“Something is rotten in the state of Denmark.” —Hamlet, Act I, scene 4

As far as I can tell, patients at New England Baptist Hospital don’t have any rights. When I was a bedridden, head-injured, multiple trauma patient being abused and terrorized by doctors and staff, there were no patient rights documents available to me, and my most basic State of Massachusetts patient rights were repeatedly violated. In a way, it’s hardly surprising -- it turns out that none of the defendants had even a basic familiarity with the applicable patient rights law, and even the "patient advocate", when deposed, couldn’t name most of them. Each hospital is permitted to create its own Bill of Rights that offers patients additional protection, as long as they uphold the basic standards in the State statute. Moreover, the JCAHO (Joint Commission on Accreditation of Healthcare Organizations) has its own patient’s rights standards, which all accredited hospitals are required to uphold. These were repeatedly violated in my case, as well.

Patient rights don’t seem to be a priority at the Baptist. For example, unlike any hospital I have ever seen, including other CareGroup hospitals, NEBH did not, as late as the winter/spring of 1999, display a copy of your patient rights in the public areas of the hospital, which is in direct contradiction to the first direction of the statute (see below). I was not, as required by law, given a copy of the patient bill of rights when I was admitted. At the time I was an inpatient there, there were no copies in the rooms, either, although the "patient advocate" claimed, under oath, that they had been installed in all patient rooms by August of 1998. I know they weren’t there because both Clara and my husband searched frantically for them that weekend as things began to unravel. . . .

Let’s see what the defendants in my lawsuit had to say when questioned by attorneys about my patient rights. And keep in mind that all of these folks had months to prepare for these depositions, and knew they were being sued specifically over patient rights violations:

Dr. Karlson (partner at ProSports Orthopedics, working at NEBH for many years)

Q. Okay. At the time you started with NEBH, were you advised of any patient's rights policy that they may or may not have had?

A. Specifically, no.

Q. Were you aware -- withdraw. Did you become aware at any point
while you were associated with NEBH prior to August 29th of '98 of a patient's rights policy?

A. Absolutely. Every hospital in Boston has a patient's rights policy.

Q. When did you first become aware of NEBH's patient's rights policy?

A. I've known that it exists before I was even there.

Q. Okay. Prior to August 29, 1998 have you reviewed NEBH's patient's rights policy? Have you read it?

A. Specifically, no.

Q. Have you ever read any portion of it prior to August 29th, 1998?

A. I'm sure I have.

Q. Is that a guess, or are you sure that you've read some of it?

A. I'm sure I've read some of it, yes.

Q. Do you feel that what is appropriate -- withdraw.
Is there a reason why you did not read the entire policy as a physician associated with the hospital? MS. HUNTER: Objection.

Q. You can still answer.

A. You're asking me if I read a specific document. I can't answer that I read a specific document. I know of the -- of the policy. I know of the various policies in all the hospitals in the Boston area. I've read various portions of the various policies, and
I can't specifically remember reading the full document --

Q. Okay. Now, that’s not --

A. -- at one hospital.

Q. That's not the question I just asked you.

A. What was the question? (Question read.)

Q. Your attorney has objected to that, but that
was the question: Is there a reason why you didn't read the policy whole policy?

A. No, there is no reason.

Q. Do you feel that you should have read it?

A. I understand it.

Q. Okay. Tell me what the policy consisted of as of August 29th, 1998.

A. May I see the policy?

Q. You said you know it. I'm asking you what you know.

A. I have not memorized it.

Q. Well, tell me what you know.

A. I know that there is a patient's rights policy.

Q. So you can't tell me any one of the patient's rights possibly at a hospital that you've been associated with for five years?

A. Not right now.

Q. Is there any patient's right at all contained within the formal policy of the hospital that you can identify right now?

A. Are you testing me on the patient's rights policy?

Q. Just answer the question. MS. HUNTER: Let him answer. He's asking you for clarification. MR. BOMBARDO: No, he asked me a question. He asked me if I'm testing him. MS. HUNTER: Well, it's a fair one.

Q. Just answer the question, Doctor.

A. What was the question? (Question read.)

A. I cannot exactly quote any of them.

Q. I didn't ask you to exactly quote. Tell me the sum and substance of any policy.

A. Is that a new question?

Q. Yes, it is.

A. Can you repeat your question?

Q. Tell me the sum and substance of any particular patient right contained in that policy.

A. I don't understand what the question is asking me.

Q. All right. I'm asking you to tell me, not in exact words, what your understanding of what those patient rights were. Do you understand that question?

A. That the patients have specific rights that they can exercise.

Q. Okay. What are they, in your knowledge?

A. I can't give you a specific one right now.

Q. You can't identify any single patient right in that policy?

A. If you give me the policy, I can give you them all.

Q. I'm asking you what you know, Doctor.

A. Right now I can't remember any.

Dr. Basilico: (chairman of Department of Cardiology, promoted after I left in 1998 to Chief of Medicine at NEBH; at the time he was questioned, he was in charge of all medical care at the hospital)

Q. Can you summarize the patient rights and responsibilities of the policy that you understood from the time you started there until August 1st, ‘98?

A. Yes. Exactly something I deal with as department chairman, and I do also deal with as chairman of the Patient Care Assessment Committee, so a patient has the right -- the physicians and it’s -- at New England Baptist Hospital and staff are dedicated to treating -- it’s offering outstanding care to its patients as well as education and research and to allow for their respect and dignity in treatment.

Q. Okay.

A. I guess there are a few others --

Q. In your understanding, what did the policy about allowing for I think respect and dignity, you said, what did that mean in your mind?

A. Well, that we -- it’s as it says, it should be respected as far as their individuality as they’re a patient, that they should be treated with a dignity and insofar as they are an individual who more or less new to a medical environment and need to be treated in the appropriate way, courteous.

Q. Okay. In your opinion, is there a circumstance under which a physician would be justified in raising their voice at a patient?

A. No.

Marcie Malay ("Patient Advocate" and now, "Senior Director of Medicine and Organizational Improvement")

Q. Was there a policy in place in August of 1998 regarding rights of patients at the hospital?

A. Specifically patient rights, a title of patient rights?

Q. No, not the title, but that dealt with those substantive areas?

A. Yes.

Q. What was the title of the policy we’re talking about?

A. I can’t probably give you verbatim titling, but the policy is how to respond to a patient concern.

Apparently, Ms. Malay, the "patient advocate" does not understand the difference between patient rights and a complaint process. Remember as you read this exchange that it was the Rev. Larsen who designed the complaint resolution procedures at the Baptist. . . .

Since she is the court of last resort under the policies designed by Rev. Larsen, this seems significant. Let’s see what she had to say when my attorney finally got her to respond to the question of patient rights.

Q. Can you name for me any of the specific patient bill of rights?

A. Right to privacy, right to review the medical record, right to refuse care, right to have informal consent for research project, right to refuse a student, right to reasonable care, and I’m sorry, I can’t remember every other one.

In case you are wondering, she only got the skeletons of six out of fifteen, and of the six above, she got the contents of two wrong. The rights she is referring to, and they are both extremely relevant to my case, are c) The right to have all reasonable requests responded to promptly and adequately within the capacity of the facility; and h) the right to refuse to be examined, observed, or treated by students OR ANY OTHER FACILITY STAFF WITHOUT JEOPARDIZING ACCESS TO PSYCHIATRIC, PSYCHOLOGICAL, OR OTHER MEDICAL CARE AND ATTENTION.

Am I the only person who finds it a little disturbing that between the "patient advocate" and the Chief of Medicine at the Baptist, they only knew , let’s slice them a break and call it four-and-a-half of the fifteen fundamental patient rights that each and every State of Massachusetts hospital patient has by law?

But, of course, I was not permitted to speak to Ms. Malay while I was immured at the Baptist, so it’s impossible to tell whether she would have upheld my rights or not, assuming that she even understood them.

I got the feeling from sitting through the depositions that the defendants were under the impression that, since NEBH is a "Private Referral" hospital, patient rights laws do not apply to them. But they most assuredly do.

In case you are wondering, here are the basic patient rights guaranteed to every hospital patient by state law. Some apply to facilities, others apply to the rights that doctors in specific are required to provide for their patients. There are additional rights that are specified for breast cancer, breast implant, and maternity patients, but since those didn’t apply to me, I’m leaving them out to save space. The ones that were violated in my case are highlighted in red:

34264 M. G. L. A. 111 § 70E

Massachusetts General Laws Annotated
Part I. Administration of the Government
Title XVI. Public Health
Chapter 111. Public Health Hopsitals
Section 70E. Patients' and residents' rights.

As used in this section, "facility" shall mean any hospital, institution for the care of unwed mothers, clinic, infirmary maintained in a town, convalescent or nursing home, rest home, or charitable home for the aged, licensed or subject to licensing by the department; any state hospital operated by the department; any "facility" as defined in section three of chapter one hundred and eleven B; any private, county or municipal facility, department or ward which is licensed or subject to licensing by the department of mental health pursuant to section nineteen of chapter nineteen; or by the department of mental retardation pursuant to section fifteen of chapter nineteen B; any "facility" as defined in section one of chapter one hundred and twenty-three; the Soldiers Home in Holyoke, the Soldiers' Home in Massachusetts; and any facility set forth in section one of chapter nineteen or section one of chapter nineteen B.

The rights established under this section shall apply to every patient or resident in said facility. Every patient or resident shall receive written notice of the rights established herein upon admittance into such facility, except that if the patient is a member of a health maintenance organization and the facility is owned by or controlled by such organization, such notice shall be provided at the time of enrollment in such organization, and also upon admittance to said facility. In addition, such rights shall be conspicuously posted in said facility.

Every such patient or resident of said facility shall have, in addition to any other rights provided by law, the right to freedom of choice in his selection of a facility, or a physician or health service mode, except in the case of emergency medical treatment or as otherwise provided for by contract, or except in the case of a patient or resident of a facility named in section fourteen A of chapter nineteen; provided, however, that the physician, facility, or health service mode is able to accommodate the patient exercising such right of choice.

Every such patient or resident of said facility in which billing for service is applicable to such patient or resident, upon reasonable request, shall receive from a person designated by the facility an itemized bill reflecting laboratory charges, pharmaceutical charges, and third party credits and shall be allowed to examine an explanation of said bill regardless of the source of payment. This information shall also be made available to the patient's attending physician.

*34265 Every patient or resident of a facility shall have the right:

(a) upon request, to obtain from the facility in charge of his care the name and specialty, if any, of the physician or other person responsible for his care or the coordination of his care;

(b) to confidentiality of all records and communications to the extent provided by law;

(c) to have all reasonable requests responded to promptly and adequately within the capacity of the facility;

(d) upon request, to obtain an explanation as to the relationship, if any, of the facility to any other health care facility or educational institution insofar as said relationship relates to his care or treatment;

(e) to obtain from a person designated by the facility a copy of any rules or regulations of the facility which apply to his conduct as a patient or resident;

(f) upon request, to receive from a person designated by the facility any information which the facility has available relative to financial assistance and free health care;

(g) upon request, to inspect his medical records and to receive a copy thereof in accordance with section seventy, and the fee for said copy shall be determined by the rate of copying expenses, except that no fee shall be charged to any applicant, beneficiary or individual representing said applicant or beneficiary for furnishing a medical record if the record is requested for the purpose of supporting a claim or appeal under any provision of the Social Security Act or federal or state financial needs-based benefit program, and the facility shall furnish a medical record requested pursuant to a claim or appeal under any provision of the Social Security Act or any federal or state financial needs-based benefit program within thirty days of the request; provided, however, that any person for whom no fee shall be charged shall present reasonable documentation at the time of such records request that the purpose of said request is to support a claim or appeal under any provision of the Social Security Act or any federal or state financial needs-based benefit program;

(h) to refuse to be examined, observed, or treated by students or any other facility staff without jeopardizing access to psychiatric, psychological, or other medical care and attention;

(i) to refuse to serve as a research subject and to refuse any care or examination when the primary purpose is educational or informational rather than therapeutic;

(j) to privacy during medical treatment or other rendering of care within the capacity of the facility;

*34266 (k) to prompt life saving treatment in an emergency without discrimination on account of economic status or source of payment and without delaying treatment for purposes of prior discussion of the source of payment unless such delay can be imposed without material risk to his health, and this right shall also extend to those persons not already patients or residents of a facility if said facility has a certified emergency care unit;

(l) to informed consent to the extent provided by law;

(m) upon request to receive a copy of an itemized bill or other statement of charges submitted to any third party by the facility for care of the patient or resident and to have a copy of said itemized bill or statement sent to the attending physician of the patient or resident; and

(n) if refused treatment because of economic status or the lack of a source of payment, to prompt and safe transfer to a facility which agrees to receive and treat such patient. Said facility refusing to treat such patient shall be responsible for: ascertaining that the patient may be safely transferred; contacting a facility willing to treat such patient; arranging the transportation; accompanying the patient with necessary and appropriate professional staff to assist in the safety and comfort of the transfer, assure that the receiving facility assumes the necessary care promptly, and provide pertinent medical information about the patient's condition; and maintaining records of the foregoing.

In addition, the state law specifies that physicians are also responsible for securing the rights of patients while they are in a medical facility. The rights that doctors are specifically charged with providing are below. The ones that were violated in my case are highlighted in red:

Every patient or resident of a facility shall be provided by the physician in the facility the right:

(a) to informed consent to the extent provided by law;

(b) to privacy during medical treatment or other rendering of care within the capacity of the facility;

(c) to refuse to be examined, observed, or treated by students or any other facility staff without jeopardizing access to psychiatric, psychological or other medical care and attention;

(d) to refuse to serve as a research subject, and to refuse any care or examination when the primary purpose is educational or informational rather than therapeutic;

(e) to prompt life saving treatment in an emergency without discrimination on account of economic status or source of payment and without delaying treatment for purposes of prior discussion of source of payment unless such delay can be imposed without material risk to his health;

(f) upon request, to obtain an explanation as to the relationship, if any, of the physician to any other health care facility or educational institutions insofar as said relationship relates to his care or treatment, and such explanation shall include said physician's ownership or financial interest, if any, in the facility or other health care facilities insofar as said ownership relates to the care or treatment of said patient or resident;

*34267 (g) upon request to receive an itemized bill including third party reimbursements paid toward said bill, regardless of the sources of payment;

*34268 A facility shall require all persons, including students, who examine, observe or treat a patient or resident of such facility to wear an identification badge which readily discloses the first name, licensure status, if any, and staff position of the person so examining, observing or treating a patient or resident; provided, however, that for the purposes of this paragraph, the word facility shall not include a community day and residential setting licensed or operated by the department of mental retardation.

Any person whose rights under this section are violated may bring, in addition to any other action allowed by law or regulation, a civil action under sections sixty B to sixty E, inclusive, of chapter two hundred and thirty-one.

No provision of this section relating to confidentiality of records shall be construed to prevent any third party reimburser from inspecting and copying, in the ordinary course of determining eligibility for or entitlement to benefits, any and all records relating to diagnosis, treatment, or other services provided to any person, including a minor or incompetent, for which coverage, benefit or reimbursement is claimed, so long as the policy or certificate under which the claim is made provides that such access to such records is permitted. No provision of this section relating to confidentiality of records shall be construed to prevent access to any such records in connection with any peer review or utilization review procedures applied and implemented in good faith.

No provision herein shall apply to any institution operated by and for persons who rely exclusively upon treatment by spiritual means through prayer for healing, in accordance with the creed or tenets of a church or religious denomination, or patients whose religious beliefs limit the forms and qualities of treatment to which they may submit.

No provision herein shall be construed as limiting any other right or remedies previously existing at law.

Here are the JCAHO standards for patient rights. The JCAHO accredits the Baptist and other acute-care hospitals; failing to provide these rights to patients is one of the things that can get your accreditation witheld, and make it impossible for you to run an acute-care hospital in Massachusetts. The patient rights that were violated in my case are highlighted in red:

This section is under construction. Check back here in a few weeks to see the specific JCAHO standards that were violated in my case.