Good Florida Hospital Bad Florida Hospital
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Hey everybody, this is Tina again with Good Nurse, Bad Nurse. Welcome back to another episode of this podcast where we take stories...

from the news and use them to shine a light on things that are going on in healthcare. And we like to do both good and bad stories. And this episode is definitely no exception to that. We've got some really interesting things to talk about. And I have an old friend of the podcast, Roger, back to record this episode. Welcome back, Roger. Hey, Tina. Hey, everyone. Hi.

Happy to be back, citing, telling crazy stories. That's what we do. So for this episode, this is good nurse, bad nurse, but I feel like, you know, for those of you who are new to the show, you'll find out quickly. It's not all about nurses. We do a lot of stories about nurses, but

There are lots of health care professionals working out there, and we want to shine a light on all of those people. And sometimes we come across a story that sort of falls under a broader umbrella. And that is sort of what we're going to be talking about today, today's story. We're going to be talking about a hospital system.

Right, Roger? Yeah. That they lost a lot of money. Mm-hmm. This was a recent, like, Roger sent this to me, um,

We kind of messaged each other. He's always sending me stories and we send each other, you know, little memes and stuff. And so he'll send me a story and I'm like, what? You know, what is going on? And this was one of those. A Florida jury has awarded $45 million to the estate of James R. Seda, a 55-year-old man, oh my gosh, so young, who died following a heart attack in July of 2020. Now that year,

piques my interest. Should all of us. It should all of us, shouldn't it? The lawsuit filed in the Ninth Judicial Circuit Court of Florida alleged that Orlando Health and cardiologist Dr. Vijay Kumar Kasi were negligent in their care leading to Sada's death. So let's talk about the timeline of what happened that led up to this. The reason before we get into the timeline, though, Roger, I do want to point out

that there was legislation in some states that protected health care facilities and health care. Well, I'll say health care facilities. I don't know if it extended to providers, but it protected them against a lot of negligence during that just that year.

Because of all that was going on due to the pandemic. And I don't know if Florida was on that or not. Yeah, they had the emergency exemptions for that period of time. I do remember that. I know that the state of Tennessee had it because there were some things that came up. There were some headline news events that happened in some hospitals and that

They would have resulted in legislation had that law not been enacted. But I don't think it was federal. I don't think I think it was state to state. And this makes me think that Florida maybe didn't have something like that going on. Florida was resistant to a lot of changes during that period of time. So they may not have seen a need to do anything different than what they were already doing.

And since this lawsuit went forward, it makes me believe that there were not any protections during that period of time. That's what I was thinking, too.

So as far as the timeline of what happened, on July 26th of 2020, James R. Sada, I'm not sure if I'm saying his name right, Sada or Sada, it's S-A-D-A. He experienced chest pain at home. EMS was called. They responded and diagnosed him with a, with an STEMI, ST elevation myocardial infarction.

He is transported to Orlando Health South Seminole Hospital, which does not have a cath lab. And I'm always like, how does that work? And I love doing these stories with Roger. Oh, my gosh. He is just a... Well, I get so excited. I'm like, I can't wait to talk to Roger about this because he can answer that. I don't have to just sit here and pontificate and just like wonder. I can ask. But...

you know, don't they need to take them to a hospital? If you literally see a STEMI, do they not have to go to a hospital that has a cath? They're supposed to. And the standard of care is that if you see a STEMI on the 12 lead, when you do that, you're supposed to take them to a PCI-capable facility. I'd

I have seen just recently still that EMS systems will still carry patients to a non-PCI facility because of local resources. They're not allowed to go out of their jurisdiction because they have a limited number of ambulances. But I can't see that this would be that issue in Florida.

They have generally very robust fire EMS systems. Being originally from Florida myself, the fire departments usually have very good coverage. And I can't see where that would be a reason. So I don't know why he was taken to a facility that was not able to address that issue other than their policy.

The only couple of things that come to mind, one, family insisted that they go to that facility. We can educate families on the need to go to a different facility, but ultimately, if the family or the patient insists, we have to take them where they want to go. Really? Secondarily, if they are like,

seem very unstable maybe, and I don't know what the distance between these hospitals are, that they may needed some stabilization of some sort that they could not provide in the ambulance, that they may stop temporarily to kind of stabilize the patient and then transfer. That is a possibility. Generally, even if the patient is unstable, you know what the problem is and you know what the fix is going to be for the patient. And you just kind of have to

Do what you need to do and get them to the PCI facility to take care of the issue.

So I don't know why. That's local protocol and you should go to a PCI facility. If you are having a STEMI, I would be requesting, even if it's 40 minutes away, please take me to the PCI facility. That's where I need to be. Don't stop. Are you allowed to like start a heparin drip or anything like that in the actual ambulance? They generally do the heparin bolus. We used to do just 5,000. It's IV.

Um, so it would be aspirin, heparin, and I don't think EMS is doing, but then Berlenta they can do. And then, um, I think what are other protocols? Of course, pain control, you would withhold nitro if it was like a right-sided MI. Um, so yeah, they do have some, you know, treatments that they can do to, um, help, you know, with, uh,

stopping any clotting action that has already started, stopping that cascade. And then also... And kind of relax everything so that it can help with the blood flow. And there's been times that I've had patients that I've done a 12 lead, they have a STEMI, do my therapies. And by the time we get to the hospital, 15, 20 minutes down the road,

you see that elevation has decreased. So it makes you think that they may not have had a complete blockage and it may have been a spasm. And now we've got some blood flow. And so you are getting kind of past that. And some of the cardiologists have, they've said, you know, when they've met us in the ambulance bay, they'll look at the latest 12 lead and go, yeah, it may not be there now. We've had STEMIs resolved.

And they're like, but you were having a STEMI 20 minutes ago. So we're still going to the cath lab. Yeah, something's definitely going on. We're still going to the cath lab. And they will find that they either have like a

a partial, like an 80, 90%. Yeah. Or I've had a couple of those that still had 100% blockage, but they still, they no longer had elevation. Some collateral flow. Yeah. Yeah. Yeah. Wow. It's so sad to think. I hope that that didn't happen, that the family was asking to go to a different facility. But this is a little perplexing to me. It's Orlando. That is a large city in the state of Florida. I know for a fact, I work for

I'm a transfer coordinator. I know for a fact there are a lot of hospitals in the state of Florida, lots of them. And now whether or not how many are capable, you know, have a cath lab or capable of doing a PCI in this in the city of Orlando. But I have a hard time believing that there aren't a few. So this.

This was perplexing to me already off the bat, early on in this story. I'm a little bit kind of scratching my head as to the decision to go to a hospital that did not have a cath lab if you truly found that the patient was having a STEMI while you're in the truck. So approximately one hour later,

Okay, time is heart muscle, people. Approximately one hour after arrival, he is airlifted to Orlando. And I guess that's not really a long time if you really think about like, he's literally, if he truly was airlifted an hour later, maybe that's not like a really long time. Just based on like the time that it takes, like once they get there, get in the door, determine, oh, yep, he's definitely having a STEMI.

let's consult, let's get, they got to get on the phone to a PCI capable person.

facility. They arrange that. They get a cardiologist at that facility who says, yes, we'll absolutely take them, get them over here. We'll send them straight to the cath lab. They're on the phone with the house supervisor. They're on the phone with transport. They're getting it all arranged. I still feel like an hour. An hour still feels like a long time to me. It does. When I'm working out at one of our satellite facilities and we get, we're on the

STEMI page so the second they call a STEMI we're also notified and we immediately go to the bedside and so and basically the once the STEMI is called we're under that clock so we go in and we basically take over so we work with it if they've got medications that have arrived but yet have not been started we'll just gather all of that up and we'll do that in route um

So that that's kind of how we handle it from a critical care transport standpoint. So our our times are very quick. Just as soon, like I said, that STEMI is called if it's at a facility that we are physically at, we're at the bedside. If not, then we are on the way. So we have two facilities that that are not PCI facilities.

if they call a STEMI. The furthest is probably 15, 20 minutes, maybe 25 minutes, depending on rush hour traffic. But we're, you know, we're on the way and they, we call and say, hey, we're 15 minutes out just to make sure that they have everything, kind of all the paperwork done. And this is kind of where I think EMS needs probably a little education and now working on the hospital side,

Once you're in on property of a facility, got this little thing called EMTALA and that patient can't move until EMTALA is satisfied. And that takes time. That's whether it's a trauma patient, STEMI, stroke. And it can be within the same health system that still has to be done and signatures have to be done.

And that's one of my frustrations is that you know this is a STEMI, bypass that local community hospital and go to the facility that can handle this because

based upon law. They arrive in that facility. Certain things have to be done before that patient is transferred out. Conversation, like you said, conversations have to happen. Yes, you know trauma is going to accept the patient. You know the cardiologist is going to accept the patient. But you got to get that cardiologist on the line and talk to the ER physician and say, hey, I got a STEMI and it is this. And they're like, yep, send them on. You know, that's still five and 10 minutes waiting for that physician to make contact. You're getting

getting paperwork because that physician has to be on the EMTALA. The physician's name, the time they accepted. There has to be an admin approval for the accepting facility. And the times are very important.

They, they, if they were to be audited for this, and some states are very, because I work in all across the country, some states are, oh my goodness, like, we all have to be on the same page. Like, I can't say as the transfer coordinator that the doctor accepted at this time, and then the hospital that is accepting said that they accepted at a different time. They all have to match up. So...

You know, EMTALA is a federal law. That is a federal law. And where you think, well, a life is on the line, surely you don't have to worry so much. Oh, no, no, no. You're talking about hundreds, like a $100,000 fine that a hospital can get if there's an EMTALA violation.

And if you're not within network of the hospital system and that was to happen, like you said, even under normal circumstances, when they come in and are doing audits and evaluations, they're looking to make sure that paperwork matches up. It's not a matter of, oh, I see the EMTALA. They read the EMTALA. They go into the patient's chart. They look and make sure that all of that adds up because they're looking to make sure hospitals didn't after the fact

do an EMTALA to satisfy their roles. And that form has to be filled out before the patient is transported. And it has very specific questions that have to be answered. When I was working as a travel nurse and I was working in an ICU in a little hospital where patients got transferred out a lot because we just didn't have the resources there to handle some people, you know, once they got to a certain point, you know, hello COVID. But, yeah,

Yeah, that inteliform could shut down a hospital, you know, a little hospital where they, you know, if they get an intel violation. So those questions are like, is this required for life and limb? You know, there are very specific questions that have to be answered. And I feel like people listening are going, you guys are blowing this way out of proportion. I promise you we're not. We're not. That can cause some of the biggest delays. Yes. In fact,

They're like, wait, wait, wait. I don't have a copy of the EMTALA. I'm like, I don't need a copy of the EMTALA. I just need to know that it's done. If you say that it's done, that's on y'all because you're taking the responsibility for making sure that it's done. What is your name and your title? I'm going to document that you told me that it was done and therefore now it's on you. So yeah. But if it's a STEMI patient, I'm not waiting on you to go print out a copy of it. But if you say it's there, I'm going to trust you that it's there. Yeah.

because everybody knows the importance of it. But there are other, I mean, if now that's within my health system, if I'm going to a hospital system outside of my system, I am taking a copy of that EMTALA. I have actually been asked by a physician to see the EMTALA.

It's not something to be taken lightly. No, it's not. And there are rules. A medical doctor or a DO MD has to be the one to actually sign, officially sign off. A nurse practitioner can, quote, order the transfer or do a nurse practitioner or a PA can do like the conference. But a

a medical doctor or a DO has to be the one to sign off on the EMTALA. And there are some physicians that will be like, wait, I'm not talking to a nurse practitioner. I've got, you know, I'm not talking to a PA. I need to talk. It's not necessary, but I get why, because it's so scary. That's how scary this whole EMTALA thing is. And so while you have, so we're sitting here, you know, Roger and I sitting here talking about

A very serious time sensitive. There are very few things in health care that are so time sensitive that you would literally like that health care people like emergency room and ICU nurses are actually going. I'm in a hurry. I got to get this done quickly.

A STEMI is one of those. A STEMI is one of those things where we are like, this has to happen as quickly as possible because that heart muscle is in the process of dying. It is losing oxygen. So we're literally, you have

Healthcare professionals who are under the gun trying to save this heart muscle, and at the same time, we're competing against this whole entail law. Right? That's what it feels like. It is. It is. Sometimes it's like an uphill battle.

especially if you're a newer nurse and you may not know how to do the EMTALA. If it's electronic, ours are electronic, you know, and you got to make sure the physician has done their part because you can't finish it unless the physician has done it and signed it. You can't finish it out because it requires, I think ours requires the last set of vital signs to be put on it, like before they leave. And sometimes that's a hindrance because the nurse is like, I'm not giving you the EMTALA until I get a blood pressure.

And you're sitting there going, okay, got to go, got to go. So, you know, at this point, you know, he's been at the hospital for an hour. So even though...

You know, Roger and I are trying to emphasize, you know, the things that can the pitfalls and the obstacles that can happen when a patient arrives to a hospital that they're then having to be transported to a different facility so that they can get the resources that they need. Even with that, I feel like an hour, an hour feels like a long time. I just feel like that sounds like a long time that he was there.

Yeah, he was there for an hour before he was airlifted to Orlando Regional Medical Center. But apparently bypassing closer hospitals equipped to handle his condition. So you've got, I'm a little, like, think about this. You've got Orlando South Seminole Hospital. I'm not that familiar with Florida. But South Seminole Hospital, wherever that is.

They that's where the patient ended up initially. They do not have a cath lab. A cath lab is where you're going to go if you're having a STEMI. They're going to go in through your leg, most likely through your thigh and run, you know, a catheter up through there. And they're going to try to get a stent in that, you know, in that blood vessel in your heart to open it up to get blood flow going.

And this podcast is sponsored by Talkspace. You know, when you're really stressed or not feeling so great about your life or about yourself, talking to someone who understands can really help. But who is that person? How do you find them? Where do you even start? Talkspace. Talkspace makes it easy to get the support you need.

Talkspace is here for you.

Plus, Talkspace works with most major insurers, and most insured members have a $0 copay. No insurance? No problem. Now get $80 off of your first month with promo code SPACE80 when you go to Talkspace.com. Match with a licensed therapist today at Talkspace.com. Save $80 with code SPACE80 at Talkspace.com. They didn't have a cath lab. They did not have that...

resource that they needed at that hospital. And so then they transported this patient to Orlando Regional Medical Center. I don't, do you know how far, I feel like I just looked it up. It's 27 minutes. Yeah. Okay. 27 minutes. 27 minutes. So they waited an hour. They were, or I'm sure they were working to get the patient transferred, but, but an hour after they got to

that other hospital, they were airlifted then to Orlando Regional Medical Center. Okay. So on arrival at the cath lab,

Sada started experiencing severe breathing difficulties. A respiratory therapist team is called, but for whatever reason, does not respond promptly. He is intubated without an available end-tidal CO2 adapter to confirm proper tube placement. This is just getting worse and worse. The tube is subsequently removed, leading to rapid deterioration.

He passed away approximately one hour after arriving at Orlando Regional Medical Center. So, oh my gosh, Roger, I cannot, that just sounds like somebody, something major went wrong in the, like, in the whole process.

in the setup, somewhere in the system. There was a systemic problem there. For an intubation to go that wrong, usually if they're having that type of difficulty, anesthesia, especially at a large health facility as this is, anesthesia is readily available to be in the ER if needed. But the

Physicians are normally capable of performing intubations and being very successful. So I don't know. I don't quite understand. I don't know if it's the reporting and they're just getting some of the facts kind of.

misunderstood about like the respiratory therapy team. Maybe that was anesthesia. I don't know. But to not have the ability to properly detect whether the tube is in place. I know by state law, I have to have entitled CO2.

as my primary predictor of whether the tube is in place or not. And it has to be waveform capnography. You can use color metric, but then you have to immediately switch them over to waveform for the duration that they're intubated. And that's a pre-hospital requirement. So anybody that, why they would not have at least color metric at the bedside, normally all intubation kits

inside of hospitals that I've been in has the color metric changes, changers that will detect CO2. So I'm not sure what the breakdown, you're right, there's some systemic issue that this intubation went very, very wrong. I feel like there may be something being left out of the complete story just because this may have not been a healthcare reporter or something that was not looking for something particular.

But it seems like there's a little gap there that may explain what happened a little better. But yeah, that situation was very, very bad. How many times have we been told we're the eyes and ears for physicians, for providers? So I cannot emphasize to you how incredibly happy I was when I discovered Echo. With Echo, you can hear without

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But I didn't have to worry about it. Being able to hear those heart sounds and lung sounds was so important, and it just wasn't a problem. In fact, doctors and nurse practitioners and PAs would literally come up to me and try to get my stethoscope because you're going to be able to detect diseases earlier using this device, using the app that goes along with it. It's like having a cardiology consult right there, a second opinion right there at your fingertips. You can also record the sounds that you're hearing and even see an ECG.

So if I think I'm hearing something and I'm not sure, I can just record it, send it over to the provider because the AI gives you a detection flag for AFib and a murmur. I get so excited when I talk about Echo because it really was such a game changer for me. In fact, I trust Echo so much that I worked with their team to create a special offer just for our listeners. Right now, you can get $50 off plus a free customizable chest piece, cover,

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Well, the lawsuit claimed that Orlando Health, the original hospital system, prioritized keeping the patient within its network over providing timely care. And that is what actually resulted in critical delays.

an attorney, Stuart Ratson, representing SADA's family, argued that the decision to transport SADA via helicopter to a farther facility instead of a closer hospital capable of performing the necessary procedure exemplified the system's negligence. So I think what they're saying is like,

well, why put him in a helicopter and fly him 27, you know, 27 minutes to a facility that has a 27 minute drive when you probably could have gone, you know, this is a large hospital. I know that in that city where I live in a relatively large city, it's not really a large city, but it's probably, I think it's like the third or fourth largest city in our state. I feel like, you know, here,

If you're at one small hospital and you need to go, my goodness, there's a PCI available hospital like on every corner, it feels like. But so that's why it's so hard for me to understand them being in Orlando and having to even helicopter fly.

a patient? Why would you? I feel like they could have gone across the street. This was probably a 10 minute drive away to another facility. I don't know. That's just kind of my gut feeling. I'm not saying that I know that for sure. But the fact that they're saying that there was that the legal argument is saying that

that there was a facility where he could have been, rather than being flighted through a helicopter, he could have gone. It does appear as though he would most likely be alive maybe today, according to this. I was looking at the map. There's lots of hospitals around this hospital, and it was a synthetic facility. And so there is...

I see a couple that potentially in between there and Orlando that probably was a PCI facility. See one that is north that probably is upon where they're located. If it's basically 30 minutes by ground, by air, once they're in the air, that should be 10 minutes maybe.

There sounds like there's a bit of a delay there with even getting the helicopter to that facility. So I wonder what the delay was. And it may be, like I said, an hour goes by very quickly. So if they arrive, you detect that they're having a semi-delay.

But should have already been established because typically they don't when the EMS come in with it in their hand, be like, here is definitely. They should have already called. Even if they didn't, the standard of care is that you do a 12 lead within five or 10 minutes of the patient's arrival. And that has to be in front of the physician to sign within a minute or so.

So there's delays, and obviously there's delays because the family was able to win a lawsuit surrounding. And also the patient staying within facilities. And I think that we're probably going to see this more because of the territorial nature of health care and trying to keep patient populations within their health care system.

Patients are being transferred all over the place for specific procedures because certain hospitals are becoming specialized in certain things like transplants or whatever. So if somebody needs a transplant, they're going to be transferred two hours away, still within that same health system. But they're.

They're going to be transferred, you know, to keep them within that system, even though there may be another facility that is capable of doing that, that may be closer. And that's kind of an extreme because that's generally not a, you know, an acute issue that is life and death right now. Stemmes and strokes and trauma.

Even sepsis and facilities pride themselves on these names, you know, naming that they're a PCI center or their primary stroke center or tertiary, you know, they're, you know, they they advertise that that that is good advertisement for them.

So I'm afraid that this may be the start of other lawsuits of patients not going to the closest facility, but going to a facility within the network. And it's also insurance driven. Insurance may have not have paid for

a closer facility. They may say, Orlando Health is it. That's the only place we're paying. If you go anywhere else, you're going to be paying a significant amount out of pocket. My insurance isn't like that. If I go out of network, it's significantly more money than if I stay in network.

Well, one of the things about EMTALA is that they are not supposed to consider insurance when it comes to EMTALA. That's true. You're not even allowed to ask for a face sheet because the insurance information could technically be on there. And that could appear as though you're, you know, then you denied taking them for that reason. Right.

So I, you know, especially when you go into regions where hospitals can be hundreds of miles in between, you know, you can, you go out to, I think of like New Mexico and Arizona, where you have patients will literally have to be transported hundreds of miles just to get, just because they're having a STEMI and there isn't, you know, a PCI.

capable facility in the area where they are. And I can also see, I can see the benefit of wanting to stay in network if it is what's best for the patient. If it's, you know, if you're not bypassing a facility and, you know, I feel like there's a fine line there because if they're in the same network, they do have access to their records readily. Like right then, they can see all their imaging, they can see all their records readily.

And so there's not as much opportunity, I feel like, for confusion, you know. So I see some of the benefit in staying in network and trying to keep it within that. Also, we can't forget we live in the country that we live in. You know, we just do. And so we do not have a national health care provider. We, what am I trying to say? National health care provider.

System or insurance. Insurance. That's the word I'm looking for. And so we have to rely on, I mean, unless you're over 65 and you're on Medicare or you're on disability and you're on Medicaid, for the most part, you got to rely on private insurance. And so these companies, these insurance companies, they are businesses and they, at the end of the day, they are all about making money. So you kind of, you know, like,

it's the system we're under. Whether you like it or not, it's the system we're under. So you kind of have to allow these insurance companies to try to make money. Otherwise, why are they in business? You don't want, do you want them to all go away? Of course we can't, you know, we need them. We got to have insurance companies or what do we have? None of us can afford, nobody can afford to go get healthcare. We would not be able to afford it. And so you have to

allow, number one, hospitals. Hospitals are in the business of making money as well. You got to kind of allow them to do what they need to do to make money. So there's just a fine line here. You know, I work for a hospital system and I believe that the priority is on patient care. I do. I genuinely believe that. I believe that that is first and foremost. And

But I also know that it's a business. And if you work at a hospital anywhere, whatever company you work for, yeah, you can be worried and concerned about the patient. But at the same time, if you're not making money, you're going to have to close your doors. So you kind of have to be worried about that as well. Yeah. So I don't want to just like completely demonize, you know, the idea of trying to make a decision that is what's,

Good for the patient and good for the hospital at the same time, I guess is what I'm trying to say. It seems like there's more that happened, though, once they did get transferred to that hospital. Like, was the delay, I'm just wondering, was the delay in that hour? The hour is bothering me. I feel like could they have gotten them quicker if they were just like call every, you know, like if I was in that ER, you were in that ER, and we literally did not have to consider

keeping them in network, anything like that. Call every ER and where can we get this patient the fastest? And it was like, you know, 10 minutes down the road and you call EMS and get them down, get them over there.

could that have saved this patient's life? Or is the fact that he ended up at this other hospital and then there was some sort of breakdown with the respiratory therapist team? And then why, you know, why they weren't able to detect that the patient was not properly intubated? I don't know. There's a lot of questions with this. There is. And then something else that comes to mind, you know, I'm looking at the map where these two facilities are, and it's not outside of

You know, I'm looking at the distance and it's like, you know, I transport patients a lot further than that. And now I don't bypass another facility that's capable of taking care of that problem, which is why I'm going to the facility I'm going to. So I truly am going to the closest facility for that issue, which happens to be our, you know, flagship hospital, our main hospital.

So I don't really have to consider that. But I look at I would like to see what what evidence they had that not only did the delay maybe be able to explain the delay, but then also, you know, you could because you could argue that, OK.

If we are going to the absolute closest hospital, that means I'm going to have to call a ground ambulance. They may or may not have a contract with can't call 9-1-1. They're going to call their their contracted transport agency. There may be a delay in getting them there by ground. Orlando, this all these hospitals sit right on I-4. If you've ever been to Orlando, you know, that's a parking lot and they may be.

just as quick to get them by air to the main hospital than it is by ground to the closest hospital. That's why I'm like, I'm just looking at this going, there's just something about this that obviously the evidence was there. It was enough to at least 50% of the jurors said, yes, there was enough evidence to say that that was to a detriment. It would be, I think, interesting if,

I knew a legal nurse consultant that was able to read through that and go, aha, here's the thing that sent it over the edge. This is what happened. And this is why the jury awarded $45 million.

Because it all has to add up. You know, there's little bits and pieces here that you can go, yeah, that hour delay. But then I'm thinking of, you know, normal circumstances. A patient arrives through the door. They're diagnosed with a STEMI. Phone calls are made. Transport's arranged.

I an hour probably is not as much as we would like it to be sooner. If you're waiting for that transport agency to come in and you don't have the benefit of like I am where I'm sitting at the facility just waiting for that patient to roll in, you know, you're you.

15, 20 minutes is probably not unreasonable for a transport agency to be able to get there. They have to receive care. They have to get the patient transferred over to their equipment because nobody ever has compatible equipment. And, you know, the process just takes a little bit of time. And so I'm looking at an hour and then you have drive time or air time, which we could say 10 or 15 minutes. So they may have been in the facility 45 minutes.

So that's even less time to get them out the door, back out the door. And then I still go back to your original question of why didn't EMS just go to the PCI center in the first place? I know. That's the first question I thought of. Because they were literally 30 minutes down the road, lights and sirens. I mean, 30 minutes down the road. I don't know what policies were in place to say, and why.

If there was a closer PCI facility then to go downtown Orlando, why didn't they just go there? Yeah. If you've got a PCI center that is close to the hospital they did take them, then why didn't you just go there? So then it goes, okay, then was the family insisting on going to this facility? Did they, you know, where...

And it would take, I guess, reading that legal complaint to see the evidence, to see what was, how it broke down into the chunks to say it all adds up to this amount. This is why. They thought for some reason that jury, and this just happened. I mean, you literally just sent this to me like last week. So on April 9th, 2025, an Orange County jury awarded $45 million to Saad as a state. So-

That jury looked at the evidence and decided that Orlando Health was at fault. The legal team highlighted over 20 instances of alleged negligence, including communication failures and procedural errors. So I feel like, like you said, there's probably more to this story that we're not quite getting like the full picture of where all of the balls were dropped.

But it definitely highlights the importance of education in every single aspect of our health care system, from the EMS people in our field of deciding where to even like people, family members and people who are potential patients to understand public awareness.

of the importance of these things. I feel like so many times there are a lot of pitfalls and obstacles

just because the public themselves, like actual patients or family members, just not being aware, just absolutely not understanding, number one, the resources that they have, number two, the importance of timeliness, of how quickly you should be responding to having chest pain or to having all of these different. And then you have the EMS professionals making decisions and

going, do you, can you override? And state to state, this may vary. I think in our state, I don't even think you can. I think they literally have to take you to the closest facility. I don't think you can be like, nope, I don't want to go to that one. I have to go to this one. They have to take you to the closest one where we live.

Because I know my husband had a medical scare probably, I mean, it was like a year ago, I want to say. He was out doing a...

I'm going to, this is not hippo. It's my husband. I can, he doesn't care if I tell. He was out doing a, oh my goodness, dragon boat. So it was like a big, like rowing kind of thing. And they call it the dragon boat race. And it's for, it's to benefit CARM, our local mission. There is a, our local, let me just give a shout out to our local mission, Knoxville Area Rescue Ministry.

CARM, K-A-R-M. Oh my gosh, I feel like every city in the country, every major city in the country should literally come to Knoxville and see what CARM is doing because this is one of the best organizations I've ever seen for taking care of homeless people.

And so anyway, I just always say that any chance I get, just because I'm so proud of them. My son works for one of, they have Karm stores in this area, thrift stores that, and they are so well run and all of the money, like all of the money, like the CEO does not make millions of dollars a year. They're so transparent about everything. And all this money goes back into this organization. And oh my gosh, they make such a difference in the lives of these people. But

But my husband was doing this dragon boat contest and he's not, you know, I'm not, I'm the same way. I've done dragon boat. They're a lot of fun. I could not do it. I would not laugh. So I'm not judging him. It's just that when I think about it, I'm like, oh my gosh, my poor husband. He got out there trying so hard on this team of the, like, there were all people he worked with too, which is awful.

Like all these people he worked with, he gets on the boat. He literally passed out on the boat. And our son, Joel, who also worked at the time, worked for the company that my husband worked for, was on the boat too. And so scared Joel to death, scared everybody. They all were just like, what is going on? They had to call the medic boat. The medic boat had to come. Yeah.

It's not funny, but it is. And so by the time they got him, his blood pressure was like 60 over 40 or something crazy. His blood pressure dropped. So what? This is so awful. But like I said, he would not care if I'm telling this. But I think he accidentally took his blood pressure medicine twice, which is...

I mean, this is something I would do. I am not... I'm laughing at him. I laugh at him all the time, but he laughs at me too. You laugh with him. Yeah. We laugh at each... We make fun of each other laughing. Look, there's a reason we've been married for 30 years, okay? We laugh at each other all the time. But I...

He thinks he took his blood pressure medicine twice and that's what happened. But I'm just like, you just didn't want to be on that road. But I know. And then he got dehydrated on top of that, probably. No telling. But EMS had to come. An ambulance had to come to the lake and get my husband up on a stretcher. And he tried to tell them, like, I don't I can.

He didn't want to go to the, quote, closest. There's literally a hospital that's two minutes from our house. But our insurance is not a network for this hospital. So he was like, oh, no, I need to go to this other one, which is like another place.

seven minutes down the road. Like we have hospitals all over the place. They're all PCI, not that he needed it, but they're all, you know, they can all do all the things. But they were like, no, we got to take you to the club. And he asked to not go to that one and they took him anyway. So I'm just, I'm like, oh, I guess you just don't have a choice around here. Oh goodness. It's, it's crazy. We get, we used to get accused of

favoritism of one hospital system over the other. I mean, we had to document the reason why we chose the hospital we did. You know, it would be patient request or if they're unconscious, it's like by protocol. So, you know, if it fits into a category where it's a STEMI stroke trauma,

that had to go for them to one specific facility or the other, then it would be by protocol. If not, then it's the closest facility, closest appropriate facility. So yeah, we had to document all of that, why we chose the facility we did, just because

The hospital systems are so competitive that one would accuse the other of showing favoritism, which, oh, if you've worked around ERs, you know, people have favorite ERs to go to because they have better snacks for the paramedics than the others. Oh, my goodness. I didn't know that. It's funny. Oh, yeah. Yeah. You go to our burn center, Augusta, and they're, they like, they treat you like

Interesting. Oh, that's fun. But they do it out of the kindness of their heart because there's no other burn center around. So it's not like they're in competition or anything. It is what it is. But they do the physician. He's no longer alive, but he was he was a big proponent of pre-hospital education, came to burns and stuff. And he was a very, very sincere, dear person.

burn surgeon and he would always treat the pre-hospital folks well so he started that trend that's the reason that they they do it but um yeah there's um and then there's some ers it's like uh you know they don't even have water for you so it's like i don't go in there i don't they don't have any snacks i'll go to this here it's not that competition but i mean in hospitals are competitive i mean even down to um

Pre-hospital care. Got to make money. Right. But like I said here, it's literally it's wherever the closest one they don't have a they apparently don't have a choice. Even if you ask to go to one farther, they have to bring. And I'm just like, that's crazy, because what drives me crazy about that is like they if they literally have to take you to the closest one.

But then if they're not in network, then the patient is just going to need to transfer to a different, they're not going to want to be admitted there. I don't know. I just feel like so crazy. All this, our healthcare system is just insane. It's fragmented. It's so fragmented. It does not. It is so fragmented. I can't imagine working in a area or a state that has

multiple multiple like i'm talking about 10 12 health different health systems you know i i have to deal with where i'm at i basically deal with three health systems so there's there's competent well particularly where i where i physically work at there's three health systems um

And then in another area of the state that I work in, there's basically two health systems and there's a third that is moving into the area that's going to be opening a hospital next couple of years. They're building from the ground up. So they all have three hospital systems to kind of deal with. But South Carolina was always kind of they didn't have a lot of health systems. So it was kind of.

regionalized by where you were. So and what county you're in as to the health system that you kind of went to. I mean, you just know it wasn't until recently that that the health systems kind of started growing and moving across county lines.

moving into each other's sandboxes, so to speak. So get a little more competition that way. But yeah, it's so fragmented. It can be very frustrating at times. Yeah, it's just a complicated system that needs help for sure. It needs an overhaul. It definitely does.

Well, I guess we can get into our good nurse segment. So for this one, I tried to find a story that would, you know, sometimes I try to find a story that can kind of offset a little bit maybe of the negativity that we're bringing toward whatever health care professional. And so for this one.

I was trying to find, I hadn't necessarily found a hospital system. I mean, I feel like this is a pretty good story. There is a hospital system, Advent Health, Wachula, that was, well, it's really a hospital, I guess. Yeah, in particular, this hospital, Advent Health, Wachula. And it was honored, this is in Florida, and it was honored with the 2024 Women's Choice Award.

And that placed it among America's 100 best hospitals for patient experience, which I feel like that's a huge honor. It says a lot. And these hospitals are, as you said, in competition for this sort of thing. And so you,

It means that they're at least concerned with patient care because there are lots of things that go into determining whether or not they're going to get this award. It's not just a title. It reflects real lives impacted by compassionate, whole-person care in a rural community setting.

So it's based on data-driven criteria that includes patient satisfaction scores, clinical performance, hospital cleanliness and safety.

Women's Preferences and Concerns, it places Advent Wechula in the top tier nationally, not just for outcomes, but for how patients feel while receiving care. And they achieve that honor through clear, compassionate communication between staff and patients, which is important. I feel like it's good to get both perspectives. Fast Response Times to Patient Needs and Concerns.

A comprehensive education to help patients understand treatments and medications. A calm, clean, and healing-focused environment. Whole-person care, which AdventHealth defines as addressing body, mind, and spirit.

A voice from the inside is Kristen Johnson is the vice president of the facility. And they said, providing high quality whole person care to our patients continues to be our top priority. To be recognized for how our incredibly hardworking team offers that care is a true honor and blessing. So it's just a reminder.

That great health care isn't limited to large academic centers. I did work at a large academic center and I've kind of I've worked at both. I've worked at both and everything in between. So I have worked in a very rural hospital that was literally an hour away from home.

a PCI facility. And I've also worked at a large academic center. And I'm proud of the work that I've done at all of these facilities. And they all have wonderful things to offer. But I like that this kind of highlights the importance, you know, of these small rural centers and what they can do and how the work that they can do. And that a small center like this is focused on

their patience and, you know, what matters to them. You know, to me, this just is a reflection of the staff that works there. Yes. They can't pull this off without the staff. I wonder what their culture, how that was developed to have all the disciplines working together.

commonality to pull this off, to make the environment where to get these kind of acknowledgements is fantastic. Because that's a hard thing to do. Any hospital I've ever worked at, they put an emphasis on, oh, the patient satisfaction scores, because they're going to be getting that letter. That letter goes out to all patients, not just Medicare patients, but it is coming from CMS. And

So, you know, they're going to be getting a letter. But just because the nurses and the other staff know that they're getting the letter doesn't mean they care. They don't care. A lot of times if they feel if the nursing staff and the other health care professionals don't feel like it matters to the hospital, like it truly matters, it's going to bleed right through the staff and bleed right through to the patient. And therefore, those satisfaction factors

satisfaction scores are not going to mean anything. So the fact that that came through and not only are the patient satisfaction scores good, but the staff seem, you know, their satisfaction scores were good as well. It just, that tells me all I need to know about this facility, that they're doing everything they can to do all the right things for their patients, which is, I love that.

If you work in health care and you read this, you know what's going on inside that facility. Yes, you do. Yes, you do. You know what's going on. It's full circle. Yeah. Because you get you can't have happy people unless you have happy people. There you go. That's perfect. Perfectly said. I love that.

All right. Well, I guess that wraps up another episode of Good Nurse, Bad Nurse, Roger. Thank you so much for coming on and talking about this. I'll be back soon. I know. I'm like, very soon. We've got so many stories. I can't wait. I have so many, like, really amazing stories. Roger's been sending me all these stories and I'm like, okay, I guess Roger's going to be literally helping me do like the next three or four episodes because I got to talk about all of this stuff. So I'm excited.

It is crazy. It is crazy. I will say one thing real quick, as long as Tina doesn't mind. Do it. There is a conference coming up in South Carolina. It's in Greenville. It's called the Swamp Rabbit Pre-Hospital Medicine Conference. It's just not for EMS folks. It's for emergency nurses, ICU nurses, physicians, and nurse practitioners and PAs. It's very high level training.

If you there's a lot of physician engagement that goes along with this conference, a lot of physician experts that come in to teach at this basically seminar is three days this year. It is cheap, cheap, cheap. And you get CEUs if you need them for recertification of any of your licensure. Oh, that's great. And I'm talking about when I say cheap. It is cheap.

It starts Tuesday, June 17th and goes 17th, 18th and 19th. The 17th is a pre-conference courses. So they're going to be covering like airway resuscitation. These are probably going to be all either in cadaver labs or in sim labs. They're going to have burn. See, I'm looking at the thing now, airway workshop and burns.

and then they're going to have a community paramedic workshop. That's the pre-conference. The conference, they're going to be covering things, heart-lung EKG lab. I did that one before. It is excellent. You get to play with a PICC heart, and you see the conduction. They walk you through dissecting, so you see valves. You get a new appreciation of right and left heart, where it lies anatomically. So that's great.

What else is going to be in here? I'm actually going to be speaking. So if you want to come hear me speak, I'm there Thursday. I'll be there the whole conference. Where is it again? This is in Greenville, South Carolina. And if you just if you Google Greenville,

You'll come up to Facebook, but it's the 2025 Swap Rabbit Pre-Hospital Medicine Conference. Okay. The cost, you can't go wrong with the cost. Your expense is just going to be travel. And that's basically it. Let me see if they have to go to registration. Actually tell you what. So for...

Two days, it's $75. If you're doing one day, it's $40 each day. Oh, that's a steal. Yeah. Because I know a lot of people are always looking for ways to get CEUs. And that sounds like a really interesting one.

And it's inexpensive. You can't go to a conference and get fed. And it's a very, very good conference. It's a very, very good conference. All right. Well, thank you so much, Roger. You guys know, send me an email, tina at goodnorspanish.com. You can find me on social media sometimes. Goodnorspanish. I'm so bad with social media. You can always find her on social media. I promise you can always find her on social media.

I do get on Instagram probably more than anything. But anyway, yeah, I get on. I'm on. I'm usually on there looking at book stuff because I'm a huge reader. I love reading books. So I get on there and I like to follow other people that read books and they're reviewing books. So I kind of cheat. I'm not usually on there doing nursing. I'm on there trying to get book recommendations from what book I want to read.

All right, you guys, we're going to leave it there for now. And of course, though, before I leave, I got to remind you, even if you're a bad girl or a bad boy, be a good nurse.