KRTV reported the disgusting infestation of bed bugs at Rocky Mountain Healthcare Community nursing home after three staffers raised concerns months before the facility took appropriate actions.  At least two residents suffered bites or rashes related to bed bugs, according to a recent inspection report by the Centers for Medicare and Medicaid Services (CMS).

Based on interview and record review, the facility failed to document the ongoing status and healing of identified skin issues; failed to show what measures were taken for the prevention of insect bites to the skin, which potentially contributed to skin infections; failed to show what measures were taken to ensure ongoing preventative measures were taken after a concern was voiced that bed bugs were observed in the resident’s bed,” the report said of one resident.  Four rooms were infested by bed bugs, according to the report, which is based on a survey completed October 8.

On one resident, staff documented pink bumps, believed by that resident’s daughter to be caused by bug bites, back on July 1.

On July 23, a family nurse practitioner seemed to agree.

“We saw some black bugs in her bed and she has lots of bites on her legs and we are worried she may have bed bugs,” the FNP wrote in the resident’s medical notes, which are cited in the CMS report.

The FNP also documented black speckles on the bed sheets and wrote that the resident was itching “intensely”.

The medical notes continue describe the skin issues throughout the summer, with an antibiotic prescribed on September 23.

Another staffer — a certified nursing assistant with knowledge of bed bugs from a previous job — reported finding a bed bug crawling on a resident’s leg. (She turned the insect over to the interim director of nursing, who somehow denied it was a bed bug, according to the report.) The staffer told CMS in October that she had reported concerns five months earlier.

“She states the facility did not act on the report, and the resident continued to have repeated skin issues from potential bites,” the CMS report says.

A third staffer — a registered nurse — also told CMS on October 6 of similar concerns and said the facility had not taken action until two weeks earlier.

 

 

 

NJ.com reported the allegations of abuse from a courageous caregiver who lost her job for trying to protect the vulnerable adults under her care.  Nikki Thompson is a licensed practical nurse who alleges that she was made to leave her job at the Voorhees Center nursing home after claiming that facility residents were being abused, according to reports.

Thompson reportedly worked at the facility for eight years until she spoke out about the alleged abuse happening at her job. After Thompson made her claims, she was sent an anonymous letter saying “snitches get stitches,” according to reports.  A photo surfaced showing an 85-year-old woman with dementia tied to a wheelchair. The photo, which was said to be taken by a co-worker who was worried, stems from an incident Aug. 16, reports say. The woman was bound to her wheelchair with a bed sheet and discovered by a nurse aid on duty.

Other allegations also surfaced involving a 73-year-old man with Alzheimer’s, according to reports. Since the claims have come to light, Thompson is suing the nursing home and owner Genesis Healthcare.

The Courthouse News reported the problem of patient dumping or abandonment in California.  California allows nursing homes to forcibly dump Medi-Cal residents into hospitals to clear bed space for far more lucrative Medicare patients, then refuse to re-admit the dumped patients, which is illegal under the Nursing Home Reform Act, elderly people claim in court.  Lead plaintiff Bruce Anderson and California Advocates for Nursing Home Reform filed a federal complaint against the California Department of Health and Human Services and its Secretary Diana Dooley.

All three elderly individual plaintiffs say they were dumped into hospitals, then denied readmission to a nursing home, in violation of the Nursing Home Reform Act. In addition to their own injuries, they say, nursing home resident-dumping across the state has cost California taxpayers more than $70 million. “California nursing facilities often dump Medi-Cal residents by refusing to allow them to return home after they have been temporarily hospitalized,” the complaint states. “Facilities do this to increase revenues and make space for more lucrative Medicare and private pay residents.”

“(F)ederal law protects against hospital dumping. For over 10 years now, however, the State of California has been in violation of federal law. The result is that residents are forcibly removed from their homes, their familiar surroundings, friends and caregivers and warehoused in hospitals. This practice has a devastating impact on residents, including plaintiffs, and has cost California residents tens of millions of dollars,” according to the complaint.

Federal law prohibits patient dumping by requiring states to establish a hearing process for readmission of nursing home residents who have been temporarily hospitalized. The states must “promptly … provide for admission or readmission of an individual to a facility if the hearing decision is favorable to the applicant or beneficiary,” the complaint states, citing 42 C.F.R. § 431.246(a). All three plaintiffs say they had hearings and won the right to readmission, but because of the state’s “shell game of inaction,” none have been able to return.

The federal Center for Medicare and Medicaid warned California in a May 2012 letter that it must “promptly take corrective actions” to enforce its readmission orders, but that too was futile, according to the complaint.  The senior citizens cite a 2008 memo from the California Department of Public Health, “stating that it was not obligated to enforce the decisions of hearing officers relating to appeals of evictions by nursing home residents.” Since neither state agency will enforce the readmission orders, no one does.  The nonprofit plaintiff cites several responses to its inquiries, in which the state said it “has no authority to enforce its own orders.”

It’s not the nonprofit’s first go-round with California. It sued the state in Sacramento Superior Court in 2013, claiming “Owners and investors in the nursing home industry have purposely and increasingly created more complexity and layers in their corporate and ownership structure so that they can avoid scrutiny and responsibility,” and the state let them get away with it.”

 

KSTP reported the 8 year sentence for George Sumo Kpingbah for the rape of a woman suffering from dementia and Alzheimer’s disease at Walker Methodist Health Center.  Kpingbah pleaded guilty to third-degree criminal sexual conduct for the assault that took place in December 2014. He originally pleaded not guilty in January.

Prosecutors asked for a 7-year sentence, which already would’ve been more time than sentencing guidelines called for. However, the judge went with what she called “a double departure” from those guidelines, tacking on an extra year.

According to the criminal complaint, at 5:30 a.m. a nurse making rounds at the nursing home saw Kpingbah having sex with the victim, who was described as basically being in a comatose state. The woman said she saw Kpingbah standing between the victim’s legs pumping his groin area in and out of the victim’s legs about five times for 5-10 seconds.

The nurse said she knocked on the door, and Kpingbah pulled back and placed the victim’s legs to the side. The nurse left the room and reported what she saw, the complaint states.  When officers spoke to administration at the facility, they said Kpingbah had no reason to be in the victim’s room.

Kpingbah apologized in court and asked if he could bring his Bible to prison.

WFLA reported the disturbing actions of the owners of University Village nursing home.  The owners won’t pay their bills and refuse to hand over the books to a court-appointed receiver. As a result, assets such as nursing home beds, furniture and other items can be seized to settle a debt. That is according to attorney Ron Rodriguez leaves people who have paid hundreds of thousands of dollars to live there in limbo.  That leaves nursing home residents vulnerable to creditors showing up and seizing assets like beds, furniture, equipment etc.

Rodriguez represents Gordon Food Service. The company claims it is owed $160,000 for supplying food to the nursing home. TR & SNF, Inc. owns the nursing facility at University Village. According to state records, TR & SNF, Inc.’s president is John Bartle. Rodriguez claims that he was amazed and shocked in a Miami court when the attorney for TR & SNF, Inc. continued to defy a court order to open its books to a court-appointed receiver.

“The lawyer at the hearing for TR & SNF specifically told the judge that we could try to go over there with sheriffs and moving trucks and try to seize the assets,” Rodriguez said.

“It tells me that the books and records are going to show something that they don’t want want people to see,” Rodriguez added.

The nursing home owes a lot of money to a lot of companies. A judge ordered a receiver to examine the nursing home’s books, pay bills and run the place. TR & SNF, Inc., has refused to turn over the books and is trying to dissolve the receivership. TR & SNF, Inc.’s previous attempt to get rid of the receiver was rejected by the court.

“They have violated the court orders in not producing the documents the bank accounts the bank statements,” Rodriguez said.

At a hearing last week, involving the receiver and TR & SNF, attorney Amy Steele Donner promised the records would be delivered.

“How about a week from today?” she asked judge Jorge Cuerto.

“By next Tuesday at 5 pm,” said attorney Eric Silver, who represents the receiver.

“Yes, that sounds good,” the judge said.

“And if it’s not provided then are we here again?” Silver asked.

“All bets are off,” Judge Cuerto said.

Tuesday came and went.  TR & SNF, Inc. defied the court again by not providing the books. Efforts to contact TR & SNF, Inc. president John Bartle have been unsuccessful.

“My understanding is they were turned over,” Amy Steele Donner said.  She added Judge Cuerto is expected to decide this weekend whether to dissolve the receivership.

Asked if the books were turned over to the receiver, attorney Eric Silver said, “No, not one shred.”

The Philly Voice and NBC Philadelphia reported that a nursing home worker was arrested after she allegedly stole from elderly residents and even used it to fund a vacation after one of the victims died, according to police.  Syreeta Nicole Jones, 30, of Philadelphia, was arrested and charged with identity theft, forgery, securing a document by deception and other related offenses.

The investigation began May 27 when police responded to the Elm Terrace Gardens nursing home in Lansdale, Pennsylvania, for a report of a theft. Police discovered someone had stolen a personal check from a resident, who became aware upon receiving a call from the depositing bank, police said.

The stolen check was written in the amount of $2,450 and made payable to 39-year-old Eugene Hudnell, of Philadelphia, who police later discovered Hudnell was an associate of Jones. Police also said Jones, who worked as a certified nursing assistant at the home, had access to the victim’s room.  Police said more than $1,500 in suspicious transactions were made to the deceased resident’s credit card, and one of those was linked to a ticket agency for a Florida hotel that was booked to Jones and a male individual. According to police, purchases were also made to a wireless phone company under Jones’ cellphone accoun

Police linked Jones to the theft of another nursing home resident, who died in September. On Oct. 19, the second victim’s estate contacted Lansdale police and reported four suspicious transactions made to the victim’s credit card after he or she passed away. Police said Jones had access to this victim’s room as well.

Investigators determined two purchases were made to a wireless phone company under Jones’ cellphone account. Another transaction was made to a ticket agency for a vacation to Florida, booked to Jones and a male companion, according to police.

An Oakland County jury in Detroit held an assisted-living facility liable for the death of a 90-year-old dementia-stricken resident after she swallowed dishwasher detergent left in an unsecured cabinet. The family of Willie Mae Henderson was awarded $5,080,000 — $3 million of which was for conscious pain and suffering in its lawsuit against Watermark Retirement Communities. An Oakland County Circuit Court jury deliberated for less than three hours following a seven-day trial before delivering the verdict, awarding the exact amount that the family’s attorney’s requested.

Lawrence J. Buckfire, co-counsel for the estate, said he was pleased that the jury determined the decedent’s age was not a factor in awarding her estate.  “One of the things you’re always concerned about when doing a case for an elderly resident is somehow the jury is going to discount the value of that person’s life or the loss of that person’s life based upon their age,” said Buckfire.

Willie May Henderson wandered into the kitchen area at The Fountains at Franklin in Southfield. One of the two caregivers on duty was on a break, leaving the other to watch over 17 residents by herself. Based on timesheets, the caregiver stayed out 56 minutes instead of the allotted 30 minutes. A substitute supervisor was not brought in.  Watermark Retirement Communities denied negligence and denied causing significant pain, suffering, fright, shock and disability to Henderson. They also denied an allegation that The Fountains at Franklin, the facility where the incident occurred, was not property staffed or supervised.

Buckfire said the cabinet doors beneath the kitchen sink had easy access, with a magnetic lock on one side and a makeshift wood-stick mechanism designed by the maintenance staff on the other. Unsupervised, Henderson opened the cabinet, opened the bottle of detergent and ingested it.

After being found with her head leaned back and her lips swollen, Henderson was rushed to the hospital. The injuries to her mouth, throat, esophagus and stomach were so severe that she could not undergo surgery and was unable eat or drink. She died 13 days later.

Buckfire said the defense did not admit liability, argued that it took reasonable measures, and asserted that no other residents had gotten into locked cabinets before.

“These facilities usually are very poor at documenting treatment and important events,” he said. “Sometimes that poor documenting hurts them, obviously, because they can’t verify what they did or didn’t do, but it can make it more difficult for us to prove negligence on their part because the documentation is so poor.”

Buckfire said the facility’s lack of written procedures for securing hazardous chemicals made an impression on the jury. And despite the facility’s claim that locks and doors were regularly checked, there were no inspection records, he added.

“The lack of that documentation really hurt the defendant; there was no way they could establish that they did all the things they argued that they did,” Buckfire said.

The facility’s administrator claimed there was a safety policy, he said, but the facility’s national risk manager conceded at trial that there wasn’t one.

In addition, Buckfire said he pointed out inconsistent statements among employees about the cabinet’s condition and how the incident occurred because of it.

“A top right hinge from the cabinet was loose, so they immediately determined that somehow my client, a 90-year-old lady in a wheelchair with dementia, forcibly pried it off with her fingers because there were no tools or utensils in the area,” he said.

Buckfire said that before trial, the defendant asserted that Henderson might not necessarily have been the one damaging the door, “but there was nobody else. It was a locked unit and no one saw any outsiders or anyone else do it.”

To prove that, Buckfire said he used three experts.

Dr. Ljubisa J. Dragovic, a forensic pathologist, testified that if Henderson would have done what the defense asserted, her fingers or fingernails would have had abrasions. The records showed none, Buckfire said.

Harold Josephs, an engineer, inspected the door and hinges and screws. He testified it was highly unlikely that anyone, especially the decedent, could have forced the hinges off the cabinet, and the probable scenario was the doors were not locked or secured.

Michael Brodie, an assisted living expert, testified that a proper caregiver/resident supervision ratio of 2-to-17 was not used during the time of the incident. Brodie also said that fatal-if-swallowed chemicals must be secured so that vulnerable residents cannot gain access.

“[Y]ou must have appropriate locking mechanisms and secondary prevention measures,” Buckfire said. “And at the very least, have a childproof cap on [the detergent]. Here, the container was actually open, making it easier for [Henderson] to consume it.”

“The son in this case visited his mom five to six times a week, and with a life expectancy of two to three years, you’re looking at hundreds of missed visits,” Buckfire said. “And the jury understood how close and devoted he was to his mother, and they had no problem determining his loss was the same as if it were a younger person.”

The jury awarded $2 million for loss of society and companionship.

In arguing damages for conscious pain and suffering, Buckfire said he relied on nursing records taken during Henderson’s 13 days in the hospital. He explained that nursing assessments were performed every four hours, which included pain-scale assessments.

“So rather than have me explain and have [the jury] believe me, I did a summary of the pain-scale assessments,” Buckfire said. “These showed that even after she received morphine or other pain medications, quite often her pain levels were at 8-out-of-10 or 6-out-of-10 and so forth.”

He said that while the defense acknowledged that Henderson’s death was terrible, the defendant tried to minimize the damages by saying a lot of times she was on pain medication or a ventilator and wasn’t conscious.

“So I used the actual nursing notes and objective data to show she did suffer every single day for the remainder of her life,” Buckfire said.

He said he felt confident in asking for $3 million for the resident’s full 13 days of suffering after a pre-trial focus group said it would be comfortable awarding that much.

“My argument to the jury and to the focus group was, this woman suffered the same way a 30-year-old, 50-year-old or 70-year-old would,” he said. “Don’t discount the amount of suffering she went through based on her age.”

In addition, the jury awarded $80,000 for medical and funeral expenses.  “Families put a great deal of trust in these facilities. It is a very difficult and emotional decision for a family to make,” he said.

Thomas Gorman of Dorsey & Whitney LLP wrote an article about Chris Brogdon for JDSupra.  Brogdon is an Atlanta area retirement community developer with a history of run-ins with securities industry watchdogs who has been accused a running a scheme that diverted millions of dollars from nursing home investments to his personal use.  Brogdon formerly served as chairman of Retirement Care Associates, Contour Medical and NewCare Health Corp., and recently announced his resignation from the board of Georgia-based AdCare Health Systems. He’s also the CEO of Global Healthcare REIT, according to the SEC.

The Securities and Exchange Commission claims Christopher F. Brogdon misappropriated a portion of more than $190 million he raised from investors, comingling assets and using investor cash for his own expenses and to fund other businesses, according to a civil lawsuit in U.S. District Court in Newark, N.J.  Those personal and business expenses included maintenance, hanger costs and the salaries for pilots for two aircraft Brogdon used, the lawsuit says.

“Brogdon secretly diverted a portion of the proceeds to either pay for his and his wife’s lavish lifestyles or to prop up his entire business enterprise, which included other facilities, restaurants, and commercial real estate holdings,” the suit said.

 

The suit says Brogdon, 66, raised money from investors through municipal bond and private placement offerings. Investors were to earn interest from revenue from the facilities. He was involved in dozens of such offerings to buy, renovate or manage nursing homes or assisted living facilities since 1992, it says.

The lawsuit says he got loans from others to help pay off investors and concealed from investors the financial performance of facilities tied to bond offerings. It says he started comingling funds as early as 2000.

The SEC charged the 25 year veteran of the nursing home and retirement community business with offering fraud. The defendant has been involved multiple offerings, raising over $190 million. SEC v. Brogdon, (D. N.J. November 20, 2015).

From 1992 to 2014 Mr. Brogdon acquired or renovated at least 60 facilities through 54 separate offerings, raising about $189,980,000. At least 22 of those offerings are still outstanding. They involved just under $100,000,000. Three municipal bond offerings are in default.

Through the issuance of public conduit municipal revenue bonds, Mr. Brogdon raised over $168,000,000. Generally, the proceeds of an offering were used to undertake a particular project. Key terms were set forth in the offering statements, many of which were executed by Mr. Brogdon. He also raised capital through private placements. Overall he raised about $22,435,000 through these placements. Typically the offerings were mixed equity and debt described in certificates of participation. The borrowing entities involved in these offerings were controlled by Mr. Brogdon.

As early as 2000 Mr. Brogdon began commingling the funds generated by unrelated facilities, securities offerings and other business ventures. As a result of this practice, and the fact that the facilities were not generating sufficient revenue to service the debt, when payments were due on an offering associated with a facility it had insufficient funds. The practice of commingling funds increased over time.

In the offerings Mr. Brogdon misrepresented the nature of the investors’ and bondholders’ investment. While investors were told their funds would be used for a particular facility and that it would be responsible for the payment of interest and principal primarily from the revenue generated, the claim was incorrect. In fact Mr. Brogdon used part of the offering proceeds for other business ventures. Mr. Brogdon also misappropriated portions of the offering proceeds, diverting the funds to other projects.

Since the projects had insufficient funding to cover the debt service from the commingling, Mr. Brogdon frequently raided the debt service reserve fund. Investors had been told that this fund would be used only if there were insufficient funds to cover debt and that it would immediately be replenished. Yet for several funds he began drawing on this fund in the first year and the funds were not replenished. He also paid debt service with third party loans.

Finally, Mr. Brogdon failed to make the required disclosures. He also misrepresented his compliance with others. The complaint alleges violations of Securities Act Sections 15(b) and 17(a) and Exchange Act Sections 10(b) and 20(e). The court entered an emergency freeze order. The action is pending.

ProPublica reported the disturbing history of N.Y’s largest for profit nursing home chain.  The state’s “character-and-competence” reviews are supposed to weed out operators with histories of violations and fines— but regulators don’t always act on the full story.  Several nursing homes are part of a group of for-profit homes affiliated with SentosaCare, LLC, that have a record of repeat fines, violations and complaints for deficient care in recent years.  Despite that record, SentosaCare founder Benjamin Landa, partner Bent Philipson and family members have been able to expand their nursing home ownerships in New York, easily clearing regulatory reviews meant to be a check on repeat offenders. SentosaCare is now the state’s largest nursing home network, with at least 25 facilities and nearly 5,400 beds.  Records show, however, that Landa and Philipson, or family members, have ownership stakes or directorships in nearly all of SentosaCare’s facilities. Fensterman also co-owns 14 nursing homes with Landa in several states, including one SentosaCare home.

That unhindered expansion highlights the continued weakness of nursing home oversight in New York, an investigation by ProPublica found, and exposes gaps in the state’s system for vetting parties who apply to buy shares in homes.  State law requires a “character-and-competence” review of buyers before a change in ownership can go through. To pass muster, other health care facilities associated with the buyers must have a record of high-quality care.  The problem arises when the decision maker in these deals is the state’s Public Health and Health Planning Council, a body of appointed officials, many from inside the health care industry.

In dozens of cases, the department reported “no repeat violations,” even when a SentosaCare home had been cited multiple times for the same serious deficiency.  Thirteen of SentosaCare’s homes have Medicare’s bottom score for nurse staffing. Inspection reports also show that at least seven residents have wandered away from the SentosaCare affiliated facilities in recent years — including one who froze to death in 2011. Inspectors and prosecutors have found that staff falsified records in some cases. Dozens of patients at SentosaCare homes have experienced long delays before receiving necessary care; some ended up in hospitals.

“The law establishes mechanisms for at least a moderate review of an applicant’s character and competence,” said Richard Mollot, director of the Long Term Care Community Coalition in New York. “The failure to provide complete information on a provider’s past performance fundamentally undermines the review process.”

Mollot’s group published a recent report saying the Health Department has one of the nation’s lowest rates of citing nursing home operators for deficiencies in care. New York is also among a minority of states that don’t mandate minimum staffing ratios, even though research shows a strong link between nursing staff and residents’ well-being.  “Direct bedside nursing home staff is probably the most important factor in nursing home care — end of story,” said Dr. Michele Bellantoni, clinical director of geriatrics at the Johns Hopkins School of Medicine.

Although New York doesn’t mandate minimum staffing ratios, federal law says homes must have “sufficient staff” to “attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.”

Patient advocates say that vague standard is one reason that the state rarely cites homes for insufficient staffing. Health Department officials, in response to an email asking about the agency’s citation rate, also noted the lack of specific minimum staffing rules.  Patient advocates say lack of staff is one of the most common complaints from residents and that state inspectors should be following federal guidance, which instructs them to look for staffing issues “whenever quality of care problems have been discovered.”

Advocacy groups and the state’s biggest nurses’ union have pushed for mandatory staffing ratios, and “safe-staffing” bills have been introduced in the New York Legislature for at least a decade, according to the office of Assemblyman Richard Gottfried, D-Manhattan, the health committee chairman.

 

I found the below on a social community blog about the writer’s experience at the hospital.  I thought it was worth sharing.

Early on a Wednesday morning, I heard an anguished cry—then silence.

I rushed into the bedroom and watched my wife, Rachel, stumble from the bathroom, doubled over, hugging herself in pain.

“Something’s wrong,” she gasped.

This scared me. Rachel’s not the type to sound the alarm over every pinch or twinge. She cut her finger badly once, when we lived in Iowa City, and joked all the way to Mercy Hospital as the rag wrapped around the wound reddened with her blood. Once, hobbled by a training injury in the days before a marathon, she limped across the finish line anyway.

So when I saw Rachel collapse on our bed, her hands grasping and ungrasping like an infant’s, I called the ambulance. I gave the dispatcher our address, then helped my wife to the bathroom to vomit.

I don’t know how long it took for the ambulance to reach us that Wednesday morning. Pain and panic have a way of distorting time, ballooning it, then compressing it again. But when we heard the sirens wailing somewhere far away, my whole body flooded with relief.

I didn’t know our wait was just beginning.

I buzzed the EMTs into our apartment. We answered their questions: When did the pain start? That morning. Where was it on a scale of one to 10, with 10 being worst?

Eleven,” Rachel croaked.

As we loaded into the ambulance, here’s what we didn’t know: Rachel had an ovarian cyst, a fairly common thing. But it had grown, undetected, until it was so large that it finally weighed her ovary down, twisting the fallopian tube like you’d wring out a sponge. This is called ovarian torsion, and it creates the kind of organ-failure pain few people experience and live to tell about.

Ovarian torsion represents a true surgical emergency,” says an article in the medical journal Case Reports in Emergency Medicine. “High clinical suspicion is important. … Ramifications include ovarian loss, intra-abdominal infection, sepsis, and even death.” The best chance of salvaging a torsed ovary is surgery within eight hours of when the pain starts.

There is nothing like witnessing a loved one in deadly agony. Your muscles swell with the blood they need to fight or run. I felt like I could bend iron, tear nylon, through the 10-minute ambulance ride and as we entered the windowless basement hallways of the hospital.

And there we stopped. The intake line was long—a row of cots stretched down the darkened hall. Someone wheeled a gurney out for Rachel. Shaking, she got herself between the sheets, lay down, and officially became a patient.

Emergency-room patients are supposed to be immediately assessed and treated according to the urgency of their condition. Most hospitals use the Emergency Severity Index, a five-level system that categorizes patients on a scale from “resuscitate” (treat immediately) to “non-urgent” (treat within two to 24 hours).

I knew which end of the spectrum we were on. Rachel was nearly crucified with pain, her arms gripping the metal rails blanched-knuckle tight. I flagged down the first nurse I could.

“My wife,” I said. “I’ve never seen her like this. Something’s wrong, you have to see her.”

“She’ll have to wait her turn,” she said. Other nurses’ reactions ranged from dismissive to condescending. “You’re just feeling a little pain, honey,” one of them told Rachel, all but patting her head.

We didn’t know her ovary was dying, calling out in the starkest language the body has. I saw only the way Rachel’s whole face twisted with the pain.

Soon, I started to realize—in a kind of panic—that there was no system of triage in effect. The other patients in the line slept peacefully, or stared up at the ceiling, bored, or chatted with their loved ones. It seemed that arrival order, not symptom severity, would determine when we’d be seen.

As we neared the ward’s open door, a nurse came to take Rachel’s blood pressure. By then, Rachel was writhing so uncontrollably that the nurse couldn’t get her reading.

She sighed and put down her squeezebox.

“You’ll have to sit still, or we’ll just have to start over,” she said.

Finally, we pulled her bed inside. They strapped a plastic bracelet, like half a handcuff, around Rachel’s wrist.

From an early age we’re taught to observe basic social codes: Be polite. Ask nicely. Wait your turn. But during an emergency, established codes evaporate—this is why ambulances can run red lights and drive on the wrong side of the road. I found myself pleading, uselessly, for that kind of special treatment. I kept having the strange impulse to take out my phone and call 911, as if that might transport us back to an urgent, responsive world where emergencies exist.

The average emergency-room patient in the U.S. waits 28 minutes before seeing a doctor. I later learned that at Brooklyn Hospital Center, where we were, the average wait was nearly three times as long, an hour and 49 minutes. Our wait would be much, much longer.

Everyone we encountered worked to assure me this was not an emergency. “Stones,” one of the nurses had pronounced. That made sense. I could believe that. I knew that kidney stones caused agony but never death. She’d be fine, I convinced myself, if I could only get her something for the pain.

By 10 a.m., Rachel’s cot had moved into the “red zone” of the E.R., a square room with maybe 30 beds pushed up against three walls. She hardly noticed when the attending physician came and visited her bed; I almost missed him, too. He never touched her body. He asked a few quick questions, and then left. His visit was so brief it didn’t register that he was the person overseeing Rachel’s care.

Around 10:45, someone came with an inverted vial and began to strap a tourniquet around Rachel’s trembling arm. We didn’t know it, but the doctor had prescribed the standard pain-management treatment for patients with kidney stones: hydromorphone for the pain, followed by a CT scan.

The pain medicine started seeping in. Rachel fell into a kind of shadow consciousness, awake but silent, her mouth frozen in an awful, anguished scowl. But for the first time that morning, she rested.

Leslie Jamison’s essay “Grand Unified Theory of Female Pain” examines ways that different forms of female suffering are minimized, mocked, coaxed into silence. In an interview included in her book The Empathy Exams, she discussed the piece, saying: “Months after I wrote that essay, one of my best friends had an experience where she was in a serious amount of pain that wasn’t taken seriously at the ER.”

She was talking about Rachel.

“That to me felt like this deeply personal and deeply upsetting embodiment of what was at stake,” she said. “Not just on the side of the medical establishment—where female pain might be perceived as constructed or exaggerated—but on the side of the woman herself: My friend has been reckoning in a sustained way about her own fears about coming across as melodramatic.”

Female pain might be perceived as constructed or exaggerated”: We saw this from the moment we entered the hospital, as the staff downplayed Rachel’s pain, even plain ignored it. In her essay, Jamison refers back to “The Girl Who Cried Pain,” a study identifying ways gender bias tends to play out in clinical pain management. Women are  “more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients,’” the study concludes—a phenomenon referred to in the medical community as “Yentl Syndrome.

In the hospital, a lab tech made small talk, asked me how I like living in Brooklyn, while my wife struggled to hold still enough for the CT scan to take a clear shot of her abdomen.

“Lot of patients to get to, honey,” we heard, again and again, when we begged for stronger painkillers. “Don’t cry.”

I felt certain of this: The diagnosis of kidney stones—repeated by the nurses and confirmed by the attending physician’s prescribed course of treatment—was a denial of the specifically female nature of Rachel’s pain. A more careful examiner would have seen the need for gynecological evaluation; later, doctors told us that Rachel’s swollen ovary was likely palpable through the surface of her skin. But this particular ER, like many in the United States, had no attending OB-GYN. And every nurse’s shrug seemed to say, “Women cry—what can you do?”

Nationwide, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing. Rachel waited somewhere between 90 minutes and two hours.

“My friend has been reckoning in a sustained way about her own fears about coming across as melodramatic.” Rachel does struggle with this, even now. How long is it appropriate to continue to process a traumatic event through language, through repeated retellings? Friends have heard the story, and still she finds herself searching for language to tell it again, again, as if the experience is a vast terrain that can never be fully circumscribed by words. Still, in the throes of debilitating pain, she tried to bite her lip, wait her turn, be good for the doctors.

For hours, nothing happened. Around 3 o’clock, we got the CT scan and came back to the ER. Otherwise, Rachel lay there, half-asleep, suffering and silent. Later, she’d tell me that the hydromorphone didn’t really stop the pain—just numbed it slightly. Mostly, it made her feel sedated, too tired to fight.

Eventually, the doctor—the man who’d come to Rachel’s bedside briefly, and just once—packed his briefcase and left. He’d been around the ER all day, mostly staring into a computer. We only found out later he’d been the one with the power to rescue or forget us.

When a younger woman came on duty to take his place, I flagged her down. I told her we were waiting on the results of a CT scan, and I hassled her until she agreed to see if the results had come in.

When she pulled up Rachel’s file, her eyes widened.

“What is this mess?” she said. Her pupils flicked as she scanned the page, the screen reflected in her eyes.

“Oh my god,” she murmured, as though I wasn’t standing there to hear. “He never did an exam.”

The male doctor had prescribed the standard treatment for kidney stones—Dilauded for the pain, a CT scan to confirm the presence of the stones. In all the hours Rachel spent under his care, he’d never checked back after his initial visit. He was that sure. As far as he was concerned, his job was done.

If Rachel had been alone, with no one to agitate for her care, there’s no telling how long she might have waited.

It was almost another hour before we got the CT results. But when they came, they changed everything.

“She has a large mass in her abdomen,” the female doctor said. “We don’t know what it is.”

That’s when we lost it. Not just because our minds filled then with words like tumor and cancer and malignant. Not just because Rachel had gone half crazy with the waiting and the pain. It was because we’d asked to wait our turn all through the day—longer than a standard office shift—only to find out we’d been an emergency all along.

Suddenly, the world responded with the urgency we wanted. I helped a nurse push Rachel’s cot down a long hallway, and I ran beside her in a mad dash to make the ultrasound lab before it closed. It seemed impossible, but we were told that if we didn’t catch the tech before he left, Rachel’s care would have to be delayed until morning.

“Whatever happens,” Rachel told me while the tech prepared the machine, “don’t let me stay here through the night. I won’t make it. I don’t care what they tell you—I know I won’t.

Soon, the tech was peering inside Rachel through a gray screen. I couldn’t see what he saw, so I watched his face. His features rearranged into a disbelieving grimace.

By then, Rachel and I were grasping at straws. We thought: cancer. We thought: hysterectomy. Lying there in the dim light, Rachel almost seemed relieved.

“I can live without my uterus,” she said, with a soft, weak smile. “They can take it out, and I’ll get by.”

She’d make the tradeoff gladly, if it meant the pain would stop.

After the ultrasound, we led the gurney—slowly, this time—down the long hall to the ER, which by then was  completely crammed with beds. Trying to find a spot for Rachel’s cot was like navigating rush-hour traffic.

Then came more bad news. At 8 p.m., they had to clear the floor for rounds. Anyone who was not a nurse, or lying in a bed, had to leave the premises until visiting hours began again at 9.

When they let me back in an hour later, I found Rachel alone in a side room of the ER. So much had happened. Another doctor had told her the mass was her ovary, she said. She had something called ovarian torsion—the fallopian-tube twists, cutting off blood. There was no saving it. They’d have to take it out.

Rachel seemed confident and ready.

“He’s a good doctor,” she said. “He couldn’t believe that they left me here all day. He knows how much it hurts.”

When I met the surgery team, I saw Rachel was right. Talking with them, the words we’d used all day—excruciating, emergency, eleven—registered with real and urgent meaning. They wanted to help.

By 10:30, everything was ready. Rachel and I said goodbye outside the surgery room, 14 and a half hours from when her pain had started.

Rachel’s physical scars are healing, and she can go on the long runs she loves, but she’s still grappling with the psychic toll—what she calls “the trauma of not being seen.” She has nightmares, some nights. I wake her up when her limbs start twitching.

Sometimes we inspect the scars on her body together, looking at the way the pink, raised skin starts blending into ordinary flesh. Maybe one day, they’ll become invisible. Maybe they never will.