An experience in cover ups.
I was asked to discuss a cover up I witnessed.
This happened when I was working in a large hospital with a busy ER. Assignments for each nurse were typically four patients. This worked well. But if a nurse got hit with something critical, their ability to cover their other patients dropped, and nurses already maxed out on their assignments had to step up and cover those additional patients for that nurse or help that nurse get their critical patient stable enough to return to the rest of their patients. It was easy to get overwhelmed quickly.
It was late afternoon/early evening, and we were at our peak busy. Everyone was bogged down, and the hallways were lined with patients too because we ran out of rooms. I was covering my patients, extra patients, plus trying to help another nurse who was getting bogged down by a needy patient. I was running past the radio trying to get back to my patients when another ambulance call came in. I had no idea where the charge nurse was, and someone needed to answer, so I stopped and keyed in.
The ambulance report was a male child who had just received vaccinations a few hours ago, who was progressively deteriorating in mentation and finally experienced sudden onset seizing. It was what we call status epilepticus, where the seizure starts, and it doesn't stop. It just keeps going. I wrote in large letters across the bottom of the paramedic report "JUST RECEIVED VACCINATIONS, NOW SEIZING". Often I didn't get a chance to convey relevant or important material to the doctors because we were too busy. That medic radio report was stuck on top of the chart when it went to the doc, and they were supposed to look at it first before anything else. It also was supposed to be part of their record for the visit as it was the only record of prehospital interventions we often received and functioned as the first director of interventions.
On EMS arrival to the scene, kiddo was still in active seizure. They had administered drugs to stop the seizure, but were not convinced it was not still ongoing at some subacute level because there was no responsiveness and they were seeing clenched hands, and tight arms, and minimal spontaneous breathing, but it was apparently there, and pulseox was getting a reading over 90%. Mind you, I'm just getting what the very scared sounding paramedic was quickly spitting into the radio. It always makes you clench up when the paramedics sound scared. Anyway, I acknowledge their radio report, and looked for an open room. There was a couple literally walking out, just discharged. we had bare minutes until their arrival. I couldn't find the nurse assigned to the room, so I just ran in and hammered out a quick clean down so we could use the room when the medics got there.
Right as I finished cleaning the room, they roll in. Charge nurse is finally back, but has no idea what's going on. I grab the papers and get them into the room yelling back at charge nurse "pediatric status epilepticus" so he knew to get people heading my way to help. I started getting bedside report as we are transferring the kiddo over to our gurney. Mom is with them, near break down freaked out. Additional help arrives as we are padding the bed rails and working on vitals, and the nurse assigned to the room finally arrives. At this point, I'm supposed to turn the case over. But this is kind of heavy to drop, so I pause and give the nurse a quickie run down emphasizing the pediatrician office visit and vaccinations immediately prior to onset of symptoms with mom nodding yes while crying in the corner and the paramedic nodding yes.
Here, I then get out of the way, and I step out of the room, telling the nurse I'll get the rest of the history and enter it for her to save her time so she can work on interventions. At this point the doctor is finally getting to the room, chart in hand, with the paramedic report and my large block writing visible on it. The medic is talking to me telling the rest of the story for their report. The doctor interrupts us and asks what happened. this is typical. Poor medics usually have to tell their story three times before they get back out the door unless all the staff meet them at the same time in the room. The paramedic starts relaying the story from call out, what they found on scene, interventions. The doctor asks if there is a seizure history. medic says no. I add in that the child vaccinated only hours ago, and symptoms onset was after vaccination. the doctor does a dismissive "humph" and turns away from me and looks at the medic and asks "is that right?" The medic says yes. Then the doctor looked at the room and the mom standing about ten feet from us, kind of glares at us, turned on both of us and walks into the room.
I finish getting the medic report. And the doctor has started some orders, and the doctor is now talking to the mom, who I hear talking about how he was perfectly healthy earlier, how the pediatrician was saying he looked in perfect health, how he got his vaccines. I figured my part was done. Everything was stabilizing, and I had to get back to my patients. I went out, entered the triage information and medic interview, and included the pediatrician visit and vaccination in the nurses notes. Then went on to care for other patients.
A couple hours go by before I finally catch a break to go check in. We dosed the heck out of the kid with benzo's, and he was sawing logs and mom was calmer. I caught the nurse and asked if he came out of it at all, and she said he had some semi-lucid speech at one point and it looked like seizures were done, but that he had been gorked out with the drugs and had been sleeping for awhile. She said the labs and imaging had been coming back, and that the doc was in contact with a peds neuro trying to decide what to do with the case.
I went in to the room to check vitals and re-document. I was honestly helping the nurse who was busy where I finally had a break, but it also gave me an excuse to get back involved and stay involved in the case. I talked with the mom while she was in the room. I asked what she had been told. Not much. She told me the doctor did not believe the vaccine had anything to do with it. I asked her when the doc had told her this, and she said right away, when they first got there and met her. I asked if she had shared what the labs and imaging showed, and she said all she was told was that there was some kind of swelling in his brain and they were getting transferred to another hospital, and the doctor didn’t know what caused it.
I went out to look at labs and imaging report from the perspective of patient education with the intention of filling the mom in more with what was going on. I also dug through to the doctors notes to see what the doctor had written up, since they were being discharged, I could help the primary nurse by printing off our chart copies to make a transfer packet. The paperwork is what kills in the ER. The primary nurse was more than grateful to get the help, and I was more than willing to help, plus it let me get a look at what was going on.
I quickly noted that there was absolutely nothing documented in the physicians notes about the vaccination or the pediatrician appointment, in spite of its obvious necessity for mention as it was the “last known normal” time and correlated with an exam by a medical doctor who declared him in perfect health. If for no other reason, that should have been in there to establish time frames for onset of illness. But it also, because of this, did not include any mention of vaccination, in spite of the mom saying it, the medic saying it, and the triage RN saying it. It appeared to be a new onset illness, out of the blue, that occurred with no outside interventions or changes in routine, if you were to simply read her physician pass-off notes (which is all the receiving medical doctor is going to do. They don’t read nurses notes). So this information was not being relayed. Most disturbing, in the face of this absence of inclusion of potential etiology, the disposition line that my doctor included under diagnostic impression was “encephalitis of unknown etiology”. Okay, well, yeah, I can’t argue with that statement, but, there was a potential source, a change in daily routine and exposure, that was temporally associated! It should have been mentioned, or at least discussed as a possibility.
Not willing to leave it alone, I approached the doctor and politely tried to broach the subject. I said that I noticed when I was putting together the packet, there was no mention of the pediatrician office and the vaccinations in her pass off report and ER summary, and did she want to amend this before I finalized the transfer packet. I thought it was a polite way of nudging to try to get her to include it. I got “the glare” and a stern voice dismissal that was something to the effect of “they’re not related”. Thats it. I said something like Don’t you want to at least include it for the neurologist to consider? And I got the glare again and was told no, and to just finish the packet.
So I went about piecing and copying the packet together. I included a larger text line with more emphasis about the vaccinations in my triage notes, hoping that at least someone over there might notice that. And then I tried to find the paramedic report to copy it. There is the paramedic radio report that I fill in while I’m talking to them on the radio and they are inbound. Then there is their official run report, which is their paperwork which they make a copy of for our records. Both were missing from the chart. In fact, every mention of the vaccines was sterilized from the chart. The primary nurse had not written in anything about it either. Now, to note, this same physician had tried ordering me not to do things in the past or to “drop” certain topics. It is an assumption, and only an assumption, but never-the-less a very probable one, that she told the nurse to drop the vaccines subject and told the nurse that they had nothing to do with it and the primary nurse simply complied with the doctors “request.” I have no proof of this other than belief and experience with her “requests” of me in the past, but I believe that is probably what happened.
Regardless, the only proof that remained was in my documentation, and I looked like the odd man out since no one else even mentioned it anywhere. I kept looking for the paramedic documents. I actually did finally find them. Stuck between two other papers, thrown in the paper disposal bin to be shredded. I pulled them out. Is it possible it was an accident? That the only two pieces of paper that corroborated my triage were disposed of, in the shred bin, and had somehow been sandwiched between two unrelated pieces of trash paper that weren’t even from the file and had nothing to do with that patient? I suppose so. I find it highly unlikely, and I believe this was intentional sterilization of information, especially in light of the refusal to acknowledge the pediatrician appointment or vaccinations anywhere in the chart, in spite of the undeniable association to onset of symptoms, compounded further by the ER doc refusing to disclose to the receiving neurologist that the child received vaccines immediately prior onset of symptoms and had gone so far as to tell the parent straight up right away that the vaccine had nothing to do with it. She didn’t know what caused it, but the vaccine had nothing to do with it.
The doctor, of course, did not report to VAERS. In spite of the fact that there were lab findings, radiology findings, and symptoms which all warranted a VAERS report, and the child was not just brought in to the ER, but was hospitalized, and assigned neurological follow up care.
When the paramedics arrived, I caught the mother in front of the paramedics and asked her permission to file a VAERS report. I knew she wouldn’t know what it was, but it was calculated. She asked what it was. It gave me the opportunity to state “Vaccine Adverse Event Reporting System” in front of the paramedics, who stopped what they were doing and keyed in to the conversation where I went on to state that anytime there is an event that happens after receiving a vaccine, just like what happened with her son, health care providers are supposed to file a report. I told her I wanted her permission to include her details so they could open a file for her child. Now, I know I don’t need her permission to file a VAERS report. I did this to point out to the medics that this was a potential adverse reaction to a vaccine in the hopes that they would discuss this more with the mom in transit and pass that information off directly when they arrived. Medics like to talk. It’s a good thing. And secondly, I wanted the mother to know there was a reporting system, and that this was potentially associated, and that she could follow up on this. It was a carefully calculated strategy.
After they left, I went and filed a VAERS report nice and publicly sitting at a prominent terminal as close to the doctors as I could get. I made sure to say it loud enough to be overheard that I was filing a VAERS report on the kid we just transferred when a colleague questioned what I was doing. I know the doctor overheard. She ignored me.
Anyway, you wanted one of my stories. I wasn’t even the primary nurse on that one, but I still got to see the cover up in play.
An experience in cover ups.
I was asked to discuss a cover up I witnessed.
This happened when I was working in a large hospital with a busy ER. Assignments for each nurse were typically four patients. This worked well. But if a nurse got hit with something critical, their ability to cover their other patients dropped, and nurses already maxed out on their assignments had to step up and cover those additional patients for that nurse or help that nurse get their critical patient stable enough to return to the rest of their patients. It was easy to get overwhelmed quickly.
It was late afternoon/early evening, and we were at our peak busy. Everyone was bogged down, and the hallways were lined with patients too because we ran out of rooms. I was covering my patients, extra patients, plus trying to help another nurse who was getting bogged down by a needy patient. I was running past the radio trying to get back to my patients when another ambulance call came in. I had no idea where the charge nurse was, and someone needed to answer, so I stopped and keyed in.
The ambulance report was a male child who had just received vaccinations a few hours ago, who was progressively deteriorating in mentation and finally experienced sudden onset seizing. It was what we call status epilepticus, where the seizure starts, and it doesn't stop. It just keeps going. I wrote in large letters across the bottom of the paramedic report "JUST RECEIVED VACCINATIONS, NOW SEIZING". Often I didn't get a chance to convey relevant or important material to the doctors because we were too busy. That medic radio report was stuck on top of the chart when it went to the doc, and they were supposed to look at it first before anything else. It also was supposed to be part of their record for the visit as it was the only record of prehospital interventions we often received and functioned as the first director of interventions.
On EMS arrival to the scene, kiddo was still in active seizure. They had administered drugs to stop the seizure, but were not convinced it was not still ongoing at some subacute level because there was no responsiveness and they were seeing clenched hands, and tight arms, and minimal spontaneous breathing, but it was apparently there, and pulseox was getting a reading over 90%. Mind you, I'm just getting what the very scared sounding paramedic was quickly spitting into the radio. It always makes you clench up when the paramedics sound scared. Anyway, I acknowledge their radio report, and looked for an open room. There was a couple literally walking out, just discharged. we had bare minutes until their arrival. I couldn't find the nurse assigned to the room, so I just ran in and hammered out a quick clean down so we could use the room when the medics got there.
Right as I finished cleaning the room, they roll in. Charge nurse is finally back, but has no idea what's going on. I grab the papers and get them into the room yelling back at charge nurse "pediatric status epilepticus" so he knew to get people heading my way to help. I started getting bedside report as we are transferring the kiddo over to our gurney. Mom is with them, near break down freaked out. Additional help arrives as we are padding the bed rails and working on vitals, and the nurse assigned to the room finally arrives. At this point, I'm supposed to turn the case over. But this is kind of heavy to drop, so I pause and give the nurse a quickie run down emphasizing the pediatrician office visit and vaccinations immediately prior to onset of symptoms with mom nodding yes while crying in the corner and the paramedic nodding yes.
Here, I then get out of the way, and I step out of the room, telling the nurse I'll get the rest of the history and enter it for her to save her time so she can work on interventions. At this point the doctor is finally getting to the room, chart in hand, with the paramedic report and my large block writing visible on it. The medic is talking to me telling the rest of the story for their report. The doctor interrupts us and asks what happened. this is typical. Poor medics usually have to tell their story three times before they get back out the door unless all the staff meet them at the same time in the room. The paramedic starts relaying the story from call out, what they found on scene, interventions. The doctor asks if there is a seizure history. medic says no. I add in that the child vaccinated only hours ago, and symptoms onset was after vaccination. the doctor does a dismissive "humph" and turns away from me and looks at the medic and asks "is that right?" The medic says yes. Then the doctor looked at the room and the mom standing about ten feet from us, kind of glares at us, turned on both of us and walks into the room.
I finish getting the medic report. And the doctor has started some orders, and the doctor is now talking to the mom, who I hear talking about how he was perfectly healthy earlier, how the pediatrician was saying he looked in perfect health, how he got his vaccines. I figured my part was done. Everything was stabilizing, and I had to get back to my patients. I went out, entered the triage information and medic interview, and included the pediatrician visit and vaccination in the nurses notes. Then went on to care for other patients.
A couple hours go by before I finally catch a break to go check in. We dosed the heck out of the kid with benzo's, and he was sawing logs and mom was calmer. I caught the nurse and asked if he came out of it at all, and she said he had some semi-lucid speech at one point and it looked like seizures were done, but that he had been gorked out with the drugs and had been sleeping for awhile. She said the labs and imaging had been coming back, and that the doc was in contact with a peds neuro trying to decide what to do with the case.
I went in to the room to check vitals and re-document. I was honestly helping the nurse who was busy where I finally had a break, but it also gave me an excuse to get back involved and stay involved in the case. I talked with the mom while she was in the room. I asked what she had been told. Not much. She told me the doctor did not believe the vaccine had anything to do with it. I asked her when the doc had told her this, and she said right away, when they first got there and met her. I asked if she had shared what the labs and imaging showed, and she said all she was told was that there was some kind of swelling in his brain and they were getting transferred to another hospital, and the doctor didn’t know what caused it.
I went out to look at labs and imaging report from the perspective of patient education with the intention of filling the mom in more with what was going on. I also dug through to the doctors notes to see what the doctor had written up, since they were being discharged, I could help the primary nurse by printing off our chart copies to make a transfer packet. The paperwork is what kills in the ER. The primary nurse was more than grateful to get the help, and I was more than willing to help, plus it let me get a look at what was going on.
I quickly noted that there was absolutely nothing documented in the physicians notes about the vaccination or the pediatrician appointment, in spite of its obvious necessity for mention as it was the “last known normal” time and correlated with an exam by a medical doctor who declared him in perfect health. If for no other reason, that should have been in there to establish time frames for onset of illness. But it also, because of this, did not include any mention of vaccination, in spite of the mom saying it, the medic saying it, and the triage RN saying it. It appeared to be a new onset illness, out of the blue, that occurred with no outside interventions or changes in routine, if you were to simply read her physician pass-off notes (which is all the receiving medical doctor is going to do. They don’t read nurses notes). So this information was not being relayed. Most disturbing, in the face of this absence of inclusion of potential etiology, the disposition line that my doctor included under diagnostic impression was “encephalitis of unknown etiology”. Okay, well, yeah, I can’t argue with that statement, but, there was a potential source, a change in daily routine and exposure, that was temporally associated! It should have been mentioned, or at least discussed as a possibility.
Not willing to leave it alone, I approached the doctor and politely tried to broach the subject. I said that I noticed when I was putting together the packet, there was no mention of the pediatrician office and the vaccinations in her pass off report and ER summary, and did she want to amend this before I finalized the transfer packet. I thought it was a polite way of nudging to try to get her to include it. I got “the glare” and a stern voice dismissal that was something to the effect of “they’re not related”. Thats it. I said something like Don’t you want to at least include it for the neurologist to consider? And I got the glare again and was told no, and to just finish the packet.
So I went about piecing and copying the packet together. I included a larger text line with more emphasis about the vaccinations in my triage notes, hoping that at least someone over there might notice that. And then I tried to find the paramedic report to copy it. There is the paramedic radio report that I fill in while I’m talking to them on the radio and they are inbound. Then there is their official run report, which is their paperwork which they make a copy of for our records. Both were missing from the chart. In fact, every mention of the vaccines was sterilized from the chart. The primary nurse had not written in anything about it either. Now, to note, this same physician had tried ordering me not to do things in the past or to “drop” certain topics. It is an assumption, and only an assumption, but never-the-less a very probable one, that she told the nurse to drop the vaccines subject and told the nurse that they had nothing to do with it and the primary nurse simply complied with the doctors “request.” I have no proof of this other than belief and experience with her “requests” of me in the past, but I believe that is probably what happened.
Regardless, the only proof that remained was in my documentation, and I looked like the odd man out since no one else even mentioned it anywhere. I kept looking for the paramedic documents. I actually did finally find them. Stuck between two other papers, thrown in the paper disposal bin to be shredded. I pulled them out. Is it possible it was an accident? That the only two pieces of paper that corroborated my triage were disposed of, in the shred bin, and had somehow been sandwiched between two unrelated pieces of trash paper that weren’t even from the file and had nothing to do with that patient? I suppose so. I find it highly unlikely, and I believe this was intentional sterilization of information, especially in light of the refusal to acknowledge the pediatrician appointment or vaccinations anywhere in the chart, in spite of the undeniable association to onset of symptoms, compounded further by the ER doc refusing to disclose to the receiving neurologist that the child received vaccines immediately prior onset of symptoms and had gone so far as to tell the parent straight up right away that the vaccine had nothing to do with it. She didn’t know what caused it, but the vaccine had nothing to do with it.
The doctor, of course, did not report to VAERS. In spite of the fact that there were lab findings, radiology findings, and symptoms which all warranted a VAERS report, and the child was not just brought in to the ER, but was hospitalized, and assigned neurological follow up care.
When the paramedics arrived, I caught the mother in front of the paramedics and asked her permission to file a VAERS report. I knew she wouldn’t know what it was, but it was calculated. She asked what it was. It gave me the opportunity to state “Vaccine Adverse Event Reporting System” in front of the paramedics, who stopped what they were doing and keyed in to the conversation where I went on to state that anytime there is an event that happens after receiving a vaccine, just like what happened with her son, health care providers are supposed to file a report. I told her I wanted her permission to include her details so they could open a file for her child. Now, I know I don’t need her permission to file a VAERS report. I did this to point out to the medics that this was a potential adverse reaction to a vaccine in the hopes that they would discuss this more with the mom in transit and pass that information off directly when they arrived. Medics like to talk. It’s a good thing. And secondly, I wanted the mother to know there was a reporting system, and that this was potentially associated, and that she could follow up on this. It was a carefully calculated strategy.
After they left, I went and filed a VAERS report nice and publicly sitting at a prominent terminal as close to the doctors as I could get. I made sure to say it loud enough to be overheard that I was filing a VAERS report on the kid we just transferred when a colleague questioned what I was doing. I know the doctor overheard. She ignored me.
Anyway, you wanted one of my stories. I wasn’t even the primary nurse on that one, but I still got to see the cover up in play.
An experience in cover ups.
I was asked to discuss a cover up I witnessed.
This happened when I was working in a large hospital with a busy ER. Assignments for each nurse were typically four patients. This worked well. But if a nurse got hit with something critical, their ability to cover their other patients dropped, and nurses already maxed out on their assignments had to step up and cover those additional patients for that nurse or help that nurse get their critical patient stable enough to return to the rest of their patients. It was easy to get overwhelmed quickly.
It was late afternoon/early evening, and we were at our peak busy. Everyone was bogged down, and the hallways were lined with patients too because we ran out of rooms. I was covering my patients, extra patients, plus trying to help another nurse who was getting bogged down by a needy patient. I was running past the radio trying to get back to my patients when another ambulance call came in. I had no idea where the charge nurse was, and someone needed to answer, so I stopped and keyed in.
The ambulance report was a male child who had just received vaccinations a few hours ago, who was progressively deteriorating in mentation and finally experienced sudden onset seizing. It was what we call status epilepticus, where the seizure starts, and it doesn't stop. It just keeps going. I wrote in large letters across the bottom of the paramedic report "JUST RECEIVED VACCINATIONS, NOW SEIZING". Often I didn't get a chance to convey relevant or important material to the doctors because we were too busy. That medic radio report was stuck on top of the chart when it went to the doc, and they were supposed to look at it first before anything else. It also was supposed to be part of their record for the visit as it was the only record of prehospital interventions we often received and functioned as the first director of interventions.
On EMS arrival to the scene, kiddo was still in active seizure. They had administered drugs to stop the seizure, but were not convinced it was not still ongoing at some subacute level because there was no responsiveness and they were seeing clenched hands, and tight arms, and minimal spontaneous breathing, but it was apparently there, and pulseox was getting a reading over 90%. Mind you, I'm just getting what the very scared sounding paramedic was quickly spitting into the radio. It always makes you clench up when the paramedics sound scared. Anyway, I acknowledge their radio report, and looked for an open room. There was a couple literally walking out, just discharged. we had bare minutes until their arrival. I couldn't find the nurse assigned to the room, so I just ran in and hammered out a quick clean down so we could use the room when the medics got there.
Right as I finished cleaning the room, they roll in. Charge nurse is finally back, but has no idea what's going on. I grab the papers and get them into the room yelling back at charge nurse "pediatric status epilepticus" so he knew to get people heading my way to help. I started getting bedside report as we are transferring the kiddo over to our gurney. Mom is with them, near break down freaked out. Additional help arrives as we are padding the bed rails and working on vitals, and the nurse assigned to the room finally arrives. At this point, I'm supposed to turn the case over. But this is kind of heavy to drop, so I pause and give the nurse a quickie run down emphasizing the pediatrician office visit and vaccinations immediately prior to onset of symptoms with mom nodding yes while crying in the corner and the paramedic nodding yes.
Here, I then get out of the way, and I step out of the room, telling the nurse I'll get the rest of the history and enter it for her to save her time so she can work on interventions. At this point the doctor is finally getting to the room, chart in hand, with the paramedic report and my large block writing visible on it. The medic is talking to me telling the rest of the story for their report. The doctor interrupts us and asks what happened. this is typical. Poor medics usually have to tell their story three times before they get back out the door unless all the staff meet them at the same time in the room. The paramedic starts relaying the story from call out, what they found on scene, interventions. The doctor asks if there is a seizure history. medic says no. I add in that the child vaccinated only hours ago, and symptoms onset was after vaccination. the doctor does a dismissive "humph" and turns away from me and looks at the medic and asks "is that right?" The medic says yes. Then the doctor looked at the room and the mom standing about ten feet from us, kind of glares at us, turned on both of us and walks into the room.
I finish getting the medic report. And the doctor has started some orders, and the doctor is now talking to the mom, who I hear talking about how he was perfectly healthy earlier, how the pediatrician was saying he looked in perfect health, how he got his vaccines. I figured my part was done. Everything was stabilizing, and I had to get back to my patients. I went out, entered the triage information and medic interview, and included the pediatrician visit and vaccination in the nurses notes. Then went on to care for other patients.
A couple hours go by before I finally catch a break to go check in. We dosed the heck out of the kid with benzo's, and he was sawing logs and mom was calmer. I caught the nurse and asked if he came out of it at all, and she said he had some semi-lucid speech at one point and it looked like seizures were done, but that he had been gorked out with the drugs and had been sleeping for awhile. She said the labs and imaging had been coming back, and that the doc was in contact with a peds neuro trying to decide what to do with the case.
I went in to the room to check vitals and re-document. I was honestly helping the nurse who was busy where I finally had a break, but it also gave me an excuse to get back involved and stay involved in the case. I talked with the mom while she was in the room. I asked what she had been told. Not much. She told me the doctor did not believe the vaccine had anything to do with it. I asked her when the doc had told her this, and she said right away, when they first got there and met her. I asked if she had shared what the labs and imaging showed, and she said all she was told was that there was some kind of swelling in his brain and they were getting transferred to another hospital, and the doctor didn’t know what caused it.
I went out to look at labs and imaging report from the perspective of patient education with the intention of filling the mom in more with what was going on. I also dug through to the doctors notes to see what the doctor had written up, since they were being discharged, I could help the primary nurse by printing off our chart copies to make a transfer packet. The paperwork is what kills in the ER. The primary nurse was more than grateful to get the help, and I was more than willing to help, plus it let me get a look at what was going on.
I quickly noted that there was absolutely nothing documented in the physicians notes about the vaccination or the pediatrician appointment, in spite of its obvious necessity for mention as it was the “last known normal” time and correlated with an exam by a medical doctor who declared him in perfect health. If for no other reason, that should have been in there to establish time frames for onset of illness. But it also, because of this, did not include any mention of vaccination, in spite of the mom saying it, the medic saying it, and the triage RN saying it. It appeared to be a new onset illness, out of the blue, that occurred with no outside interventions or changes in routine, if you were to simply read her physician pass-off notes (which is all the receiving medical doctor is going to do. They don’t read nurses notes). So this information was not being relayed. Most disturbing, in the face of this absence of inclusion of potential etiology, the disposition line that my doctor included under diagnostic impression was “encephalitis of unknown etiology”. Okay, well, yeah, I can’t argue with that statement, but, there was a potential source, a change in daily routine and exposure, that was temporally associated! It should have been mentioned, or at least discussed as a possibility.
Not willing to leave it alone, I approached the doctor and politely tried to broach the subject. I said that I noticed when I was putting together the packet, there was no mention of the pediatrician office and the vaccinations in her pass off report and ER summary, and did she want to amend this before I finalized the transfer packet. I thought it was a polite way of nudging to try to get her to include it. I got “the glare” and a stern voice dismissal that was something to the effect of “they’re not related”. Thats it. I said something like Don’t you want to at least include it for the neurologist to consider? And I got the glare again and was told no, and to just finish the packet.
So I went about piecing and copying the packet together. I included a larger text line with more emphasis about the vaccinations in my triage notes, hoping that at least someone over there might notice that. And then I tried to find the paramedic report to copy it. There is the paramedic radio report that I fill in while I’m talking to them on the radio and they are inbound. Then there is their official run report, which is their paperwork which they make a copy of for our records. Both were missing from the chart. In fact, every mention of the vaccines was sterilized from the chart. The primary nurse had not written in anything about it either. Now, to note, this same physician had tried ordering me not to do things in the past or to “drop” certain topics. It is an assumption, and only an assumption, but never-the-less a very probable one, that she told the nurse to drop the vaccines subject and told the nurse that they had nothing to do with it and the primary nurse simply complied with the doctors “request.” I have no proof of this other than belief and experience with her “requests” of me in the past, but I believe that is probably what happened.
Regardless, the only proof that remained was in my documentation, and I looked like the odd man out since no one else even mentioned it anywhere. I kept looking for the paramedic documents. I actually did finally find them. Stuck between two other papers, thrown in the paper disposal bin to be shredded. I pulled them out. Is it possible it was an accident? That the only two pieces of paper that corroborated my triage were disposed of, in the shred bin, and had somehow been sandwiched between two unrelated pieces of trash paper that weren’t even from the file and had nothing to do with that patient? I suppose so. I find it highly unlikely, and I believe this was intentional sterilization of information, especially in light of the refusal to acknowledge the pediatrician appointment or vaccinations anywhere in the chart, in spite of the undeniable association to onset of symptoms, compounded further by the ER doc refusing to disclose to the receiving neurologist that the child received vaccines immediately prior onset of symptoms and had gone so far as to tell the parent straight up right away that the vaccine had nothing to do with it. She didn’t know what caused it, but the vaccine had nothing to do with it.
The doctor, of course, did not report to VAERS. In spite of the fact that there were lab findings, radiology findings, and symptoms which all warranted a VAERS report, and the child was not just brought in to the ER, but was hospitalized, and assigned neurological follow up care.
When the paramedics arrived, I caught the mother in front of the paramedics and asked her permission to file a VAERS report. I knew she wouldn’t know what it was, but it was calculated. She asked what it was. It gave me the opportunity to state “Vaccine Adverse Event Reporting System” in front of the paramedics, who stopped what they were doing and keyed in to the conversation where I went on to state that anytime there is an event that happens after receiving a vaccine, just like what happened with her son, health care providers are supposed to file a report. I told her I wanted her permission to include her details so they could open a file for her child. Now, I know I don’t need her permission to file a VAERS report. I did this to point out to the medics that this was a potential adverse reaction to a vaccine in the hopes that they would discuss this more with the mom in transit and pass that information off directly when they arrived. Medics like to talk. It’s a good thing. And secondly, I wanted the mother to know there was a reporting system, and that this was potentially associated, and that she could follow up on this. It was a carefully calculated strategy.
After they left, I went and filed a VAERS report nice and publicly sitting at a prominent terminal as close to the doctors as I could get. I made sure to say it loud enough to be overheard that I was filing a VAERS report on the kid we just transferred when a colleague questioned what I was doing. I know the doctor overheard. She ignored me.
Anyway, you wanted one of my stories. I wasn’t even the primary nurse on that one, but I still got to see the cover up in play.