By Robert Davis
USA TODAY
Copyright 2008 Gannett Company, Inc.
YREKA, Calif. — In 2001, Sandee Pingatore was determined to find out why her son, Troy, 29, had died in a California hospital while being treated for a drug overdose just hours after she had been told he was stable. But Pingatore was unable to get the hospital to produce a key medical record showing his blood pressure in his final hours.
When the record finally surfaced last year — too late under state law for Pingatore to file a civil lawsuit — it indicated Troy had been in mortal danger for several hours while awaiting care.
In 2006, another California woman, Beth Stover, ran into difficulties when she tried to get medical records to help her understand why her full-term baby had died in her womb.
When she got the records, she noticed something was missing: a strip-paper readout from a fetal monitoring device from Stover’s last routine checkup. She eventually got a readout showing normal activity for a mother and her baby, but in a lawsuit she says she doubts it came from her records.
The hospitals involved — Fairchild Medical Center in Yreka, Calif., and Kaiser Foundation Hospital in Walnut Creek, Calif., respectively — deny any wrongdoing.
But the cases reflect a common complaint nationwide by patients and their families: It can be difficult to obtain medical records from hospitals and other treatment facilities after something goes wrong.
Under federal law, every patient or a designated representative has the right to see and copy the patient’s medical records. However, missing or disputed records are the most common source of complaints on USA TODAY’s Patient Safety website (patientsafety.usa today.com), which was created in 2006 to give readers a venue to express concerns about inadequate medical care.
Although there are no statistics on such cases, disputes over medical records often are at the crux of malpractice lawsuits. Such claims often center on records that patients or their families, such as Pingatore and Stover, believe were purposely withheld by hospitals.
Harry Rhodes, a spokesman for the American Health Information Management Association, says most cases of missing records are honest omissions. When patients ask for their medical records, the staff provides summaries and what they think are key documents, Rhodes says, but not necessarily everything in a thick hospital file.
But Sidney Wolfe, a physician who heads the health research group at Public Citizen, a Washington, D.C., consumer advocacy group, says “there is essentially a double standard” when it comes to accessing medical records.
When doctors or hospitals ask for records to use in making a diagnosis, they usually get what they ask for, Wolfe says. “If you are in the medical system, it works perfectly fine. If it’s just the patient who wants the records or the patient’s family if the patient died, it’s a whole different story.”
The federal law giving patients and family members access to medical records is the privacy section of the Health Information Portability and Accountability Act.
HIPAA allows health care providers to withhold records in some circumstances, as long as they explain why they are doing so. Among the records that may be withheld: psychiatric documents and documents generated in preparation for a legal action. Pingatore and Stover say the hospitals never indicated they were withholding records for any reason.
In her lawsuit against Kaiser, Stover says she suffered emotional damage. Pingatore could not find a lawyer to take her case, she says, because she did not have enough documentation until after California’s three-year statute of limitations for filing a civil lawsuit had expired.
Lucian Leape, a professor at Harvard’s School of Public Health, says the medical culture does not ensure that hospitals are honest with patients. Leape, one of the founders of the National Patient Safety Foundation, says it’s still a challenge “getting people to be honest when things go wrong.”
Charles Phillips, an emergency physician from Fresno who provides expert testimony for plaintiffs in court cases, believes thousands of Americans simply give up the fight to get complete copies of their medical records after a problem occurs with their care, because doctors, hospitals and their lawyers can make the process so difficult.
Even when records are provided, they sometimes are obscured, Phillips says, a practice he calls “wrecking” a medical chart.
“I see this all the time. Pages are darkened, they are lightened, they are enlarged, shortened — put slightly down so you can’t see a signature,” he says.
In such situations, he says, time is money. “In malpractice there is a time clock working against the patient.” Statutes of limitations for medical malpractice cases are set by state law and range from one to seven years.
USA TODAY asked Phillips to review several of the complaints submitted to the patient-safety website regarding disputes over medical records.
The cases involving Stover and Pingatore and her son, Troy Starling, were among those that reflected the effect such disputes can have on a family.
The death of a son
Starling, an auto mechanic from Yreka, Calif., battled addictions to alcohol and the painkiller Vicodin. Despite his problems, he remained close to his mother, she recalls.
“He’d come over, and we’d play cards,” Pingatore says. “People called him a mama’s boy.”
 If you are in the medical system, it works perfectly fine. If it’s just the patient who wants the records or the patient’s family if the patient died, it’s a whole different story.  | ||
| — Sidney Wolfengton Public Citizen advocacy group | ||
On June 6, 2001, Starling collapsed in his bathtub. According to a police report, he had overdosed on pills, including Verapamil, a medication that lowers blood pressure. He was taken by ambulance to Fairchild Medical Center, a community hospital, and was admitted for treatment of an overdose.
Pingatore, 59, says she stayed at the hospital until 2 a.m. the next day, when a nurse suggested she go home to rest. When she returned the next morning, she was directed to a waiting room. “I heard a ‘Code Blue’ (signaling a patient in cardiac arrest) and I said, ‘God, don’t let that be my son,’” she says.
It was. Starling was pronounced dead at 9:20 a.m. Pingatore wanted to know what led to her son’s death. The nursing staff had appeared confident Starling would be fine just seven hours before.
So Pingatore asked for Troy’s medical records. “The hospital would not respond to my requests at first,” she says. “Then they would send an abundant amount of records, dating back to 1989.”
The hospital gave her details about Starling’s treatment for a bruised hand after he fell from his bike at age 17, Pingatore says, but only sketchy accounts from the night he died. “I just kept trying to get my son’s medical records to see what happened,” she says.
One key record that was missing was an accurate blood pressure reading from the hours before Troy’s death. At the hospital, Pingatore had seen a device that appeared to automatically track blood pressure, and she hoped it would explain what had happened.
California’s deadline for any civil action against the hospital expired three years after Starling’s death. Pingatore didn’t get the records she sought from the hospital until October 2007 after USA TODAY sought them on her behalf. The blood pressure printout shows her son had been left in shock with a median blood pressure of 53/31 for five hours before he died.
Jonathon Andrus, an associate administrator at the hospital, declined to comment on the records or any other aspect of the case.
Phillips, who reviewed the records for USA TODAY, says they prove Pingatore’s fears about the last hours of her son’s life.
He filed an ethics complaint to the California State Bar asking it to review the hospital’s Risk Management Office and legal team over the delayed release of the records.
The California Department of Health investigated last November and found deficiencies in the hospital’s handling of the case, according to an investigative report. The state faulted, but did not penalize, the hospital for failing to monitor Starling’s heart in the emergency room.
Pingatore asked a local prosecutor to determine whether the hospital could be held criminally responsible. The prosecutor, Siskiyou County District Attorney Kirk Andrus, says he is still investigating.
“I just have a feeling that there is going to be no accountability,” Pingatore says. “I just don’t know how I will be able to deal with that.”
Questions about authenticity
Beth Stover was pregnant and one week past her due date on March 2, 2006, when she went to Kaiser Foundation Hospital complaining of upper-abdominal pressure, a headache and concerns that her baby was not moving much.
Stover, a designer and illustrator, told a labor and delivery nurse she thought she was in labor. Stover was put on a fetal monitor, her medical records show, but was sent home less than two hours later.
“I thought I was going into labor, because I had never experienced those feelings before,” she says. “I was having contractions, this upper abdominal pressure, that made it hard for me to walk.”
| I see this all the time. Pages are darkened, they are lightened, they are enlarged, shortened — put slightly down so you can’t see a signature. | ||
| — Charles Phillips Emergency physician, Fresno, Calif. | ||
She was given written instructions directing her to call and come back to the hospital if her water broke, if she was bleeding or if she had chills or fever.
Over the next two days, Stover says, she stayed home and waited for her condition to change. The unborn child, named Lehna Jordann Brewer, died in her mother’s womb March 4, medical records show. Stover says she tried to find out what had gone wrong. She asked for her medical records but noticed that a fetal monitor strip from her last checkup — on the day she had gone to the hospital thinking she was in labor — was missing.
The paper strip, which documents fetal heart rate and evidence of contractions in the mother, was particularly important to Stover because she recalled a technician expressing concern after hearing something unusual on the monitor. When the strip was missing from the medical records Kaiser gave her, Stover wondered whether the monitor had indicated Lehna was in some kind of trouble.
Stover asked the California Department of Health for help. It investigated in November 2006.
During that inquiry, Stover says, “I got a call from the Kaiser ombudswoman who told me that they found the strip.”
Unlike the other strips in Stover’s file that had her name, date and time, this documentation — of a healthy baby — had no time or patient data. On the envelope containing the strip that the hospital said was made days before her baby died is written “Stover, Beth,” and “IUFD” for intrauterine fetal demise, “Female 3-5-06.”
Stover and Lehna’s father, Andy Brewer, do not believe the strip came from their child.
The state did not penalize Kaiser, although investigators noted some of the records Stover had sought were missing when they visited the hospital.
It took four hours for the hospital staff to find them, a delay it blamed on a “fairly new” employee, the state’s report said.
In a written response to questions from USA TODAY, David Niver, chief physician at the Kaiser Foundation’s Walnut Creek facility, says the hospital regrets the “delay in locating one of the patient’s records after she received her care, but it’s important to understand that the delay did not affect the medical care that was provided.”
The state report does not mention the fetal heart monitor strip, which Niver says Kaiser is certain came from Stover’s visit because it was signed by her doctor and noted in other records.
Stover and Brewer split up after the death of their daughter. Brewer, a Kaiser information-technology employee, quit his job in disgust.
Get copies of documents
The best way to avoid a problem with medical records, health specialists say, is for patients to routinely ask for copies of all documents pertaining to their care.
When records appear to be incomplete, the patient and their family or other advocates can turn to the Office of Civil Rights at the Department of Health and Human Services, Rhodes says.
They also can turn to their state medical board. But Julieanne D’Angelo Fellmeth, administrative director at the Center for Public Interest Law at the University of San Diego School of Law, says her review of California’s medical board found long delays and much frustration, like that experienced by Stover and Pingatore. Her review found that complaints typically took 2.6 years to investigate.
Wolfe of Public Citizen calls the prolonged delays “a slap in the face of justice. ... The family wants to make sure the doctors did what they said they were doing.”
Many lawyers agree.
“The one thing people really want to know is, ‘How did my loved one die?’” says William Campisi Jr., a lawyer in Berkeley, Calif., who specializes in malpractice cases. “I have to tell these people, ‘We will never know why your father or your husband or your child died.’ It’s sickening.”
Marie Skelton and Mark Hannan contributed to this story.