Ease of Appointment
Spends Time with Me
Follows Up After Visit
I am a disabled Desert Storm Veteran. I use the Charlie Norwood VA Medical Center exclusively. Up until I met Dr. Rivera, 99% of my experiences with this VA have been very positive.
I was referred to Dr. Rivera for surgical consultation through my Internal Medicine Practitioner, Dr. Luis F. Montalvo, because of painful, bleeding, prolapsing hemorrhoids. I met Dr. Rivera on March 22, 2013. That day, he noted that I had not had a follow-up colonoscopy, so he scheduled me for a colonoscopy first (April 3, 2013) and then a hemorrhoidectomy the following day (April 4, 2013). I was emphatic that I would not have a colonoscopy without General Anesthesia, as I had had a very traumatic experience with my prior colonoscopy. Dr. Rivera assured me that I would be asleep.
I had my colonoscopy on April 3, 2013 without incident. I breathed a great sigh of relief because I did not remember any of it. The nurse anesthetist was excellent. Dr. Rivera spoke to my husband while I was in Recovery, telling him that he was very glad anesthesia was present, as he had had to do âsome other things.â Dr. Rivera did not give my husband or me any further instructions. I did not get the chance to ask about the procedure, what in entailed, how long I might be in surgery, how long my recovery would be, my diet afterwards or what to expect once I was done. The nurse simply told me to wait for a phone call to find out when I was to report to surgery the following day. I do not know if she was even aware that he had not talked to me. Later than day, I received a phone call to report to surgery at 6:15 AM.
I realize that I could have stopped the surgery at this point but I had been suffering for quite some time and wanted a quick resolution to my pain.
On Thursday, April 4, 2013, my husband and I arrived at 6:15 AM and I was given a bed and gown quickly. Around 7:00 AM, I overheard the nurses questioning where Dr. Rivera was. Someone said that his resident was present but Dr. Rivera was nowhere to be found. A short while later, another said that he had been called to a Surgery Conference, which seemed quite odd to me when there were patients waiting for their surgeries. The OR transport (Monica) came three times to pick me up and each time she was told that Dr. Rivera had not yet arrived.
Around 9:00 AM, the she at last took me to the OR. When I reached the OR, the nurse anesthetist had to stick me three times to get the saddle block in place. I was moved to the operating table, and shortly afterwards Dr. Rivera arrived, barely acknowledging me. He chose instead to talk over me to the nurse anesthetist and a surgical resident he was tutoring. He told them that I had a very tortuous colon and he listed numerous anesthetics used. He began the surgery without further ado, explaining everything he was doing aloud to the resident. I was terrified that I would feel pain because I was still awake and I began to cry. The nurse anesthetist asked me why I was crying but I could not formulate the words. I begged him to please put me to sleep.
Shortly afterwards, I realized that I was not feeling anything and settled down. I also believe that the nurse anesthetist gave me something for my anxiety, but he did not tell me he was doing so. I drifted, not quite asleep but not entirely awake. I overheard Dr. Rivera saying something about how he used to attend Surgery Conferences at night but not any more. It didnât make sense. I believe I slept some.
I drifted back to alertness when I was asked to transfer from the OR table. From there I went to Recovery where I slept more. My husband said a nurse called him around 10:20 AM in the Waiting Room and told him I was in Recovery and they would let him know when I got back to the Holding Area. I woke up as I was being transferred back to the Holding Area. I saw that it was 11:00 AM. I asked my husband what Dr. Rivera had said to him. He told me that Dr. Rivera had not come to the Waiting Room to speak to him after the surgery. I felt angry that he thought so little of us.
The nurse said I had to urinate before I could be discharged. I walked to the bathroom and accomplished that a few minutes later completely soaking the bandages they had applied. I removed the bandages after soiling the second set, humiliated and befuddled. The stitches were inside my rectum and the bandages were jammed between my buttocks, doing nothing more but irritating an already sensitive area and getting soaked every time I urinated. I had very little bloody seepage.
I slept some more but fully awoke at noon with my derriÃ¨re fully awake and beginning to ache. I asked for pain medication, but most of all I wanted to go home to get into a sitz bath. The nurses were apologetic, saying that Dr. Rivera had gone straight into his next surgery without leaving any Discharge Orders. They said they would call the Nurse Anesthetist to obtain something for pain and would try to get Dr. Rivera to allow someone else to sign my discharge papers.
Time rocked on and the nurses attempted numerous times to get Dr. Rivera to come discharge me. Around 1:30 PM, I asked to speak to a Patient Advocate. After no advocate called or came to see me, I decided to check myself out around 2:45 PM. I was quite angry that Dr. Rivera had dropped the ball and no advocate was available to help me. My derriÃ¨re was burning and I desperately needed to get into a warm sitz bath or tub of water. I asked for my clothes and began removing my IV. A nurse came in and helped me with it. I put on my clothes and told them I was leaving.
I was going to sign AMA but when I read the form, I refused because it was the doctorâs fault that I was still in the Holding Area. I knew that there was no reason for me to still be in the hospital other than his negligence and I had no intention of releasing him from it.
An OR staff nurse, Carolyn Toole, RN, came to the desk and got me a wheelchair. Another nurse called the OR to let Dr. Rivera know I was leaving the hospital. We were then told he was on his way; however, I was so distraught over the whole situation that I had no desire to wait for him. Ms. Toole, my husband, and I left the Holding Area and had just arrived at the public elevators when Dr. Rivera came striding up to me with his resident in tow. He was very flustered. I was livid.
He asked me, âWhy I are you leaving? I didnât release you.â I told him that I had been waiting entirely too long to be released, that I had met the criteria to be released hours earlier. He told me that it wasnât true; that he was keeping me the prerequisite time for the type surgery I had. I already knew that was not the case and became even angrier that he would use subterfuge to cover himself. The conversation quickly escalated into a loud argument in front of the public elevators where patients or visitors were walking by. He asked me why I was upset, saying that he had been in surgery all day. I replied that I was upset that he had not even had the courtesy to come out between his cases to talk to my husband in the Waiting Room. We had basically been left in the dark. He became even more defensive and began talking down to me in a very loud voice as if I didnât count. He stated that, âI was in surgery all day and I was busy teaching my resident.â
I was humiliated and furious. All I could think was that this arrogant doctor considered his surgical skills and his teaching expertise paramount to my feelings or needs. I was but a teaching tool for him to use to his advantage.
I told him that I was going to report him. That I knew what he had done was negligent. He immediately stated loudly, âWhat good do you think that will do you? Nothing will happen to me! Who are you going to see? What happens if you have complications? I am the only one who knows your case! How are you going to know what to do when you get home?â For a moment, I thought he was going to get more abrasive. I felt extremely intimated and fearful that I would have no one to follow me, but I was now even more determined to report the incident.
During this time, my husband was trying to diffuse the situation, asking me to calm down because he did not want me to stoop as low as Dr. Rivera was stooping. I saw that Ms. Toole was flustered. I knew from my own experience that she was caught between her loyalty to her patient and keeping the doctor from becoming antagonistic towards her later.
Dr. Rivera finally apologized loudly, âI am sorry that I didnât come see your husband in the Waiting Room. I admit I was wrong about that! But just as I was going to see him, they called me to say that my patient was on the table and I had to go to the OR. I didnât have a choice!â
When I heard that, I felt that he once again considered his surgical procedures and coaching his resident more important than the well being of his patients and their families. He definitely lacked a decent bedside manner.
He finally composed himself enough to tell us that I needed to have Discharge papers to know what to with my incision site. I agreed to go back inside to let him fill them out. Having lost my cool when he lost his, I decided not look to at him again, afraid that I would cry or show emotions that would stroke his rather large ego. The incident had left me drained and emotionally raw.
He went to fill out the paperwork and I looked at both Ms. Toole and my husband in total unbelief in his unprofessional manner. Ms. Toole told me that she would be making an incident report, having been put in a very awkward situation herself. My husband said that he had never seen a doctor lose his cool like that and was incredulous.
When Dr. Rivera returned, he had better composed himself and this time apologized in a more even tone: âI admit I was wrong in not going to see your husband. You are right about that. But thatâs all. Now, letâs go over your Discharge Summary. Mrs. McTier, you need to look at me. Iâm going over some things that you need to know. Ok. Oh, Mr. McTier, I see you are listening to me. Good thenâ¦.â
I continued to stare outside the window, afraid to look at himâafraid of my emotionsâbut listening intently. He went on to explain that I needed to go to prosthetics to get a sitz bath. He said I needed to sit in the bath four times a day. Ms. Toole interrupted to say that they (the Holding Area) usually gave the patient a sitz bath once the orders were written. Dr. Rivera sounded momentarily confused and restated that he thought prosthetics would have the sitz baths. Ms. Toole assured him that the Nursesâ Stations always provided them to the patients. He told my husband that I needed to return to see him on April 19 at 1:00 PM. Then he handed my husband a 3x5 index card with
Sitz back > â
â Warm tub water â
April 19 â 1 PM
I asked if I was going to have a Regular Diet. He agreed and left. I was glad he left. I felt antagonized and extremely tense while he was present.
My husband gave the card to Ms. Toole so she could write down his orders. She returned it to me afterwards with her name added. Although the nurses tried every Nurseâs Station in the hospital, they were unable to find a sitz bath. Ms. Toole was very apologetic. Having worked in many areas in a hospital myself, I know that sometimes these things occur. There are several reasons why this can happen. I am not upset. (My husband and I went to CVS Pharmacy and purchased our own later.)
I received my Discharge Papers, along with a two-page Hemorrhoidectomy CareNotes System printout, which Dr. Rivera should have provided to me PRIOR to the surgery. (I believe Ms. Toole printed the data for me.) Then we went downstairs to the Pharmacy to get my pain medication and bandages. I was surprised to find out that Dr. Rivera had ordered Hydrocodone 5/500 APAP when I was already on Hydrocodone 10/500 APAP daily. This leads me to believe that Dr. Rivera did not review my medications prior to discharge. Had he done so, he would have known that I did not need any new pain medications. I was also put on Tramadol 50 mg. This also leads me to believe that he did not review my chart. I am currently on a high dose of an SSRI (Citalopram Hydrobromide 40 mg). Since Tramadol induces the release of serotonin, combining both with my current dose of Hydrocodone could lead to Serotonin Toxicity. I was incredulous.
I have always been very pleased with the service the Charlie Norwood Veterans Administration has given me. That is, up until now. This is the first time that I have encountered a physician who was so self-centered and absorbed.
Here is a synopsis of the observations I made about Dr. David E. Rivera during my brief but eternally memorable hospital procedures:
1. Concerned more about the surgery procedure itself than the person and her needs.
2. Concerned more about teaching a medical student, intern, or resident.
3. Failed to check the patientâs chart for current medications.
4. Failed to consider the patient and her familyâs emotional needs.
5. Failed to teach the resident a vital part of a surgeonâs role: to meet with and explain procedures prior to surgery and to alleviate family fears by taking a few minutes to reassure waiting family members of the patientâs status.
6. Failed to follow HIPPA regulations by speaking to a patient in a public area where other visitors became spectators and privy to private matters.
7. Failed to keep the hospitalâs best interest in mind by giving the patient, her family, and visitors a first-hand look at bad medical conduct.
8. Failed to keep the patientâs best interest in mind by attempting to intimidate and bully her into not reporting his malpractice.