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Archive for Sunday, April 23, 2006

Checking into Lawrence Memorial Hospital’s Emergency Room

April 23, 2006

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A sexual assault victim is in one room.

A Kansas University student with the mumps is in another. She's running a serious fever.

Christee Thoman, a mother of five, is here with her 2-month-old son, Finias.

"He has some kind of pneumonia," Thoman says. "He's been coughing for like two or three minutes at a time. It's pretty bad. He's been turning purple."

By 11 p.m. this particular Saturday, most of the 16 beds at Lawrence Memorial Hospital's emergency room are full. They'll stay that way until about 3 a.m.

"We're not some podunk emergency department," says Dr. Scott Robinson, director of the emergency department. "Thirty thousand visits is big time. We see everything - soup to nuts."

The department last year logged 30,138 patient visits - an average of 85 per day.

Among the emergency rooms in and around Kansas City, only two - "Shawnee Mission and KU Med," Robinson says - are busier than the one at LMH.

It is busy and cramped.

"This emergency room was designed for seeing 17,000 patients a year, back in the 1970s," Robinson says. "That was before the advent of computers. So if you look around, you'll see that just about all the available counter space is taken up with computers. There really isn't a place to sit down and write."

And not all the rooms are as functional or as private as they could be.

LMH Endowment Assn. recently launched a $40 million fundraising campaign aimed at converting the hospital to all private rooms, improving surgery and nursing facilities and building a new maternity ward and a new emergency department.

"We hope to have a new emergency room in two years," says Robinson, who's also on the association's board of directors.

If all goes as planned, the new emergency room will take up the first floor of a three-story addition to be built near the hospital's Maine Street entrance. The second floor will be an expanded intensive care unit; the third floor will be obstetrics.

The new emergency room will have between 22 and 25 beds.

'Vital service'

Though owned by the City of Lawrence, LMH is considered a nonprofit, stand-alone community hospital. It is not subsidized by the city or by Douglas County.

That doesn't mean it's a money maker.

According to LMH records, the emergency room cost the hospital about $15 million last year. Its billings brought in $13 million. The hospital ended up writing off another $4.6 million in uncollected E.R. payments.

"Emergency rooms don't make money," says Janice Early-Weas, director of community relations at LMH. "They're considered a vital community service. They're what hospitals do."

Almost half the people who used the emergency room last year had health insurance. Twenty percent were covered by Medicare.

"We see a lot of elderly," Robinson says.

They're why Sundays and Mondays tend to be the busiest days.

"What happens is that for whatever reason, they can't get in to see their doctor," he says. "They try to make it through the weekend, but they can't. So by Sunday afternoon or Monday morning, they're in the emergency room."

Sunday censuses also are driven by so-called lawnmower trauma - injuries suffered while working in the yard or on the house.

"Yeah, that's me," says Brent Ojanguren, who fell off a ladder painting his house in Baldwin. "I fell about 10 feet and then I fell down another 10 feet of stairs. It feels like I cracked a rib or something."

Actually, he cracked three vertebrae. A deep cut on the back of his head had to be stapled shut.

"I'm an idiot," Ojanguren says, laughing at his misfortune.

He praises the emergency room staff.

"I've been here two hours," he says, "and they've kept me well-informed. I've been well cared for."

'Some dude syndrome'

Saturday nights often are busy with young adults who've either passed out after too much alcohol or been in a bar fight.

"We call it the 'some dude syndrome,' as in 'I was just standing there and some dude hit me,'" Robinson says.

That's sort of what happened to 22-year-old Nick Huckabey, who drove to Lawrence from Overland Park to celebrate a friend's birthday at Abe & Jake's Landing, a popular night spot at 8 E. Eighth St.

"I was just hanging out," Huckabey says, "and this guy was getting beat up pretty bad - getting kicked in the head and stuff.

"There weren't any bouncers around, so I tried to stop it. The next thing I know, I got hit."

He lowers an ice pack to reveal a deep gash between his lip and nose.

"My whole face is numb right now," he says, letting a nurse know his anesthetic had taken effect.

Because Huckabey's lip, Robinson says, was cut "through and through," the on-call plastic surgeon, Dr. Lee Reussner, is called in to do the stitches.

It's now a little after 2 a.m. Sunday.

"If it were up to me, 'last call' would be midnight at the latest," Robinson says. "I can't think of a good reason for people to be drinking at two o'clock in the morning."








Some nights you don't soon forget:

Some memorably busy nights at the Lawrence Memorial Hospital emergency room:

¢ May 19, 2005

"The night (then-KU basketball player) J.R. Giddens was stabbed stands out," emergency department director Dr. Scott Robinson said, referring to the altercation at the now-closed Moon Bar, 821 Iowa. "J.R. suffered a pretty serious injury," Robinson said, "but people tend to forget that one of the other victims was in here with his intestines hanging out."

¢ Aug. 28, 2002

After stabbing his 11-year-old developmentally disabled son and leaving him to die on the Kansas Turnpike, a Missouri man, Raymond Boothe, crashed his car in Lawrence in an apparent suicide attempt while his three children were asleep in the back seat. "We had three kids in here who'd been in a potentially fatal car accident," Robinson said. "And then, in another room, we had their father who was, let's say, unstable." Boothe, he said, became belligerent. "He had a policeman down on the floor," Robinson said. "We had a security officer at the time who had a black belt in karate. He ended up on the floor, too."

¢ Oct. 7, 2005

"The Boardwalk Apartments fire - we had a lot of orthopedics that night," Robinson said, referring to injuries caused by tenants jumping out windows or off balconies. "We were plenty busy that night before the fire," he said.

¢ Dec. 25, 2005

"We had five intubations, right in a row," said Jessica Osburn, a registered nurse, referring to the delicate procedure of putting a tube down a patient's throat to keep the patient breathing. Two or three intubations is typical. Five in one night is unheard of. "Holidays are stressful," Robinson explained. "They push our emotional and physiological reserves to the max, and when those reserves are spent, underlying diseases take over. I'm convinced of that."

Comments

offtotheright 8 years ago

Everyone posting here should be looking into it. Could be usefull.

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mztrendy 8 years ago

ragingbear, you obviously haven't been to LMH lately. They now have a mental health assessment screening room with a whole new process. You should look into it.

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offtotheright 8 years ago

Curiosos_husband, How much did that ambulance ride cost you?

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wolfmn58 8 years ago

I have lived in Lawrence for 30years,and have been to the ER a number of times. I have yet not seen of one of these 4hr waits that some of these posters are talking about.

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Vince2909 8 years ago

We should rename the ER to the "I expect to be seen right now because I'm too damn lazy to go to my regular Dr."

That's why you experience the four hour wait. The other moron's there in front of you... ;)

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Susan Mangan 8 years ago

I think the ER at LMH is very good. I worked there, briefly, years ago while I was in school. The assortment of cases they get is astounding for a town this size. Since the closest "major" hospitals are in KC and Topeka, LMH handles all types of emergencies from a several county area. They have to transfer some patients to other hospitals, but they do an excellent job, overall. I have spent the last few years as an RN at a Trauma Center in KC, and I still think LMH has an excellent ER.

I've witnessed them treat everything from bug bites to gun shot wounds to the head. I will never forget the night we had a 1 week old baby coding at the same time a man in his 50's coded. Three-fourths of the staff was working feverishly trying to save the baby (which DID survive, I might add) when, out of the blue, the gentleman went into pulseless V-Tach. He had come in complaining of shoulder pain and, while that IS a possible symptom of a heart attack, he had been playing football that day and thought it was probably an injury from that. This was at around 4:00 am, when the staff is usually at it's lowest level. The man was treated, survived, life-flighted to Kansas City, and recovered. The baby was treated, survived, and transported, by ambulance to Children's Mercy. The staff was professional and outstanding.

But I also remember the two most irritating cases...both were ambulance calls. The first was a woman who had (literally!) stubbed her big toe the previous day and called an ambulance because it still hurt. They transported her because they were required to. The other was a woman who called an ambulance because she had been bitten by a spider earlier in the day and "it was still red." Those are the types of patients that make the ER worse for everyone. Patients coming in by ambulance get into a room immediately, making everyone else wait.

I could name several ER's in the KC Metro that you couldn't pay me to go to. But I trust the staff at LMH to treat me and my family professionally and thoroughly.

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rightthinker 8 years ago

OK, you mean Republicans, tight?

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Multidisciplinary 8 years ago

RT..where have you been?..the LJW BOARDS are for the mentally ill! And we have the posts to prove it!

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rightthinker 8 years ago

This comment was removed by the site staff for violation of the usage agreement.

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Godot 8 years ago

I wonder if the people receiving treatment gave written, informed consent to have the details of their medical conditions published on the front page of the newspaper?

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QAS1956 8 years ago

I'm glad most of you have had such wonderful care at LMH. I wouldn't take my sick dog there.

When my father got up one morning complaining of pains in his side, we took him to the ER at LMH. After there so called expert diagnosis, he was told it was just kidney stones. They gave him a shot for the pain and sent him home. After 3 -4 days of not getting any better, his doctor decided they should do an abdominal scan. They discovered he had a burst apendix and that from the looks of them during surgery, they had burst while he was at the ER and the shot they gave masked the pain. By the time that was found out, he had gangrene and almost died. When talking to other doctors and telling them our experience their first reaction is "How in the world could the ER have missed that?"

Our next so called wonderful experience was when my parents were in an auto accident. My mother was taken to the LMH ER by ambulance. After her arrival, the doctor and a nurse were removing her from the backboard because they thought she might have neck or spine injuries. They picked her up off the board and DROPPED her on the exam table. Just the thing you want to do when you suspect someone with those type of injuries.

When I lived in Lawrence, I always told people if I had a heart attack or whatever, don't take me to LMH, take me to Kansas City. I'll take my chances. I now live in Springfield, MO and sure am glad I never have to step foot in LMH again. It is the only hospital I know where a person can die from the common cold.

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smitty 8 years ago

ragingbear, you were the patient in crisis while I accompanied those in crisis It makes sense to me that your description of the experience is quit different than mine. I wasn't the one in crisis. If the two that I accompanied were to describe the visits, I'm sure their perception is different than mine.

Still stand by the efficent and qualified attention rendered by the ER in the intervention of these two mental health consumers.

Ladylaw, the ER wasn't the first place for treatment nor the last. Both are under care of professionals. In one case the meds were not working and intervention was needed. In the other case meds were not taken as directed thus an intervention was needed. In both cases there was a possiblity that either one could be committed. The ER was able to sort through all the details to make appropriate referrals.

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Terry Bush 8 years ago

While have as yet not been to the LMH ER for anything mental related, I have had the (mis)fortune of visiting it fairly often over the last 20 years. With my son it was stitches and some mysterious vomiting disease. My mom had what turned out to be something needing surgery. Dad had flu so bad it mimic'd a heart attack for quite awhile. My husband had an asthma attack that had him almost purple from lack of air. And I almost cut off a finger in a car trunk. The ER staff in each situation could not have been more timely, professional, helpful, and sympathetic. They did the best they could in each situation, and made us each feel like there was hope and help. I am not a huge fan of the medical professionals in general, having seen the problems there are in correctly diagnosing and then treating some people's health problems. But the ER folks are the best of the best in my book!! They get right down to brass tacks, and fast. For those whose medical problems are the type that require long term treatment (like mental issues) ER probably isn't the first place to start. But for a genuine emergency health crises... the ER staff at LMH are all aces in my eyes!

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lawrencechick 8 years ago

Raging bear ,I'm not sure what hospital you were at. The mental health rooms have a desk, computer, chairs, TVs and no pop machine. Of course it's going to take 3 or 4 hours. Do you think a full mental health screen is like doing an eye exam? Or that there are people just waiting for the moment you check in with your problem so they can drop all the patients before you? It time to start some Lexapro and maybe you won't be "raging" anymore.

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curiosos_husband 8 years ago

I once had very persistent, severe chest pains, that got worse, not like heart burn. I called to go to my doctor's office right down the road. They know my medical history.They heard my description, with all the facts, and told me to call an ambulance immediately, to NOT drive myself under any circumstances. So I called. The ambulance arrived, they started all the procedures required. They hooked up for an ekg. One mentioned I was throwing PCV's. The other two determined that with all of the symptoms I had, while they were taking me to the ER, it was most probably not heart related, my doctor's office had just done a knee jerk reaction without taking all of the information into account. The one EMT who had mentioned the PCV's got a bit defensive, I could tell he felt the other two were a little out of line. Mind you, I was not arguing or protesting, I was in enough pain, I didn't even want to talk. At times I was so faint, I was very surprised. During the ride, a few more "rude/reprimanding? comments were made. It made me feel very uncomfortable,(all while in great pain) to have ambulance personnel making these comments, when my doctors office had ordered me to make this call! I had been willing to get checked out at the doctors office first! They were the one's to take my medical history into account and decide it was a danger for me to drive and that I was a high risk for to it be a real heart attack. The ER staff was kind, did what was necessary.They were busy...discovering a patient from out of town who had been beaten by her SO, head injury, had been sent home by that ER...(didn't press charges) headaches for a week, came into LMH, they found she had a brain bleed, and they were sending her to KUMC. (What did she do? Call her daughter to call her boyfriend and threaten him, "if this kills her,her daughter is going to make sure he PAYS for it!" Her DAUGHTER is supposed to call and threaten the boyfriend!)And no, she had no insurance. I did.

I will never call an ambulance for myself again. If I cut my arm off using my chainsaw trimming trees, and am bleeding profusely, you all better just stay out of my way and hope I don't pass out and kill you before I get all the way across town. I'd hate to go through burdening the ambulance boys again.

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Ragingbear 8 years ago

Smitty, don't try to BS a BSer. I have had to use the services at our hospital several times. From the point where we had a mental health ward, to within the last few months.

Whatever you saw, or whatever crap you were told was wrong. I was there, that is how I witnessed it. Because I know for a fact that it never goes as smoothly as you stated.

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ronin 8 years ago

And why don't more people have insureance???

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ronin 8 years ago

I thought one of the biggest problems with ERs is the fact that so many people don't have health insurance. And the fact is that most of the uninsureds are not illegals or meth-heads.

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Solti 8 years ago

I sure can sing our ER's praises! Our family has been in there twice since we moved to Lawrence and both times we have been very, very pleased with the quickness, friendliness, and knowledge of the staff. When our daughter when in, she was in pretty bad condition and they got her stabilized and admitted very efficiently. Thank you all who work in that department!

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glisp42 8 years ago

Do you have a cite for these facts?

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rightthinker 8 years ago

Oh and I meant to mention glisp42.....Larrytown does not represent America as if it were some case study fo ER's.....my comments point to the trend across America.

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rightthinker 8 years ago

Don't get out too much, do you glisp42.....my points are very general, but true as a big part of ER woes.

You can break it down further....many of my general points also overlap,ie, drug users=no bennies, illegals=bennies so go to the ER. Also, society is so friggin' neurotic, if they have a swollen lymph node, they hit the ER, and it again may be due to the fact they have no insurance.....ERs' dont' turn those people away and they know it......wake up!!

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glisp42 8 years ago

How nice it must be for you to know everything there is to know about ERs. Ride your high horse often?

Personally I would prefer if people erred on the side of caution when it comes to their health. I'd rather have that than people dying on the streets because they didn't think their problem was "serious" enough to go to the ER.

Re: Meth users. Did you even read the article? it said most of the injuries were a)home improvement gone awry, b) bar and alcohol mishaps and c genuine emergencies. Please point out where it mentions meth users in the article, or find some statistics to back up your claim.

Re: Illegals. This is an obvious hijack attempt and I'm therefore not going to discuss it here. If you want to discuss illegal immigration, stick to the illigal immigration threads.

When I got hit by a car, the staff at LMH were very professional and caring people. X-rays and diagnosis was very quick and I left there with a plan already set up.

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rightthinker 8 years ago

This comment was removed by the site staff for violation of the usage agreement.

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smitty 8 years ago

Ragingbear, you so wrong!!

I have been present for two mental health patients in the last couple of weeks and none of what you sputter is close to accurate.

The patients were met at the in take window for a quick prescrening to evaluate immediate priority or regular rotation.

One was immediately taken into the triage a room before being placed in a private ER room. The other was less sever and waited in the waiting room until their rotation came up.

The service was immediate and appropriate for both patients.

When the vitals and health screen was completed and health issues treated the patients were then moved to one of the two mental health rooms.

The screener is a profesional social worker with experience. The SW co-ordinated services that were appropriate for each individual. It took time for this process but it was through and adequate.

The social worker arranged for transpotation to the proper out of town facility in one case. In the other the SW made calls to Osawatamie and Bert Nash to decide proper care and then referred to the proper agency immediately. We left the ER and went to the appointment with a mental heath provider who took over from there.

There was no questionair, there was one on one discussion. There was timeliness. There was not a soda machine or student nor backroom shuffling.

The patients both were fed a meal due to the time frame this all took since the lunch hour passed before all the co-ordination could be completed. The LMH ER staff was gentle and considerate.

Your version of things suck at times. You loose much respect for the valid points that you are capable of relaying when you so grossly misrepresent the situations.

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wolfmn58 8 years ago

Ragingbear,Do you ever have anything nice to say? I have a type of staff infection that likes to pop up ever now and then.If it was'nt for this ER and the rest of the hospital I would of lost my leg and arm to this infection.I have never waited more then 45mins.I have never had a college student that was a screener.I also have never been asked a ton of questions from a questionair. Don't blame LMH for the lack of a mental facility, blame the state of Kansas for taking away the funds.

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yankeelady 8 years ago

typical ER. Do they operate in a vacuum? Is there ancillary staff also? Does LMH have xray, RT, lab and pharmacy? I'm sure the staff in those areas are also dedicated and cramped for space. It would be nice to see the whole picture. The ER is the tip of the iceberg, without support staff, they don't function.

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Ragingbear 8 years ago

Dr. Soda machine. Go in there for a mental issue, and they will place you in the dictation room. There is a soda machine, a table, and a chair in there. You will wait for 4 hours or more until a screener will visit you. All a screener is is a college student that is studying under Bert Nash. They have a questioniar, and the score determines whether you can stay. You are either then sent out, or you are then placed back in the room for another 4-8 hours as you wait for transport to a mental facility in Topeka or whatever.

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smitty 8 years ago

For whatever reason the two private rooms for the mental health were left out of this story. These rooms are to the right of the area drawn.

To occupy these rooms a patient must go through the ER triage, have gerneral health evaluated and treated including lab tests before assignment to the mental health holding rooms.

It's the same doctors and nurses that do this time consuming effort for the mentally ill even after assignment to these holding areas.

Unfortunate that the mental health aspect is curiously not included in this story. They do an excellent job with this process that is all part of the ER.

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pundit 8 years ago

Great article. Dr. Robinson and his staff are a great asset to the town.

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