In March, Susan Whiteneck was traveling back to Longmont from Estes Park when she hit a patch of black ice and spun out, crashing her car. An ambulance took her to the hospital but what she discovered after looking at her insurance statements was the most shocking.
Whitneck was treated for crash injuries and released from the emergency room with instructions to take over the counter pain medication for the pain. The hospital she went to was thorough with its testing, putting her through CT scans and x-rays, she said.
She left the emergency room believing everything was fine until six weeks later when she received a comprehensive statement from her auto insurance — which included medical procedure details. The insurance documentation included a line that a solitary pulmonary nodule had been discovered by the hospital staff — a fact that was not revealed to Whiteneck by a doctor.
A pulmonary nodule is a mass found in the lung by CT scan or x-ray greater than 3 millimeters in size. There are four identifiers for a nodule: the size, shape, location and consistency of the nodule. Doctors recommend that a nodule greater than 8 millimeters be evaluated, according to Whiteneck.
“I freaked out because I was not informed of this by anybody at the hospital. So I went and got my radiology report and my CT scan that the doctor had ordered on March 7 and the only result from that CT scan was my solitary pulmonary nodule recommending further evaluation and a dedicated CT,” Whiteneck said.
After finding out this information, Whiteneck attempted to contact the hospital about her results several times, with no success, she said. During one attempt, Whiteneck connected with a charge nurse who allegedly told her that she could not provide Whiteneck information on her case because the nurse did not work on her case that day.
Chris Thomson, interim CEO at Longmont United and certified emergency physician explained that a patient calling for their results is an important point of balance. It is important to give the patient the information they need, while also being aware of the Health Insurance Portability and Accountability Act, or HIPAA.
“You want to always, for valid patients calling back trying to get their results to enhance and elevate their care, we want to be able to facilitate that. At the same time be very cognizant of HIPAA and privacy,” Thomson said.
According to Whiteneck, the radiologist marked in her chart that the nodule was suspicious. The CT scan was performed right after she was admitted, and the radiologist made these notes while she was still in the Emergency department.
“There is no reason, literally every single thing about my pulmonary nodule was suspicious: the size, shape, border and the location,” Whiteneck said.
Thomson explained that in the LUH emergency department there is a buddy system put in place, where radiologists and physicians work together to help ensure that individuals are receiving the most accurate information about their test results as possible.
“Even though the emergency physician may be able to look at a radiographic image and X-Ray, CT scan and MRI, there is always support from a radiologist, reading that in real time providing real time specialist interpretation of studies,” Thomson said.
Also, Longmont United uses EPIC as an integrated electronic health record. This system allows all of the personnel working on the case to stay current on the patient’s condition.
“It's called an enterprise electronic health record, meaning that everyone associated with either Longmont, Centura or even our physician groups use the same electronic health record and can access the same information. It's a real benefit so you're not locked out from using different electronic health records,” Thomson said.
Whiteneck allegedly was told that an emergency physician's job is to make sure the patient is stable and treat illnesses that are life-threatening at that moment. She understands the nature of an emergency room physician’s job, but she believes that no matter the condition, results should be shared with the patient as soon as possible.
“If someone found an incidental mass in their gut or a brain tumor, are they gonna not say something? How do you not say something? It feels like it's your job to say something, you don’t have to diagnose it, but you sure as heck should inform the patient of the results of the test that you ordered that was made available before you left,” Whiteneck said.
Thomson explained that emergency room physicians must have a specific skill set, particularly the ability to treat any patient that comes in with whatever illness they have.
Emergency physicians do not perform surgerys in the operating room, but they are expected to do smaller procedures in the emergency room, like laceration repairs, abscess drainage or an abscess incision.
“So that is what an emergency physician really does. They are the expert of any single condition for an initial period of time and can care for anything. There is no other speciality that really does that on an emergent basis,” Thomson said.
On May 21, Whiteneck underwent thoracic surgery because the nodule was too big for a bronchoscope procedure.
“I am lucky. Other people might not be so lucky. Had it been aggressive malignancy 6 or 7 weeks could be the difference between life and death and there is no way they could have known or I could have known because nobody told me,” Whiteneck said.
Thomson explained that mistakes can happen in any emergency room.
Although mistakes can happen anywhere, it is how they are addressed and learned from that makes a difference. For the emergency room at LUH mistakes provide an opportunity to evaluate the emergency room’s process and make it better for future patients.
“We go back and look at that patient’s initial issue to try and resolve that in the best way that we can, but also look back on the process that led to that so ultimately whatever process can be generalized to all patients can also be improved,” Thomson said.
Thomson also explained that while emergency departments strive for perfection they will never be perfect.
“Will we ever be where we want to be for a point of perfection for that patient’s system of care? I don’t know,” Thomson said.
Corriection: The photo attached to this article was mislabled. It is not a photo of UCHealth's emergency room but Longmont Unitied Hosptial's. Also, UCHealth was not interviewed as part of this story. All comments made by Thomson concern only Longmont United practices and procedures.
