Staffing changes at Camp Zama clinic draws criticism from former employee
By Fred Knapp, Zama bureau
chief
Wilson |
CAMP ZAMA — Changes at the post medical clinic — including
not having a doctor and a nurse on call at night — could endanger lives, a former
nurse here has charged.
But clinic officials say the changes actually help get patients more
quickly to the care they need at Japanese hospitals.
Last month, the clinic — MEDDAC-Japan — stopped staffing a
doctor and nurse after 7 p.m. The clinic is still staffed with emergency medical
technicians for people who need help, but those with medical emergencies are supposed to
call 911 for an ambulance to take them to a Japanese hospital.
“You have a community at Camp Zama that truly believes if
something serious happens [after 7 p.m.], they can walk into the doors at MEDDAC and will
be assisted [by] professionally trained health care workers,” said Darlene Wilson, a
former nurse at the clinic, “and that’s just not the case.
“They are met with people with very basic medical training who
do not have the ability to make advanced lifesaving decisions … the quality is so
poor that people are going to be hurt,” Wilson said.
Wilson said she was fired last week after what she described as a
series of disagreements about how the clinic was being run.
Maj. Donald Hutson, the deputy commander of the clinic who Wilson
said fired her, declined to comment on the decision, citing the confidentiality of
personnel matters.
However, Hutson strongly defended discontinuing the clinic’s
“urgent care” services after 7 p.m., saying the change had been made to enhance
the quality of care.
Hutson |
The clinic was never supposed to offer emergency room services,
Hutson said. The “urgent care” it used to offer at night was supposed to
accommodate cases like people suffering from a high fever who were miserable and
didn’t want to wait until morning to be seen.
“What we found was that the ‘urgent care’ moniker
attracted patients that were far beyond our capabilities,” suffering from things like
cardiac arrest, stab wounds, and trauma from car accidents, he said.
In March, a consultant advised the clinic to “dispel the myth
that you are an emergency room,” Hutson said.
There was a practical reason for the change as well.
“In a number of cases, patients [were] brought to us, bypassing
hospitals, extending the time it took to get them to the … care that they
needed,” Hutson said. “In the interest of quality medical care, we closed the
urgent care clinic.”
In emergencies, Zama residents are told to call 911.
On Camp Zama, a clinic ambulance will take patients to a Japanese
hospital if needed. On nearby Sagamihara Family Housing Area and Sagami General Depot, the
base fire department will relay the call to a Japanese ambulance, Hutson said.
But while that system is supposed to speed up service, it slowed
things down for Pfc. Melinda Lopez when she went into labor shortly after midnight July
11.
Lopez said she called 911 and was taken by a Japanese ambulance to a
Japanese hospital, where she was told she was not sufficiently dilated to stay.
Only then, after 90 minutes, was she transported by Camp Zama’s
ambulance to the hospital at Yokota Air Base, where her she had her baby Janelle later
that day.
If she had been able to go directly to the Zama clinic, a doctor
there could have made the same determination as the Japanese hospital and sent her to
Yokota directly, saving 90 minutes of confusion and delay, Lopez said.
However, Hutson pointed out that even if a doctor had been on call at
the clinic, there is no one who specializes in obstetrics and gynecology on the staff.
“The right choices were made” in the Lopez case, he said.
Officials were tight-lipped when asked about another case involving a
toddler who was recently brought to the clinic at night with trouble breathing, then
transferred after some time to a Japanese hospital, where he remains.
The boy, 3, remains in the hospital in stable condition but is
improving, according to his father, who asked not to be named.
Lt. Col. Steven Boylan, base spokesman, confirmed that two
investigations — one internal to the clinic, one by the military police — are
looking into his treatment.
Wilson said another respiratory case, during the daytime on July 11,
contributed to her firing. In that case, Wilson said she was on an ambulance run dealing
with a woman complaining of respiratory problems when Hutson, over Wilson’s
objections, ordered the woman taken to a Japanese hospital that specializes in
orthopedics.
Wilson, whose letter of dismissal refers to “disrespectful and
disruptive” behavior, acknowledged that when the incident was over, she went back to
the clinic and expressed her displeasure in sometimes earthy language.
“What made me go back and yell … was I am a competent,
trained health care worker who made a decision in the best interest of a patient and was
overruled by a non-medical administrator (Hutson) who sent the patient to an inappropriate
treatment facility,” she said.
Hutson, whose background is in administration, not medicine, declined
to discuss the specific incident. But he noted in general that the shift leader at the
clinic or a more qualified clinical person who might also be on duty can direct an
American ambulance where to go.
Boylan said changes at MEDDAC, including not having doctors and
nurses on call at night, have allowed the clinic to extend its operating hours for primary
care by 2½ hours on most days.
Formerly, it was open from 7:30 a.m. to 4:30 p.m. Monday through
Friday. Now, it is open from 7:30 a.m. to 7 p.m. weekdays except Thursday, when it opens
at 12:30 p.m. And it is also open Saturdays and Sundays from 9 a.m. to 1 p.m.
The changes have been well publicized in the base newspaper, on the
base television channel, and direct mail, Boylan said.
“The community is aware. They may not like it, and that’s
their prerogative,” he added.
Wilson, preparing to return to the United States last week, said she
supports the idea of the changes, but not the way they are being implemented, in her view,
with inadequate staff.
“I’m not disgruntled that I’m leaving,” she said. “I feel bad
that I couldn’t do more to help.”
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