Under Investigation: Patient Death in Cayuga Medical Waiting Room

Categories Health Care, Ithaca

By Josh Brokaw

The death of a patient who was awaiting care at Cayuga Medical Center’s emergency department is under state investigation.

The New York State Department of Health confirmed on Friday, Feb. 3, that it is investigating a patient death on Jan. 19 in the emergency department waiting room at CMC. [1]

Requests for comment to Cayuga Medical Center leadership have so far been ignored. This story will be updated with any comment that CMC administrators would like to share with the public.[2]

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The nurse who is apparently being held responsible by CMC administration for the patient’s death told her story to Truthsayers over the phone last week. She requested that her name be withheld, so let’s call her Roberta. Roberta, according to herself and two other emergency department [ED] staff nurses, is a travel nurse who had worked in the CMC ED since June 2016 on short-term contracts. Roberta was a staff nurse in the Rochester General Hospital emergency department for more than 10 years before becoming a travel nurse, and says she has her certified emergency nurse [CEN] credentials.

Roberta was working in triage on the night of Jan. 19, which is a position in the ED that  requires that the nurse sort “injured and ill patients into categories of acuity and prioritization based on the urgency of their medical or psychological needs,” according to the CMC ED triage policy. In other words, the triage nurse decides who most urgently needs medical attention and is responsible, under CMC policy, for monitoring patients in the ED waiting room.

Truthsayers will take a closer look at current problems with CMC triage policy and practice later in the week. Roberta said that she was never shown the CMC triage policy before the events of Jan. 19 and never received a “one to one” orientation from another nurse on triage practices. For example, she said she only learned after the patient’s death that, per policy, the triage nurse is supposed to “make a round” of a busy waiting room to take vital signs every hour.

UPDATE: Joint Commission Investigating, CMC ER Nurses Talk Triage

The following is Roberta’s account of what happened on the evening of Jan. 19. Text in direct quotes are Roberta’s words; everything outside those quotes is my characterization of our conversation with additional details in parenthesis:

The patient, a man in his 50s, was brought by paramedics to the ED from a West End convenience store, where a worker found him on the floor, asleep but responsive.

“EMS went to the scene twice. The store called the first time, he was supposed to mosey on his way. I guess he didn’t, then the store called the police department, the police department called EMS back and somehow this guy finally agreed to go to the hospital.”

[The Ithaca Police Department activity log for Jan. 19 shows a call to the store at 5:43 p.m.]

The patient was refusing care en route from the store to the hospital.

“We had no history on this guy, we had nothing. The policy states EMS is supposed to take the patient to the charge nurse and the charge nurse determines where he goes. The charge took the phone report and gave the go ahead to put him in the waiting room without putting eyes on him.”

Roberta said the patient refused her first attempt to take his vital signs, when he was first brought in around 6 p.m. “We were keeping eyes on him.” There were about 12 patients in the waiting room at the time, she said.

“There was nothing obviously wrong with him. His breathing was normal, nothing obvious … That’s the part I keep beating myself up about. Did I miss something? It keeps playing over and over and over in my head. What did we miss? What did I miss? He wasn’t complaining of chest pain, so there was no reason to get a EKG … He literally appeared stable. His color wasn’t off. When [the receptionist] told me ‘I think that guy is dead over there,’ the one thing I noticed right away is there was a color change. What he looked like when he first came in to when she said that to me …”

The patient allowed Roberta to check his vital signs sometime between 6:45 p.m. and 7 p.m.

“He wasn’t somebody who was making a lot of noise, he was just kind of hanging out there … I went over and asked him a couple basic questions – basically asking if he was having any pain, if he was lightheaded or dizzy. Basic, simple, yes no questions. He wasn’t having any pain, he didn’t know why he was there and wanted to go home.”

An “acutely ill patient” came into the ED with shortness of breath around 8 p.m., and Roberta said she took that patient back to an open room inside the ED.

“When I took him to the back that left pretty much nobody but registration staff up front, to keep an eye on a waiting room of 10 to 15 people. I came back, the registration clerk said ‘That man looks like he’s dead.’ I went over, checked him for a pulse and rushed him to the back.”

Resuscitation did no good: the man was declared dead around 8:30 p.m. on Jan. 19.

The next day, a Friday, Roberta said she was called “into the office” by administrators and “asked for the chain of events” from Jan. 19. She was then put “right back in triage” and held that position through another busy day with numerous people in the waiting room.

“Around 5:30, 6 o’clock, [p.m.] they turned around and they suspended me until the investigation was over. First, it was the timeline didn’t match. Then it came down to the camera never saw me encounter the patient. I don’t know what’s wrong with the camera – I have a moral obligation to encounter the patient. Whether it’s the EMT or Grandma Etna brings them in and gives the report it’s still your responsibility to see the patient …”

The following Monday [Jan. 23], Roberta’s travel nurse agency called her to say that CMC was terminating her contract “based on falsifying documentation.” The claim CMC made, Roberta said, was that she back-timed the record of when she took the patient’s vital signs. She cited two problems with this reasoning: first, that CMC practice is to always back-time the record of when vitals were taken to within 10 minutes of a patient’s arrival. The second problem Roberta cited is that the patient refused her taking his vital signs at first: “Per our triage, the way the computer system is set up you have to get vital signs on a patient … or you can’t complete triage. You can’t go in there and put all zeros.”

On Tuesday [Jan.24], Roberta’s agency was told CMC was going to set up a meeting with her, and she retained an attorney. The next day, Wednesday, she met with the attorney in the morning in anticipation of a meeting with CMC in the afternoon. While her attorney waited to hear from CMC administration whether he would be permitted to attend the meeting, Roberta waited and the meeting was eventually called off. Since that day, Jan. 25, Roberta said that as of Feb. 5 she had heard nothing from CMC. She continues to work at another per diem nursing job.

“There was minimal resources,” Roberta said of the CMC ED on Jan. 19. “It’s a system that needs to be fixed. The lack of resources really showed … I’m somebody who thinks I can do everything by myself, and apparently I can’t.”

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[1] In response to a request for comment sent to the New York State Department of Health press email, I received this response from an unnamed employee last Friday and was asked to “attribute to the Department of Health.”

The Department of Health takes the health and safety of hospital patients very seriously. The Department is investigating the death of a patient at Cayuga Medical Center and will take appropriate action based upon the results of the investigation. Because the investigating is ongoing, the Department cannot comment further.

[2] A call for comment to John Turner, CMC vice president of public relations, was made on Tuesday, Jan. 31, with no response. This reporter sent a follow-up email to Turner last Friday evening, with the entire CMC senior leadership staff and several board members listed at this link carbon copied, informing them the Department of Health had confirmed the investigation and that Truthsayers would be publishing this report come Monday. By first publication on Monday, Feb.6, no response had been received from CMC leadership.

Josh Brokaw is an independent reporter based in Ithaca, N.Y.
Email josh.brokaw@truthsayers.org with tips, story suggestions, and gentle criticism.
Twitter: @jdbrokaw

42 thoughts on “Under Investigation: Patient Death in Cayuga Medical Waiting Room

  1. I have been in that waiting room several times and no one has ever came out and took vs. I’ve never seen this happen to any patient.
    This is a shame for this nurse they have way to many patients per nurse.
    This needs to be changed the ratio patent to nurse is ridiculous.
    I hope there are no charges for this nurse.

    1. I myself had witnessed maybe 2 of many visits there they took vitals in waiting room but like I said that’s only 2 out of Many visits . In September 2011 when my son had vary bad headache they came out and did everyone’s vitals and one other time I was there with a friend whom needed to be seen however that was in 2014. I was a regular there when my boys were young and during my father’s testing for cancer and all the other years before that in 2011 my first response to triag was this is new she said no it’s policy I then was like really hmmmm ….

  2. It seems to have started with a poor orientation. Often a nurse is thrown into a situation ill- prepared. I have been in this hospital with severe pain and was left in the waiting room for a long period of time. Nobody took my vitals. The reception staff were sitting on their cell phones. As an RN I agree with this nurse that there no indications of need for an immediate response. When something bad goes down in a heath situation it immediately is blamed on the nurse. A proper quality review will often reflect a system failure which it appears it did here with lack of orientation.

    1. This patient continued to refuse treatment. When she spoke with him he was stable. Zero support for the nurse. Sad story all around.

  3. Over the past 6 yrs I had been in the CMC ED a handful of times with my ex husband, never once did I EVER see a triage nurse come out at take vitals of patients waiting in the waiting area….Never!!! And the waiting area wasn’t packed, maybe 6-7 people waiting at the most at any given visit. I personally don’t think that CMC is very good at protocol, whether it’s informing staff or enforcing it.

  4. I have been to CMC ER numerous times, NO ONE has ever came out there to check any patients, I have waited in the ER there for over 3 hours before and like I said NO ONE EVER CAME OUT TO CHECK ON ANYONE OR DO ANY VITALS EVER!!! I have also been there waiting forever, then get taken to a room and wait even longer and being basically refused treatment. I have severe fibromyalgia throughout my body and I was in excruciating pain and nothing was helping it so it went to the emergency department. After waiting a few hours and finally getting into a room I was told we do not treat pain and I was sent on my way. Never even seen a doctor or nurse practitioner just a nurse. This is the part where I was refused treatment. I refused to sign any documents that they wanted me to sign and discharge papers.
    Prayers for the man’s family.

    1. A lot of ERs are not treating chronic pain. It’s an effort to stop all the drug seekers. Also, you probably saw an NP in Triage as it is illegal to not give a patient MSE.

  5. Sounds to me the charge nurse should be suspendid also for not making eye contact with this guy and only took phone info…

  6. If a client comes in via EMS they should be brought in the back. This should be policy as it is in my state where I work.

    1. Not necessarily so. People who think they go to the front of the line just because they come by ambulance spurs abuse of EMS. I stubbed my toe but if I call an ambulance I get scene first. That is what triage is for. EMT/PARAMEDIC FOR 44 years

    2. People use EMS for ridiculous issues! Some use it “just to get to the back”. That’s what triage is for. What state you wor in?

  7. I also have been in this er and the convinent care also run by cmc and do NOT come into the waiting room and do vitals that’s bs they trying to cover their butts

  8. I’ve been to CMC many times for myself aND others. I’m 40 years old and a life long Tompkins County resident. I’ve never once had my vitals checked in the waiting room nor seen others have it done. I have spent hours at a time in the waiting room there.

  9. As an RN that has been a travel nurse and charge nurse this is the most important thing I can say. First even if they tell you that their policy is to back time documentation, you never do that. I would have left that time blank. Every computer system I have worked with has a place for additional notes. That is where you document patient refusal. Use those memo boxes for documentation often. You never know when it will come back to save your ass! When it comes down to a court of law if it is not in that chart, it didnt happen! I hope she is able to make a case and one of the clerks backs her up, but this can be a warning to others to not let the ease of the cluck of a button let you become lazy with your documentation.

  10. Been there like 20 times and never been checked on in waiting room nor had vitals checked , and had exploratory surgery by a surgeon that has had many lawsuits against him for malpractice, when nothing was even found, and 3 times before I had appendix out, kept saying I’m ok

  11. I used to work there and never saw nurses coming out to take vitals! And, it was understood if a patient came in via ambulance, they were put into a room even if their medical problem was not respiratory or cardiac related.

  12. I have been in CMC ED many times in the past 28+ years and have NEVER seen a nurse come out to the waiting room and take vitals on patients…
    One of my worst experiences was (2014) when my young adult daughter got 2nd and 3rd degree burns on a large section of her legs and one of her arms due to a
    “out of control” bon fire.
    I brought her to the ED we did not call an ambulance. We registered at the desk, explained what was wrong and were told to “have a seat” there are a few people ahead of you. My daughter’s burns were blistering and ozzing and she had to sit on a public, germ infested vinyl chair without any “protection” of infection between her and the chair for WELL OVER an hour. I had to get paper towels from the bathroom for her to sit on, as I do know that with severe burns you have to be careful of infection.
    Never did any “Triage Nurse” come out and check anybody’s vitals.
    I hear people say that they wouldn’t take a “sick animal” there much less a loved one.

  13. Never in my many visits to the CMC ER have I seen vital signs being checked in the waiting room. I understand that nursing is stressful and that proper protocol explanation was possibly not given. In October, I had an experience where I experienced a seizure, fell out of bed and was not given a check for head trauma, but was instead taken to the behavioral unit, where I was kept for 6 days. The consensus was that I had overdosed on medication and a brain MRI was only administered 5 days after my admission after my husband insisted. In the meantime, I was kept locked away in a ward headed by some pretty hardened nursing and physician staff. My husband’s efforts to get me released to a regular ward were met with derision and I was subjected to repeated efforts to “admit” that I had overdosed (no evidence of an overdose was ever found) and that my husband was abusive. Perhaps proper protocol wasn’t explained to all of these professionals either? My point is that CMC has shown me and many other patients that they don’t seem to follow ANY sort of protocol when it comes to assessing a patient. They appear to form their own opinion and stick with that. Unfortunately for this man, he suffered the consequences for CMC’s lack of training and its staff’s apparent dislike for upholding truth. I wouldn’t send my worst enemy to that ER.

  14. When the hospital is liable, they will always blame it on the nurse. Of course, first they will always try to blame the patient themselves or a patient’s family member. It’s never the hospital;’s fault, of course! What’s new? Also, the triage nurse should not be taking patients into the ER. the triage nurse is supposed to be watching and triaging patients who are waiting and patients who walk in. Here’s another tragic event, a fatality, that can be attributed to short staffing. When will the public wake up and back nurses who demand safe nurse patient ratios and safe staffing. Don’t think it can’t happen to you, or your loved one, in ANY HOSPITAL, USA!

    1. Absolutely agree… an excellent nurse can have an event like this happen at any time, give us nurses the adaquate staff to do what we do best, and unfortunate events like this will not occur!!! Faculty is to blam when. Years and personal are not given the proper training and staff to complete policies, should have been viewing the camera before this occurred to assure staff were following a policy that they knew nothing about…..

    2. The hospital, not the travel nurse should be held responsible. It’s the hospitals responsibility to train the nurse. The administration will protect themselves and throw that poor nurse to the wolves. Oh, never in my nursing career as an er nurse have I seen triage nurses take vital signs in the waiting room. I’ve worked at three emergency rooms in and around Cayuga medical center. I feel bad for that poor nurse. This is what’s wrong with hospitals. Administration never owns their mistakes the blame the undertrained and understaffed nurses!

  15. Just like others on here….I myself, have been to the ER many times over my residence in Tomkpins County and NEVER ever has a Triage Nurse or any staff taken my vitals in the waiting room. Once I sat there waiting for a really long time after I was involved in a Car Accident with with Neck injuries waiting to be seen. Let me give you another example, My Brother sat in the waiting room while in anaphylaxis for an allergy until my sister happened to see him there by total coincidence and yelled for help cause he was barely breathing and swollen. Unfortunately these posted comments are true and CMC is being dishonest about taking Vitals in the waiting room.

  16. I have also been in CMC”s waiting area for stomach problems and alot of pain and i have never in 20+ yrs i have gone there i have Never had vitals taken on myself or seen them taken on anyone else and we are all waiting hours to be seen thats alot of BS they will be doing it now wont they!!! To sad that happened to that poor man my condolences to his family and they should be held responsible for their negligance.

  17. I spent over 6 hours in the CMC ED waiting room and another hour in an ER room in the fall of 2015. I had just found out I was expecting and was in severe pain so I had even called ahead to tell them we were coming. The receptionist was insensitive and rude. Her response when I explained what was happening was “ma’am, this is an EMERGENCY room. We take patients on a first come first served basis”. There was a handful of people in the waiting room including some woman who appeared to be having trouble breathing and a HS aged boy in a wheelchair who suspected that his leg was broken. It was two hours before the woman was taken in and at least 4 before the boy. Not once while my husband and I sat there did a nurse make rounds or check vitals.

  18. Hospitals try to avoid hiring and paying permanent staff (which they desperately need) and instead hire travel nurses to cut costs. Travel nurses do the best they can being thrown into a new situation without adequate time for orientation. I’ve seen it time and time again, the hospital blames the nurse for deadly system issues that result from them trying to save on staffing and equipment costs. Fire those administrators who fail to staff properly; stop throwing nurses under the bus to make up for hospital system failures.

  19. I’ve been to CMC ER many times, I’ve never seen a nurse taking vitals in the waiting room. But I will say this, I’ve always had excellent nurses when I actually get in to see someone. Doctors are less than stellar, office staff are hit and miss with customer service. Money would be better spent on training, additional staff, and safer policy protocols instead of water sculptures and valet parking.

  20. Unfortunately someone from the hospital is lying because i took a person there thinking she had Mono and when getting there not once did anyone take her vitals, just took her name/info, symptoms and told us to go wait in the waiting room and someone will be with us…for 3 HOURS we sat there and NO ONE came and checked on her let alone took her vitals….while waiting a guy came in with a dislocated shoulder and he sat with us for almost 2 hours before i said “f*** this” and left and went to another hospital…..and god knows how long that other guy waited to be seen…..i’ll never go back to that hospital!!

  21. I have been to CMC myself and the staff is unprofessional….. .My hubby went in with shortness of breath and chest pain…..He had a heartattack prior and it took them well over five hours to let us know he had another heartattack ……Took them twelve hours to get him in the cath lab and he was then put in ICU and four weeks prior he was given several heart tests and they told us his heart was normal with no new blockages……I find it hard to believe that the 80 percent blockage happened within four weeks time……When he was in ICU the Dr came in after placing the stent in and grabbed his belly and pushed his head down in front of family and myself and tried telling him the reason why he had a heartattack to begin with was all because of his weight even though he has family history of heart issues…….And while he was in ICU they never asked if he wanted to wash up….A clean bed…..Pain level or if he urinated or had a bowel movement or even to brush his teeth……Prior to going to the hospital he took his normal regiment of meds and they tried to say he was trying to overdose…..He was admitted on a Saturday morning and he signed himself out of ICU on Sunday morning…….They would not tell him what meds he should and shouldn’t take because he signed himself out….He called to make a complaint in September 2015 and left a message on their machine and nobody has returned my call still…….. I would have anybody’s back that would have a lawsuit against CMC……. PostI wouldn’t take my dying goldfish to CMC

  22. The CMC ER placed my brother in a room to get and EKG, and left him there for over 5 hours, essentially ”misplacing” him. They thought they had placed him back in the waiting area and they had not. So 3 hours later when they called him, he did not respond and they discharged him from their census, even though he was only 10ft from the nurses station in the ER. It was 5 hours into his stay that I called and advised them he was literally in their ER. That alone was a sentinel event waiting to happen. I feel bad for this RN that was placed into this culture of poor care that exists at CMC. A policy is only as good as the managers and directors that train and enforce them

  23. It’s well known in our community that CMC’s ER is understaffed. I’ve been told by nurses that it’s dangerous at times for nurses and patients. I’ve heard that administration turns a deaf ear to concerns from the staff. Blame the nurse in an understaffed environment? Shame on your CMC!!

  24. Many times I’ve been there I never seen anyone have their vitals taken in the waiting room or any nurse come out to the waiting room. It’s my understanding that the nurses also work a 12-hour shift and many times pulling double shifts. I assume that’s to save on benefits to pay for additional employees. With the huge responsibility of nurses it should be mandatory that no nurse be able to work more than 40 hours a week.

  25. The administration is horrible. To them it’s not about health care or even right from wrong. It’s about the almighty dollar. Had dealings with them for over 50 years. Us townies know them better as the Band-Aid Center and if it’s anything that can wait an hour we go to Syracuse or Robert Packer Hospital. I will say the majority of their staff and their nurses are fantastic. I would love to hear from the nurses and their points of view without consequences from their horrible leaders, covering up everything only for their pockets. Their feedback will be all the great things they do for the community . All businesses do that for our community . Please nurses speak your peace. Does anybody have to work over 40 hours a week without being look down on?

  26. This place has had serious issues for a very long time! My daughter is deceased proof of that she died when she was 4 and I strongly believe if the doctor would have listened to me when I told him she didnt just have a urinary tract infection. That she would be alive today and he should have done blood work or more test like I asked for. A extremely sad part is he is a disease specialist and travels to upstate where she ended up dying from bacterial meningitis. I went in on a Sunday amd wemt back Monday to the same doctor told him their was something else wrong and begged for more testing. She was almost completely cationic, she was not communicating and would wake up yell in pain and go back to a vegetative state all this right infront of him and the secretary. He sent us home I got her out of the truck to go inside our home and she started to what seemed to be fighting with me.( I was later told this was most liekly a seizer due to temperature changing quick or one of the many stroke spots they found in her brain) As a results she fell out my arms and smacked her head on the paved driveway. Then the next three weeks of horror started after she was airlifted from our home to upstate. Ive been to this ER multiple times before I decided I will go some place else at all cost! Never ever once was their anyone doing rounds BUSY or NOT!!! Their staff is extremely rude for the most part and have very horrible bedside manor. They do not listen to patients nor provide adequate care. Their have been so many incidents with this place ive personally experienced and witnessed. They need to be shut down! They will do whatever they can to blame worker’s shut people up and stay open. Look into thier history and name changes. This is so much deeper than this one incident.

  27. This nurse seems so detached from what is really going on. There is a family mourning the loss of a loved one which could have been prevented. Many thoughts & countless prayers going out to the family who lost their loved one that day. May he forever rest in peace knowing he will always be remembered.

  28. We have had two very bad experiences with CMC ER. Here is the worst of the two. My husband who has a kidney transplant became very ill at home. He was experiencing severe abdominal pains, fever etc. I rushed him to CMC, explained his medical history and after having his temp. taken and blood pressure we waited in the waiting room for six hours! No one ever checked on him even once! I continued to check with the receptionist and kept reiterating that his transplant could be in jeopardy, but they didn’t care. Finally at 11 pm he was called back to a room. Upon examining my husband the doctor was very curt and said if you hurt that badly I can’t continue to examine you, I need to get a CT. Three hours later the results showed that he had appendicitis. We were then told that because of his transplant CMC was not comfortable treating him! After being there ten hours! They told him he was discharged and we started on our way to Strong Memorial in Rochester, where his transplant team is. We got just before the thruway and his cell phone rang, it was CMC wondering where he was! They didn’t know he had been discharged, and wanted us to come back and get the CT results to take to Rochester. What?! Told them to send them electronically. They guessed they could do that. Upon arriving at the ER at Strong, they rushed my husband through the ER admitting process. They still had no records from CMC even though it had been two hours since we had left there. Because of the incompetence of CMC ER, by the time we arrived in Rochester, my husband’s appendix had burst and we were faced with greater complications. Thank God he was in great hands at Strong and he recovered from this, but no thanks to the Cayuga Medical Center ER. I’d also like to add that we filled out the patient questionnaire that was mailed to us by CMC, but lo and behold never heard another word.

  29. I was admitted into the behavioral health unit and had a braclet on staring my allergies to Ativan and sure they administered that to me causing hulusintions ugh so awful but they stated that it was an emergency and they misunderstood

  30. As soon as this patient declined care, he should have been released. Unless he is under arrest, an adult patient has a right to decline care. EVEN IF HE IS VERY SICK! Hospitals are not jails. We do our best to convince people to stay and be evaluated but everyone has the constitutional right to make a bad decision. It is very sad that this man died and it appears there are other issues with CMC’s policies but this patient had every right to decline care.

  31. I am not surprised by any of the comments made or the fact a man lost his life in the waiting room. I have been an ER and ICU nurse for over 30 years and I can tell you I am surprised this has not happened before. In my own experience I went to CMC with a strong suspicion I had food poisoning. I had nausea, vomiting and diarrhea. I had also started to feel “skipped beats” and muscle cramps. I explained all of this to the reception staff and she said someone would tend to me as soon as they could and to take a seat in the waiting room. I waited almost 2 hours and finally I asked to speak to a nurse. I was refused to speak to anyone except the reception staff and I would have to wait my turn. Now is when I learned a very valuable lesson. As soon as I was dismissed by the reception staff a young man arrived in a wheelchair pushed by his Mother. She told the reception person her son was having an acute asthma attack. This young man is slouched in the chair, right leg over the arm of the chair with regular even non obstructed breathing. NOW what this Mama said next is the lesson I learned to get care at CMC. She announced in a loud voice, “I guess I better call my lawyer”. BAM the son and Mother goes back into the ER care area. I, in turn told the receptionist I was leaving and going somewhere else. She attempted to get me to sign AMA forms, I didn’t sign, because I never received any medical care. I went to Elmiria to Arnot, I had a friend who was also a RN worked there. I was taken back to the care area of the ER, got blood work, an IV, EKG and assessed by a RN. Long story short I was admitted that night with critically low blood values, changes on the EKG and dehydration. The NP and RN that examined me before they even touched me told me they knew I was dehydrated had “bad blood” as we describe it in the ICU. Meaning nothing more than abnormal blood levels usually in the critical stages. At CMC I was never seen by a RN, LPN or tech. just a reception person. I must say I will never ever take anyone or allow myself to go to CMC for anything. You try to use the services in your community and keep your money local…thankfully for me Robert Packer is also local for me.

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