The Conversation Starts Here

To whom it may concern,

I have long ago abandoned visits to Sparrow Hospital because of the horrible medical care I have received. Unfortunately, I have had to come to the hospital twice since February. I was there in February as a patient, and I filed a complaint about the privacy violations which occurred as a result of my being forced to disclose my HIV status standing in a crowded ER check in desk. I was told things would be changed, but I did not see that when I was there Sat. Nov. 21.

I accompanied a 2[0-something] who had been the victim of a sexual assault to the hospital on Nov. 21. His experience, and mine with the Sexual Assault Nurse Examiner Justine, was more than acceptable. However, the victim requested a prescription for post exposure prophylaxis– which is a combination of antiretroviral medications taken over a 28 day time period to prevent infection with HIV. Because this was a stranger sexual assault, the HIV status of the assailant was unknown.

This victim and I spent four hours in the E.R. to receive a prescription which should have taken no more than an hour. Sadly, the E. R. Dept. Supervising doctor was unwilling to prescribe the medications, as is recommended by the Centers for Disease Control and Prevention in Atlanta for NonOccupational Post Exposure Prophylaxis (nPEP). In fact, this doctor, a Dr. Moreno was rude, uninformed, and provided several falsehoods to the victim in denying him access to necessary medications.

As a result, we had to demand that the Risk Management person on call be called in order to force the issue because of the time considerations necessary for effective nPEP treatment. The medications can be started as late as 72 hours after exposure, but are significantly more effective when started earlier, with studies showing start of nPEP in the first 48 hours is extremely likely to prevent infection in both vaginal and anal HIV exposures.

Dr. Moreno continued to lecture both the victim and I about World Health Organization guidelines– which have absolutely nothing to do with the CDC. Sadly, Dr. Moreno attempted to convince the victim and myself that WHO and the CDC were one and the same. When I called him a liar, I was accused of being abusive. I am sorry, but as a doctor, Dr. Moreno should know the difference between the World Health Organization (funded and operated by the United Nations) and the CDC (funded and operated by the U.S. federal government).

Dr. Moreno left the patient to talk with the Risk Management person, a Mr. Cole. And also provided a tablet with CDC guidelines of PEP in occupational exposure situations– which was not the case in a sexual assault, as you can imagine. Right there in paragraph two of the occupational exposure guidelines by the CDC was an 800 number staffed by CDC experts on PEP. Did your doctor find this number and call it?

No, that was left to me. The doctor from the CDC, upon presentation of the clinical facts– 22-year-old, unprotected, nonconsensual same sex activity in a high prevalency area (defined as have a 1% or higher incidence, which Ingham county has)– nPEP was indicated as an immediate treatment.

Dr. Moreno was given the name and telephone number of this CDC expert, and within minutes, the story changed.

The point of sending this email is to point out that the insensitivity and behavior of staff could have resulted in a deadly result for a sexual assault survivor. Here are the major issues:

1. Patients should NEVER be expected to provide emergency room personnel with widely available Centers for Disease Control and Prevention guidelines on medication use which is life saving; and yet both the ER doctor and the Risk Management official expected both myself as an advocate and the sexual assault victim to provide them with those guidelines.

2. A patient advocate and a patient telling a doctor he is lying is not being abusive, it is setting the record straight and making it clear that misinformation is not an acceptable mode of communication.

3. nPEP, as defined by the CDC, is safe and effective. There is no excuse for a major urban hospital in a high prevalence region of HIV infection to neither be informed of nPEP protocols, or willing to prescribe nPEP.

4. No patient should be required to call a readily available and obvious 800 number to gain access to the CDC in order to teach the hospital about nPEP.

5. Offering a patient HIV testing in response to a request for nPEP is not only inappropriate, it is offensive. The victim in this case knew his HIV status to be negative from previous testing– a question never once asked during the conversations. Yet the ER doctor continued to press for testing and refusing to write a prescription for nPEP.

6. Telling a patient that a medication won’t be prescribed because the hospital does not do follow up is also offensive and inappropriate. The Emergency Department encounters injuries and illnesses every day which result in a discharge of a patient, without the potential for follow up. To say you will not provide necessary medical treatment because of this is unacceptable and inappropriate.

7. Telling a patient that a medication has such severe side effects you will not prescribe it because their might be an adverse effect is inappropriate and offensive. Emergency Departments across the country send patients out the door with prescriptions for various medications– all of which can have adverse effects from allergic reaction to organ failure. I know for a fact I have had antibiotics prescribed to me in an Emergency Room, and never was I told the ER would not write a script for antibiotics because it might have an adverse effect.

8. Access to nPEP should be an essential part of Sexual Assault intervention and treatment, and yet it is not at Sparrow.

I have written a blog about this incident, which has been posted on Facebook. I expect that I will receive a phone call from Sparrow by 5 p.m. EST Monday Nov. 23, with a clear cut outline of exactly what Sparrow will be doing to address these issues, or I will ratchet up the pressure and bring this issue public.You can rest assured that as a reporter, I know MANY reporters and media sources here in Lansing who will find this story of great interest. Patients at Sparrow, particularly sexual assault victims have the right to have access to life saving prevention measures such as nPEP, and Sparrow has a responsibility to have culturally sensitive and appropriate programming to address the use and prescription of nPEP that is neither offensive, a refusal or judgmental.

You can reach me at 517 XXX XXXX. I will be in a meeting with students from the Lansing Community College Gay Straight Alliance from 4 p.m. to 5 p.m. on Nov. 23,

Thank you for time and attention to this issue.

Sincerely

Todd A. Heywood
[redacted]@gmail.com
517 XXX XXXX