TRAVERSE CITY — On a recent summer evening, Ramon “Ray” Novarro sat at his kitchen table, reviewing a large stack of medical documents from his stay last October at Munson Medical Center.
“I feel like I’m back in school, working on my degrees,” Novarro, 86, a retired music teacher, said wryly.
On Oct. 17, 2023, Novarro told his wife, Penny Novarro, that he wasn’t feeling well and she called an ambulance — it would be the first of two trips to the emergency room within the next few hours.
On the first visit, Novarro said he asked for a bedside commode, was told none were available. He was helped to a public restroom, went in alone and fainted, hitting his head and hip on the tile floor.
Novarro had locked the door and it took several minutes, and several staff, to get the door opened.
“I was sitting in an alcove and I heard ‘clunk!’ and I yelled, ‘He just fell!’” Penny Novarro said.
Ray Novarro was released after a CAT scan and X-rays showed no major injuries, and Penny says she drove her husband home.
Once they arrived, Ray fainted again, landing on the cement floor of the couple’s garage, so it was back to the ER.
“One of the nurses told us he never should have left,” Penny said, describing how the couple were eventually both hospitalized, on separate floors, with COVID-19.
Penny went home a few days later, but Ray did not. The bump on his head wasn’t serious, but his hip was badly bruised and he was weak.
Ray takes prescription medication for heart and blood sugar issues, his leg swelled to twice its normal size, making it painful, he says, to get out of bed or shift his position.
All of these elements — advanced age, immobility, weakness from COVID and chronic health conditions — put Novarro at increased risk for developing a pressure injury.
Scourge of pressure injuries
Sometimes called pressure ulcers or bed sores, pressure injuries are a prevalent concern in hospitals and long-term care facilities, as documented by the National Library of Medicine, which said skin and soft tissue damage can be severe.
Dr. Joe Santangelo, chief medical, quality and safety officer for Munson Healthcare, said he couldn’t speak about specific patients, but acknowledged pressure injuries are one of healthcare’s persistent challenges.
“They are a hard nut to crack,” Santangelo said. “No one has solved this. Every facility I’m aware of has some rate of pressure injuries and we’re all working very hard to prevent them.”
Munson Healthcare has a protocol for prevention and treatment, including a head-to-toe skin assessment, early intervention, support mattresses and pads when needed, and acute attention to a turning regimen and to good skin hygiene.
“The goal is not to have anybody, ever, be lying in bed for a long time in the same position,” Santangelo said.
Months of rehab
Back at the Novarro’s kitchen table, Ray draws a reporter’s attention to his feet. He was wearing shoes, he said, for the first time in six months.
That’s because, in Ray’s case, risk of a pressure injury turned into a painful reality. At some point during his care — the Novarros’ account and Munson documents differ on timing — Ray developed a pressure injury on his heel.
The injury itself was under the skin, dark purple and about the size of a quarter. But swelling and skin damage spread until it covered his entire heel.
Ray says he heard at least one care provider use two frightening words: “Possible amputation.”
The Novarros say Ray didn’t have the injury when he went to Munson, and initial Munson records state “multiple skin assessments during your stay … but no documentation of a pressure ulcer to your heel.”
The injury was discovered by clinical staff at Pavilions, where Ray spent a week for rehab after his hospital stay.
“We do a head-to-toe body assessment. It was discovered by our clinical staff within an hour of him being here and pictures were taken,” Holly Edmondson, Pavilions’ infection preventionist who is also in charge of admissions and medical records.
Edmondson said the dark purple color, to clinicians, signaled dying tissue, which was worrisome.
A Munson healthcare worker, that same day, had transported Ray to the Pavilions in a wheelchair via an underground tunnel between the two facilities — leading Penny to quip, “I guess he got it in the tunnel then.”
Ray is complimentary about his rehab experience, and credited Pavilions’ medical staff for discovering the injury. Once home, the healing process was slow, and sidelined him for months from the basic activities of daily living.
Physical, mental well-being
Ray slept in a living room recliner, with his foot off the footrest, so there would be nothing touching his heel. He wore a bubble boot, and used a walker until a Pavilions-assigned physical therapist helped him learn to walk again — heel, toe, instead of using the ball of his foot.
Penny was his caretaker, cleaning the injury daily, and applying a fresh bandage. She used a mirror to take photographs on her phone, so Ray could see his slow improvement.
Most of the physical pain has subsided, he said, but the emotional effects took longer to heal.
“I consider myself an active person, and it changed my outlook on life for a while,” Novarro said. “It affected the family. My knees hurt, in ways they didn’t before.”
Novarro says he felt isolated. His frustration grew.
Differing accounts
Ray says he didn’t want anyone else to suffer a similar injury and, with that in mind, he started making phone calls and sending emails.
To Munson officials, attorneys, insurance companies, and others, and he says their responses left him unsatisfied.
Munson paperwork that Novarro shared with the Record-Eagle, from the hospital’s patient relations department and the legal department, offered apologies for care not meeting his expectations, and said a clinical review showed no gaps in care.
“Thank you for taking the time to share your experience at Munson Medical Center in October 2023,” one letter stated. “Clearly our care did not meet your expectations with a lack of courtesy and a failure to recognize your need for admission on your first emergency department visit. For that, I sincerely apologize.”
His complaint to his insurer was investigated and reviewers found no wrongdoing by the hospital or hospital staff, documents show.
One assertion — that Ray should have pulled the call light for help after he fell in the bathroom — he says is particularly galling.
“I fainted, I was passed out cold in the john, I wasn’t thinking about any call light,” he said.
Screeners at offices of unnamed attorneys’ offices told Ray that “there wasn’t enough meat on the bone,” for a lawsuit against anyone, he said.
“They told me if I’d lost a foot, I’d have a big case,” Novarro said, chuckling for the first time during a lengthy interview. “I wasn’t in it for the money anyway,” he said.
“We’re well insured,” Penny added.
“I would just like recognition that something went wrong,” Novarro said. “That I’m not just some number on a chart.”
Edmondson, at the Pavilions, said Munson representatives asked for Ray’s records, which she provided after securing Ray’s permission.
That’s reflected in communication from Munson’s legal department, in a letter acknowledging Ray’s request for compensation, the pressure injuries that healed during his stay there, and the injury discovered by the Pavilions.
Ray said Munson provided addresses and phone numbers of state and federal agencies, if he wanted to file formal complaints, but he said he doesn’t plan to do so.
“I’m tired,” Ray said. “I know what happened to me. And I know, with Penny’s help, I worked hard to get better. I just want to be heard.”
The Record-Eagle shared Ray’s final comment with Dr. Santangelo, who besides his role at Munson Healthcare, also serves on the Michigan Hospital Association’s quality committee.
Santangelo again explained he couldn’t comment on specific patients, but complimented staff working in patient relations at Munson as particularly kind and caring, and urged all patients and patients’ families to continue to advocate for their loved ones’ care.
Santangelo said as a general rule, patients should do what they can to move as much as possible during hospital, rehab and home recovery. It helps increase circulation, which is good for the body, as long as approved by a patient’s care team.
He said a new internal campaign at Munson Healthcare, Movement Matters, reminds providers about the importance of helping patients to move their bodies, whether that’s sitting up to eat meals or taking short walks as approved by their care team.
“Patients taking care of their general health as much as they can — getting preventative care, making sure they’re following up if they have a chronic condition, and staying in a good nutritional status — is really important,” Santangelo said.
“It’s important for pressure injuries (prevention), but it’s important for a whole lot of other things, too,” he said.