Letter by Tracey L. Cutri, Director of Case Management at Acuity Specialty Hospitals of Ohio Valley

I would like to respond to a recent article that criticized long-term acute care hospitals (LTACH). I am a registered nurse with a clinical background working in intensive care units (ICUs) and emergency rooms (ERs). Currently, I am the director of case management at Acuity Specialty Hospitals of the Ohio Valley, which operates three LTACHs in Ohio and West Virginia. I work with the sickest of the sick at these facilities. I see people recover from the acute part of their illness and progress so well that they can return to their homes and families.

My father, Edward, sold his farm almost a year ago and moved to Texas to live near my sister. He had bought a camper and planned to spend his retirement traveling around the country and visiting family and friends.

On August 11, my sister called and told me that our father was admitted to the hospital after falling and injuring his back. He had suffered a couple of fractures in his back and was having a difficult time walking. The plan of care was to send him to an acute inpatient rehab center for rehabilitation. But instead, he was sent to a skilled care facility for rehab. A nurse told my father that was the only place that would accept his insurance.

My sister kept me informed about my father’s progress. Initially everything seemed to be going as planned. He was alert and oriented. Then a few days later, he became nauseated and was medicated with a medication to treat the nausea, a side effect is that it makes you sleepy.  He was not eating or drinking. He was given daily rounds of medications, including diuretics. Before catching a flight to Texas, I told my sister to have my father transferred to the emergency department immediately. When my father arrived at the hospital, he was unresponsive and was in complete kidney and liver failure, which was probably caused by a buildup of poisons in his body. My father was admitted to the intensive care unit, where he began hemodialysis treatments.

When I arrived at the hospital in Texas, my father was on a ventilator and was receiving sedative medications. My stepmother had chosen to make my father DNR (do not resuscitate) because a nurse had told her he was so sick that CPR would fracture his ribs and “hurt” him. The doctor treating my father didn’t think there was much hope. When I spoke to the doctor on the telephone he had the events being that my father was like this for 5 weeks and he was not hopeful of any recovery.  I explained to him that all of this just happened and when he was released from their hospital 5 days earlier he had completely normal kidney function. I made is perfectly clear to him that this was an acute episode and requested that they give him a chance for the medications to work. My father’s blood was showing that there was an infection.

I explained to my family that my father was suffering from an acute illness. We should give him a chance for the medications to work. I asked myself, why are they just going to let him die instead of trying to save his life?  I knew he was acute and that he could recover, and if he didn’t then we could at least say we tried. I wanted to have my father transported to an LTACH as soon as he was stable, where he could get specialized care. An LTACH would give my father a fighting chance to recover. Meanwhile, I had to return home to Ohio for a few days, but I was planning on flying back to Texas later in the week.

Unfortunately, my father passed away on August 27. It didn’t have to be this way. My heart hurts just writing this letter.  I searched for local LTACHs and the closest one was a couple of hours away. As a nurse, I am still in shock that medical professionals would tell a family member that CPR would hurt their loved one.  The LTACH where I have worked for the past 11 years is very aggressive, compassionate, and caring, we are used to taking care of this type of patient and seeing them recover. I do not feel that LTACHs get enough credit.  They take care of the sickest patients and help them through a horrific time in their and their families lives.

I firmly believe that if my father was in an LTACH, such as Acuity Specialty Hospital, he would be alive today. I hope that other patients and families don’t have to go through the same nightmare that my family and I experienced.


Tracey L. Cutri