AdventHealth Hendersonville: An Open Letter to Brandon Nudd, President and CEO

On June 13, 2021 I was admitted to the AdventHealth emergency room in Hendersonville, North Carolina with extreme pain underneath my right shoulder blade and lower right neck.  I presented as a 60-year old very healthy (taking no meds) athletic person who had not changed any sporting activity in the previous weeks  leading up to the visit.  I was seen by Dr. Smith and her PA who examined me and who diagnosed “back and shoulder pain with suspected spasms.”

They told me they thought the pain was caused by the rhomboid muscle.  They DID NOT order an x-ray although they should have.  I was given two shots in the arm – a muscle relaxer and Toradol and also given a prescription for Oxycodone, and released.  The horrific pain persisted so on June 14, 2021 I called my internist (also under AdventHealth) who saw me later that morning.  He suspected the pain was not from a muscle injury so he prescribed a 6-day dose of prednisolone and a recommendation for physical therapy (which I declined to pursue because I don’t want anyone working around my neck unless I know what’s wrong).

The pain continued so I called my internist’s office on June 15, 2021 and spoke to his PA who told me the doctor was out of the office for the rest of the week.  She advised me to go to EmergeOrtho (also under AdventHealth) – an emergency center for orthopedic injuries – which I did.  I saw an orthopedic surgeon who immediately ordered an x-ray that showed arthritis between vertebrae C5-C6-C7, which was causing the pain (apparently arthritis makes the bone bigger pressing on the nerves).  He said prednisolone (a steroid to reduce the inflammation) is the proper medication (and that I may need a second 6-day dose, which I did) but to NOT do any physical therapy.  He also ordered an MRI in the event the relief from the prednisolone didn’t last and I would need shots directly in my neck).

I called my internist’s office again and spoke to his PA informing her of the diagnosis and asked why an x-ray of my neck and upper right shoulder were not ordered?  I then asked what I could do so that this does not happen to anyone else – no one should go through more than 48 hours of horrific pain for a diagnosis, which turned out to be arthritis in the vertebrae in my neck.  She advised me to file a complaint with the hospital and consider “that I took one for the team.”  Really????

I called the hospital and then filed a formal complaint (3 times because of no response) protesting the $1,300 emergency room bill because Dr. Smith and her PA should have ordered an x-ray given the presentation.  How could they not even consider arthritis to be an issue for a 60-year old athletic woman who had not changed her physical routine in the weeks prior?  And, to give me shots and drugs that I didn’t need is appalling.

In response to my complaint, I received a letter from Gretchen Nicholson, the Director of Collaborative Improvement at AdventHealth Hendersonville who wrote:

“based on your initial presentation, emergent radiographic imaging” (x-ray) “was not indicated, and even if imaging had been obtained, the treatment from the emergency department would not likely have changed.” 

I find Ms. Nicholson’s response frightening for two (2) reasons.

One, I did present as arthritic with pain from the neck shooting down the right shoulder (being 60 is a big red flag) as an indicator (all Dr. Smith had to do was order an x-ray and the CORRECT diagnosis would have been made).  The x-ray taken by Emerge Ortho 2-days later confirmed the arthritis; and

Two, Ms. Nicholson’s claim that an x-ray would not have likely changed the treatment is categorically false. The x-ray taken by EmergeOrtho showed the arthritis (as confirmed by the orthopedic surgeon) who prescribed prednisolone – not muscle relaxers because there was nothing wrong with my muscles.

The bottom line is that I did not get a correct diagnosis from AdventHealth Hendersonville emergency room health care providers and was therefore given medications I didn’t need.  But, what is equally horrific is Ms. Nicholson’s claim that an x-ray would not likely have changed the treatment.  How could she write those words knowing that the orthopedic surgeon at EmergeOrtho (under AdventHealth) ordered an x-ray, diagnosed arthritis, and prescribed a steroid instead of muscle relaxers?