Alice Milton Helps Patients Survive the Hospital ExperienceJune 2017
By Jon Van Zile
Alice Milton never set out to become an advocate for hospital patients. Instead, the path that led her to create Patient Care Advocates started out as “a labor of love.”
“My father became seriously ill in 1997,” Milton said. “At one point, a surgeon tried to give my father a medication, but something went off in my brain and I asked if it was contraindicated for his condition. The surgeon looked it up, and saw that it was. Two years later, I read that the same surgeon was convicted in a wrongful death case for giving the same medication to another patient with my father’s same condition. If I hadn’t been advocating for my father, he wouldn’t have made it out of the hospital alive.”
But it didn’t stop there. Milton spent so much time in the hospital with her father that the staff knew her name—and she saw too many other examples of potentially lethal medical errors. In one case, a man came into the emergency room with a snakebite and was left alone on a gurney in the emergency ward.
“They had forgotten about him,” she said. “I alerted staff and they rushed to give him an antidote. If I hadn’t told them, he would have died.”
Later, she advocated for both her mother and her stepfather—and in each case prevented more medical errors.
“I realized if this was happening to me, it was happening to other people,” she said. “So I started a company.”
Today, Patient Care Advocates provides professional care advocates at surprisingly reasonable prices to patients in the Tucson, Arizona, region.
A Grim Litany of Problems
For generations, people have viewed the hospital as a place to get better, whether that meant receiving trauma care for an accident or surgery for heart disease and everything in between. Unfortunately, this view isn’t based in reality. The truth is that hospitals are some of the most dangerous places in the United States—especially for people who are already medically vulnerable.
According to a 2016 study conducted at Johns Hopkins and published in the prestigious British Medical Journal, medical errors account for more than 250,000 deaths every single year in the United States. This makes medical errors the third leading cause of mortality, behind only heart disease and cancer. To put that into perspective, that’s almost five times the number of people killed in fatal car crashes and gun violence combined every year.
To make matters worse, there’s no single, easy fix for the problem. The Johns Hopkins researchers wrote that “most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability.”
Milton sees all of this firsthand.
“I wish I could say there was a most common type of error, but the truth is that all errors are common,” she said. “It’s a failure of communication across the board. We see wrong medications, no medications. Surgical errors. Poor hygiene and infection control. Unnecessary treatment. It even includes things like not getting elderly people off the emergency gurneys they come into the emergency room on and into a hospital bed. These gurneys are uncomfortable so the patient complains of pain and is treated with morphine, which only makes them more vulnerable and starts a downward spiral that results in that patient never leaving the hospital or living independently again. It’s frustrating, maddening, and totally inexcusable.”
While it’s easy to get angry about the failures of the system, that alone won’t solve the problem. As Milton is quick to point out, her own company—which sends qualified advocates into trauma centers and patient rooms to follow up on procedures, track medications, and increase communication between care providers—relies on cooperation from the same healthcare providers it’s trying to protect clients from.
In the early days, Milton said she received pushback mostly from nurses, who were already overworked and concerned that Patient Care employees would increase their work load and “make it look like they weren’t doing their jobs.”
Still, she pushed ahead and got meetings with senior hospitalists at health systems throughout Tucson.
“When I told them what I wanted to do and why, I thought they’d throw me out,” she remembered. “But to a physician, they all said, ‘That’s great! We need all the help we can get!’ When they saw we were there to help them take the burden off, it changed everything.”
How the Organization Works
Since those early days, Patient Care Advocates has grown and refined its process, along the way creating a national model for patient advocacy. The idea, says Milton, “is to anticipate what the errors will be and try to stop them.”
Because medication errors are so common, and communication among the various elements of our healthcare system is so poor, the process begins with a full medical history.
“This will include medications, herbs and supplements, disease history, everything,” says Milton. “We also look for unnecessary medications and keep this history continually updated.”
Patient Care Advocates has a medical doctor on staff who is qualified to look at medications and flag potential problems—but simply compiling the history isn’t enough.
“We have found that sometimes we give doctors and hospitals the list of medications, but it doesn’t make it into the records,” Milton said. “You have to make sure it makes it into the records.”
Once the history is complete, patients (or their families) are instructed to call Patient Care Advocates as soon as possible after a hospitalization. For emergencies, it’s not uncommon for Patient Care Advocates to arrive at the hospital quickly and meet the patient while they are still in the ER.
“This is a great morale booster and safety net for them,” Milton says. “For example, we provide electronic health records with the latest medication list and updated health histories. So we know if Mrs. Smith has dementia or she is only presenting that way because she probably has a urinary tract infection.”
If the hospitalization is for scheduled treatment, Patient Care Advocates should be brought into the earliest discussions to help go over the proposed treatments, ask questions, facilitate communication between the hospitalists and the patient’s primary care doctors and regular specialists, and participate in the plan of care.
How long the advocate stays depends on the situation and patient. Some patients only need their advocate for as long as it takes to get settled in their room. Other patients prefer to have their advocates at their side overnight.
At every point in the process, communication is critical—including with the patient’s own caregivers and family.
“We work very closely with caregivers,” Milton said. “No one else except the patient is as invested in their care. Caregivers can be so important and such a powerful advocate.”
So far, no insurance companies cover patient advocacy, so Patient Care Advocates works hard to keep costs down. The company charges only $23.50 a month for existing patients. In-hospital advocacy is $65 an hour, and working with caregivers is $20 an hour.
Currently, Milton says she’s in discussion with local insurance groups about reimbursement and she’s hopeful that insurance companies will someday reimburse for advocates. From an insurer’s point of view, there’s a compelling argument to paying for patient advocacy: reducing medical errors will lower direct costs through shorter hospital stays and less unnecessary treatment and reduce the potential for expensive lawsuits.
Building a Safer Hospital System
While the company is focused on day-to-day advocacy, Milton is happy to talk about ways she thinks the chaotic, expensive, and error-prone healthcare system can be improved.
Perhaps not surprisingly, her solution begins with better information at every step of the process. As an example, she cited some of the protocols developed by Life Extension® that have been shown to improve outcomes in everything from surgery to infection control through the use of supplements like coenzyme Q10 and probiotics to offset the loss of gut flora caused by antibiotics.
“I’m a big believer in Life Extension protocols,” she says.
Milton also says we need better communication between physicians at every step. If a patient goes into the ER, it’s essential that that patient’s primary care physician and specialists know what happened and why. She’d also like to see more consistent quality control when it comes to giving care.
“I’d love to see doctors using checklists like pilots do,” she said. “Hospitals that have tried something as simple as making doctors use a checklist before a procedure to make sure everything has been done have seen medical errors drop dramatically.”
Doctors also need to have access to, and actually read, relevant test results. Milton has story after story of patients who suffered harm because doctors didn’t read test results.
Finally, the medical profession as a whole needs to have the freedom to bring forward these types of issues without the fear of penalty or lawsuit. In too many cases, government sanctions and insurance company policies have backfired and actually made the situation worse. For example, hospitals are under tremendous pressure to discharge patients earlier, while at the same time providing better patient education, often to acutely ill patients. As a result of this herculean task, hospital systems are increasingly turning to home healthcare companies and primary care physicians to fill in the gaps and help prevent a rehospitalization, which can often trigger a penalty for everyone involved.
“Hospitals are incentivized to see patients in the ER and not admit them,” Milton said. “You can see how care gets denied and how patients fall through the cracks with this approach. A patient will get discharged, but they’ll still be obese and diabetic when they get home. Then something new will happen and they’ll need to go back to the hospital, but guess what? The hospital won’t readmit them because of the sanction and they won’t get the treatment they need.
“We can do better. Unless everybody talks to each other, we’ll never get good outcomes.”
If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.
Patient Care Advocates can be contacted at:
- 2122 N. Craycroft, Suite 116
- Tucson, AZ 85712
- (520) 546-4141