I spent more than half of January in Kings County Medical Center in Brooklyn, N.Y. My father became ill the day before I was scheduled to return to St. Thomas and Kings County was the closest hospital.
I quickly learned that when someone you love is in the hospital, you spend as much time there as you can if you want him to be as comfortable as possible and to get optimum care.
So I wangled a pass to help give him breakfast before visiting hours started and returned when they did start (or just stayed on until they did). I would only leave to get ginger ale or some such thing for my father and to pick up some lunch for myself, and left when visiting hours, and the grace period they give you, were over in the evening.
I got to know the nurses, the nurses aides and the doctors. Since this is a teaching hospital, there were interns, residents, fellows and attending physicians. At one point, because I was there, I happened to learn that the cardiology fellow and an intern had decided to subject my father to a procedure that, while appropriate for his acute heart condition, was not imperative, and had serious risks for an 88-year-old man with his chronic health problems. As they described it when questioned, one of the possible "side effects" was death.
The procedure was not done; the records indicate that the family refused it. It may well have been different if I had not been there since they had not planned to ask anyone but my seriously ill father for permission.
I am told that most New York City public hospitals are understaffed. Perhaps that is why I never heard the nursing staff answer a request for assistance to a patient with anything other than a variant of "I'm busy right now" or "I'll get to it when I can," no matter what they were doing, including reading a magazine. I finally decided that they must believe that they would be inundated with requests for help if they ever responded to one as soon as they were asked.
This experience keeps coming back to my mind as we go through yet another debate on hospital autonomy in these Virgin Islands.
Once again we are reminded of the lack of supplies, the personnel problems and the predicament of a governing board with responsibilities but precious little power, all caused by the failure of previous legislatures and executives to give the hospitals significant autonomy.
The situation has become so grave that numbers of residents prefer to seek treatment in Puerto Rico and the United States in the belief that our hospitals provide inferior care.
Yet, at the same time, we regularly read letters to the editor in our newspapers, written both by residents and by visitors, extolling the marvelous care that they have received in our hospitals. Quite often, these letters name specific medical personnel and praise them for the care and concern which they extended.
It is this sense of caring and concern that I did not feel from most of the medical staff in New York. And it is this care and concern that can support the spirit of a person who is ill, inspiring them towards regaining their health.
This attitude is not enforced by the executive branch, it is not a product of oversight by the Health, or any other, Department. This attitude can only come from the sensitivity and compassion of the hospital staff itself.
It appears that the staff of the hospitals have maintained an atmosphere dedicated to the welfare of their patients, despite the lack of adequate materials, the continuing threat of decertification, and having many crucial decisions about their institutions made for them.
As the debate about hospital autonomy continues, and as administrative and financial arguments fly back and forth, it occurs to me that our hospitals need to be run by boards that are in partnership with the staff, and not beholden to what is, of necessity, a political branch of government. The hospitals have had the responsibility for patient care; it's time that they also have real authority.
Editor's note: Judith Bourne is an attorney in private practice in St. Thomas.
