Tom Britain and wife Angela of Ridgefield make lunch, something Tom was unable to do while recovering from sepsis and an appendectomy. He and Angela, who has a doctorate in nursing, discuss the circumstances surrounding his hourslong wait in two different hospitals for his emergency surgery. (Photos by JAMES REXROAD for The Columbian)
RIDGEFIELD — Appendectomies are among the most common surgeries performed in the United States with about 300,000 a year. Yet, a delay in receiving this routine procedure nearly cost Ridgefield resident Tom Brittain, 56, his life.
His medical crisis highlights the growing strain on the health care system, which is still reeling from the COVID-19 pandemic amid staff shortages and increased demand.
Tom Brittain’s ordeal so alarmed his wife, who has a doctorate degree in nursing, that she fired off letters to state and federal agencies that regulate health care. Angela Brittain also posted a video on Facebook.
“This is not my norm. I don’t usually record videos, post videos, anything like this,” she said. “But I really want to share our story in the hopes of advocating for positive change.”
‘Very dangerous’
On March 3, Tom Brittain, who works as a real-time energy trader, developed severe abdominal pain.
The Brittains called an advice nurse with Kaiser Permanente, their insurer, who recommended Tom Brittain seek care at an emergency department.
The nurse instructed the couple to go to PeaceHealth Southwest Medical Center because it was the closest Vancouver hospital contracted with Kaiser Permanente.
The couple checked into PeaceHealth’s emergency department at 10:17 p.m. but waited several hours before Tom Brittain was seen.
By 3:12 a.m. March 4, Tom Brittain was officially diagnosed with appendicitis at PeaceHealth’s emergency department.
Instead of receiving immediate surgery there, he was transferred to Kaiser Permanente Westside Medical Center in Hillsboro, Ore. — nearly an hour away.
A PeaceHealth physician warned the couple that Kaiser often wants to keep their own patients within the Kaiser system for surgery, Angela Brittain said.
“According to Kaiser, it was PeaceHealth that requested the transfer, which was not how it was presented to us by the PeaceHealth physician,” Angela Brittain said. “The PeaceHealth physician said it was Kaiser that was mandating the transfer. So it’s confusing to us, because both things can’t be true.”
Tom Brittain was officially discharged at 6:35 a.m., according to paperwork the Brittains received from PeaceHealth. By 7:45 a.m., he arrived at the Kaiser Permanente Hillsboro facility via ambulance.
Upon arrival, however, staff informed them of shortages across the facility, the couple said.
“They said, ‘We’re short on nurses today. We’re actually only working out of one operating room in the entire hospital,’ which then negated the argument they sent us there because that’s where they had the availability to help us,” Angela Brittain said.
Kaiser Permanente spokeswoman Debbie Karman disputed that. She said the Westside surgical teams were operating at normal capacity that day across eight operating rooms, and patients receive surgery based on the acuity of their conditions.
Tom Brittain didn’t undergo surgery until after 7 p.m. March 4 — nearly 12 hours from the time he was admitted to Kaiser Permanente Westside Medical Center.
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By then, he had developed sepsis, which was diagnosed by a Kaiser Permanente surgeon and confirmed through blood culture testing.
The appendectomy treated the main source of the infection, but Tom Brittain was given intravenous antibiotics as an additional form of treatment.
“From having symptoms from Monday morning and not being treated until Tuesday night and waiting so long for surgery, developing sepsis was completely, completely unnecessary and very dangerous,” Angela Brittain said. “Sepsis is often fatal. Our concern is that policies and protocols need to change so that people aren’t being endangered.”
She believes the infection, along with the lingering complications that followed, including a prolonged recovery period, could have been avoided if he had remained at PeaceHealth Southwest Medical Center.
“That was a really stressful time, wondering what was happening and wondering if he was even going to survive the surgery,” Angela Brittain said. “Had Kaiser permitted surgery at PeaceHealth, my husband could have been treated expediently and safely. By mandating transfer to Hillsboro, they profited monetarily, while greatly risking his life.”
The couple has received conflicting accounts from PeaceHealth and Kaiser Permanente about who ultimately authorized the transfer, they said.
Karman said in cases when a Kaiser Permanente member is receiving care at one of its affiliated partner hospitals, such as PeaceHealth Southwest Medical Center, transfer requests are initiated by that hospital.
“Any patient needing emergency care or hospitalization will always receive it, regardless of whether it’s at a Kaiser Permanente hospital or one outside of our network of hospitals,” Karman said in an April 20 email to The Columbian. “We are continuously working with our partner hospitals to ensure that patient transfers are handled safely and consistent with high-quality care.”
PeaceHealth spokeswoman Debra Carnes said, in general, PeaceHealth does not seek to transfer patients if the service the patient needs is available at PeaceHealth Southwest Medical Center.
“At times, we do transfer stable patients based on unique circumstances, such as available specialty services, patient preferences, carrier guidelines, and other factors,” Carnes said in an April 22 email.
Nationwide strain
Hospitals have been strapped since the COVID-19 pandemic.
Since February 2020, hospital employment has decreased by nearly 94,000, including a decrease of about 8,000 between August 2021 and September 2021 alone, the American Hospital Association reported.
“The pandemic has accelerated the need to make investments in the health care workforce to ensure people in communities across the state have access to health care services when they are needed,” Cassie Sauer, president and CEO of the Washington State Hospital Association, said in a news release.
In 2023, the Legislature amended an existing staffing law by improving accountability, expanding reporting requirements and ensuring hospitals adhere to staffing plans.
Hospitals must now establish hospital staffing committees to develop unit-based staffing plans, and they are held accountable for compliance with these plans, according to the bill.
Call for accountability
The Brittains have contacted the federal Centers for Medicare and Medicaid Services, as well as state agencies — the Department of Health, the Washington Attorney General’s Office and the Office of the Insurance Commissioner.
Most of those agencies have either closed the Brittains’ complaint because they say it is outside of their parameters or forwarded it to a different agency, Angela Brittain said.
PeaceHealth and Kaiser Permanente spokespeople said they could not comment specifically on Tom Brittain’s case due to medical privacy laws.
However, Karman reiterated Kaiser Permanente’s commitment to patient safety and the importance of timely care.
Kaiser Permanente is reviewing the situation and has contacted the Brittains to discuss their concerns, Karman said.
“We follow our internal process that gives careful consideration to the patient’s medical condition, in close coordination with physicians and clinical teams, to make transfer decisions between hospitals,” Karman said in an email. “We transfer patients when it is in their best interest, so they can benefit from our unique model of care that integrates emergency, specialty, and primary care, as well as labs and testing and other care, into one integrated, connected whole. That is how we are able to ensure we are delivering the right care at the right time and in the right setting.”
For the Ridgefield couple, however, those explanations offer little comfort.
“It’s people’s health and livelihood,” Tom Brittain said.
This story was made possible by Community Funded Journalism, a project from The Columbian and the Local Media Foundation. Top donors include the Ed and Dollie Lynch Fund, Patricia, David and Jacob Nierenberg, Connie and Lee Kearney, Steve and Jan Oliva, The Cowlitz Tribal Foundation and the Mason E. Nolan Charitable Fund. The Columbian controls all content. For more information, visit columbian.com/cfj.
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