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[IP] Re: Fwd: No Subject - See Attachment - A mom's letter to a local

I received this from Judy Premerlani <email @ redacted>
It is from a friend of hers regarding her (the friends) daughter. The=20
letter speaks for itself.

Anyone who feels like writing an appropriately irate letter, have at it,=20
the address of the "appropriate" party is below.

> May 5, 1999
> Mr. Frances R. Dietz,
> Hospital Administrator
> 111 Brewster Street
> Pawtucket, RI   02860
> Dear Mr. Dietz:
> On May 3, 1999, at approximately 1:30 p.m., I brought
> my 13-year old daughter Ashley Dacanay to the
> Emergency Room facility at your hospital.  What
> necessitated this visit was that Ashley was suffering
> from diabetic ketoacidosis (DKA) requiring the
> immediate assistance of medical professionals.  I
> opted for your facility simply by virtue that it was
> the closest in location to us and I was afraid of
> encountering any traffic obstacles by attempting to
> get Ashley to Hasbro in Providence.
> Ashley has been an insulin dependent diabetic since
> the age of 9 months and has been followed for her
> disease by the prestigious and progressive Joslin
> Diabetes Center in Brookline, MA.  In April of 1998
> under their direction, she began continuous
> subcutaneous insulin infusion the delivery of which is
> done via an insulin pump and has been extremely
> successful as evidenced by near perfect A1C levels.
> The symptoms that my daughter presented on May 3rd
> prior to us seeking medical assistance were vomiting,
> rapid breathing, ketones and blood sugars that
> continued to increase despite efforts to lower them
> through conventional methods, all of which are
> symptoms of DKA.  Inclusive in Joslin=92s careful
> education are a set of specifically established
> criteria that determines whether or not the insulin
> pump may be the cause of any symptoms that are
> indicative of hypoglycemia or hyperglycemia and the
> ability to correct them.  I assure you, Ashley=92s
> insulin pump was not the cause for her DKA.
> Page 2 =96 Ashley Dacanay
> The purpose of this letter to you is to inform you of
> not only unacceptable procedures that occurred at your
> facility, but also the potential life-threatening
> position that the Triage staff placed my daughter in.
> Upon our arrival, I filled out the required slip of
> paper at the Triage desk with Ashley=92s name, age and
> that the complaint was =93? DKA =96 Diabetes=94.  I handed
> the slip of paper to the staff person sitting behind
> the desk, who in turn placed the slip in a bin
> containing several other slips and was told to take a
> seat.  Although I patiently made every concerted
> effort to explain to this person that Ashley needed
> immediate assistance, I was ignored and rudely told to
> =93take a seat=94.  By now, Ashley was becoming increasing
> more difficult to keep awake and alert as a result of
> her progressing DKA.  Never the less, we were
> relegated to the waiting area where I watched a
> progression of much less seriously ill and injured
> people proceed to the treatment area, including
> individuals escorted by Pawtucket and East Providence
> Police Officers in handcuffs and clearly not bonafide
> emergencies.
> At approximately 2:30 p.m., Ashley was finally called
> to the Triage area to be checked in.  I had to shake
> Ashley awake and assist her to the nurse.  I explained
> to the nurse that Ashley was in DKA and that she
> needed attention immediately and gave a clear account
> of the symptoms.  The nurse responded to me
> sarcastically, =93how do you know?=94  I=92m sure it won=92t
> be too difficult for you to ascertain the name of this
> nurse as she did sign her name on Ashley=92s check in
> sheet.  Ashley did ask if she might lie down and the
> nurse did get her a gurney to lay on in the hallway.=20
> I suggested to the nurse that someone might contact
> Joslin and offered the telephone number and I was told
> that it =93isn=92t necessary=94 and off the nurse went.
> At about 3:30 p.m., after requesting again at the
> Triage desk for attention for Ashley and receiving
> none, I finally called Joslin myself from my cell
> phone.  I requested that they call Memorial Hospital
> in an effort to expedite Ashley=92s care.  Joslin told
> me that while Memorial could contact them for
> direction, Joslin could not call in advance of this
> and issue any orders for Ashley.  I was advised by
> Joslin to be more aggressive in my efforts to obtain
> attention.  I then proceeded to the Triage desk and
> this time demanded attention for my daughter who by
> now was semi-comatose.  Another nurse (I believe that
> the nursing shifts may have changed) told me, that she
> would be with us shortly.  At this time, I considered
> taking Ashley out of Memorial and transporting her to
> another emergency facility, however, choosing not to
> do so based upon my concerns that I was too upset to
> drive safely.
> Another 10 minutes passed and this same nurse asked us
> if a blood sugar had been done, which had not and I
> offered the use of Ashley=92s glucometer, which was in
> our possession along with her little record of blood
> sugars.  The reading was 310, unacceptable for anyone
> in general, more so for an insulin pump user
> Page 3 =96 Ashley Dacanay
> who does not use NPH insulin, but Humalog.  I will
> assume that at this point, my pleas for attention were
> finally acknowledged because suddenly, there was a
> place for Ashley in the treatment area.
> Upon arrival there, an IV was started and blood tests
> taken by a Dr. Farzaneh Sarlak, who rendered the
> diagnosis of DKA (which I already knew) and from there
> proceeded to have Ashley transferred to Hasbro (I will
> be addressing the excellent treatment Ashley did
> receive from this wonderful doctor in a letter to you
> later on).  My issues are not with the treatment phase
> at this time, but with the callous care received at
> the hands of your Triage staff, which exacerbated an
> already dangerous situation.  I would assume that any
> state board examination for a nursing license includes
> a section on diabetes.
> I am appalled that any hospital and more so that a
> Brown University affiliated hospital would ignore the
> seriousness of DKA.  Furthermore, to ignore any
> individual in DKA for two hours is unethical,
> unprofessional and wreaks of negligence and
> malpractice.
> I may not have MD or RN after my name, but as the
> mother of a diabetic and having lived with her
> diabetes for 13 years, I am more than well-qualified
> to make a diagnosis relative to diabetes.  I have
> attended diabetes conferences and educational seminars
> with my daughter and in addition, searched out the
> best and brightest of endocrinologists (Joslin) to
> educate and empower Ashley with the most technological
> of resources so that she may have the best possible
> quality of life while living with diabetes.  In short,
> I=92m a well-educated parent who is very much involved
> in my daughter=92s diabetes and aware when matters have
> gone beyond my ability to resolve them, hence
> requiring the assistance of the medical community.  I
> would highly recommend that the nurse who was so quick
> to question my ability to recognize and diagnose DKA
> be educated or reeducated in the complications of
> diabetes, as well as, the capacity to listen to a
> patient (or in this case a parent) who certainly knows
> what they are talking about and not respond with
> sarcasm the way that she did.
> Furthermore, therapeutic strategies for diabetics are
> changing rapidly, requiring medical professionals to
> become educated in the various technologies available
> to diabetics.  As we discovered, your facility does
> not know anything about insulin pumps, which presents
> a serious health threat to the population that uses
> them.  In Ashley=92s case your staff should have
> immediately contacted Joslin for assistance and
> direction, which the Triage staff refused to do.  If
> they were not comfortable contacting Joslin, they
> should have informed the physician in charge, who
> could have made contact.
> This recent unforgivable experience at the hands of
> your facility is only one of many we have encountered
> over the years when having to use the emergency=20
> Page 4 =96 Ashley Dacanay
> room.  However, this one defies any reasoning or
> excuse and I expect that immediate action be taken
> against those individuals involved in this and that I
> am afforded an explanation as to why a child in DKA
> had to wait two hours for medical attention.
> Sincerely,
> Cynthia J. Dacanay
> =3D=3D=3D
> Judy
> _________________________________________________________
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