Bronx Hospital: A Memoir

By Tom Walker

This book is based on my experiences and observations during a most exasperating and frustrating time as a newly hired Director at Bronx Hospital.

Sometimes it takes the uninitiated to see the truth. I do not believe that the shock evoked in me upon my arrival as a police lieutenant in the Four-One Precinct in 1971 will ever be duplicated. But this came damn close. At Bronx Hospital, it wasnt the shock of Fort Apaches violence and mayhem. This time, it was in many ways a much more sinister jolt. Most disturbingly, there was a laissez-fair attitude for the routine and outrageous conduct of the staff, the cover-ups, the medical errors and yes, criminal activity, i.e., assaults, sexual abuse, fraud, reckless endangerment and so much more.

• Language: English
• Publisher: iUniverse
• Release date: Apr 23, 2013
• ISBN: 9781475987140

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Copyright © 2013 Tom Walker.

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ISBN: 978-1-4759-8713-3 (sc)

ISBN: 978-1-4759-8714-0 (e)

Library of Congress Control Number: 2013907268

iUniverse rev. date: 4/19/2013

Table of Contents

Introduction

Prologue

Chapter 1.   First Encounters

Chapter 2.   Godzilla

Chapter 3.   Priscilla, Sirena and Scybalis

Chapter 4.   Lorrie, Sally and The Team

Chapter 5.   Vito

Chapter 6.   Dora

Chapter 7.   Mitch

Chapter 8.   Medical Errors

Chapter 9.   Bernice

Chapter 10. JCAHO Tales-Not

Chapter 11. JCAHO

Chapter 12. The Attack

Chapter 13. Endings

"Every bureaucracy seeks to increase

the superiority of the professionally

informed by keeping their

knowledge and intentions

secret….in so far as it

can, it hides its knowledge

and action from criticism."

Max Weber

Economy and Society 1920

"Resistance is futile. You will be

assimilated."

The Borg

Star Trek T.V. Series

Introduction

A fierce street fight is being waged for control of New York City’s hospitals. On one side is the reform-minded Republican mayor who is determined to streamline the municipal hospital system to make it result-positive and self-sustaining in order to provide better medical care. While the other combatants, the hospital unions, supported by Dennis Rivera and the City Council, are equally determined to protect the status quo—plentiful union jobs under the guise of better medical care.

New York City’s Health and Hospitals Corporation (HHC) is comprised of 11 municipal hospitals, 4 long-term care facilities, 6 diagnostic and treatment centers, 6 certified home health programs and numerous off-site clinics. In these facilities there are 1 million emergency cases seen each year, 5 million outpatient visits and 200,000 hospital admissions.

With the introduction of mandatory managed care for Medicaid recipients (67% of HHC’s patients), the Corporation expects a bumpy road ahead—a 1.5 billion dollar pothole filled road.

I’ve been told that nobody wants to read about the administration of a hospital—it’s not sexy.

Nobody, they say, is interested in why our healthcare costs are out of sight, e.g., the fraud, the thefts, the misguided adventures, the medical mistakes and the inefficiencies that all add to a hospital’s overall costs. I think that they are wrong.

This book is based on my experiences and observations during a most exasperating and frustrating time as a newly hired administrator.

Sometimes it takes the uninitiated to see the truth. To those immersed over time in the daily battles for survival, whether it be a police precinct or a hospital, the subtleties and shading of events go unnoticed or pushed aside in the struggles to win the day.

I’m sure that if I had waited too long to record my observations, Bronx Hospital’s culture would have absorbed me too and prevented my writing this book.

I do not believe that the shock evoked in me upon my arrival as a police lieutenant in the Four-one Precinct in 1971 will ever be duplicated. But this came damn close.

At this hospital, it wasn’t the shock of Fort Apache’s violence and mayhem. This time, it was in many ways a much more sinister jolt.

Most disturbingly, there was a laissez-fair attitude prevailing in the hospital for the routine and outrageous criminal conduct of the staff. In truth, there was a proclivity toward cover-ups.

Now, I’m talking here about felony crimes as defined in the New York State Penal Law, e.g., assault, sexual abuse, reckless endangerment, fraud and other serious crimes.

Lesser crimes might be appropriately handled by the hospital’s Personnel Department. But even there, the internal administrative discipline that did exist was consciously warped in the perps direction.

Medical malpractice was another critical issue at the hospital. However, the real story wasn’t that medical malpractice took place—it’s pervasive in all hospitals. The real story was what didn’t happen after it took place. Now that was an eye-opener.

But I wasn’t alone. The Class of ‘02, as we came to be known, was comprised of five newly hired executives who would share this adventure together.

While each of us was presented with problems unique to his assignment, we all experienced Bronx Hospital’s pervasive administrative inertia for positive change—it was like trying to get an aircraft carrier to execute a 180 degree turn in a stormy sea.

And the attitudes—they came in all ego sizes and from all directions; and the working conditions weren’t much better.

I’ve opted not to specifically identify this facility because I’m sure that the conditions here are an endemic disease throughout the municipal system in this city and all large U.S. cities. Recent media investigative reports support this conclusion.

As my book "Fort Apache" once focused the public’s attention on crime, I hope that this book will help focus the public debate on improving our city’s healthcare system.

Let the words, Well, it is a hospital no longer connote a patient’s demise. We owe that to our patients.

It is my belief that those who hold the public trust can only validate that trust by fully disclosing all aspects of hospital life—the good, the bad and the ugly. As Abraham Lincoln told a visitor to the White House: If you once forfeit the confidence of your fellow citizens, you can never regain their respect and esteem. It is true that you may fool all the people some of the time; you can even fool some of the people all the time; but you can’t fool all of the people all the time.

At the same time, we must provide positive protections and compassionate support for our doctors and nurses whose heroic efforts save thousands of lives each year, whose untiring efforts alleviate untold suffering and whose good works literally turn ruptured lives into productive ones.

Not unlike our police officers, we owe a great debt of gratitude to our doctors and nurses for their contributions to our well-being.

The best way to show that support is to provide our good doctors and good nurses with the help necessary to make our hospitals more accountable, more efficient and more humane.

To do anything less would be unworthy of their efforts and simply put, absolute folly.

Prologue

A conversation overheard in the hospital’s fast food restaurant.

Nurse One:    How did it go?

Nurse Two:    We killed two this weekend.

Nurse One:    That’s lousy.

Nurse Two:    Well, it is a hospital.

Nurse One:    Anything unusual?

Nurse Two:    I’m worried about the overdose the cops brought in in cuffs.

Nurse One:    Why?

Nurse Two:    I’d hate to see the cops blamed—absolutely nothing was done for the kid.

Nurse One:    That’s sad.

Nurse Two:    Well, it is a hospital.

Nurse One:    And the other one?

Nurse Two:    Sara, pretty 40ish mother of two—real bad.

Nurse One:    What happened?

Nurse Two:    Heard she came into the ER around 2 A.M. Abdominal pain and nausea. Promptly vomited all over the place. She had a stomach mass and an elevated white blood count.

Nurse One:    Sounds like an urgent surgical situation.

Nurse Two:    Yeah, but a simple operation. We do six or seven of them a week. But she laid untouched in the ER for 10 hours.

Nurse One:    10 hours?

Nurse Two:    Right, she was eventually sent for a CAT scan which indicated that she had an obstructed intestine. After reading the CAT scan, the attending visited her intending to immediately send her to us in surgery. But that was impossible; she had to be resuscitated first.

Nurse One:    This gets worse and worse.

Nurse Two:    It got even worse. The attending orders the emergency help, but for God knows why, it never arrived. Now get this. Instead of being resuscitated, Sara is sent to a ward where she arrived with low blood pressure and an astronomical heart rate.

Nurse One:    There had been no efforts to resuscitate her?

Nurse Two:    Right, no resuscitation effort, no medications, absolutely no help. She was dying. The only question was, Could we overcome this series of errors and save the poor woman? The doctors tried everything possible to save Sara, but in the end they couldn’t overcome the earlier mistakes. Sara had a cardiac arrest in the OR and died.

Nurse One:    That’s really sad, but you tried your best.

Nurse Two:    I feel real upset about it. It was a bad weekend.

Nurse One:    Well, it is a hospital.

1

First Encounters

Weird stories and tales of horror echoed throughout the borough for many years about Bronx Hospital. Exaggeration, most scoffed, but sadly I knew differently from personal experience.

In 1961, my father rushed to Bronx Hospital’s Emergency Room fearing that he was having a heart attack. Diagnosed as a cardiac neurotic, he was sent home. A week later, he died at home—a heart attack.

In 1976, my mother-in-law had a heart attack and was taken to Bronx Hospital. Thanks to the ER’s heroics she survived and was admitted. The next morning, walking down a hospital hallway to a pay phone, she dropped dead. We had planned to move her that very afternoon by police ambulance to another hospital.

Our queries as to why she was allowed to get out of bed went unanswered. My father-in-law, Jack Faherty, often wondered why he never got a hospital bill. Now, I know why—it’s just good risk management.

In 1990, my daughter Cathy was admitted to Bronx Hospital after a diabetic attack at home left her unconscious. That night a nurse gave her some medicine to take. Cathy realized that it was the wrong medicine and refused to take it—a big argument ensued. We moved Cathy to another hospital. The diabetes would take Cathy’s life a year later.

So, when it was suggested to me by a close friend that I apply for a vacant position at Bronx Hospital, I had, as noted above, some serious reservations. But reality grabbed me, let’s say, where it really hurts—in the pocket. Out of work for several years, my pocket money gone and my NBC T.V. mini-series in doubt, I applied for the job.

Mr. Rosario Enrico, a De Nobili cigar hanging from his lips, interviewed me for the position of chief of police at the hospital. While I had never worked in a hospital environment, I had commanded several units in the NYC Police Department and retired from a patrol borough office as its operations officer.

In that office my responsibilities included the planning of major events, i.e. the obligatory presidential visit to the South Bronx’s Fort Apache; coordinating detective and patrol functions at major disasters and disorders; developing strategies to reduce the accelerating robbery and murder rates of our senior citizens and to reduce bias related crimes.

Mr. Enrico, an engaging and pleasant man, told me, You’re not qualified for this job, Tom—no hospital experience.

I was shocked.

I’m not qualified for a 60 officer department? I asked incredulously. I was responsible for 2,000 cops and detectives.

That’s just the point, he said. These guys are not cops, they want to be cops. I was befuddled.

So, you don’t want a real cop for this job? I asked, trying to clarify the issue. Not quite, he said calmly. I need someone with hospital experience.

Mr. Enrico refused to budge from his position, but did mention the possibility that another less demanding assignment might be opening shortly.

Now that ticked me off. Sure, I was 62 years old, out of shape, overweight and bald, but he didn’t have to be so condescending. But, I held my tongue. If I didn’t get a job here, I might end up working for the ASPCA.

In light of later events at the hospital, I want to publicly thank Mr. Enrico for not giving me that job. A week later, the hospital director, Rocco Pasquale—loquacious, direct and political, interrogated me.

Do you know any politicians in the city? he asked. I was surprised by the question.

Bob Garcia, Pat Cunningham and Stanley Friedman, I replied after a moment of reflection. He started to laugh.

Politicians who weren’t convicted of crimes would be nice, he chuckled. Oh, you want Republicans, I wryly responded.

We were both laughing now. I knew I had a job.

Okay, he said, I’m going to make an offer you can’t refuse. He did and I accepted, my reticence and good judgment buried by the salary offered and the hospital’s proximity to my home. He put me in charge of Occupational Health, but also wanted me to use my background in risk management to correct the out of control workers’ compensation program at the hospital—an assignment in which I had achieved much success in the private sector.

I would soon unhappily realize that this wasn’t the private sector. But first, I had to have the required pre-employment physical at Occupational Health, my new unit.

My new office was on the l0th floor of a converted dormitory building.

Word spread at Occupational Health that the new director was coming in for his pre-employment physical.

Most of the nurses and staff were friendly, except for one well-tanned lady who gave me the evil eye.

The nurse practitioner, Lorrie, an attractive Asian lady with Bambi eyes, who was to conduct my physical said, That’s Ms. Fisk, a clerical associate.

She doesn’t look too happy, I offered. Never is, said Lorrie, matter-of-factly.

To my surprise, Lorrie did a complete physical. She put on a rubber glove and said, Drop your shorts and bend over. Then added, It’s required—your age, you know.

For me, this gave a new meaning to