Safety of hospital stays greatly affected by staff and culture

Chris Walker/Chicago Tribune

Less than 48 hours after returning home from a 12-day hospital stay, John McCleary woke up with a 103-degree fever, too weak to sit up in bed.

An ambulance rushed him to the hospital, where eventually he was diagnosed with a methicillin-resistant Stapholococcus aureus (MRSA) infection. The 83-year-old never came home again.

It took hospital staff six days to pinpoint the infection and prescribe the proper medications. Although McCleary had pneumonia when he was readmitted, doctors didn't order tests. Every time his daughter Kathy Day suggested a sputum sample be taken, she says, "I got a lot of attitude."

McCleary, originally admitted to the hospital for an ankle fracture, never recovered from the infection's onslaught. Over the next three months, he lost 50 pounds, one-third of his body weight. Too weak to stand, his skin broke down as he lay in bed.

"He just couldn't understand how this happened to him," says Day, a retired nurse, declining to name the Maine medical center where he was treated.

Day later learned that two other elderly patients treated at the hospital had died in the month before he father's admission. "This hospital had had a small outbreak and yet no precautions were being taken," she says.

"Avoid hospitalization if possible, but if it's necessary get out as quickly as you can," Day advises other families.

Dorothy Etheridge, 73, was planning on enjoying her grandchildren and her garden when she retired after 30 years as a counselor at a mental health hospital in New Hampshire. Instead, she too contracted a MRSA infection after lung surgery and died eight months later.

Lori Nerbonne, one of Etheridge's four daughters, describes hospital staff who refused to listen when the daughters expressed alarm about their mom following surgery. Soon after, the elderly woman collapsed with respiratory failure. On the rebound, she developed secondary pneumonia and collapsed again with acute respiratory syndrome.

Alarmed by poor nursing care and complacent doctors, the daughters decided to transfer their mother from the hospital in New Hampshire to Massachusetts General Hospital. "It was like night and day," says Nerbonne, noting that her mother spent eight weeks at the Boston hospital without contracting an infection.

Mass General had "very strict hygiene policies," Nerbonne explained. "They had 24-hour coverage by a (specialist doctor in the) intensive care unit so if a nurse needed something he was right there. They valued what we said and told us to speak up if any of us thought we saw someone wrong. It was a total culture change."

But Etheridge developed multiple infections after being transferred to an under-staffed rehabilitation facility in Boston. That facility failed to diagnose two broken ribs the elderly woman suffered during a transfer to her bed from a wheelchair. Nurses often didn't wear gloves while handling her mom's respirator, Nerbonne said.

Admitted again to a community hospital in New Hampshire after a short stay at home, Etheridge died of a brain hemorrhage after receiving heparin, Lovenox, and aspirin — all of which act as blood thinners. Nerbonne says she suspects her mother suffered from an anti-coagulant overdose. But the hospital, which she declined to name, refuses to release the results of its investigation.

"Research as much as you can," Nerbonne advises. "The hospital that you're admitted to and the doctor that takes care of you, both can make an enormous difference."

jegraham@tribune.com