San Augustine woman denied overnight hospital admission upsets family

A San Augustine County family that cares for their 89 year old relative is upset that they didn't receive the expected overnight hospital admission that they expected after Willie Mae Consford, 89, took a bad fall.

The family has been caring for Consford since September in her home. "Since then we've been 24-7 with her. We take turns as a family," said her daughter Mary Hakenewerth.

But on Sunday morning the caregivers recognized their limitations. Consford fell. A broken wrist and nose, bruises and bleeding told her daughter she needed to get her mother in a hospital. With their family doctor on vacation, Consford was transported by ambulance from a San Augustine hospital emergency room to Nacogdoches Memorial Hospital's ER.

"I could see the obvious damage she had. I knew we needed extra help with pain relief for the night," said Hakenewerth. To the family's surprise, the patient covered by Medicare and a supplement insurance policy was not allowed to stay overnight for observation and pain relief.

"The ER doctor does not have admitting privileges. The orthopedic doctor that set her wrist and checked her nose and the contusions said that he had done his job. He had no reason to keep her," explained Hakenewerth.

The family was persistent. They say the ER doctor called four physicians to ask them if they would admit the woman. Not one accepted the case.

"Is it because of Medicare regulations that doctors are afraid to admit somebody just for 23 hours for observation? That's what it looks like," said Hekenewerth.

Consford's granddaughter Betsy Fuller posted her frustration on Facebook along with the image of her grandmother's injuries. It has been shared with thousands of others.

"Even if my story stops it from happening from one more person, then it is worth my story out there," said Fuller.

For Mary, the Memorial Day weekend ordeal was disrespectful to the woman who influenced a long line of military servants.

"It's (the regulations) taken common sense out of a doctor's hands."

Hospital Reaction

Nacogdoches County Memorial Hospital could not address the Consford case specifically due to HIPPA regulations and not having the family's permission. Arrangements for a family member to sign the release papers couldn't be arranged immediately.

The hospital did explain its policy in this statement.

At Nacogdoches Memorial Hospital, a patient is first assessed by an emergency physician to determine if they are experiencing a medical emergency and if a higher level of medical attention is needed. Hospital protocols require the emergency physician to consult with physicians in whatever specialty is needed for a particular patient's needs, i.e. Orthopedic surgeon, general surgeon, internist, cardiologist, etc. (the emergency physician can also, after assessing the patient's condition and determining that admission to the hospital could be necessary, call in the patient's personal physician, if the patient requests.)

Once the referring physician has been consulted, the patient's care is turned over from the ER doctor to that consulting physician. Emergency room physicians typically don't admit patients to the hospital, because they are not able to "follow" the patient and provide the continuation of care needed during a hospital stay. (Every patient staying in the hospital has an attending physician, who directs the care given.)

Federal law directs hospitals to render care that is reasonable and necessary for the diagnosis or treatment of illness or injury, but the Centers for Medicare & Medicaid Services states that inpatient care, rather than outpatient care, is required only if the patient's medical condition, safety or health would be significantly and directly threatened if care was provided in a less intensive setting. Patients are admitted to the hospital for medical care that requires constant monitoring or intense services, like intravenous medications, specialized testing and surgical interventions. Hospitals are tasked with providing proof of "medical necessity" for all care provided to medicare patients. The federal government (CMS) penalizes hospitals for inappropriate admissions. The decision to admit is a complex medical decision and occurs only after a thorough medical exam is done by a physician.