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Health Secretary says No Patient Left Alone Bill would violate fed law, pose risks

By Kari Travis

UPDATE: The NC Senate passed the “No Patient Left Alone Act” today June 19, 2020. The bill passed by a 40 – 4 margin.

RALEIGH — On May 7, Cheryl Holtsclaw took her dad to the emergency room at Watauga Medical Center in Boone. Hospital policy blocked visitors to prevent the spread of COVID-19, so the 86-year-old man, suffering kidney problems, awaited treatment alone. 

While waiting, he suffered a catastrophic stroke. He was paralyzed on the right side. He couldn’t swallow. Still, no one was allowed to stay with him.

“Our parents have been married 64 years, rarely being apart,” Holtsclaw wrote in a letter to the NC General Assembly. “Our mother was allowed a short visit of about an hour on two occasions over the seven-day period. Dad was confused as to why his family wasn’t there.”

The legislature is considering a bill to protect others from the situation that left Holtsclaw and her family heartbroken. But the bill violates federal rules and opens doors to risk during the COVID-19 pandemic, says N.C. Department of Health and Human Services Secretary Mandy Cohen.

Senate Bill 730, The No Patient Left Alone Act, is about human rights and companionship, Sen. Warren Daniel, R-Burke, told Carolina Journal. The bill, in the Senate Rules Committee at press time, would let patients choose one visitor to stay with them during hospitalization. The visitor would be tested for infection. Stay in the patient’s room.

Nobody should be forced to sit alone in a hospital room, Daniel told CJ. Nobody should face days and weeks of isolation after a major surgery. But that’s what several of Daniel’s constituents endured since the beginning of North Carolina’s COVID-19 shutdown. Hospitals — to protect patients from infection — are banning visitors. Family members are split apart while patients are hospitalized. 

Holtsclaw, in her letter, said her father was confused, unable to advocate for himself.

“We have to wonder if he completely understood his course of treatment because he was unable to wear his hearing aids,” she wrote. “He couldn’t get out of bed, couldn’t hold a phone or dial a number and couldn’t eat or drink because of the paralysis. This surely was terrifying in his condition.”

Once a strong man with the will to live, according to Holtsclaw’s letter, the 86-year-old gave up. He refused hospital treatment after seven days, choosing instead to be with his family. At home. 

He died 60 hours later.

“It’s heartbreaking,” Daniel said. Cohen shares those sentiments. The DHHS secretary told a House Health Committee on Wednesday she stays awake at night thinking of those who are separated from their families. 

But, traumatic as those separations may be, Cohen said she couldn’t support S.B. 730.

“We are concerned about this bill as it is currently written related to infection control in health care and hospital settings,” DHHS spokeswoman Amy Ellis told CJ in an email. 

Decisions like this are “excruciating,” Cohen told House members Wednesday, but hospitals and nursing homes are at high risk for the spread of COVID-19. The secretary also pointed to “rules and laws that are conflicting with that piece of legislation.” 

S.B. 730 is inconsistent with “conditions of participation” from the Centers for Medicaid and Medicare Services, a division of the U.S. Department of Health and Human Services, wrote NC DHHS spokesman Matt Gross in a June 8 email to Daniel. 

The rules allow hospitals to “adopt policies that restrict or limit visitors when clinically necessary and reasonable.” Examples include infection control, Gross wrote, citing a page from Cornell Law School’s website and linking to the CMS Manual System. 

Ellis pointed CJ to the same resources. 

“The North Carolina Healthcare Association is working with the bill sponsors to ensure that the bill is in compliance with federal laws, and we are looking forward to seeing updated language soon,” Ellis said.

Daniel said he hasn’t had the chance to read all the way through the CMS Manual.

“Frankly, I don’t think state law can override federal regulation, anyway,” he said.

The NCHA, which has objected to the bill since it was introduced last month, was the first to question how S.B. 730 complied with federal regulation, Daniel said. Senators considered adding a line clarifying that it doesn’t override federal law, but legislative and NCHA analysts deemed it unnecessary, Daniel said.

Now, the NCHA has backed off the issue, he said.

“The main overarching issue is, you know, hospitals don’t want the legislature telling them they have to do this,” he said.

Last week, NCHA spokeswoman Leah Burns suggested the General Assembly form a working group including NCHA, doctors, patients, among others, in the discussion. The situation is too urgent, said Sen. Joyce Krawiec, R-Forsyth, whose daughter has Crohn’s Disease. Krawiec is also a primary sponsor of S.B. 730. She was unavailable to speak with CJ for this story.

“If that were my loved one, the hospital would be calling the police,” Krawiec said before a Senate committee June 11. “Because I would be going in.”

Like Krawiec, many families want to protect and care for loved ones. Daniel has the letters to prove it.

“My sister who is 76 and mentally handicapped fractured her neck cervical disks in a bad fall,” Susan Pearl wrote to Daniel in a June 10 email. “I lobbied the charge nurse, patient advocate and doctor to allow my daughter (who is an RN) to stay with her. They finally relented and my daughter stayed 5 days with her.”

The nursing staff was grateful, Pearl wrote, and her daughter left the hospital room only to get food.

“I too am having knee replacement surgery in August and am not happy that my husband can’t be at my side,” Pearl wrote.

Kenda Carpenter, a registered nurse, wrote to Daniel about her great grandmother, who was recently hospitalized in Charlotte for a head injury. Family couldn’t advocate for the “spry, active lady,” Carpenter wrote. After several days alone in the hospital, after conflicting messages from doctors and nurses, Carpenter’s great grandmother was discharged. But she’d been given too many medications, sedated for days. She was incoherent. She was in pain.

“We all can’t help but wonder, how much better could she have been right now if she had been allowed one family member,” Carpenter wrote. “One advocate. One person to watch over her.”

“Please help us. Please help future patients.”

“We have a problem,” Krawiec said. “We have heard it from real people. Real people who have to live with the fact that their loved one died alone. … We just can’t let that happen.”

Editor’s note: Travis is a reporter for Carolina Journal News Service

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