Tuesday, May 8, 2018



I chronicled our hospital stay at Bay Med in Panama City, Florida in this post.

This is the response we got from Bay Medical Center.

Dear Ms. Jones,

Thank you for your letter of May 2, 2018.  

Our concerns regarding Bay Med cover many issues.

The prevalence of life-threatening bacteria within the facility requires immediate attention. My husband acquired pseudomonas and staph during what should have been a relatively simple procedure (or so we were assured). Was the cause of the infection due to inserting a shunt that was contaminated or up to standards of protocol?
Or was it simply due to not providing a sterile environment in the Operating Room or lack of administration of proper antibiotics? 
I understand that hospital staffing is expensive, but I would suggest that training the janitorial staff, overseeing their work more carefully and providing them with the very best materials (Sterilize the mop heads, or perhaps provide disposable mopheads and wipe down cloths that do not go from one room to another might help cut down on hospital born infections.) Seek out janitorial staff that realize the importance of their job and pay them well. Cutting costs at this point may be the cause of so much cost later on. (Interestingly, on May 15, 2018, I was told by someone in administration that they have no control over Janitorial concerns because those are contracted out. I told them they needed to regain control, because they are responsible for the MERSA, PSEUDAMONUS AND STAPH INFECTIONS running rampant through the hospital. Dirty mop heads going from room to room cannot help but spread bacteria throughout the hospital!)

While we were told that my husband (in with a brain infection acquired at Bay Med) was informed that the only way to call the nurse was through the remote, his caretakers (my daughter and myself) were not informed. The stationary NURSE CALL on the side of the bed was operative but no one came. That is an obvious concern because the remote frequently gets lost between the bed and the rails or within the folds of the covers, while the stationary remote could always be found in an emergency. When my husband was vomiting my daughter pressed the NURSE CALL over and over. Had he aspirated, we could have had a disaster. Has this issue been addressed?

The ICU Director and the nursing staff on the ICU floor owe me an apology for threatening to call security on me when I returned to a dirty room on the ICU FLOOR. That director (a nurse? not a doctor?) should have shown better management skills by KNOWING that my husband was going in for surgery and then DIRECTING the cleaning staff to thoroughly clean the room for his return. When I walked into that dirty room and left outraged that it had not been cleaned the staff should have immediately called the cleaning lady to address the issue without berating ME for my outrage and fear of consequences because it had not been done! Tim, the nurse at the desk, had no business threatening me, a wife in tears at their lack of concern for cleanliness when we are in the hospital because of negligent sanitation conditions. (The shunt contaminated with pseudomonas and staph was the cause of the infection!)

As it has been brought to my attention that the staff is strictly divided as to labor tasks, it would be helpful to put posters throughout the facility informing patients as to what task each color co-ordinated member of the staff actually is responsible for doing. 
a. BLUE OUTFIT (RN)    I discovered that the RNs, the blue clad nursing staff, hang meds. That is it. If you ask them to come out of the order of things (before the CNA has taken the BP or Temp) they cannot come in and take the BP and Temp and go ahead and hang the meds. 
b. RED OUTFIT   (CNA) Pushes the blood pressure machine and takes the temperature. Will sometimes bring ice if requested. No one offers juice or other fluids to the patient. No one takes the time to put a straw in a cup and offer it to the patient unless they are administering meds. THERE IS NO DAILY BATH OR SHEET CHANGING. If the patient is to be bathed, family had better come and do it. My mother, a nurse in WWII, saw bathing a patient as an important part of nursing care. How else are you to see bed sores or a rash as a consequence of a medication? We were the told that the cause of the rash on my husband's back was due to the detergent used in washing the sheets. How often do those rashes turn into bedsores?
The CNA desk was right opposite our door and I witnessed hours of cell phone operation and very little patient care. 

We did not realize it was necessary to order from the menu in order to receive a meal. Patients like my husband with brain issues would not have known that it was necessary to "order" a meal. We brought him food from outside. A dear friend, so thin she does not need to miss a meal, went two days with nothing to eat at Bay Med until her daughter came and addressed that issue! Educate caretakers that they can get a discount on their meals. 

Could the cell phone that nurses and doctors carry with them from room to room be a source of hospital contagion?

Have these issues been addressed? You write that the senior leadership was merely made aware of our concerns. That letter I am sure found its way into the round file by each "member of the senior leadership team." I just wonder if those entrenched in "senior leadership" should remain in "senior leadership" when this was THEIR RESPONSIBILITY. 

One of our major concerns was whether antibiotic prophylaxis was administered within 60 minutes before the incision for the insertion of the shunt. https://www.medicare.gov/hospitalcompare/hospital-safe-surgery-checklist.html

First critical point (period prior to administering anesthesia)Second critical point (period prior to skin incision)Third critical point (period of closure of incision and prior to patient leaving the operating room)
  • Verbal confirmation of patient identity
  • Mark surgical site
  • Check anesthesia machine/medication
  • Assessment of allergies, airway and aspiration risk
  • Confirm surgical team members and roles
  • Confirm patient identity, procedure and surgical incision site
  • Administration of antibiotic prophylaxis within 60 minutes before incision
  • Communication among surgical team members of anticipated critical events
  • Display of essential imaging as appropriate
  • Confirm the procedure
  • Complete count of surgical instruments and accessories
  • Identify key patient concerns for recovery and management of the patient

We are aware that the official protocol for this surgery calls for the administration of one antibiotic prior to the surgery and at least one afterwards. In looking at the records, we cannot help but wonder if that actually occurred. We are curious if a AIC = antibiotic-impregnated catheter was used for the surgery. 

We know pseudomonas and staph in the CATHETER was the cause of the infection. If the shunt was antibiotic impregnated, how did the bacteria get onto the catheter? 

As you can see, the shunt used for my husband's operation was a SPVA-2010. I assume that means it was produced in 2010. There is no notation as to whether it was an ANTIBIOTIC INFUSED CATHETER. Yet, as noted below in the new protocols, antibiotic infused shunts are recommended. Apparently this shunt was NOT ANTIBBIOTIC INFUSED. We do know that the shunt valve Polaris cost  $12,161.70.

We wonder 
1. Was this an Antibiotic Infused Catheter?
2.  Was the antibiotic administered pre-op?
3. Why did my husband have no hanging IV when he returned to the room after surgery. Was the antibiotic administered IV post op?
4. We remain curious as to why powerful antibiotics were charged and then the charge removed. 

It is important for those having surgery at Bay Med to know that every procedure is followed to eliminate contamination. 

Does the return of those meds to the pharmacy have anything to do with this 

As you see above, under Cefepime the notes are:

  1. Late Medication not available
  2. Late: Clinical Decision
  3. Not given: Medical Contraindication
Does this mean he did not receive the antibiotics ordered?  When and where in the MEDICATION ADMINISTRATION HISTORY REPORT do you see the administration of antibiotics mentioned?

I am quite familiar with Cefepime as our daughter and I administered the infusions of Cefepime at home after my husband, because of the care given at Bay Med, pleaded to be let out of the hospital for home health care after his readmission with not only life threatening infection, but a subdural hematoma. 

We are also curious about the note regarding the administration of pain medications when he NEVER HAD ANY PAIN! Cecily and I were always asking him, do you hurt? He never had pain and refused pain meds because we both have a fear of addiction. 

We wonder why Hydrocodone and Morphine are listed as a Medication administered for a pain score of 8 when Joe never requested pain meds and always amazed Cecily and me when he denied having pain when queried. Remember, if I was not with Joe, Cecily was. We never left him alone. 

Dr. DeSilva's notes on the day after the surgery, upon his release, include the statement that he has no significant complaints of pain. 

We also wonder why the surgeon in charge of doing the abdominal aspect of my husband's surgery was not already in the operating room before the abdominal incisions were begun. Is this the usual procedure?

You will notice in the protocols earlier recognized even the opening of doors and the position the patient in the room are significant in infection control. SIGN ON OR DOOR RESTRICTING TRAFFIC. POSITION HEAD AWAY FROM THE MAIN OR DOOR.

The surgery occurred on February 8th. We went home on the 9th. On the 19th we returned with a subdural hematoma and a serious infection that nearly stole his life. 

Ms. Jones, you are the Director of Patient Experience and you are therefore the mediator between management and consumer, I would appreciate your answering specifically the issues listed above.

These are merely the concerns regarding the initial surgery that may have led to the later entry with infection with the issues chronicled in the post on 2/24/18. 

My husband and I would take some solace if this was a learning experience for the hospital to improve conditions for all.

Sharman Ramsey 

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