance company was waiting to hear from the Baptist, specifically from my attending physician, before they could authorize my transfer.
We repeatedly informed everyone involved that all that was needed was a phone call from Dr. Basilico to get my insurance company to pay for my treatment at Spaulding. What followed was a long wait in which we got no response at all. When we got a phone call at the hospital from our insurance representative, asking us why the Baptist had never contacted them nor responded to their phone calls to the Baptist, my brother was simply incredulous.
During the hours-long wait for Dr. Basilico to respond, the case managers continued to threaten to have me discharged to home if I didnt leave the hospital immediately. Their threats are attested to by the physical therapists record from that day. (MR) He too, was appalled at the idea that someone in my condition would be discharged to home by the Baptist.
My medical and legal records showed that the case managers, at least, understood that Dr. Basilicos cooperation was the missing element that was needed in order to get my insurance company to pay. (MR) (LR)
Keep in mind that case managers work under the direction of, and by attending physicians orders. No matter how hard Dr. Basilico tried at that time, or in later legal proceedings, to distance himself from their abusive behavior and persistent and inappropriate threats, as well as his own, he was the one who was directing their actions, under both legal and medical standards. As the attending physician, he is not only in charge of assuring that discharge planning is appropriate, he is ultimately responsible for what the case managers do. The persistent threats that I had received from the case managers over the previous three days could not have been made without the knowledge of Dr. Basilico. Dr. Basilico was well aware of what type of insurance I had (it was written in my medical records) and what would be required from him as the attending physician to authorize my transfer, i.e., one phone call. He had been paid, for example, less than a year previously by my insurance company for a very expensive and unneeded test simply because he had requested it.
But he never responded to the case managers, or to the calls from our insurance company.
After several hours went by, and after repeated phone calls from our insurance company to my brother at the hospital and to my husband at home, letting us know that the people at the Baptist had "dropped the ball", we figured out that Dr. Basilico was never going to make the phone call that would get me into Spaulding.
Oddly, he asserted in his medical malpractice deposition that he believed at the time that a high-level rehab facility, not a nursing home or assisted living facility, was an appropriate place for me to be. (LR) Yet he provided no good explanation during his deposition testimony as to why he failed to respond to requests for him to authorize my transfer.
My husband, in fear that I would be loaded into a wheelchair and rolled out to the curb at 125 Parker Hill Avenue if he didnt intervene, called Spaulding and paid for a two-week stay with our American Express card.
Seemingly, I was all set to leave. However, in a final farewell gesture, Dr. Basilico failed to produce the transfer paperwork and ambulance order for my departure for close to eight hours.
While we were waiting for my transfer paperwork, I received a surprise CYA** visit from my shoulder doctor, Alan Curtis. He walked into my room, did the biggest double-take I had received or was to receive during my entire hospitalization, and exclaimed, "Mary Lou, you look terrible!"
Clutching my brothers hand for reassurance, because by then I had remembered the financial connection between Dr. Curtis and Dr. Basilico, I told Dr. Curtis in a tremulous voice that it was nice to see him. Then, without offering me any kind of help, assistance, consolation, reassurance, or anything else, he launched into the same CYA/"you-need-elbow-surgery" speech I had heard from all the other orthopedists at the Baptist.
I thought that by this time I was so numb from the trauma and shock of the abuse I had been experiencing that nothing could hurt me further. But having this man who, though he was busy and distracted, had been my doctor for almost two years, feed me the same line I had heard from Dr. Terrono, Dr. Bunch, and the others was almost more than I could bear. Wednesdays date was September 2nd. If he knew I was at the Baptist now, he must have known the day before, Tuesday. Chances were good, I supposed, that he had returned from his vacation over the weekend and knew as early as Monday that I was a patient at the Baptist, and that I was desperately in need of elbow surgery. Yet he never contacted me, limiting his interaction with me to this CYA visit after I was already scheduled to leave the hospital.
To a certain extent, I could sort of understand how doctors who had never met me or didnt know me could villify and dehumanize me to the point where they felt comfortable abandoning me and letting me be thrown out of the hospital without the surgery I needed to prevent me from being crippled for life. But the idea that Dr. Curtis could do this as well was deeply painful.
I waited for him to finish his CYA speech and then waited again, hoping against hope, for something more. Nothing came. As he turned to go, I thanked him politely for coming to see me.
After he left, it occurred to me, and I discussed with my brother, and later my husband, that Dr. Curtis obvious revulsion and recoiling from the sight of me may have formed part of the explanation for why so many doctors and staffers at the Baptist were willing to abuse, terrorize, and villify me: I looked ugly. I think part of the reason that the people there were so awful to me is that, with my two blackened, blood-filled eyes, swollen face, broken teeth and swollen lips, hair stiff with blood, sticks and dirt, and stitches down my nose and tacking the skin back onto my scalp and forehead, I looked very unattractive. Perhaps the hospital staff was so repulsed by my temporary ugliness that they were unwilling to treat me like a real human being. Certainly, thats how it seemed to my family and friends when we talked it over.
The only exception to this, of course, was the nurses, who never had any problem looking me in the eye or treating me like a person. Its odd, too, because NEBH has advertised on the radio for accident victims to be brought to the hospital.
Even after we were forced to pay for my stay at Spaulding in cash in advance because Dr. Basilico wouldnt call my insurance company, we were kept waiting in my room until Dr. Basilico got around to coming to my room and actually examining me for the first time. According to the nurses, he also had to sign off on my transfer paperwork. Even though it was at least 8:30 p.m. by the time I was finally able to leave the Baptist, and my morning Oxycontin was scheduled to wear off at 9 p.m., (MR) and the Percosets I had been given earlier wore off at 7p.m., Dr. Basilico did not authorize any pain medication to cover my transfer, as all of my previous attending physicians had done, and all of my subsequent attending physicians did.
This means that I had a hospital transfer and ambulance ride while a multiple-trauma patient with a broken neck, broken back, double-impact head injury, broken face, and unreconstructed left elbow, with virtually no pain medication in my system. My attending physician at Spaulding blanched when he looked at my pain medication record later that night. The very first question he asked me was, "Is your pain medication adequately managing your physical pain?" My answer was an emphatic, "No."
Knowing that I had been slandered by doctors and staff while I was a patient at the Baptist, and suspecting that I had been slandered to persons outside the hospital while I was there (which turned out to be true), my husband and I forced the ambulance driver to show us my transfer paperwork and discharge summary. It was, as I had suspected it would be, filled with half-truths and misstatements.
Dr. Basilico had evidently spent quite a bit of time, certainly more time than he spent giving me medical care, constructing a document that contained numerous misrepresentations about what happened to me, and what had been done (and not done) for me, that obscured Dr. Karlson and the staffs abusiveness, and attempted to place the blame on me for my being discharged without the elbow surgery I needed. I was forced by circumstance to borrow a pen from one of the EMTs and to correct this discharge summary by writing notes in the margins using only one hand while I was riding in the ambulance to Spaulding.
Its difficult to describe the terror this event produced in me. Here, I thought I had escaped from NEBH, only to discover, as in an old-time zombie horror film, its dead hand reaching up from the grave to clutch me as I fled.