This big issue, in my estimation, is how hospitals deal with their problems (especially ones that impact quality of care) and more to the point how they deal with patients and their chosen caregivers when they have complaints.

I’ve witnessed and experienced a significant number of problems at Sihanouk Hospital Center of HOPE (SHCH) over the past few years.

A lot of people, even some of my best and closest friends don’t know that I, for more than four solid years, have supported and taken care of a poor, sick, Cambodian friend here in Phnom Penh. I can’t provide many details; no name, no gender, and no specifics about my friend’s medical status other than to say that my friend is very frail and sickly and has been in and out hospitals at least a few times each year.

But this post is not about me and it is not really about my friend. It is about how Sihanouk Hosptial Center of HOPE has responded (or declined to respond at all) to a variety of serious complaints about critical quality of care issues that I have communicated to doctors and to senior administrators and executives there in good faith.

For consistency’s sake I will paste at the end of this posting various posts that I made on Facebook today about what I consider to be SHCH’s unacceptable actions and reactions to completely legitimate complaints that I’ve made to them. Complaints that I believe any reasonable person would find to be authentic, serious, and certainly worthy of a dignified, compassionate and helpful response.

Unfortunately I’ve often not recevied responses, replies or other feedback about my complaints from the hospital that were polite, reasonable, dignified or even constructive. Rather they have too often been decidedly rude, unprofessional, discouraging and disrespectful. At times they’ve been downright dishonest and have acted in ways that tarnish the reputation of what many consider to be the best hospital in all of Cambodia. Its been very distrubing and disappointing for me and more importantly for my friend.

 —————————————————————————————————-

First let me tell you a few good things about SHCH. I think they are generally a great hospital that does amazingly good work to help an incredible number of dirt-poor, helpless, and very sick Cambodians… and they do this for FREE! That’s pretty cool in my book I respect and admire them, except for the despicable way that they’ve treated me and my poor sick friend.

The hospital is also a training center for doctors, which Cambodia does not have enough of, so they double their value to my community. Yes I said my community. Sure I’m an American citizen, but I live here.This is my community, and that is why I am aghast at not only some of the things that I’ve seen and experienced at SHCH, but doubly shocked at the consistently unprofessional, rude, undignified and (I believe) unethical things that they have said and done that have harmed rather than helped my friend.

If the kind of responses, behavior and institutional nincompoopery that I’ve pretty consistently received from SHCH are what they are teaching young Cambodian doctors, then there’s a lot to be worried and angry about.

Want to learn more about SHCH? Here’s a link, if you’re interested:

- Sihanouk Hopsital Center of HOPE website

———————————————————————–

OK, here is what I posted on the hospital’s Facebook page this morning, along with some of the additional comments:

COMPLAINTS AND PATIENT’S RIGHTS

AT SIHANOUK HOSPTIAL CENTER OF HOPE IN PHNOM PENH CAMBODIA

Sihanouk Hospital Center of HOPE is an important hospital in Cambodia and does a lot of very good work helping poor, needy and underprivileged people, but they also have some very serious problems, some of which they do not seem to be addressing in a professional constructive and positive manner.

I have a destitute Cambodian friend that I have provided daily care and support to for over 4 years.

Unfortunately my friend (a patient for many years at SHCH) and I have had some terrible, shocking and extremely upsetting experiences with SHCH over the past few years: suffice it to say these are things that any sane person would complain about because they directly or indirectly impacted my friend’s health and outlook in a clearly negative and on numerous occasions in a decidedly mean-spirited way.

When I have voiced my very serious, reasonable and legitimate complaints, both orally and in writing, my complaints have absolutely NOT at all been met with the care, compassion and respect that the hospital prominently advertises. Actually they (SHCH) have, on a number of occasions, simply ignored me entirely. In fact I have been told repeatedly on numerous occasions by Dr. Gerlinda Lucas that – on the subject of my complaints –”it doesn’t help”. This attitude of not being able to do anything about problems that are pointed out is one that I have found, in my dealings with the hospital, to be pervasive and persistent over a period of years, though – to be completely fair – certaianly there have been occassions where my input was taken graciously and acted on in a constructive and appropriate manner.

Once a doctor at the hospital – in response to me having clearly and calmly suggesting a simple solution to a serious training deficiency at SHCH that he himself identified – said to me as he laughed “never mind, that was all in the past and there is nothing to worry about” – about a serious problem that had caused harm to my friend”. My suggestion was that they simply provide more training on a very particular topic.

As most reasonable people would agree, if complaints about serious problems are not handled in a respectful, professional, courteous and timely manner with prudent action then the problems actually become compounded and exacerbated, rather than alleviated. Clearly that is what has happened to my friend. Now I am making these problems public in an effort to continue to press SHCH to act in an upstanding and constructive manner.

Dr. Gerlinda Lucas and Dr. Sopheak Thai of SHCH have even gone so far as to threaten to discontinue my friend’s lifesaving treatment as retribution in response to my complaints. These threats have proven to be extremely upsetting to both me and the poor sick patient. I believe that these unconscionable threats also badly tarnish the reputation of SHCH by violating a basic tenet of generally accepted medical ethics.

I have written to Mr. Kevin O’Brien about these problems and he has only responded by banishing me from the hospital, (negatively impacting the care that my friend is able to receive by limiting and compromising the quality of the care that I can provide) and by offering to return the money that I had donated to the hospital. I had not asked for my money back, Mr. O’Brien’s offer to return my donations was unprompted by me, but I did take him up on his offer.

Mr. O’Brien evidently also fully endorses and approves the decision by Dr. Lucas and other doctors on his staff to cease communicating with me entirely about my friend’s condition, while knowing full well that the patient was/is entirely dependent upon me for daily care and support. This conscious decision was made in response to serious complaints about the quality of care my friend was receiving… and it resulted in directly increasing the patient’s suffering and placing the patient in a more risky health position on a daily basis.

This conscious decision to end cooperation with me and to leave me in the dark about the patient’s status (diagnosis, treatment, nutritional advice, prognosis, and information about what to do in case the patient’s condition worsens), clearly needlessly places the patient in a higher risk health situation on a daily basis

It seems to me that SHCH has an obligation to all of its patients and their respective care-givers to refrain from doing things that are harmful and restrict their activities to doing things that are helpful and supportive.

I find this type of uncivil response (uncooperative, rude, demonizing, threatening, etc.) to legitimate complaints about life-saving healthcare for a fragile patient to be reprehensible and indefensible – it is shocking and scandalous in my opinion.

I let Mr. O’Brien know about this in a letter I sent to him via e-mail and his response was to avoid any discussion at all (with me) about the issues I raised, to ban me from the hospital, to accuse me of harassment (a completely ludicrous, bizarre and baseless accusation), to tell me that he had shown my letter to his board of directors who thought that “there was something wrong with me”, and then to tell me that I “need therapy”.

After witnessing Mr. O’Brien’s and Dr. Lucas’ rude and unprofessional response to my complaints I wrote a letter (months ago) and sent it via e-mail to Bernard Krisher, the chairman of the board of SHCH. To date Mr Krisher has not replied to my polite plea for help.

I am making these facts public on the SHCH Facebook discussion forum with the hope that SHCH will reconsider its decisions and actually live up to the promises that it makes to both patients (and their care-giving friends and families), and to SHCH’s many donors.

- What do you think about this?

- If a hospital – any hospital – makes mistakes or has pervasive, persistent and identifiable problems or shortcomings shouldn’t they be held accountable to make amends in an honorable fashion, remedy the situation professionally in an above board way, and take corrective action to ensure that the problems of the past are not repeated in the future?

- Is it appropriate for the hospital’s CEO to offer to return a substantial donation given in good faith?

- Is a refusal to engage in civil discussion an acceptable response to legitimate complaints?

- Should people who complain about healthcare problems be ignored, insulted and demonized?

- Should patients who complain either personally or via the advocacy of their caregiver be threatened with discontinuance of treatment?

- Should doctors intimidate patients about actions taken by their care-givers that the patient had no responsibility or control over (this is what has happened)?

- Do you think that SHCH should take prompt action to remedy this specific situation by cooperating with the patient’s sole-caregiver and sole means of support in a positive, friendly and constructive manner that would benefit all parties involved?

- Do you need more information? I can provide more factual detail, but not to the point that would jeopardize my friend’s privacy.3 hours ago

 ———————————————————————-

 Steve Goodman

——————————————————————————————————–
Phnom Penh, Cambodia
Tuesday March 23rd, 2010

Dear Mr. Krisher,

My name is Steve Goodman and I am an American citizen who has lived in Phnom Penh for the past five years.

I am the sole caregiver and only means of support for a CAMBODIAN FRIEND who COMES FROM UNFORTUNATE HOME CIRCUMSTANCES.

My friend, with my assistance, had the good fortune to be admitted as a patient to the Sihanouk Hospital Center of HOPE about three years ago and since then has received generally excellent healthcare there on an out-patient and in-patient basis as required.

THE PATIENT and I are extremely grateful for the care and treatment that THE PATIENT has received from SHCH and I have personally made donations to the hospital and have promoted and publicized the hospital’s good work in an effort to solicit donations from friends and family here in Cambodia and at home in America.

Unfortunately there has been a serious and recurring problem at SHCH over the past few years that directly and adversely impacts the health and well-being of my friend and when I have attempted to complain to Dr. Gerlinda Lucas in the past and more recently to Mr. Kevin O’Brien my complaints and those of my friend have been handled in an extremely unsatisfying, unresponsive, unprofessional, undignified and dismissive manner that is resulting in my friend receiving less than adequate care and placing THE PATIENT in a situation where risk is increased and THE PATIENT’S outlook and expectation for improvement is highly compromised.

The recurring problem is that many of the doctors at SHCH have been routinely uncooperative and have on numerous occasions refused to speak with me at all in my role as the patient’s sole caregiver, even when I take my friend to the hospital for urgent emergency treatment and attempt to politely introduce myself. This lack of cooperation effectively blocks my good faith efforts to provide the doctors with information about the patient’s condition (signs and symptoms) that THE PATIENT is often unable (due to severe illness) or unwilling (due to depression and other psychological conditions) to communicate completely and accurately ALONE. By dismissing me and blocking me from providing timely and accurate information SHCH has needlessly put the patient at increased risk and this has upset US BOTH – resulting in fear, mistrust, apprehension and anxiety – sometimes even panic – none of which are desirable for the patient. The anxiety from this lack of cooperation has at times exacerbated THE PATIENT’S immediate health and worsened THE PATIENT’S condition and outlook.

Furthermore, by refusing to cooperate by providing me with the specific advice I need to act as a fully empowered caregiver I have been placed in a position where I am considerably less effective than I might otherwise be and more importantly the patient is consequently placed in a position where THE PATIENT may be unintentionally neglected and placed at a much higher risk than THE PATIENT ought to be.

Dr. Lucas and SHCH have been clearly advised many times by both me and the patient that it is THE PATIENT’S wish that the doctors cooperate fully with me and inform me in detail about all the information needed to provide the best possible home care for THE PATIENT and they are well aware that it is with the patient’s explicit consent that I continue to complain about this urgent and completely solvable problem.

As you may know, it is generally accepted among medical professionals worldwide that reports from patient’s caregivers (who see the patient on a daily basis) are vital and invaluable for doctors so they can quickly and accurately assess their patient’s condition and then provide appropriate care and treatment. There are many studies documenting that the veracity, accuracy, scope and reliability of caregiver reports greatly exceeds those given by patients alone.

Similarly it is every patient’s right (along with every patient’s designated or chosen caregiver) to be fully and accurately informed about the patient’s condition including specific information concerning diagnosis, treatment plan, prognosis, medication schedule and directions, along with other recommendations, restrictions, dietary advice and what to do in case of an emergency or in case certain signs and symptoms are present.

My friend is absolutely unable to support and care for HIM OR HER SELF unaided and is completely dependent and reliant upon me exclusively. This has been the case for almost four years and is highly unlikely to change. There is not anyone else who is both willing and able to provide THE PATIENT with the kind of loving care, comfort, attention and financial support that I do.

Recently, after I once again lodged a complaint with Dr. Lucas, the patient was taken to a conference room at SHCH where THE PATIENT alone met with five male doctors who intimidated and coerced THE PATIENT (in a gentle Cambodian way) to sign a hand-written non-standard document that is; discriminatory, clearly against THE PATIENT’S best interests and that breaches universally accepted medical ethics by unreasonably threatening to disrupt and discontinue THE PATIENT’S life-saving medical care. This is absolutely shocking and unacceptable. THE PATIENT was told that if THE PATIENT did not sign the agreement that THE PATIENT’S care would be terminated abruptly and in fact this is clearly stated in the document itself.

I am writing to appeal to you as the chairman of the board of SHCH to bring this matter to your attention and to appeal to you to please help in any way you can to promptly resolve the matter in a way that remedies the violation of the patient’s rights and allows THE PATIENT to receive the best possible medical care by having SHCH cooperate with me in a professional and dignified manner.

I am extremely reluctant to make the regrettable facts of this situation public by making them known to the press or to human rights advocacy groups or other organizations that may be in a position to both reason with and pressure SHCH because this would inevitably result in taking time, money and attention away from the hospital’s mission and its other patients and would presumably weaken its ability to raise funds and best serve my community here in Cambodia. Suffice it to say there are many gory and unpleasant details and almost of them are impeccably and irrefutably documented.

I will be happy to furnish more information if you or others require and I do genuinely apologize for bothering you with this problem, but I feel strongly that I must exhaust all possible avenues on my friend’s behalf before I am forced to share factual information in a more visible and even public manner to rectify this very upsetting and dangerous situation on behalf of my friend.

In the past week I have privately and confidentially consulted with a rabbi, with a prominent psychiatrist, a medical doctor, a law professor and a few other prominent and distinguished individuals here in Phnom Penh, some who know my friend and some who do not. There is unanimous agreement among these professionals that the facts point clearly to misconduct and a breach of ethics on the part of SHCH. Similarly there is unanimous agreement that this situation is still completely solvable in a way that could be mutually beneficial and satisfying to all parties involved and it is my friend’s wish and mine that we can work together to achieve a mutually acceptable and practical solution at once.

In closing, with great respect and admiration I want to plead with you for your help to quickly, quietly and properly resolve this situation in a dignified, ethical and pragmatic way. Feel free to contact me by phone or e-mail at any time.

Please help.

Sincerely with best regards,

Steve Goodman

——————————————————————————————————-

- What do you think about this?

- Is it appropriate that Mr. Krisher chose to not to see fit to reply to my polite letter and plea for help?

- Is it appropriate for doctors (or others) at SHCH to intimidate a patient into signing a discriminatory agreement?

- Does this make you feel good about how problems have been handled at SHCH?

- Can you make any constructive contribution to resolving this very serious problem that has now been made public only due to the lack of an honorable response by SHCH doctors, administrators and management?

 ANOTHER POST FROM FACEBOOK

Forget about Leonard Cohen, here is something that is really controversial and seriously important…