Hospital meeting results

So we went to the hospital today to meet with the CEO. Nice guy, quiet, unassuming accountant of a guy. He had been told of our situation by the other hospital CEO guy, so he was a little better prepared than that first guy was going in.

And like any good administrator, he defended his staff from a perceived attack. One of the points he raised struck me as quite valid, although its practical application during the incident in question was still skewed badly. Health care providers need to gather a "social history" of each patient to better inform the treating professional in his or her decision-making and diagnosis. For instance, I am a recovering alcoholic and drug addict. That is important information for my health care providers to have. If a person had a history as a sex worker, that would be valid information for doctors to know. If a person has no support system at home to help in dire circumstances, that is important for the providers to know as well.

{For those of you joining this story late in the game, the original post is HERE, followed by THIS, and THIS. The most recent post was this morning, and you can scroll down to see that - you don't need a damned link for it.}

The fact that N is a lesbian is technically irrelevant. The reasons given by her PA at the time to defend her disclosure of N's sexual orientation ("so he'd know you weren't pregnant and didn't have any STDs") is patently bogus. As I said before, lesbians get pregnant, and they get STDs. How on earth could this woman believe that stuff? I cannot fathom it. Anyway, N's orientation is irrelevant. What should have been said was "this patient is not pregnant, nor is she at risk for STDs." As far as a social history, these might have been more appropriate words: "she has a long-term partner at home who is able to care for her if she is physically unable to care for herself. That partner's name is XXX and is listed as her emergency contact person."

All of the pertinent information is transferred from one medical professional to the other without necessitating writing the word "gay" in large letters and then circling it at the top of the clipboard containing N's medical information. That was bad form all around. But this meeting was not about that institution. It was about the institution that oversees the PA who disclosed the information in the first place. Only we don't know specifically what was said by her to the ER doctor. Only that whatever it was, it was sufficient for him to write "gay" at the top of the page and circle it. Perhaps there is some kind of stomach ailment relating to being a lesbian of which I was previously unaware. I've looked it up, but never found anything. Huh.

So anyway, we met with this CEO guy. Nice enough guy. Turns out he really is an accountant. After a few minutes of conversation, and I was trying to impart upon this decent man just what kind of risk and isolation the glbt community faces here in Hancock County, Maine, I stepped boldly across one of those lines that can so often be a huge error and asked him "where do you worship?"

He was stunned. "What?" He just looked at me.
"Where do you worship?"
His eyes showed comprehension. "Bangor."
I nodded. "You drive to Bangor then?"
"Yes."
"This is about discrimination and vulnerability and feeling safe in our own communities." I said to him. "You get that, don't you?"
It was an invitation for affirmation, and he nodded.
"I get it."

Bangor is where the nearest synagogue is.

He knows what it is to be a misunderstood minority. He knows what it is to have people believe they know everything about you because they know one little thing about you. He knows what it is to be hated because you're just a little bit different. And I bet he knows what it is like to be vulnerable and to get kicked.

I have hope that this guy will do the right thing and offer (require) training to the staff under his supervision, and I would be delighted to participate in that effort in any way I can. But I also know that doctors like to listen to other doctors, and so a mutual friend (who has lots of expensive letters after his name) will probably be the one who is tapped for that duty. That's fine by me. This whole thing is not about me. It is about teaching our medical system and the people who work in it how to treat sexual minorities like humans. It is challenging work. It will require them (and perhaps us) to discuss very personal things very frankly and with candor. And again, we will have to educate our doctors. With any luck, it will not happen again for a while, and the frequency of these incidents will grow thinner and thinner until they disappear altogether.

Stay tuned for updates.

Hospitals, round two

Remember the post about how badly some friends of mine were treated in the emergency room at a local hospital? Remember how we met with the CEO of that hospital and he was really good, promising to do some training and education for his staff and exacting some measure of discomfort upon the staffers who screwed up so badly? Well, this morning we go to meet the CEO of the other hospital, the one that oversees the clinic where the PA works who originally shared with the ER doc that my friend was a lesbian.

Only one of my friends is able to make the appointment - the other has to work - so we will be attending together, with me in a supportive role. But I'll be taking notes as well. I like to do that. It makes people nervous about where their words might show up. Good. This guy has reason to worry. What happened at his institution was horrible, and he should be worried. If lawyers get involved, it could get very expensive. I don't think my friends want to do that, although I know that some lawyer-ish people have contacted them. I don't see this as being about money or retribution, I see this as being about getting it right and making sure nobody treats people like this again.

But I think the turning point in that decision-making process is today. It may not be fair to administer a hidden test to the CEO, but that is what will happen. If my friend is satisfied, even hopeful at the end of today's meeting, chances are good she'll tell the lawyers no thanks. But if something goes badly, odds are she'll be inclined to loose the hounds, as it were. I hope it goes well. This is the kind of thing that once it begins to go badly, will only continue to do so for a very long time. It rarely turns around and gets good. Resentments linger here, and a nasty confrontation will be remembered for years, decades even; by the same measure, a cooperative effort at progress will be remembered as well. Somehow, though, the good thing is always vulnerable to going bad, but the bad thing never seems to be at risk of becoming good.

So today we go forward tentatively, hoping things go well and making a good effort to be a part of the solution. Think kind thoughts in our direction, world. We're going to need all the energy and support we can get.

On trust, betrayal and progress

So remember my friend who was treated so badly at the hospital? (See Labels.) Well, she and her partner, plus my friends K and D, and I all trooped up to the hospital in Ellsworth to meet with the guy in charge of it all. He's the whiz-bang CEO guy, the top administrator, which means he is not a doctor and not prone to the "doctors-protect-doctors" thing that so often happens.

Six of us crammed into a teeny little meeting room and my friend N told of her experience in the ER, as did her partner C. Doug (the hospital guy) listened and took notes. I saw him blink an extra time once or twice, and suck in his breath at the appropriate moments. His attention seemed genuine and his concern sincere. When she finished, he said "I am shocked."

To his credit, he did not try to defend the hospital staff, nor did he try to justify what had happened. He was able to explain how the handwritten note disappeared, and in a manner that I understood and could believe without having to like it (notes are read into dictation for later typing and then tossed - it makes sense logistically, although it originally smacked of cover-up). He promised to look into the situation, to speak to the ER doc in question to get his side of the story and to check out the dictated notes.

My friends are guarded in their optimism. After all, as queer people, we are accustomed to being promised things that never happen (think Clinton administration).

Trust is tricky stuff. It is often granted to medical professionals because of who they are. With others it takes years to build. With anyone, it can be destroyed in seconds. What happened to N and C was a betrayal and a violation. It was disrespectful and rude and there are no excuses. If a provider of health care has a problem with anyone's sexual orientation or religion or politics or whatever, they need to park those problems and behave professionally. Until last week, my friends had nothing negative to say about their hospital experiences in Ellsworth. But one nasty turn in the ER has soured them, probably for months, perhaps even years. It all depends on how this thing comes to some kind of resolution.

What it boils down to is this: two hospitals are involved, and that complicates things. N's primary care person (a PA) is out of a local health clinic that is administered by the hospital in Bar Harbor. But the ER she went to was in Ellsworth. The PA called the ER doc and gave him a bunch of stuff over the phone. That's where the "gay" (and circled!!) came from. Its position at the top of the page indicates that it is probably the first thing the PA told the ER doc about the patient. More notes about pain and symptomology were further down the page.

Now in an ideal world, the ER doc would have read some kind of professional riot act to the PA when she even mentioned that my friend is a lesbian. An astute guy would have told her in no uncertain terms that such information was unimportant, indeed irrelevant to the situation. Remember, of course, that lesbians DO, in fact, get pregnant, and we DO in fact get STDs. It astounds me that anyone got to be a PA thinking that, and that an ER doc was dumb enough to write it down. Holy shit.

But that's neither here nor there. It is over, it is done. What remains to be seen now is what kind of apology letter the ER doc writes to my friends, and how they are treated the next time they come into the ER. There is some real fear that they will be labeled as troublemakers. It is a very small community after all. Word of a doctor getting chewed out by the big shot will get around, and the story will circulate. We'll see what kind of care they get.

But for now we have hope. Guarded hope, but hope nonetheless. I think progress has been made. Although he tends to use a lot of bureaucrat-speak, Doug really seemed to understand the urgency of the matter and just what potential for tragedy there was in this incident. We'll all keep our fingers crossed.

And before I forget, let us not believe that hate does not exist in this idyllic area. It was just a year or two ago when a woman of African American descent was attacked and called racial epithets. The drunken white guy kicked her pregnant belly, threw beer cans at her and shouted about "white power" in the parking lot of a gas station and convenience store. He was arrested, and the community rallied around the victim, but the point is that the crime was committed. It was real. It happened. And it happened not five miles from where my friends live. This attack happened in broad daylight with lots of witnesses. How difficult would it be for something much worse to happen in the dark of night, fueled by too many beers and bravado? And how long would it take for the police to come?

Stay tuned for updates.

Update

A meeting has been arranged between my friend and her partner, me, two other friends who are local community activists, and the CEO of the hospital for early next week. The CEO has previously said he wants to know when ANYONE has a negative experience in his hospital. So we're going to tell him what happened. I will update here after the meeting. Stay tuned.

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A friend recently related a disturbing experience that happened to her when she went in search of medical treatment at her regular health care provider.

She went to see her doctor complaining of abdominal pain. The doctor sent her to the ER. While she was in the ER and dealing with the triage nurse, she noticed a piece of paper with some of her medical information on it. Directly under her name, in quotation marks and circled, was the word "gay".

That can't be what I think it is, thought my friend, but she saw it again clearly in the room when the doctor was examining her.

She asked him about it, and his response was "oh, you weren't supposed to see that. I don't want to get X (my friend's primary care MD) in trouble."

She said she went to her doctor the next day and confronted her about it, and the doctor was oblivious to the reasons for my friend's outrage.

Even if my friend made half of this up (not likely) it is terrifying to consider.

My friend was (and is) concerned about violence being visited upon her person. She is about as butch as me, but weighs less than half what I do. She's teeny. Being butch won't do you much if three knuckle-dragging rednecks decide to take out their sexual insecurities upon your head in a parking lot at night when you weigh something around 100 pounds dripping wet in a sweater.

Now for those of you who may not understand what is making my friend and me so angry, here's the basic run-down:

The justification used was that the note was written so the ER doc would know that my friend "was not pregnant and didn't have any STDs to test for."

Reality check here: because of the nature of the sexual behavior, lesbians are the group at lowest risk for sexual transmission of HIV. That does not mean we are immune, merely that we are the group at lowest risk for transmission. Not zero risk, lowest risk. There is a HUGE difference. Nor are exempt from any other form of sexually transmitted disease, and just because a woman is a lesbian does not mean she cannot or will not become pregnant, in any of the usual ways that event occurs.

The thought that one physician, never mind two, could believe this misinformation is horrifying. The alternative is that they used this bogus reasoning as a pathetic excuse for their outrageous behavior. Anyone feel any better about this yet? Yeah. Me neither.

The point is, now and as it always should be, that a person's sexual orientation HAS NOTHING TO DO WITH THEIR MEDICAL TREATMENT!!!!! Providers should take universal precautions with everyone they treat. Doctors should ask the same battery of questions of each patient as determined by appropriate diagnostic protocol.

If news of this woman's queer status were leaked outside the hospital because of that document, it would be a grave breach of confidentiality rules. Agreed. And we all know that never happens. No nurse or CNA or doctor EVER goes home with interesting stories about what transpired at the ER that night.

Bullshit. I have known plenty of health care providers. Some are more ethical than others, but all have stories from work. It is human nature to share one's experiences.

So it is not out of the realm of possibility that someone from the hospital might tell someone at home about this woman who came through the ER the other night whose doctor had written "GAY" at the top of her folder. Can you imagine a doctor doing that? Oh, you know her, too. She works at such-and-such, or she drives that little truck with the stickers, you know, yeah, the blue one. And now skinhead wannabe boyfriend has a target for his hate. Bingo.

And the doctor has no clue.

After we had both vented our frustration and outrage, I was able to think a little bit more clearly.
I suggested that she call the Maine Human Rights Commission and gave her the phone number.
I suggested that she call a lesbian doc with whom she has a friendly relationship and who works at the same office and tell her what she had experienced.
I suggested she call a local activist guy I know because he's smarter than I am and probably knows lots of people who could help. Plus he's got letters after his name and everyone knows him as a stand-up guy. His name was familiar to her from letters to the editor and news stories, she said. He was a practicing psychologist in the area for many decades and is widely respected.

It was also my instinct of course, was to call my friend Jen at the Maine Speak Out Project BUT ITS FUNDING WAS CUT AND IT NO LONGER EXISTS!

These docs need some education, some sensitivity training and some real awareness. The woman doc still does not understand that it is not safe for people to be out in many parts of Hancock County.

So, what else do we do? This really seems like a job for the MSOP, but it's not there any more. I told her to call the Human Rights Commission FIRST because once something is reported there, it becomes a little more real for people like hospital administrators. Someone complaining to a doctor friend might get brushed off, but when the conversation involves "when I spoke with Pat Ryan at the Human Rights Commission in Augusta, she said..." shit is much more likely to happen and mean something when it does.

I also told her to write down everything as it happened, using quotes as much as possible and recording her feelings and fears as the events of the past two days played out. I figured a record like that would be useful somewhere in this mess.

I don't know what else to do. The one organization that would have been perfect to address this thing is gone because of lack of funding. I know there are still volunteers out there, but there is nobody to coordinate or train them. What happened to my friend was outrageous. The automatic cover-up by one doctor for another was outrageous. The fact that the note with the handwritten "GAY" label has now disappeared is outrageous, and possibly illegal, could it be proved.

I guess all I can say is be careful when you go for health care in Hancock County, Maine. Ignorance runs deep here.