My family crafted our letter carefully and positively. In it, we suggested specific ways that the hospital could achieve national standards for treating systemic infection. Given the technical nature of our concerns, we asked that I be contacted as our family's spokesperson. We mailed the letter to the hospital president, chief medical officer and chair of emergency medicine, and then we held our collective breath.
Within a week, I received a voice-mail message from the director of the hospital's emergency department. "Hi, Dr. Welch, I did receive your letter today. . . . I have already had discussions with the chief of the intensive care unit, and we are planning to review this case. . . . I wanted to let you know and touch base with you to see if you wanted to have any further discussion right now."
Finally, I thought, we're getting somewhere. I returned the call and left a message, asking to be called back, and waited for a response. But there wasn't one. In fact, there wasn't a return phone call, or any communication from the hospital, for four months.
Initially I thought the administrators there might still be reviewing the case. But as the months ticked by, I began to think our letter had been tossed aside. Angry and reconsidering a lawsuit, I called the director of the emergency department again. This time my call was returned by one of the hospital's top administrators.
The administrator, who happened to be an intensive-care physician, said he'd reviewed the case with other doctors, and, he admitted, the hospital's actions didn't reflect "the degree of urgency" required. A sanitized, verbal admission of error, but an admission nonetheless.
During the next month, some of our letter's concerns were addressed, and changes were made: The emergency department was beginning to enact new guidelines for treating systemic infection. But other changes were dismissed: The hospital wouldn't have intensive-care physicians assume immediate responsibility for all new ICU patients. The administrator said the hospital had tried to move toward that model earlier but there were "political barriers" to doing so.