Student who needs lifesaving surgery wins medical records
Caitlin Secrist can’t eat, can’t work, can barely go to school online and is in constant pain from a severe illness that could kill her.
Although there is a surgery to help her, the 21-year-old Florence college student has been unable to get it for six months because she can’t get copies of her own medical records.
The files are locked away in a repossessed electronic-records system while creditors of bankrupt Florence Hospital at Anthem and Gilbert Hospital bicker over who should pay for access to them.
More than 300 patients have requested medical records without success since the hospitals shut down in June 2018, court records showed. Secrist’s family has asked for hers repeatedly.
Former patients need the documents to deal with chronic conditions or pursue medical malpractice lawsuits.
Prospective employers of nearly 200 doctors and hospital staffers looking for new work have been unable to check their employment histories.
But Secrist’s case may be the most urgent.
The medical records are the only thing standing between her and a life-
saving surgery by a top
Johns Hopkins Hospital.
The doctor has refused to perform the operation without a complete understanding of Secrist’s health history, including what her pancreas looked like when she was originally diagnosed, she said.
Every week that goes by, the danger increases of another attack of acute pancreatitis that could cause her organs to shut down.
“Without those records, we can’t go forward. We can’t make me better,” said Secrist, who lives with her parents in Florence. “Having my life, practically, in the hands of a judge and people I don’t even know, who don’t even know my situation, it’s upsetting.”
Secrist and her primary-care physician sent letters to Maricopa County Superior Court urging swift release of her records.
Federal and state law require medical facilities to send patients copies of their medical records within 60 days of a request.
“It’s really hard to watch your daughter go through (pain), knowing there is a surgery that can fix this and we can’t (do it) because we’re missing stupid medical records,” her mother Suzette Secrist said. “There’s just one thing holding us back.”
A knot of attorneys with competing interests have tied up the case since last summer, arguing over who bears financial responsibility for maintaining former patient files.
Even Judge Roger Brodman admitted shutting down the hospitals has been more complicated than he anticipated.
“A major problem has been the issue of patient records,” he wrote in December. “Everyone acknowledges that, as a matter of law and public policy, the patient records need to be preserved . ... At multiple hearings, the Court has repeatedly sought proposals to resolve the document retention/patient record problem . ... If the Court errs, it will do so in the public’s interest.”
After brought Secrist’s story to light, pressure increased on the court and attorneys to find a solution. Even Gov. Doug Ducey stepped in. physician
‘I thought I was going to die’
at
The first time Secrist had an attack of pancreatitis in 2017, the stabbing pain in her stomach was so intense she crawled to her mother on her hands and knees.
“It hit me like a truck,” Secrist said. “I thought I was going to die, it was so bad.”
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Suzette and Bill Secrist rushed their daughter to the nearest emergency room at Florence Hospital.
They learned her pancreas, which helps the body digest food and regulates blood-sugar levels, was malfunctioning. The tube connecting her organ to the small intestine is so small that digestive juices reflux back into the pancreas every time Secrist eats. Her pancreas, in essence, is digesting itself.
Secrist no longer eats by mouth. A feeding tube attached to her belly pumps liquid nutrients straight to her intestines from a backpack she wears 24/7.
Nothing worked.
Multiple surgeries to widen the tube have failed.
Removing her gallbladder didn’t help. Her daily medication bottles — including drugs for digestion, pain and nausea — overflow a large, plastic box.
Secrist has been hospitalized more than a dozen times, according to her mother. Twice she has nearly died.
The fatality rate for patients with severe acute pancreatitis can be as high as Secrist’s doctors tried has 50 percent, according to a 2016 study.
“It’s just like a ticking time bomb,” Secrist said.
‘My life is on hold’
Before she was diagnosed, Secrist carried a full course load at Central Arizona College, went out with friends and worked full-time at Safeway as a cashier. Now she stays at home. She only has enough energy to take one online class a semester, she said.
“I was able to do everything like a normal teenager. And suddenly, my life just stopped because of the pancreatitis,” Secrist said. “I feel like my life is on hold. It’s not going anywhere.”
It’s rare for a person as young as Secrist to get acute pancreatitis.
The illness typically afflicts the elderly or people who smoke, drink or take drugs excessively, which doesn’t apply to Secrist, her parents said. Preliminary testing suggests her condition is caused by genetic and congenital defects, they said.
Once treatment after treatment failed, Secrist’s gastroenterologist in Phoenix made a tough decision.
He recommended she seek a drastic surgery to remove her pancreas, spleen and appendix. The procedure would require three months of recovery andcould render her diabetic.
It’s the first time in the physician’s 20-year career that he has referred a patient for a total pancreatectomy with autologous islet transplantation, Secrist’s parents said.
Few surgeons in the United States perform the operation. Although Mayo Clinic in Arizona can do it, Secrist’s insurance won’t cover the facility, her parents said.
Years of rocky finances at Florence and Gilbert hospitals preceded the medical-records dilemma affecting Secrist and hundreds of other Arizonans.
The health centers had declared bankruptcy once before, in 2014. The half-built skeleton of Peoria Regional Medical Center, another facility once owned by parent company New Vision Health, still sits on a dirt lot unfinished.
As the medical facilities faced imminent closure last summer, the judge appointed a receiver, Resolute Commercial Services, to independently manage affairs.
Resolute rushed to find other hospitals to take patients; safely dispose of radioactive medical equipment, narcotics and hazardous waste; collect final payments from insurers; handle patients’ medical records; and tie up other loose ends, court documents showed.
Florence and Gilbert hospitals owed many companies, but the largest debt was more than $13 million in loans to New York investment company IndigoDLI Holdings.
Other creditors included Medhost, which maintained the hospitals’ electronic health records, and Somerset Capital Group, which provided computer servers to host records.
It didn’t take long for Resolute, Indigo, Medhost and Somerset to begin quarreling over getting paid. Over hundreds of pages of legal filings, their arguments followed these basic contours:
❚ Resolute argued Medhost and Somerset allowed too little time to transfer an estimated 170,000 patient files before shutting off access, demanding hundreds thousands dollars in payment
and threatening to destroy files. Then, Resolute was left with little money to negotiate access after Indigo quickly sold hospital equipment and pocketed more than $1 million, Resolute told the judge.
❚ Indigo accused Resolute of generating hundreds of thousands of dollars in unnecessary expenses. Indigo then tried to block Resolute from reaching deals to purchase records access from Medhost and Somerset, arguing they weren’t entitled to be paid ahead of Indigo. Indigo finally suggested the court force Medhost to eat the costs or make patients pay to access their own records.
❚ Medhost and Somerset said they tried for months to work with the hospitals, and later Resolute, to come up with a plan to transfer patient files. Medhost and Somerset blamed Resolute for wasting time and money and lambasted Indigo for obstructing progress.
All parties expressed sympathy for patients in interviews with — except Indigo.
When asked if the lender planned to do anything to help Secrist obtain records to undergo vital surgery, an attorney for Indigo repeatedly said he would not discuss ongoing litigation.
“My client does not object to any patient obtaining a copy of his/her records at the patient’s expense,” Indigo attorney Kyle Hirsch later said in a written statement. “My client does object to being forced to pay the cost of patient record fulfillment.”
Waiting for the judge
Even if Secrist wanted to pay for her medical records, she couldn’t, said Bradley Cosman, an attorney for Resolute.
It is too technically difficult to reactivate the entire electronic-records system to respond to an individual request, he said.
“The Receiver empathizes with former patients and has been working since his appointment to preserve and protect medical records,” Cosman said in an email. “Unfortunately, circumstances outside the Receiver’s control — including the estate’s lack of funding, unilateral actions taken by creditors, technological challenges associated with migrating electronically-stored medical records, and other factors — have significantly complicated and delayed the issue.”
Medhost has gone to extreme lengths to help the parties comply with medical record requests, Medhost attorney Bryan MacKenzie said.
“We provided Gilbert and Florence with access to our software and systems ... more than six months after termination (of their contract) and more than two months after the receiver was appointed,” MacKenzie emailed. “Since then, we have continued to work with the facilities, and have agreed on a plan with the receiver that would allow the facilities to access the necessary records. Unfortunately, in an apparent effort to protect their own financial interests, the senior creditor is standing in the way of this plan, forcing us to wait for the receivership court to work through their opposition.”
Somerset lawyer Larry Hirsch said he feels bad for patients who are waiting and hopes the proposed deal goes through.
“Everybody truly wants to come up with a system to get the patients their records,” he said in an interview.
A chance to plead her case
After began looking into Secrist’s story, things started moving quickly.
Ducey directed his staff to see if they could help her obtain records.
“We’ve spoken with the patient’s family and other outside organizations that could help with this to find any avenue possible to get these records to her,” governor spokesman Patrick Ptak said.
And Judge Brodman held a hearing to consider competing proposals to resolve the situation. Indigo, the senior creditor, wanted the judge to:
❚ Make patients pay potentially thousands of dollars for their records.
❚ Send the bill to former hospital executives.
❚ Or force the electronic-records company to shoulder the costs.
Medhost and Resolute, however, had negotiated a different compromise:
❚ Pay Medhost to reactivate the electronic-records system for 90 days, launch a publicity blitz to alert patients and hire employees to collect the records and respond to requests.
❚ The $92,000 cost would come out of hospital assets that otherwise would go to Indigo.
“Everybody agrees this is a critical issue,” Brodman said during the hearing. “The hospital has the duty to produce the records. The inherent problem here is there is no hospital. The hospital has gone kaput.”
Secrist and her parents drove an hour and a half to the courthouse but didn’t get a chance to speak.
As it turned out, the judge didn’t need Secrist’s encouragement.
Brodman ruled quickly that the most efficient, fastest and probably least expensive option was to use remaining hospital assets.
Indigo’s attorney may appeal to stop the plan. But for now, it will move forward.
Next steps for Caitlin, other patients
If all goes well, Secrist can expect to receive her file in a few weeks, attorneys said.
Other patients who need records from Florence and Gilbert hospitals — and have not already requested them — should do so as soon as possible.
The window of opportunity to receive records is expected to be roughly March through May.
Secrist and her parents said the decision was a “big win” for her and hundreds of other patients.
“It’s a good feeling,” Secrist said outside the courthouse. “I can finally get those records and get on my way to getting better.”
Secrist promises the opportunity to get back to a normal life will not be wasted. She is taking pre-med courses to become a nurse.
“I want to pay back for all those nurses that made me happy when I was in the hospital,” Secrist said. “I want to make that kid feel special in the ER.”
Her mother, Suzette Secrist, said she was grateful to the judge. “He realized there’s a human part to all of this,” she said.
Suzette Secrist also credited with
Secrist’s case poses the wider question of why Arizona patients were put at risk at all.
Disputes between health care facilities and software and server companies overbilling, access and obligations to patients have cropped up as medical records across the country have been moved online.
There are not always clear answers in current federal and state law.
For instance, attorneys for Medhost, the electronicrecord company used by Florence and Gilbert hospitals, argued it is not a “health care provider” and thus was not subject to records-retention regulations that apply to hospitals and doctors.
The Arizona Department of Health Services declined to intervene in the case despite requests from attorneys. A spokesman said the state “did not have jurisdiction to intervene.”
The Governor’s Office hopes to review state laws for possible loopholes that contributed to the quagmire, Ptak said.
“We are open to discussions about how to prevent something like this from happening in the future if a hospital were to close,” he said.