Bob A.
Yelp
I recently went to Ascension Seton ER at 38 1/2 Street with a relative suffering neurological effects, likely from a drug-drug interaction (prescribed). This time, with cannabis. He was in a fugue state. He was showing an inability to speak and severe motor control problems. This drove me to seek emergency assistance for him.
AS A SERVICE:
⁃ The parking situation is ridiculous. In the midwest, in poor communities, they have *FREE valets* at ERs. You can get a valet at a restaurant in Austin. Why not at Seton's ER?
⁃ The checkin process is confusing. It's not clear whether you're to go to the tired woman on the right behind the spit shield, or the angry women behind the bulletproof glass barrier on the left.
⁃ Understaffed for the volume they get. We had a 2-3 hour delay before being seen. Midday.
⁃ Insufficient number of rooms. Our eventual MD consult was in a hallway.
⁃ The ER is overwhelmed by urgent care-type cases, yet there's no signage at all referring people to nearby Urgent Care facilities. They obviously don't want to lose that revenue.
⁃ Billing shenanigans. Compare one-star reviews at Seton and one-star reviews at St David's, and you don't find people getting billed years after service.
⁃ They seem much more interested in simple, fixable cases, or cases they can turf to the hospital, rather than complex cases.
⁃ The staff seems tired and overworked.
⁃ Poor communication, both in the lobby and among administrative/medical/technical staff, and between medical/technical staff and patient.
⁃ The basic model appears to be "confirm no imminent death & discharge" (to the hospital or release), not "fix and discharge". This approach is the minimum standard by law, as applied to indigent patients. My relative is not indigent.
⁃ Overall, it points to poor management and a poor leadership culture.
MEDICALLY:
⁃ They did not do a review of the relative's medications.
⁃ They did not remotely attempt to get a complete medical history.
⁃ The 33-year-old doctor, three years out of residency (according to the TMB), did an MME and neuro exam, checked his chest, and that was it. He spent perhaps five minutes, and then, when the relative gave him lip, obviously mentally checked out.
⁃ Miscommunication then set in: the doctor explicitly said there was no value in additional tests (questionable), but after we returned to our hallway location, the various techs started arriving--to do blood, ECG, x-ray, and a CT scan.
⁃ After the first tech arrived, the nurse promised to check why the tests were ordered, but never did.
⁃ The patient expressed his confusion to EACH of the techs, but none followed up with the doctor. This suggests a lack of employee empowerment.
⁃ Later, the nurse denied promising to check why the tests were prescribed and instead said the patient was refusing them.
The relative, coming out of his fugue state in the reception area, was combative and irate. At one point, a triage nurse called in Security to quiet him. This type of behavior, later, probably shut down the doctor, but also demonstrates his nonprofessionalism: you DON'T get to choose your patients, and an errant brain is just as much a serious issue as any other organ in the body.
It also raises the question of why, in a city as woke as Austin--which wishes to dismantle its police force--level III armed security guards are used. If there's any environment that requires social workers and a soft touch, it's an ER. I'm not complaining about the professionalism of the security guards: they were great, for what they're designed to do. But in a hospital, a different approach might be indicated.
The bottom line is this: the ethical obligation is to STABILIZE and release, and stabilization involves the practitioner understanding the root cause of the problem. No such attempt was made.
Instead, the doctor resorted to the minimum legal obligation, which is to confirm there is no immediate exigent crisis, and then release. Since the relative had started to come out of the fugue state, thanks to the hours-long delay, this criteria was met. This is a chickenshit approach to medicine.
Subsequent to discharge, the patient was afraid of, well, death.
He picked up a refill of a medication at CVS, where the pharmacist flagged a potentially dangerous interaction. So that night, he went to a different ER, at Baylor Scott & White. The nurse took careful account of his meds, and the doctor spent 30 minutes with him. They found significant cause to be concerned about a specific drug interaction that was almost certainly causing his symptoms. They adjusted his dosages.
This was, ultimately, a psychiatric case, and should have been referred to psychiatry.
My family (and I) have had great results on the hospital side at Seton, using it for various major surgeries over the years. But the ER is a trainwreck.
