Critical Safety Concerns by Turks about Glen Rose Medical Center - Historical Communications and Reports


 
Blown Off by Glen Rose Medical Center- Shelley Turk FIRED

Critical Safety Concerns by Turks about Glen Rose Medical Center - Historical Communications and Reports
 


23 June 2015 at 7:55:00 PM
salon

Received this today, source confidential; did not come from any board member. This is with regard to how Glen Rose Medical Center handled the complaints regarding patient safety and other concerns that the Turks have had and is a timeline. For background see Doctor Expressed Strong Concerns about Ray Reynolds and Followup on that Texas State DHHS Services Visit to Glen Rose Medical Center in Dec 2014 

4-7-2014: Shelley Turk RN reported the following:                                                                                   

Write up: We were extremely busy in the ER today.  We had 3 critical patients in the ER that needed cardioversion.  That procedure takes a minimum of 2 nurses to be with the patient.  I called Robert Richards and Laura Hodnett to the ER to help with the critical patients.  They both came to the ER and triaged a patient that had a fever and congestion.  After they triaged the stable patient both of the not only left the ER, but they left the hospital because they routinely leave the hospital between 3-330 pm to go home.  Robert Richards and Laura Hodnett have been asked to be oriented in the ER and they both have refused up to now.  They have discussed in our morning huddles that they want to hire a house supervisor so they do not have to respond to patient care.  They have also stated in nurse leader meetings and in the morning huddles that they are not interested in being on call and the managers should not be required to do patient care. 

5-14-2014: Shelley Turk RN reported the following:

Write up: The emergency department (ER) was busy.  We had several critical patients besides an emergency department full of sick patients.  I had the nurses call an administrator and Ladonna Green came to the ER.  Rob Richards and Laura Hodnett were also called to come help with the critical patients.  Robert Richards and Laura Hodnett came to the ER and triaged a patient that had nausea and vomiting.  It took both of them to triage one patient.  When they finished triaging the one patient they both left the ER.  Ladonna Green was still in the ER helping at this point.  At one point Kelley VanZandt came down to help because our nurse leaders would not help.  This has been an ongoing problem in this hospital for some time.   We have had several meetings to try and figure out how to fix this ongoing issue.  Ray Reynolds and Michael Honea suggested that Robert Richards and Laura Hodnett be oriented to the ER and given the education packet for T-Systems.  They have yet to come to the ER to orient.  They always have excuses not to be trained.  This issue is a patient safety issue and needs to be addressed.  There are times in the ER when more than 2-3 nurses are required to take care of patients, there has to be a plan in place for those times and that plan has to be acted on.  

5/19/14: Shelley Turk RN was called to Ray’s office concerning a complaint from Robert Richards (Med/Surg Director) Shelley Turk’s position is

I was called to come to Ray Reynolds office at 2:45 today for a meeting.   Robert Richards, Laura Hodnett, Michael Honea and Ray Reynolds were also present in the meeting.  Ray Reynolds proceeded to say that the meeting was a request of Robert Richards.  Robert Richards stated that the reason he called for the meeting is that someone on the floor told him that I called him an idiot. Once they explained what they were referring to, I informed them that what was said to the nurse was “let me know if he doesn’t get it”, referring to an IV that Robert Richards was attempting to start. I can’t believe a leader in his position would pursue action in a situation like this. I am opinionated enough that I would have no problem telling Mr. Richards to his face if I thought he was an idiot.  I don’t understand why he didn’t simply ask me directly what I said if it bothered him so. I do not think he is an idiot but I do have some concerns about the lack of effort for each of them to become competent in their own departments or get cross- trained in the ED, as instructed by administration, and I have voiced these concerns openly.   I was shocked that a meeting with the CEO and CFO of the hospital would be set up to confront me with such a childish situation. It is apparent to me that Robert Richards and Laura Hodnett would bring me before the head of the hospital like this only to attempt to intimidate me and/or get me fired because I have been vocal of the situation.  I feel like this was retaliation or they look at me as a threat to them because I am a working team member and manager in my department. I believe a small hospital needs its managers to work.  They have been critical of me for working my department. I feel like they criticize me because it makes them look bad to their employees. On the other hand, my employees like and respect me, as I am the only nurse on the nursing leadership team that is a working manager. I believe this meeting and the time spent writing an official response to said meeting is time taken away from patient care.

5-26-2014: Shelley Turk RN received an email from Hayley Darnell and she forwarded it on to Ray Reynolds.

Zimbra sturk@grmf.org

May 24 staffing issue

 

            From :  Hayley Darnell  

Subject :  May 24 staffing issue

To :  Shelley Turk  

 

Mon, May 26, 2014 06:04 PM 

Hi Shelley,

Sandy and I worked on Saturday, May 24, with Craig scheduled from 11am-3pm.  We had been steady throughout the day, but were down to 1-2 pts at about 3:10, so Craig left at that time.  Approximately 4 minutes after Craig left, we had a STEMI come in, 5 minutes after he arrived, there was an ambulance tone out for an MVC, then 5 minutes later an ambulance called out for an unresponsive pt at GRMC-NH, plus 2 pts that came in for triage within a 30 minute time frame.  When I found a moment, at approx. 1540 I called Sherry on med/surg and asked if she could call admin on call to assist us in getting staff to help.  I had not heard from her after about 10 minutes, so I called back and she stated that she was told to call Laura and Rob by Ray, who was admin on call.  She states that she called them and was told by Rob to call in the third nurse that was scheduled for the med/surg floor and that when they arrived, she (Sherry) was to come help us.  She stated that when she called in her 3rd nurse, that the nurse was in Fort Worth with her daughter and that it would be over an hour before she could come in.  At 1554, as we were receiving the GRMC NH pt who was saturated with urine all the way through the EMS sheets, we also received word from EMS that the MVC pts refused transport and would not be coming in.  At that time, Sherry was finished making all of the phone calls and was able to come from med/surg to assist, leaving one nurse on the floor with 5 or 6 pts (I'm not sure exactly how many they had). The weather was questionable for flying the STEMI, and since Sandy and I were both working on the pt, Brent from Cardio asked if he could start calling air services to try and arrange transport to THR HMFW. During this time, Brent was having to make multiple calls to Careflite trying to arrange transport for the STEMI pt.  It took us over an hour to get the pt out of the ED d/t weather/flying issues. The busy time in the ED went on for about 2 1/2 hours and Sherry was able to assist us for about 2 of those hours.  Dr. Hoang was questioning times for Careflite/Air Evac after the incident because of the long time it took to transport the pt, but we were not able to get times d/t Brent did not write them down (this is not part of his job description and he was just trying to help). We appreciated both Brent's and Sherry's willingness and ability to help us during this situation, but we definitely could have benefitted from having a 3rd nurse already here at the time. It takes both of the staffed ER nurses to stabilize a critical pt, therefore we don't have time to make the phone calls to get help in this situation, and we usually need help RIGHT then unfortunately.  I just wanted to make you aware of this incident in case there were any problems that arose from it.

Thank you,

Hayley Darnell

 

6-7-2014: Shelley Turk RN forwarded a complaint from an ER staff nurse to Ray Reynolds.  After she forwarded the following complaint, she was called to Ray Reynolds office and verbally reprimanded for forwarding the complaint.  Ray Reynolds sated that he did not want Shelley Turk to ______ any more complaints by email.  He said that everything that is documented can be accessed through open records request and he did not want the board of the hospital to find out what is going on in the hospital.  The following email was forwarded to the president of the hospital board and the rest of the correspondences that I sent to the CEO to present were CC to the hospital board president.  

I feel like this is a patient safety issue.  The new nurses on the floor have not had enough orientation and they are thrown into a situation that endangers the patients not to mention the nurse's license.  The nurse leaders are responsible for the patient care in all the departments.  The problems on the floor do not seem to be getting better.  Thank you 

Shelley Turk RN, BSN    Emergency Department Director Trauma Coordinator, Glen Rose Medical Center, E-Mail sturk@grmf.org, 254-897-1447

----- Forwarded Message -----

From: "Hayley Darnell" To: "Shelley Turk" sturk@grmf.org Sent: Saturday, June 7, 2014 6:59:48 PM

Subject: pt concerns

Shelley,

Just wanted to make you aware of a some questions posed by a pt's family on Saturday, 6/7.  We took care of a pt in the ER and after a couple of hours in ER, he was admitted to the floor.  Dr. Carpenter's pt, but Dr. Turk admitted because he was on call.  I gave report to Glen on the floor and took him over there at 1315.  When I took the pt to the floor, the nurses saw me take him by the nurses station, and after getting him situated in the room, I informed Glen that Dr. Turk had ordered a 2nd Blood Culture and that needed to be drawn before the pt rec'd antibiotics and that all of those orders were on the inpatient order sheet. I informed the pt's family that they would be getting a 2nd set and then starting the antibiotics because they were concerned about getting them started as quickly as possible d/t WBC 28,000.  I left the orders with Glen and returned to the ED.  At 1505, the pt's son (or son-in-law, not sure which) came over to the ER registration desk and asked to speak with the nurse.  Craig went to speak with the gentleman and he told him that nobody had been down there and asked him if it was typical for the nurses not to start antibiotics for 2 hours after admission. Craig told him that it was not usually the case, but that he had not been over there and didn't know what all was going on over there or how many patients they had.  I'm not sure if this was accurate, but I believe there were 6 or 7 patients on the floor and 3 nurses (one of which was Glen, who was orienting). Craig informed me of the situation because I was the nurse that had taken care of them in the ER and had been the one to give report, so I called the floor and asked Glen to have Misty call me in the ED (I didn't know who was in charge, and was not familiar with the other nurse, so I asked to speak with Misty). Then, I called the lab to ask if the 2nd set of blood cultures had been drawn; they said they had had no order for a second set.  I received no call back from Misty, so after about 10 minutes, I walked over to the floor and she made a comment that the pt and family were upset. I spoke with her privately to ask her about it, and she said that the call light had gone off and she went in to check on him. She said the family was "short" with her and asked for help to get him up to use the urinal, then told her that he needed to be hooked up.  She informed them that she would find out about his orders from his nurse and would return. I explained to her about the family member coming to the ED, and that they stated that no one had been in there since he got there.  She was unaware of this until then and stated that she would find out about it.  I also informed her that the cultures had not been drawn and that the pt had not had his antibiotics started and that lab said no orders were entered into the computer.  She stated she would take care of it, and as I was walking over there to speak with her, I did hear her on the phone to speak with lab to have them come draw the cultures.  After an hour or so, she called and stated that she had found out that the CNA had been in to take the VS when he got there, and the nurse had been in, the family was fine now, and had just had a rough couple of weeks with the pt's illness and they were no longer upset. She stated that the son told her he was a doctor and was just concerned about the antibiotics, but once they were started, he was fine.  I don't know that they will write a complaint, but just wanted you to be aware of the situation, because he had been over there for almost 2 hours before any of this was addressed and instead of speaking to the nurses on the floor about the issue, he came to the ED with it. I feel like it's important that we protect our licenses as nurses and work together with the other nursing departments as a team; and that our patients receive a continuum and quality of care that protects their health over anything else so that we are successful in these and any other goals. Thank you, Hayley

6-13-2014: Shelley Turk RN was called to Ray Reynolds office and given a formal written reprimand for going outside the department to help other departments as well as talking to the staff and physicians. 

 

 

6-15-2014 Jay Turk MD sent a letter to Ray Reynolds (CEO) in regards to patient care at the hospital

            Dear Mr. Reynolds

The last time I wrote you I pointed out that for over two years I and several of the other doctors have been reporting to you that there were serious problems with the nursing leadership on the med-surg floor.  For the first several months after I arrived I would frequently bring you my concerns. I would invariably be assured that it would be addressed, corrected, looked into etc. Nothing ever changed, so I stopped wasting my time bringing my concerns to you. After several patients died as a result of these problems, I wrote you the letter pointing out that since you and the rest of the management team were notified of these problems, all of you share in the responsibility of these deaths.  Apparently the letter spurred some action because one of the nurse leaders that were part of the problem left shortly thereafter. However, that alone was only a small step towards solving the problems.  You have pointed out on several occasions that the ER and radiology departments work very well. Both of those departments work well because they have working leaders. We still need clinically strong leaders, who are willing to work!, for med-surg, the CNO, and the OR.

The current director of the OR has been there several months and is still not oriented to her department. Not only does she not work in her department she doesn’t even know how to work in her department. You have repeatedly admitted that she was a poor choice and wasn’t working out. Yet, unbelievably, you appointed her as interim CNO. She has failed to orient to the OR, the floor, the ER, or the Omnicell so essentially she can’t provide significant help anywhere in the hospital.

There have also been several surgeons who have either stopped coming here or have significantly decreased their case load here because of the poor performance of the OR. I have personally spoken to four of them and they all gave poor comments concerning the OR director. I subsequently passed this information on to you. Again, nothing was done.  When we discussed this last, you said that you only needed her to be in the CNO position until the hospital went through the joint commission inspection and that as soon as we were through that she would be let go. Once again you have not followed through with your word. Instead, you have promoted someone that not only performed poorly in their department but actually cost this hospital money because of decreased procedures in the OR. But she is still here, espousing the same nursing leadership philosophy that I have been fighting against ever since I arrived here.

The interim CNO believes that a manager shouldn’t have to work in their department, or work hard at all. That may be so in a large hospital, but in a small hospital it is wasteful of resources, provides a poor example to others and leads to poor nursing care. As I have mentioned before the hospital in Bowie provided excellent medical and nursing care, but when they changed to CNOs that didn’t have strong clinical skills and didn’t stay involved with patient care, our nursing care declined noticeably. This brings me to the current med-surg director. He does have the clinical skills to perform well in this department but I believe he has been influenced by the CNO to not directly work in his department. But we desperately need someone to actually work in the med –surg department in order to improve patient care. Due to the influence of this CNO there was a significant delay in his orienting to the floor and gaining access to the omnicell. I was beginning to believe that he would be as worthless as the CNO until this past weekend. Once again there was a problem with the care of patients on the floor.

This involved a patient I admitted on 6/7/14. The family of my patient complained to the ER nurse concerning the lack of care by the floor nurses. This was written up by the ER nurse and given to her manager and to the chief-of-staff, both of whom happened to be working that night. They both wrote responses reporting the continued problems on the floor. The good news is that after those reports went out, I saw a remarkable improvement in the med-surg director. He came in and worked Sunday and assisted me in rounds and taking care of the patients. This improvement has continued this week so far, making me pleasantly surprised. Hopefully, he will stop being influenced by the CNO and this improvement will continue. Now if we can get him and his staff to cross-train in the ER where we can expose the floor nurses to more acute patients and to codes in particular, I believe we will finally see some of the improvements that I have been trying to get you to do for almost three years now. The bad news is that on Monday morning, because she sent out that memo, you called the ER director to your office to reprimand her for not getting along with CNO and the med-surg director. She was even threatened with being fired and told to not report any more complaints, even though she was doing exactly what she was supposed to. Are you are trying to hide the fact that the problems still haven’t been fixed under your watch? I, and I believe the other doctors, will continue to insist that everyone continue to bring problems to our attention and to yours so that we can improve our hospital into a facility that provides excellent care of our patients.

I should be able to focus the majority of my efforts directly on medicine, but I am spending way too much time trying to protect my hospital patients from your decisions and your management team. Might I make a simple suggestion? Rather than reprimand an employee for reporting problems, why not just fix the problem? I might also add that the ER manager has been working under direct orders from some of the physicians, me included. I have instructed her, since I have not seen any interest for improvement from upper management, if you see a problem on the med-surg unit correct it if you can and if not write it up and report it. This appeared to be the best option, since the physician complaints were being ignored, and, I might add, this option was beginning to show signs of slight improvement on the floor.

As you well know, I have declined to sign a new contract despite being offered more vacation time and a significant increase in salary. As much as I would appreciate these perks, I place improvement of our patient care of utmost importance. I ask you to perform your duty to protect the patients in our hospital. The results to date are unacceptable. You have had more than two and a half years to address these problems.

J. Turk M.D.

As of today, Dr. Peters reports hope in the nursing leaders getting involved in the patient care

8-24-2014 Jay Turk MD sent a letter to the president of the hospital board.

            Dear Mr. Harrison

I have been pushing for improvement of patient care my entire career. When I came to Glen Rose I continued in those efforts. My initial concern was with the inadequacy of nursing leadership on the med-surg floor and the subsequent concern of the effect of nursing care on patient safety. However, after reporting these problems to Mr. Reynolds on multiple occasions over several months, I realized that he was essentially ignoring these warnings. I was then concerned with how to protect my patients in the hospital. I started discussing these problems with some of the other physicians and found that they had similar concerns. I knew that some of them had informed Mr. Reynolds but still nothing was being done. During meetings I started making requests that we have nursing leaders with strong clinical skills. I pointed out on multiple occasions that the lack of strong nursing leadership was endangering the patients. I also pointed out on multiple occasions that Mr. Reynolds was placing people in positions for which they were unqualified. Such as having an employee with no medical or nursing background in charge of the quality of patient care and in deciding what issues should come to medical staff. I reported on multiple occasions where a nurse would not have the clinical skills to recognize the seriousness of a patients’ condition. I reported that the nurses were not assessing their patients in a timely manner and in general were not familiar with their patients or the patients’ medical conditions. Unfortunately, the problems continued. About one year after I started reporting these problems to Mr. Reynolds, I had a patient that was admitted to our hospital that had an episode where she choked on her food. I was not on call but was notified and I came in to find her in the ER. She was a little shaken but told me how she had choked on her food and went out into the hall to get a nurses attention. She reported that the nurses came over tried the Heimlich but after that failed put her in a wheelchair and quickly wheeled her to the ER where the ER staff dislodged the food bolus. I was praising the quick thinking and rapid response of everyone involved when an ER nurse pointed out that the floor nurses had dropped the patient off and when leaving reported that this lady was someone that had wandered over from the nursing home. They started the further workup of the patient including admitting her to the ER. They then noticed that she had a saline lock in place as well as a hospital bracelet. They had to then call the floor nurses to inform them that this was already their hospital patient and not someone that had wandered over from the nursing home. So, though thoroughly relieved that the patient was taken care of, I was concerned that the nurses did not recognize her as one of the few patients on the med-surg floor. I reported this incident, again nothing was done.

Shortly after this I had a patient admitted that had dementia and was more confused than usual. One of the ER nurses was called to start an IV. The ER nurse noticed that he was having some difficulty breathing and that the floor nurse had not even addressed the problem and had left him lying flat. The ER nurse raised the head of his bed which helped  his breathing, notified his nurse of the situation and told her to keep his head raised and notified me of the situation. I called the floor and ordered oxygen and a chest x-ray. Later that day I was told that the patient had expired. He was a DNR and as such was not coded but I believed that his nurse should have been able to keep a closer eye on him to let me know that he had worsened. Upon investigating the situation further, I found that after his x-ray the patient had been laid flat again. I then found out that his nurse had given him a dose of Ativan because of “anxiety” shortly before he expired. It appears that his “anxiety” was actually due to his breathing difficulty. I then was told that this patient who had been “anxious”, was ordered to be on oxygen, had a chest x-ray and had difficulty breathing  apparently  had nobody watching him because his elderly wife had to walk out to the nurses station to tell them that she didn’t think he was breathing anymore. I took this straight to the CNO and also told Mr. Reynolds, again it was just swept under the rug and we continued to have poor nursing leadership and nonclinical people “ensuring” the quality of our medical and nursing care. I made it a habit to check on my patients more often including trying to call every night to check on them before going to bed to protect them as much as possible. I do have full faith in the other doctors covering when they are on call, but I am concerned that the patients are not being given continuous care by clinically strong nurses due to the poor nurse leadership. I have never been in a situation where I have been so concerned about the safety of my patients and having an administration that ignores the physicians’ concerns like this.

Approximately one year later, (after two years of warning) I happened to be on call and came in later in the morning since it was a holiday. So by this time I had already been on call for approximately four hours, but I had not been told of any problems whatsoever. I sat at the nurses’ station looking at the charts and chatting with nurses. They still saw no reason to let me know that a patient was having difficulty breathing. After ten-fifteen minutes the respiratory therapist walked by and asked if I knew about the patient that he had been working on. After letting him know that I was unaware he told me about the 48 yo male that was having severe respiratory difficulties that he had been working on for some time that morning.  I immediately went to the room and was shocked to find a patient in critical condition. I quickly examined him, reviewed the chart, told the nurses to call on the transfer line to find someplace to transfer him, and to call the helicopter. I went to retrieve equipment to intubate the patient and got back to the room just as the patient coded. That was when I found that not all of our hospital rooms had a code blue button. The respiratory therapist and I were having to work on the patient while trying to use the call button and yell out in the hall for help. The ER team arrived and I was able to get the patient intubated and after a short while we got the patient back. I went to go talk to the receiving physician. Upon returning I found that the helicopter crew was arriving and I began to update them on our situation and what we had done so far. As I reported to them all of the meds recently given to the patient the nurse added that she had given him some IV Ativan shortly before I had arrived to the hospital. I would like to stress this was the same nurse mentioned in the preceding case, again given because a patient with respiratory difficulty was “anxious”.  Just as we transferred the patient to the helicopter gurney he coded again and after additional resuscitation we got him back again. The flight crew then took him to the other hospital but, unfortunately, in route he coded again and this time they were unsuccessful and he died. If the nurses would have called me at home, told me immediately upon my arrival or not given him the Ativan, he would have at least had a chance to survive. I had to tell the wife and child of this man that he had an extremely low chance of surviving. And later upon being proved right I had to sign this man’s death certificate. Afterwards I kept thinking what if Mr. Reynolds would have heeded the warnings that I and the other physicians had been reporting. Would both of these people still be alive? There have been several other patients that I was concerned about their care but I did not have enough evidence to address them directly.

Over the past twenty years, dealing with at least five other hospital CEOs I would take my concerns to them directly and the problem would be addressed. Due to the concerns of frivolous lawsuits and to specifically protect the hospital I would report these concerns verbally but I always knew that they were taken seriously.  I had already seen that going to Mr. Reynolds and telling him in person did not work and as you saw in our last meeting he conveniently claimed if he was told of these problems he just doesn’t remember. So, I brought this up in the next med-staff meeting and wrote him a strongly worded letter to document the problems so that they would have to be addressed. I assumed that this would force him to make the changes necessary to improve patient safety but I saw only minor changes and he continued in his pattern of keeping unqualified people in positions that oversaw patient safety. At this point the other doctors, me and a few of the nurses had to circumvent Mr. Reynolds and started pushing for changes in other ways. Some of these are addressed in the second letter that I wrote which I will provide. Some of the doctors, Dr. Hutchinson in particular, started having the floor nurses make rounds with her which forced them to become more accountable and to be more knowledgeable about their patients. I also referenced the improvement in the current med-surg director due to the pressure put on him by the doctors and the continued write-ups documenting the problems. Now I am greatly pleased that there is improvement but I am still greatly concerned about Mr. Reynolds leadership and his accountability. He has shown no indication that he will place qualified people in critical positions. I also went back to confirm that he did give the order to a nurse to not write up any more problems and  told her if you have to pass on any patient complaints do not include that it is a patient safety issue because it forces them to address it.  He also, as you will recall from our first meeting, reported that I was the “lone wolf” and that the other Doctors weren’t complaining.  I would like to point out that upon reading the last letter Dr. Davis said that he would have to agree with most of it and that the other Doctors had concerns but weren’t as vocal as I was. Dr. Burroughs read it and said she could understand why one would question why it took so long for the situation to improve. Dr. Hutchinson read it and said she agreed with it but thought it was too harshly written. I cannot count the number of times that she has told me that she wondered if things would ever get better and told me that it is so hard to keep fighting to make improvements and that she often feels like giving up. After reading the letter I asked Dr. Petino if there was anything in the letter that he disagreed with and he said he agreed with all of it. Additionally, Dr. Peters added to the letter and signed it with me.

I wonder why all of these Doctors would report all of these concerns but for some reason not openly stand up and fight for these improvements. Is it just because Ray is a nice guy? I might add that I believe that he is, but our responsibility is to the patients. Is it because they are worried that the new hospital board is going to try to shut down the hospital and they think that showing any lack of support for Ray would be dangerous to the hospital? Or are they concerned about retribution from Mr. Reynolds? I believe I saw some of that retribution when, despite the recommendation from the TORCH representative to have a month extension, my contract changed from a twenty thousand dollar a year raise to an actual pay cut. However, I had given you my word that I would give you more time to make our hospital better. So, despite this costing me tens of thousands of dollars to keep up this fight, I signed the contract to fulfill my word. You gave me your word that you would strive to improve the quality of care at this hospital. I am holding you to your word.                                                                      Respectfully: Jay Turk M.D.

9-3-2014: Shelley Turk RN sent a patient complaint to Teresita Dequina (acting CNO) and Ray Reynolds (CEO)

From: "Shelly Turk"
To: "Teresita Dequina"
Cc: "Ray Reynolds"
Sent: Wednesday, September 3, 2014 1:48:29 PM
Subject: staff and doctor  complaint

We had an issue in the ER yesterday.  The nurses were extremely busy.  Between 7 am and 11pm we saw 40 patients.  The nurses called for help and Tec Dequina came, but she did not stay due to meetings.  Robert Richards came and started an IV and took out an IV and left.  We have to have more help in the ER and nurses from other areas in the hospital have to be cross trained.  40 patients in 16 hours with 2 nurses is unsafe for the patients and the nurses.  The day shift nurses did not get lunch or any other break.  Mistakes are going to be made and the quality and safety of the patients is going to be affected.  There were critical patients that needed better monitoring than the staff could provide due to the shortage. 

Dr. Hoffman stated that there was a delay in care because the ortho room has not been fixed since it was relocated. Because it is not organized it was not restocked. I was told last week that by Michael that it would be fixed.   Shelley Turk RN, BSN

9-5-2014: Shelley Turk RN sent in a formal grievance to the HR department and Ray Reynolds because she found out that the CNO, med/surg director and the head of the quality department sent a petition around to the med/surg nurses to attempt to have her fired.  The following is the grievance.

I would like to file a formal grievance.  I am being bullied and framed by my direct supervisor, Teresita Dequina.  I was made aware by an employee of this hospital that there is a petition going around for people to sign to try and get me fired and my boss, Teresita Dequina not only knows about it, she is encouraging people to sign it.

Mrs. Dequina told this employee about my personnel file and complaints against me that have not  brought to me or the HR department.  Mrs. Dequina is accusing me of taking drugs and doing other things that are incorrect.  I was also made aware that Robert Richards is not only aware of the petition, he is encouraging employees to sign it.  Teresita Dequina stated that she would sign the petition.  The actions of Teresita Dequina and Robert Richards is not only unprofessional, it is illegal, and I feel I am being harassed, slandered and bullied.   

I love this hospital and I have worked very hard to make the emergency department a good place  work, as well as provide a high quality of care.  The thought of having to retain an attorney in order to protect my nursing license is the last thing I want to do; however, I am bringing this to you because I am being backed into a corner, and now I have to protect myself as well as my nursing license.  The fact that the administration of this hospital was aware of this yesterday, and those responsible are still here today, makes me wonder if some of them are involved. 

I will not give in to bullying, harassing and framing.  I will provide letters from my direct employees that work with me on a daily basis as references to my character and nursing ability.  I would like to assume that this situation will be handled, and no further action will be required.  Thank you for your help with this matter. 

Sincerely

Shelley Turk

A copy of this letter will be forwarded to the hospital board.

10-21-2014: Shelley Turk RN received an email from Dr. Hoang  that she forwarded to Ray Reynolds and the president of the hospital board. 

From: "Long Hoang"
To: rreynolds@grmf.org, tdequina@grmf.org, sturk@grmf.org, rrichards@grmf.org
Sent: Tuesday, October 21, 2014 9:07:24 PM
Subject: 10/13 AM code blue

Sorry it took me a while to write this email. We had a patient on the floor that coded early AM /13. When the ER nurse, respiratory, and I arrived, no CPR had been initiated. I also was suprised that the crash cart only had an AED, which the pads were not placed at time of arrival. Are all crash carts only equipped with an AED and not a cardiac monitor? Just wanted to make someone aware that if code blue is called, CPR should be initiated as soon as possible while waiting for the provider and ER nurse to arrive.
 
Let me know if you have any other questions for me. Thanks,
Long Hoang, DO

10-24-2014: Shelley Turk RN emailed a complaint to Teresita Dequina, Robert Richards, Ray Reynolds and Chip Harrison (board president) in regards to a code on the med/surg floor on 10-11-2014.  There were two different codes called, one on 10-11-2014 day shift and 10-13-2014 night shift.  I responded to the code on the day shift and Dr. Hoang and Stormie responded to the code on the night shift.  

            10/11/2014

We had a patient safety issue on the floor today.  The code Blue light sounded in the emergency department alerting the emergency department that there was a code on the med/surg floor in room 101 and Craig Merritt RN, Hayley Darnell RN, Dr. Pensom and myself (Shelley Turk RN) responded to the alarm.  When we got to the med/surg unit, the crash cart was in the room but was not turned on or attached to the patient.  CPR had not been started.  The cardiac monitor was attached to the patient and the rhythm read asystole.   This is not the first time this has happened.  I and others have requested that the med/surg nurses be trained in CPR and ACLS.  It was hard to find the things that were needed in the crash cart because the cart was not organized and there were things on top of the cart in the way.  The most important thing is starting CPR.  Anybody who comes into a room can start CPR.  Could someone please address this issue?  Not starting CPR is a sentinel event and requires peer review.

11-3-2014: Jay received a letter from Ray Reynolds stating he is in breach of his Glen Rose Health Care Inc. by not using the EMR in the hospital. 

11-4-2014: Quality meeting, code blue RCA discussed.  Quality packet available. 

11-7-2014 Shelley Turk RN forwarded an email sent to her from Dr. Long Hoang and Stormie Lightfoot

I agree with what I recall took place per Stormie. Is this been an ongoing discussion or is she chiming in b/c there's been no response to my initial email?

Thanks for the update.

Long

Sent from my iPhone

On Nov 7, 2014, at 7:46 AM, Shelly Turk wrote:

From: "Stormie Lightfoot"

To: "Robert Richards" , "Teresita Dequina" , "Kim "

Cc: "Shelley Turk"

Sent: Friday, November 7, 2014 6:29:39 AM

Subject: code blue on the floor

I have heard many different variations of what took place during an early morning code on the medsurg floor on 10-13-14 with patient #10087413. Whether wanted or not I feel compelled to share my personal variation of what I personally witnessed during this event. This is solely to point out areas we as medical employees could improve or be educated further on. I am not one to get involved but this is not my first encounter with a disorganized code blue on the medsurg floor over the past 4 years. This is about what is best and safest for our patients.   

I was in the ER with Paula Eno RN and Denise Rutledge RN when Paula answered a telephone call which was a lab tech calling from the floor informing us that the nurses needed help that it was possibly a code. Paula states "you need to call the code overhead" in which she gets a reply of "I don't know how to do that". Paula hangs up the phone and her and myself head to the code. Luckily I was in the ER when the call was placed otherwise I would not of known about the code until even later. Passing by the doctors room I knock on the door and yell "code blue on the floor". As myself and Dr. Hoang enter the room, "Code Blue" was then announced over head. I arrived in the patients room where there is two lab techs (Dakota who I believe was in orientation and Lauren) two nurses (Kathy RN and Tracie RN), and the crash cart. No compressions were being administered when I entered the room. I began to remove the ambu bag and assemble it to start breaths, a few seconds later Dr. Hoang arrives and just shortly after him Paula arrives. Dr. Hoang starts compressions immediately as I began breaths. Paula then took over compressions for Dr. Hoang so that he could run the code. Two rounds of epinephrine were given total. During the first rhythm analysis I realized the leads were on but not the defibrillator pads, I then stated "the pads must be placed in order for it to stop saying remove test plug". Pads were then placed. There was no suction set up in the room as well. At some point Paula asked the two lab techs if they could assist in compressions, both stated they did not know CPR. She then proceeded to tell them they needed to be recording the code so that others are free to assist with direct patient care. I believe immediately following that Suzie from lab came in and began assisting with compressions. In my opinion it felt completely unorganized from start to finish. This is a list of concerns that could possibly be addressed. If you have any further questions feel free to contact me. Also, Paula Eno states she is available to answer any questions as well.

1. Code button was not pushed/code was not called over head

2. No compressions were being given at the time myself, Paula, or Dr. Hoang arrived.

3. Leads were placed by medsurg nurses but they did not know they must have defibrillator pads placed

3. No suction in room (when a patient is placed in a room, suction should be on the list of things to set up EVERY time)

4. Are lab employees CPR certified so that they could assist with compressions? If not, it could be something to consider. Thanks, Stormie       

11-7-2014: Shelley Turk RN received an email from Dr. Long Hoang in regards to the RCA done by Kelly VanZandt, Robert Richards and Teresita Dequeana

              ----- Forwarded Message -----

From: Long Hoang

To: rrichards@grmf.org, tdequina@grmf.org, rreynolds@grmf.org, sturk@grmf.org

Sent: Fri, 07 Nov 2014 11:32:34 -0600 (CST)

Subject: Code Blue issue

I just received from the grapevine the "analysis" from the meeting about the code blue I previously emailed. I did see the actual report today.

I have the following concerns:

1. Rob replied back to my email and wanted to meet and discuss. I replied on availability, but never got a reply back. Concerning as the investigation was finalized without my input.

2. "Causal Factor #1 and #3" - I agree an orientation on the code on the floor would be helpful for new ER doctors. Despite this, I would think that floor nurses would know how to call a "code blue" in the hospital and that AED pads need to be placed on the patient to analyze the rhythm. Also, they would be most familiar with the equipment. I am a very approachable doctor and always open to input from staff. This is also encouraged in ACLS. Although the physician directs the code, it is a TEAM effort. It is how we do it when we code in the ER or have a trauma.

3. Casual Factor #2 - That statement was a lie. I was the first to start compressions. Nurses were standing idle at bed side when I arrived. Supposedly there is question when code blue was called. Per Paula Eno, a phone call was initially made to the ED was made to call the code blue instead of overhead or code blue button pressed.

I hope that this is not the way issues are addressed in the hospital. Patient care and safety if priority. May this be a time to learn and improve. I live here in Glen Rose and desire quality patient care as much as our patients.

I have no problem submitting a letter of resignation these issues are not addressed in a satisfactory manner.

Thank you, Long 

11-7-2014: Jay Turk MD sent another letter to Ray Reynolds in regards to the 2 codes and the RCA of the codes.  The letter to Ray was forwarded to the hospital board and DSHS

            Dear Mr. Reynolds,

Once again I find myself in a position where I must intercede on behalf of our patients and champion for their safety.  As I am sure you can recall, I brought to your attention problems with our patient safety programs several years ago and recommended to you that we needed to implement strong clinical leadership in our nursing management positions.  I am pleased to report that compared to where we were three years ago, there have been some improvements.  While I understand the process to implement any change can be tedious and time consuming, it should not take multiple letters and an inordinate amount of time.  With that being said, it has been brought to my attention, yet again, that there are still grievous safety concerns that are costing patients not only their safety, but possibly their lives. 

In October of 2014 we had two cardiac arrests on the med-surg floor and each arrest was an example of poor management, lack of proper education, and lack of leadership from administration.  In both instances it was reported that CPR was not started by anyone on the med-surg floor and actually was not started until the ER staff arrived from their department.  At that time the defibrillator pads were placed and the code was initiated.  This is entirely unacceptable.  If you recall, shortly before leaving Jackie gave instructions that the nurses had a three month deadline to acquire their ACLS certifications.  More importantly, every nurse in the hospital is required to be CPR certified.  If the med-surg nurses are unable to perform basic CPR, then there is a break down in proper management and quality control for this hospital.

I have suggested that the floor nurses cross-train in the ER or at least respond to codes in the emergency room to help them with their comfort level, skill set, and technique.  Administration has failed to support me on this request and the floor nurses have not been able to take advantage of this opportunity.  Waiting for the ER staff to arrive to a code to begin CPR can literally make the difference between life and death for our patients.

I am now forced to address an even greater problem.  I have suspected for several years that some of the more serious problems facing our hospital are being glossed over to protect some of those in administration and their employees.  Unfortunately, I have now seen evidence of this.  I have read the official review of the last two codes that were performed on the med-surg unit and disagree with the findings.  What I read did not coincide with reported events.  This prompted questions which lead me to my own investigation.  After speaking with four different ER nurses, two respiratory therapists, and both ER physicians involved with the codes, it was discovered that at least part of the review was a “complete lie”.  Not a single participant from the ER that actually ran the code was ever questioned about their participation in the codes.

This leads me to the legal quagmire that is the possible falsification of a medical record.  How often does this occur at our hospital?  How often does administration “review” a patient record without the proper investigation and discovery of facts in order to protect their own? This is a question to be asked and answered by governmental bodies if you cannot provide an adequate answer.

What is it going to take to bring about the patient safety programs that are needed?  Administration has been made aware.  The hospital board has been made aware.  It is time for immediate improvements so that our patients and their families have a safe haven to recover.  If, after multiple attempts, I cannot implement improvements that start with you, then I shall be forced to take it to the next level.

Regards,

Jay Turk M.D.

11-12-2014: Jay Turk MD received a letter from Ray Reynolds in regards to the letter that Jay wrote on November 7, 2014 concerning the 2 codes on the med/surg floor.

 

 

11-18-2014: Jay Turk MD gave Ray Reynolds CEO a formal letter asking for accommodations for his handicap

Dear Mr. Reynolds,

This is a formal request for accommodations for my disability. As you well know I have had tremendous difficulties with using the computer to document and place orders. The conversion to a computer system has resulted in a loss of income for me and my family from between seventy and one hundred thousand dollars per year. This has forced me to work at several other facilities in order to try and make up the difference. The clinic system was so difficult that I had to ask for assistance in entering the data and orders; the hospital system is even more difficult. A Dragon dictation system was provided and I worked with that for several months. Unfortunately, this did not result in any significant increase in productivity. At this point a decision was made that providing me with a scribe would be financially beneficial for the hospital. This has significantly improved my productivity but it has not improved to anywhere near where I was before the change to EMR.

In order to maximize my productivity in the hospital and in turn to maximize revenue for the hospital I request a transcriptionist enter my documentation and a nurse enter my orders, especially since a nurse has already volunteered to do so. This would be by far the most efficient way to allow me to see the maximum amount of patients and allow me to provide excellent medical care to our patients. I currently start clinic at 8:00 AM. If I am unable to have the above accommodations and need to use my scribe from the clinic it will force me to delay the start of clinic until approximately 9:00 AM. Not only will this decrease revenue to the hospital but I can ill afford any further decrease in my productivity. I am just now improving my efficiency with my scribe to where I believe it will soon be possible to reach a bonus. The change to computers is already costing me up to one hundred thousand dollars per year and I have had an additional pay cut recently, apparently as retaliation for reporting patient safety problems.

I believe that allowing my accommodations would be a win-win situation. It would allow me to continue to focus on practicing medicine and taking care of patients, maintain my efficiency in the hospital and would increase revenue to the hospital and could keep me from pursuing a claim against the hospital through the Americans with disabilities act via the EEOC.

Please note letters attesting to the above mentioned disability.

Thank you for your consideration,

Jay Turk M.D. DABFP,DABSM

12-11-2014: DSHS and JACHO came to Glen Rose Medical Center to do an unannounced survey

12-18-2014: Jay Turk MD found out that he had been removed from the medical executive committee and in return Dr. Turk wrote a letter to Ray Reynolds asking why he had been removed and was it because of him reporting to DSHS.

From: "Kelly Van Zandt"
To: administrators@grmf.org, directors@grmf.org
Sent: Thursday, December 18, 2014 10:34:21 AM
Subject: Medical Staff

Attached is the Slate of Officers for 2015, the Meeting Calendar for Medical Staff, MEC and Surgery Committee as well as the 2015 Dept Chairs. Please let me know if you have any questions.

Thank you,

Kelly Van Zandt, CPHQ
Director of Quality Improvement/ Risk Manager
Glen Rose Medical Center
(254) 897-1496

            Attachment:

GRMC Slate of Officers for 2015

Office

2012

2013

2014

2015

Chief of Staff

Dr. Carpenter

Dr. Davis

Dr. Peters

Dr. Hutchinson

Chief of Staff for Nursing Home

Dr. Burroughs

********

*********

**********

Chairman of Surgery

Dr. Greene

Dr. Greene

Dr. Greene

Dr. Patino

Vice Chairman of Staff

Dr. Davis

Dr. Peters

Dr. Hutchinson

Dr. Carpenter

Secretary

Dr. Peters

Dr. Hutchinson

Dr. Turk

Dr. Burroughs

Member at Large

Dr. Hutchinson

Dr. Turk

Dr. Burroughs

Dr. Davis

 

 

 

Article XIII
OFFICER
S

13.1      Officers of the Medical Staff.

13.1.1   Identification. The officers of the Medical Staff shall be the Chief of Staff, Vice Chief of Staff, and Secretary.  Should there be only two (2) Members qualified to hold Medical Staff office, the offices of Vice Chief and Secretary shall be combined. 

13.1.2   Qualifications. Officers must be physician Members in Good Standing of the Active Medical Staff at the time of their nomination and election, and must remain Members in Good Standing during their terms of office.  Failure to maintain such status (except for suspensions for failure to complete medical records lasting less than thirty (30) days) shall create a vacancy in the office involved.

13.1.3   Nominations. Nominations shall be from the floor, either in person or in writing and will be recognized if the nominee is present, qualified and consents, or is qualified and has consented in writing to the nomination.

13.1.4   Elections. The Vice Chief of Staff, Secretary and Member at Large shall be elected at the annual meeting of the Medical Staff in November.   The Chief of Staff position shall be filled by succession of the current Vice Chief of Staff to that office; therefore, the Chief of Staff position need not appear on the ballot.

All Members of the Active  Medical Staff and Courtesy Staff in personal attendance at such annual meeting shall have one vote.  Officers shall be elected by majority vote.

12-19-2014 Jay Turk MD sent a formal grievance to Ray Reynolds about the unfair slate of officers for 2015

            Dear Mr. Reynolds,                                             

I was shown an email last night that showed my removal from the medical executive committee. Since I have been here there has been a persistent pattern of rotation through the medical executive committee by the medical staff. I have never seen anyone suddenly removed from that rotation. I find it to be highly unusual that this occurred so quickly after reporting patient safety issues, reporting on the falsification of hospital documents, and filing a formal request for accommodations for my disability. I believe this was initiated by the administration of Glen Rose Medical Center for a couple of reasons. First, I know that the majority of the other local physicians have expressed some of the same concerns that I have. Secondly, this continues the pattern of retaliation that I have witnessed at the hands of the administration of this facility. Having been on the receiving end of this retaliation, I can certainly understand why the other physicians would not want to express any of their concerns openly.

I believe that anyone that has worked with me would have to truthfully say that I provide quality medical care to my patients and that I vigorously fight to protect them. My entire struggle during all of this has been to protect my patients, to protect the nurses from being placed in situations that would risk their licenses and their livelihood, and to protect my ability to take care of my patients. Even though some of the other doctors may disagree with me for taking on the patient safety problems head on, I believe I have exhausted every other avenue to bring about improvements. I also think they would have to agree that if this results in the saving of even one patient’s life it will be worth it.

Based on the above finding, and due to my past experience with this administration, I am forced to write this letter as a formal grievance.  A copy of this formal grievance will be forwarded to the hospital board.

Respectfully,

Jay Turk M.D. DABFP,DABSM

12-29-2015: (on or about): someone from the hospital reported Jay Turk MD to the board of nursing. 

1-6-2015: Jay Turk MD received a letter from Ray Reynolds CEO in regards to Jay being removed from the medical executive committee. 

 

1-15-2015: Shelley Turk RN received her notice from the board of nursing that there was a formal investigation due to a complaint that they had received from someone from Glen Rose Medical Center. 

1-18-2015: Shelley Turk RN wrote her 2nd grievance letter to Ray Reynolds

            1/18/2015

Mr. Ray Reynolds,

This is a formal grievance against Glen Rose Medical Center.  I am filing this grievance due to the continued harassment and retaliation towards me from personnel in this facility.   The most recent attack against me was the false accusation to the board of nurses that I was practicing outside my scope of practice.  The procedure in question has been performed in our hospital on the same patient approximately every two weeks over the past nine months. Dr. Turk has had many nurses and students assist him with this procedure. There has been no other complaint on any of the others.  I continue to be singled out because I have consistently taken a stand for patient safety and have reported problems including the falsification of medical documents.   A copy of this will be forwarded to the Glen Rose Medical Center hospital board.  Shelley Turk RN, MSN

1-28-2015:  received the DSHS report 3 years is correct.   

1-29-2015: Jay Turk MD received notice from the Texas Medical Board that someone sent in a complaint against him.

2-2-2015: Shelley Turk RN received a letter from Ray Reynolds responding to her grievance she turned in on 1-18-2015. 

 

 

 

 


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Comments!  
1 - salon   7 Jun 2016 @ 7:58:03 AM 

Was looking at this again, this part is very disturbing to me. 

Ray Reynolds sated that he did not want Shelley Turk to ______ any more complaints by email.  He said that everything that is documented can be accessed through open records request and he did not want the board of the hospital to find out what is going on in the hospital. 

Repeating this. HE DID NOT WANT THE BOARD OF THE HOSPITAL TO FIND OUT WHAT IS GOING ON AT THE HOSPITAL............................


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