Thank you. In light of the situation we're talking about, Mr. Rivera, had Mr. Rivera called 9-1-1 and had been picked up, what would have happened between the time you picked him up in the hospital?
Well, according to the testimony that I've heard to date from the hospital at Aria, they would have went right back to the treatment area, would not have been in the triage. 151 2/2/10 - PUBLIC HEALTH - RES. 090915
What type of assessment do you do en route to the hospital?
The assessment that we do starts immediately upon the arrival of the patient. We take a general impression, then we take the vital signs. Also the first thing is, we ask the patient or a bystander just what the chief complaint is and what the patient called us for, and then we have protocols that govern all of our action depending on what we find.
So you would have taken his pulse, his vital signs, all of that?
And reassess, depending how long the trip to the hospital would take.
Thank 152 2/2/10 - PUBLIC HEALTH - RES. 090915 you.
Thank you so much for your testimony. Thank you for coming.
Excuse me, sir. Do you have testimony? LIEUTENANT ACKERMAN: No. My name is Lieutenant Brian Ackerman. I was here to answer any questions you may have.
The next panel would be Dr. Karen Sarpolis, Margaret Robinson, Lisa McGarrigle Vanderwoude. (Witnesses approached witness table.)
Hi. My name is 153 2/2/10 - PUBLIC HEALTH - RES. 090915 Dr. Karen Sarpolis. I'm a former ER physician and a women's health advocate, but today I'm mostly here as a mother, because my daughter died after a 9-1-1 call when I was living in the Philadelphia area while I was pregnant. And I'm going to talk about what's supposed to happen when somebody walks into an emergency room. First thing is supposed to happen is triage, and I'm kind of surprised to hear some of the comments here, because in the rest of the country -- I'm a transplant from the midwest -- that's supposed to take place within zero to two minutes. It's supposed to be almost immediate as you hit the door. You get registered, very minimal information, and you go right to triage. What triage is is a short history and physical that's sufficient to determine the maximum amount of time that a patient can safely wait to see the 154 2/2/10 - PUBLIC HEALTH - RES. 090915 physician. It is done by a nurse, but a physician in the hospital is ultimately responsible for that exam and for anything that happens out of it. Most ERs implement one of the standard methods for triage, and I know you've heard about them several times, ESI, the Canadian system, things like that. And that method is usually bolstered by prompts and more detailed protocols that are embedded into the electronic medical records. So as you're pulling up, putting in the patient's chief complaint, you can be prompted and reminded to take certain assessments. But the most important thing to triage is to put your best and most experienced nurses in those positions. There really aren't any cookbook methods that are going to help you if you're not really familiar with emergency medicine. And according to law, pregnant women and their babies have to be triaged in the ER if they present there. It has 155 2/2/10 - PUBLIC HEALTH - RES. 090915 to cover routine labor, it has to cover problems with the pregnancy, it has to cover any non-pregnancy-related problems. And mom and baby both have to be treated in the same timeframe as other patients according to their level. At the end of the initial triage, the patient is assigned on a five-point scale, which is no longer there, but I'll talk about it, and that level corresponds to the maximum wait time. As people have said before, there's five levels. It corresponds to the maximum ideal wait time for the patient to see the doctor. And if the wait time ends up exceeding these, which it shouldn't unless you're on one of the lower levels, the patient needs to be re-triaged. Level I's, those are people who need immediate resuscitation, and we all know who those people are. You don't have to have a medical degree. They're patients coming in by ambulance, they are 156 2/2/10 - PUBLIC HEALTH - RES. 090915 people who are being dragged in by their family members, they're staggering in by themselves. This is not rocket science. The second level is emergent. This is really the highest level that the triager actually deals with in actual practice. And being at risk for rapid deterioration is one of the main criteria that gets you put into Level II. They wait for the doctor back in an ER bed with a nurse. That nurse is supposed to start working on them, taking more history, slapping electrodes on them, putting IVs into them, those kind of things. When they say "time to nurse" on these levels, when they say "time to nurse," they're talking about the nurse in the back. They're not talking about the triage nurse. And what that means is, if they code on you, if they do tend to rapidly deteriorate, if they do actually do that, then a nurse is right there and you start resuscitating them, you defibrillate them, all those kind of 157 2/2/10 - PUBLIC HEALTH - RES. 090915 things. So I was really shocked to hear all these comments where they seem to think that registration is some kind of a process where you can safely delay triage.
Triage is an immediate process to help you gauge you can safely delay seeing the doctor. Like I said, I'm from out of this state. This is where I practiced and this is where most of my experience is from. This is what they do in the rest of the country. So your waiting room is really supposed to be composed of Level III's, IV's and V's. Those are urgent, less urgent and non-critical patients. I mean, I can't believe they're putting tape on the floor to go look for people who are going to code. If I had to put tape on my floor of my ER, it would be in front of the patient bed. You know, that's where the nurse is supposed to be that's looking for the patient who might code soon. People aren't supposed to be 158 2/2/10 - PUBLIC HEALTH - RES. 090915 coding out in your waiting room. And I know a lot of people have mentioned EMTALA, the Emergency Medical Treatment and Labor Act. That requires a medical screening exam. This is very different than triage, and probably one of the biggest mistakes in emergency medicine is confusing these two things. A medical screening exam is an exam by a physician. It's done in the back. It's got to be sufficient to determine that emergency medical condition, whether there is one or isn't one. And the reason we do that is so you can treat them and stabilize them before the patient deteriorates. So triage really isn't mentioned specifically in the law, but if it isn't done correctly, you don't get the patient to that required, legally required, medical screening exam and stabilization before they deteriorate. And it is a law. It's not just a guideline or a standard of care or 159 2/2/10 - PUBLIC HEALTH - RES. 090915 anything like that. 2 million community restitution programs, court-supervised protocols, criminal charges, murder indictments, threatened or actual expulsion from the Medicare program. So elsewhere in the country not only -- maybe they're tied together. Maybe the reason we're so much more attuned to these restrictions in other parts of the country is because the fines and the penalties are so much worse. In Pennsylvania, it seems like there's really no consequences. I mean, again, from what I've heard here, they let the hospitals write their own rules, they let the hospitals decide their own punishments, and they put out these safety bulletins that are endorsing actually questionable practices. And I think people in Philadelphia expect more. 160 2/2/10 - PUBLIC HEALTH - RES. 090915 They expect much more done. And if the state and federal authorities really can't do it, then perhaps the District Attorney in Philadelphia needs to emulate those in Los Angeles and Chicago and file 7 some kind charges to get these problems under control. Thank you.
Please speak to and elaborate on the Chicago -- did you say Chicago and Los Angeles?
Chicago and Los Angeles. There was a very famous case like a couple of years ago where Los Angeles hospitals were dumping patients from the ER on skid row. You probably heard about it in the news. The district attorney went in and charged them with things like elder abuse, dependent care person abuse. They had like $2 million worth of fines. They weren't really 161 2/2/10 - PUBLIC HEALTH - RES. 090915 fines; they were kind of mandated donations to community organizations to take care of homeless and to take care of indigent people. It was very severe. In Chicago area, they've used -- they've had murder indictments for death by waiting. I understand, the state is supposed to be the one that's regulating these laws and enforcing them. Unfortunately, the penalties are about 13 years old. They go back to the beginning 14 of the law. So the maximum fine per 15 incident is $50,000, but when you 16 investigate, you can find more than one 17 incident. And so if you look -- I think 18 I included a link of enforcements 19 throughout the country. They go in for 20 one incident, they may come out with 21 $250,000 worth of fines, because they 22 find a bunch more. And the state and 23 local authorities can also take other 24 action. I'm not a lawyer. I don't know 25 exactly how they do this, but talk to 162 2/2/10 - PUBLIC HEALTH - RES. 090915 these people, you know.
Thank you very much. Our next witness is Margaret Robinson.
Hello. Greetings, Chairperson and members of Council. I lost a loved one in emergency too.
Thank you for allowing me to speak to you. My name is Margaret Robinson and I have come before you today to testify on behalf of my deceased sister, Diane Robinson. On June the 27th, 2008, my sister called 9-1-1 163 2/2/10 - PUBLIC HEALTH - RES. 090915 because she was having difficulty breathing and she had a history of asthma and congestive heart failure. When the paramedic arrived to transport my sister from her home at 5th and Lawrence Street, my sister was able to walk to the ambulance. None of my family members were able to go to the hospital. It is my understanding that when my sister arrived at Temple University Emergency Room, she was told to wait in the triage room, despite the fact that she couldn't breathe. After about 15 to 20 minutes, my sister stood up and insisted she receive some immediate assistance because she could not breathe. By that time she was escorted to the patient treatment area and she passed away. My family agreed that an autopsy would be necessary to determine the cause of death, because we were concerned that my sister died after being in the emergency room for such a short 164 2/2/10 - PUBLIC HEALTH - RES. 090915 amount of time. Today, our family still questions whether or not my sister would have survived had she received immediate attention when the paramedic brought her in. The autopsy report and other hospital records do not contain any documents from the EMT report nor did they have any notes from the triage nurse explaining her passing. I am requesting that the City Council investigate the circumstances surrounding my sister's death. I am concerned that the procedures -- excuse me. I'm so nervous -- be followed when it comes to emergencies similar to my sister. Anyhow, I have something here stated that when the EMT -- the autopsy from Temple Hospital, when the EMT brought my sister into the hospital, they did not escort my sister in. They dropped my sister off at the emergency door. My sister walked into the 165 2/2/10 - PUBLIC HEALTH - RES. 090915 emergency, sat in the triage room and waited there. No one assisted my sister. She had four kids and one grandchild, and all we do is cry, because she was only 52 years old. And I'm trying to find out how did my sister just die like that. Nobody wanted to hear my case, but it took this other guy to pass away and I came here to let y'all know this is what happened to my sister and somebody need to find out what happened to my sister, too. Thank you.
Thank you very much. Would you stay once the testimony is over. We'll have a chat with you. Next is Ms. Lisa McGarrigle.
Yes; Lisa McGarrigle Vanderwoude. One thing not noted in my written statement is, our experience came out of Aria Bucks County Emergency Room. Good morning, members of City 166 2/2/10 - PUBLIC HEALTH - RES. 090915 Council and everyone here. I am here to support Resolution 090915. The following is our experience during a medical emergency involving my 73-year-old mother who was ambulanced to Aria in critical condition. Sadly, she laid in the emergency bed for over an hour and a half before even an IV line was started on her. I witnessed one emergency room 12 nurse, Rick, torn between two dying patients. A second nurse with authority over Rick flew through and ordered Rick to prioritize. " I asked Rick what that meant. Disappointedly he replied, Leave the 73-year-old, treat the 20-year-old overdose first. When Rick was able to scurry from bed to bed, in disbelief, we then worked as a team tandemly. I assisted Rick by locating targeted sites for blood draws, so if Rick could return, we could 167 2/2/10 - PUBLIC HEALTH - RES. 090915 utilize what little time he was allowed to spend with her as effectively as possible. By then, her blood was hemolyzed. I now know that means too thick to use for tests. Rick had to run over to the overdose victim, who was vomiting while on the ventilator. As mom declined, I analyzed what was unfolding, and I yelled, Rick, dehydration? Rick yelled out to the hall, We need an IV line stat. Staff ran it in and left it on the counter. Rick briefly returned to redraw blood. Still too thick to use. Rick found the IV task not completed, let alone started. Rick yelled, I need assistance. One nurse returned, hung the IV, inserted it and hurried off. The third time Rick ran back to draw, it was still unusable. Rick noted the nurse didn't open the IV drip. Aria also missed three breathing treatments in ICU in one day. 168 2/2/10 - PUBLIC HEALTH - RES. 090915 Aware of obvious staff shortage, we didn't leave her alone. The longer we stayed, the more transparent staff shortage became. Aria is staffed short from professionals to housekeeping. I witnessed extremely stressed staff run from patient to patient, to the point of confusion and physical exhaustion. I believe to remedy not only Aria's reputation, but to restore the public confidence, Aria needs to increase staffing. The only other thing I can say is, I found inexperienced nurses. When I asked Rick what "hemolyzed" meant, he told me he wasn't sure. Not only that, when she was, first of all, in ICU for four days, they handed her her own suction with a BiPap mask on. What she was suffering from was carbon monoxide poisoning as a result of being a COPD patient on oxygen at home. She had gotten a cold. It turned into 169 2/2/10 - PUBLIC HEALTH - RES. 090915 bronchial pneumonia. She was not able to expel the carbon from her body. It took over an hour and a half to get blood that they could draw to find her carbon levels. They put a BiPap mask on her that blows air into your face at 65 miles an hour, put her in an ICU bed. The nurses that came in were dripping with sweat, and in the meantime, she was bringing up phlegm. They handed her her own suction to hold through the mask to be able to suck the phlegm out of her mouth and left. From then on, we stayed. On the fourth day in ICU, I asked the nurse to please dispose of the original suction tube and the canister in which the debris was left. They never cleaned her face. When we mentioned the fact that there was phlegm all over, they handed us the brush to open and wash her face down. No one ever touched her hair. Regardless of that fact, in less than 24 hours, they stepped her down on a BiPap machine from ICU into a regular bed and 170 2/2/10 - PUBLIC HEALTH - RES. 090915 had a social worker that was looking for a rehabilitation center for her. They gave us a list of about four. One of them that was on the top that they were recommending was brand new.
I started going to these nursing homes to see what they were, to see how rehabilitated they were. The first one that I went to, I found out the one they highly recommended had no 12 respiratory therapist on staff. So in the meantime, my brother was over with the nursing supervisor. When this woman came in, she was the color of a statue. My brother called me. I went to the apartment. They let me in. The police then came. The ambulance came, and she was in such a dehydrated state, they weren't even able to start an IV in the ambulance. I had left with my children with no shoes. We ran out the door to her house. From her apartment -- we all live in the same town -- I went and got my children's shoes, got them 171 2/2/10 - PUBLIC HEALTH - RES. 090915 stuff to occupy them at the hospital, went to the hospital, went back into the ER room to find her still laying there on oxygen with nothing else done. I said to my brother, What did they say? He said that they said that they're going to do tests. And that was it. There was no other staff member that came in to assist that man. Luckily, the overdose victim who had vomited had his girlfriend with him. As Rick is trying to catheterize my mother, trying to get any relief for her, he's screaming to her, Tilt him on his side and he'll be there as soon as he can. Through all of this confusion, no one came in to assist him. So we kept vigilant, and even in the ICU room, the respiratory therapist would come in, write down her stuff and be called stat to leave. That's how the treatments were missed. As a matter of fact, I believe two of them were even logged, but since my other 172 2/2/10 - PUBLIC HEALTH - RES. 090915 brother was there and had witnessed them come in, write it up and be called out, we knew they were not done. Once we went to the third nursing home, which was the oldest of the few that we were given, that's when I found out they were one of the only rehabilitation places in the area that staffed two respiratory therapists 11 hours a day. 12 They were sending a woman in 13 desperate respiratory distress, 14 recommending a step-down rehabilitation 15 place that had no respiratory staff. 16 Luckily, she's still alive to 17 this day, but had not there been family 18 intervention and someone with her almost 19 continuously, I can guarantee you that 20 would not have happened. 21 They told him to follow 22 protocol, to leave her. There was one 23 nurse between two critically ill patients 24 in an emergency room and it was -- I just couldn't believe. Then when we went into 173 2/2/10 - PUBLIC HEALTH - RES. 090915 the regular rooms, they were never dusted. The beds were never cleaned. Housekeeping wasn't done. The same bag of trash stayed in her room for four days until we requested that they come and take it out. All I can say is, it's been my experience and I can also testify that a friend of mine went to Aria Torresdale in an accident, miles an hour. He hit a 12 tree. They gave him 35 stitches in his 13 mouth, never cleaned his face. He was 14 left basically unattended for three days 15 until they discharged him. Again, family 16 had to stay with him, wash the blood off 17 his face, wash his hair. 18 It just -- it seemed like in 19 either of the two hospitals if you didn't 20 have family, you didn't stand a chance. 21 That was my personal experience 22 with Aria. 23
Thank you 24 very much for your time. 25 Any comments or questions? 174 2/2/10 - PUBLIC HEALTH - RES. 090915
And thank you for inviting me to testify, because I'll tell you, going through it, it was really hard, and to try and complain and to follow steps and to get supervisors and to keep your track of mind, it was horrendous. It was the most horrendous experience I can recall.
Well, you have the leadership here of the hospital listening to your testimony. I'm certainly sure they would certainly pay attention to your comments and backtrack and try to see what happened.
Thank you. Again, when I was there, they asked me if I was a nurse, and the only experience I had was as an avid blood donor and first aid CPR and stuff like that that pertained to children, being a caregiver myself.
Thank you again for the invitation. 175 2/2/10 - PUBLIC HEALTH - RES. 090915
And I can't express how grateful I am that this has come to court. And that's it.
Is there anyone else here to testify on this bill? Yes. Would you come forward, please. Thank you all for your testimony. (Witnesses approached witness table.)
Good afternoon. Thank you so much for staying, and certainly we appreciate your coming in to share with us your testimony. And so would you please identify yourself for the record. Each of you who plan to speak, identify yourself and proceed with your testimony.
Hi. I'm Susan Gast. I'm a concerned citizen from Philadelphia and I've been on both sides of the coin. I'm sorry for the loss of Mr. Rivera. I 176 2/2/10 - PUBLIC HEALTH - RES. 090915 know he was an activist well known in the community, and it's a real loss. And I worked in healthcare as a unit secretary. First the title was Ward Clerk in the emergency room at Nazareth for years, 7 some part time, mainly full time. I was 8 on the floors for a short time as well. 9 And I've also been a patient in the 10 hospital, and I've also lost loved ones 11 in hospitals, my father at 12 Frankford-Torresdale. I don't blame the 13 hospital for that. I do understand how 14 hospitals are. 15 Do you want me to continue or 16 let everyone else introduce themselves? 17 Continue my testimony now? 18
You've 19 started, so you can certainly proceed 20 with your testimony. 21
Okay. So I can see 22 from both sides of the coin what it's 23 like being a patient. I had good care. And I know how important fire rescue is to get to the scene when someone is 177 2/2/10 - PUBLIC HEALTH - RES. 090915 injured or having a heart attack, myocardial infarction, as family members, my mother and father had had, or someone having an overdose. The hospital that I worked at, I no longer work at. I was trained as a paralegal. I don't work in that field. I don't enjoy working with attorneys. I'm out of work right now, but -- and I also have no health insurance at 51 after my grandparents coming from a foreign country, my grandfather living in a barn when he arrived here. We still have the same problems going on today. A lot of people coming over from foreign countries for a better life. We had five people in New York City die from Guatemala. I don't know if they were illegal aliens, green card people or special invitation card members. Fourteen firefighters in New York City critically injured, a baby of two critically injured, a head injury, 178 2/2/10 - PUBLIC HEALTH - RES. 090915 with a mother having to throw her out the window of a tenement in New York City, little baby, who may die. Fire rescue there, but unfortunately layoffs there and here as well. And also hospitals closing throughout the country, starting in California, where a lady was left in the waiting room of a hospital there and I think she may have been someone from Mexico with no insurance. I'm not sure. I know she had no insurance and there was a problem with that. She may have been born here. But there was no insurance and there was a problem. And I know how hard the staff works. When the bigwigs at the hospital, the CEOs that are making six figures or more, are home with their families on the holidays, the staff is there in the emergency room. It's a different breed. Most people in the hospital don't want to work there. Even though they're registered nurses and physicians, they don't -- and nurses aides or even the 179 2/2/10 - PUBLIC HEALTH - RES. 090915 ward clerks, they don't want to go to the emergency room. You don't know what you're going to see. A girl that's pregnant from the prison in active labor, three overdoses on Christmas day with teenagers dragged in. Me, not a nurse, and the nursing staff and the nurses aides having to run out with three stretchers because somebody that I guess got them high drove them to the hospital instead of calling 9-1-1. We had to drag three people out, three teenagers out of a car and their parents don't want to come in. You know, myocardial infarctions, heart attacks, CVAs, strokes. We at Nazareth took care of the oldest population in the country. Rhawnhurst with all the nursing homes and the age per capita is the oldest -- was when I worked there for 23 years, I left around 2003 -- the oldest population in the country per capita. Some people live 180 2/2/10 - PUBLIC HEALTH - RES. 090915 to 105. A lot of people are do not resuscitate, some the family wants everything done for them, meaning mechanical means of keeping someone alive even if they have cancer throughout their body. They need to be put on a respirator. Sometimes RNs and physicians and nurses aides are taking care of five people at a time on a respirator, and then they have an overdose, a young person that needs help. A girl from the prison in active labor, you know, this is where she's going to go to have her baby. The maternity ward is closed. We've lost many hospitals throughout the country, starting in California. Here in this city we lost Philadelphia General Hospital, which was the hospital for the police and firefighters and also for the indigent community. I knew people that worked there that were LPNs at my hospital, now deceased unfortunately, and they worked 181 2/2/10 - PUBLIC HEALTH - RES. 090915 there and loved working there. I know people that worked at Nazareth that work at the VA. I know she started as an LPN and became an RN.
All the nurses work all different hospitals, call an agency. They don't just work at one place. A lot of them work all over the City. They work at Jefferson, they work at Penn, they work at Frankford-Torresdale or Frankford-Frankford. I grew up in an area where Frankford-Torresdale is now. It wasn't always there. Nazareth was the closest hospital. If you collapse, you could have a subdural hemorrhage or a heart attack, if you don't have oxygen to the brain in seven minutes to 15 minutes, I think, brain damage sets in, unless you have a miracle, like some people in Haiti are getting. Nazareth was too far, but still people had to make due with it. Now we've had -- we've seen so many close: 182 2/2/10 - PUBLIC HEALTH - RES. 090915 Parkview; PGH; Kensington; St. Mary's in Fishtown, not in Langhorne where there's more money; Episcopal, other than ER and Rape Crisis Center; Lawndale; St. Agnes with the Burn Center; Misericordia; Women's Medical. I could go on and on. There's more than that, I'm sure. And, of course, Northeastern, where Governor Rendell didn't bother to show up, neither did two senators, one who calls himself a democrat now, named Arlen Specter, who the President, who I campaigned for, is running around the City and State campaigning for, when he did nothing to stop Northeastern Hospital from closing. And I feel that people, called attorneys, that continue to blame hospital staff when it's the people at the top, not the ER physicians, unless they're truly negligent, and not the nurses. And the LPN schools even closed. One program in the City that was a success was James Martin Public School, LPN School, closed, turned down, put out 183 2/2/10 - PUBLIC HEALTH - RES. 090915 of business. A lot of our RN schools closed. St. Mary's in Fishtown, their LPN school closed. Jefferson's LPN school closed. We have CNA programs. Governor Rendell was supposed to work on the shortage of nurses in this state. We have RN programs that closed. There's an article I have here from yesterday's paper, is it? " Many people went to nursing school to get a better job because their companies, maybe their unions, folded. How many companies has this city lost? When you work in a hospital, it's like a city. There's so many people employed there. It's not just doctors and nurses. There are medical records people, there are billers, there are gift shops, there are dieticians, nutritionists, physical therapists, orderlies, all kind of people, secretaries, of course, the CEO. And we now have at Aria things like massage. 184 2/2/10 - PUBLIC HEALTH - RES. 090915 And Nazareth --
Ms. Gast, we have two other people to testify. Could you please try to bring your testimony to a conclusion.
My conclusion is this: We have legislators who are attorneys. They start out as attorneys mainly, and they've allowed hospitals to close in a city where we were attacked on September 11th, two in Queens, now a third, St. Vincent's, to be overtaken by corporations. And, you know, our country is not corporate America, and Ruding (ph) Corporation wants $300 million to erect a Congo complex that is probably a tax abatement, and, you know, the Continuum Health Partners wants to take this over. Everything has become corporate in America, and it needs to stop and people can continue to put money in their pockets. People have put money out for 185 2/2/10 - PUBLIC HEALTH - RES. 090915 programs for nursing school. We don't have enough physicians trained that are Americans. We don't have enough nurses at all. And any of us at any time could be attacked. We're at war. We have things like Triumph Strollers that when I went to paralegal school at Manor Junior College were supposed to be put out of business.
They're back to destroy a child's fingers, amputation. When you work in an ER, if you volunteer there, you can get to see exactly what goes on. And I just want to end with one thing. One thing I want to say is, 107-year hospital there, 125 at Northeastern. We have a woman at Temple University named Ann Weaver, who I don't see you bringing a suit against her, because the direct cause -- Ann Weaver Hart is the direct cause of killing Mr. Rivera and other countless unknown 186 2/2/10 - PUBLIC HEALTH - RES. 090915 individuals, because Northeastern closed. There wasn't enough -- and in LA, we have a man named Bill Cosby who came from the City, who grew up in a project in North Philadelphia --
-- a son named Ennis, and if he was found on the street, if there wasn't enough fire rescue in LA because of cuts and there wasn't a hospital, if he was shot by someone from a foreign country, who probably had a DPA card, unlike millions of Americans don't, then Mr. Ennis Cosby would have lived if he had gotten to a hospital and everyone knew who he was. Regardless of his color, he would have lived if they had gotten him to a hospital in time, and everyone would have been pleased to save his life because he was Bill Cosby's kid, 187 2/2/10 - PUBLIC HEALTH - RES. 090915 who grew up from a project. How many people today who grow up from subsidized projects are going to make it in America with people making everything corporate?
Good afternoon, Councilwomen Reynolds and Tasco and Quinones. My name is Susan Rivera and I'm a resident in the North Philadelphia area and I'm here because the death of Joaquin Rivera really, really upset me. He was a family friend. I remember when I was about 18 or 16 years old, I went out, it was like caroling, but in Spanish we say parang giando (ph), with them for Christmas, and everywhere I went, he always was there. A month before his death we were at a 188 2/2/10 - PUBLIC HEALTH - RES. 090915 conference and he was playing his guitar. When he died in Aria Health, it was very shocking, and to call my father-in-law and say, Look, your best friend up here in Philadelphia passed away, to hear the choking in his voice, you know, just realized how shocking it was to lose him. And, like I said, he's a family friend and it was horrible the way he died. And to add insult to injury, being robbed in the emergency room also. The reason why I'm here also is because two years ago, my brother also passed away and we feel that if we would have gotten the proper care at the emergency room, my brother would have been alive today also. So it's just like -- it's not just Aria Health Emergency Room. It's every emergency room need to check their policy and check the patient. My brother was brought in. He was dehydrated. We're not doctors, but 189 2/2/10 - PUBLIC HEALTH - RES. 090915 we saw he was dehydrated. He wasn't talking. He wasn't eating. He wasn't drinking. We took turns as a family to go with him to his medical doctor, take him to the hospital, take him where he needed to go to get care. And at the time, my sister, Maria, here, she went with my other sister to a certain hospital emergency room and we brought him in and we told him exactly what was going on. We're the family. We knew how he was, who he was and what was going on. They just basically told them to just have his seat and someone would be with them. A few minutes later, an hour later, it seemed like days later, no one was seeing him. I really can't get too much into his case because it's still an ongoing case, but the anger that I feel about how Joaquin Rivera as a family friend just brought up the anger with my brother, you know, when he passed away. His name was Jose Fontanez. 190 2/2/10 - PUBLIC HEALTH - RES. 090915 Like I said, we took him to this hospital. They didn't treat him. My sister took the initiative and they said, You know what, you're not going to care for my brother in the emergency room, you're not going to take care of him, you're going to make him get up from his wheelchair when he couldn't even get in the wheelchair. They basically had to walk him in there. They made him get out of the wheelchair and sit in a chair, because they needed the wheelchair for somebody else. So they made the decision to leave that hospital and take him to another hospital, where there they coded him. They gave him a yellow sticker. We don't know what that meant, but I'm sure it didn't mean he was in emergency. He waited there for a while, a long while. By 9 o'clock at night -- and this all had started early in the morning. By 9 o'clock at night at this certain other hospital, my brother was finally admitted 191 2/2/10 - PUBLIC HEALTH - RES. 090915 for dehydration, and within the next day, he was in ICU. Two days after that to three days after that, my brother died. There was no reason for this 31-year-old to die a couple of weeks before his birthday, and this was all -- this I say would have been prevented had in the emergency room they would have took the initiative to say, Listen, we're going to bring him right back. Just because we didn't bring him in in an ambulance doesn't mean that it was not an emergency. My brother is just, I guess, a case number, but to us he was our brother. This is Jose Fontanez. This is all we have besides our memory of him to live with, to hold on to. Why?
Because someone in the emergency room was either too tired to come out and say, Okay, we're going to bring him in, or they thought someone had a bigger issue or bigger problem. We're not doctors. We don't know how they code people, but I know 192 2/2/10 - PUBLIC HEALTH - RES. 090915 that it's not an isolated incident. Joaquin Rivera would have been alive with us today had he been taken care of. My brother would have been alive today. Everyone that testified here with a lost family member would have been alive today if someone in that ER would have just came up to them the time they were sitting or even when we as a family member came up to them and said, Listen, we've been waiting here a half an hour, he's not getting any better, he's practically passed out on the chair, and they would tell us, Someone would be there in a few minutes to help him. And as family members, we decided that we're not going to allow that anymore. Now there's always going to be a family member to go into the triage room with our loved one, to go into the MRI room 22 with our loved one, to go into the x-ray and wait outside. They tell us at the hospital you can't do that. Two years ago I lost my brother, and two years ago 193 2/2/10 - PUBLIC HEALTH - RES. 090915 I vowed that even now that my father is in the hospital and we're constantly for the last two weeks fighting doctors who know more than us and tell us, You can't come in, we're fighting with them and saying, Oh, no, we're going to come in, because when we're here, you treat our family member with respect and you treat him as a person. When they're here by them self, you ignore them, and that's never going to happen again. So I support this bill, and I hope that anybody else that has suffered a loss of a family member because they don't know what to do in the emergency room take the chance to listen to your heart and say, This is my family, I'm not going to let them down. Just because it's not your mother, your father, your brother, you're not going to let this happen to mine. I'm in the medical field. I'm a dental assistant. I treat all my patients like they were my mother, my 194 2/2/10 - PUBLIC HEALTH - RES. 090915 father, my brother. I stand up and fight for those who can't fight for themselves. My brother is not here. Joaquin Rivera is not here. His family, if they're not here, it's because the grief. I wish somebody would have came up here and fought for my brother when I was grieving his loss. And now I thank you for allowing me to speak today.
Hi. Good afternoon. My name is Maria Rivera. I am the sibling of Susan Rivera, and just as she said, yes, we did lose a family member, but it was more hard and more shock. More windows opened, more light came in when I saw this man die the way he did. He was my high school music teacher, and we're talking about plus 30 years ago. To know that this happened in an ER and know that there were people sitting there while it was happening, no 195 2/2/10 - PUBLIC HEALTH - RES. 090915 one came to even say, Are you okay, sir, they just went about their business, it's really hurting not only to me. I am also an advocate. I am a surgical technologist. I'm also a medical assistant, and I deal with patients all the time, and I have where you come in and I will triage you in a minute and then take it to the doctor and say, This patient is really doing this, you need to see this patient. It's not happening anymore. It's not like back in the old school. This is what we do. Not anymore. So I understand and I grieve with the family as well, because he was a well-known person to our community. He was always in Concilio, in Centro Pedro Claver. We always met up with him there when we had auditions or any kind of stuff. We were always there with Joaquin. Always. And on behalf of the church on 6th and Venango and on behalf of Centro Pedro Claver and everyone else, 196 2/2/10 - PUBLIC HEALTH - RES. 090915 we all want to thank you guys for letting us speak up on him, because it's not just about the immediate family, it's about those who grew up around him, and we do miss him dearly. Thank you.
Thank you very much. Thank you for coming in to testify. Is there anyone else here to testify on this resolution? (No response.)
I'll be brief. Thank you, Susanna and Maria, and for all the folks in Hunting Park and San Ambrosio where Joaquin spent most of his life sharing. I hope that today's hearing has enlightened many of us as to the serious issues that emergency rooms face given 197 2/2/10 - PUBLIC HEALTH - RES. 090915 the fact that they are critical care centers. I'm encouraged by some of the best practices that were shared by some of the medical professionals who were here around procedures and what patients should be asking for and looking for as they enter our emergency rooms. I will recommit myself to working with Aria Hospital to ensure that they strive for those best practices and provide the best medical care to the community of Frankford and to the City as a whole. So I want to thank Chairwoman Tasco and Blondell Reynolds, my colleague, for co-sponsoring this hearing, and I think that what I'd like to be able to do is go visit some of these emergency rooms and look at some of these practices and definitely talk with our state colleagues around what other things we could be putting into play as it relates to regulation but, more importantly, support for training and 198 2/2/10 - PUBLIC HEALTH - RES. 090915 ongoing training of medical personnel, especially in underserved communities. So I want to thank Aria Hospital officials and all the folks that came today and testified, and as I said in the beginning of this, this is exactly what Joaquin would have wanted us to do. It is part of his legacy. He continues to provide advocacy even from where he is today. Thank you.
Thank you, Madam Chair. I will only add and suggest and urge the panelist Margaret Robinson, we will be having a conversation with you sidebar, but I need to get the name right of -- please, is it Lisa McGarrigle?
I would urge you to seize the moment and have a conversation with the leadership here at 199 2/2/10 - PUBLIC HEALTH - RES. 090915 Aria Health on your particular matter, and go on the record to say that Councilwoman Sanchez and I will present a formal letter with recommendations based on this hearing to our colleagues at the state and at the state Department of Health. So, again, we thank you all for your important testimony. You can put a comma at the end of this hearing, not a period. Thank you very, very much.
Thank you. This Committee is adjourned. Thank you. (Committee on Public Health and Human Services adjourned at 1:40 p.m.) - - - 200 CERTIFICATE I HEREBY CERTIFY that the proceedings, evidence and objections are contained fully and accurately in the stenographic notes taken by me upon the foregoing matter on February 2, 2010, and that this is a true and correct transcript of same. ______________________________ MICHELE L. MURPHY RPR-Notary Public (The foregoing certification of this transcript does not apply to any reproduction of the same by any means, unless under the direct control and/or supervision of the certifying reporter.)