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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10341
Experience:  14 years as clinician in the field of Family Practice
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As a patient, I entered the OLOL ER around 12:30AM on

Customer Question

As a patient, I entered the OLOL ER around 12:30AM on 11/15/2015 experiencing severe anxiety, depression, and elevated blood pressure at 171/85 and elevated resting heart rate at 104. Shortly after I arrived, I was administered an EKG, which looked normal.
I was then directed back to the general waiting areas for approximately the next 3 hours as my anxiety symptoms continued to elevate and increasingly worsen. Upon entry to the OLOL ER (with EKG exception), I was NOT given any treatment/medicine to lower anxiety, heart rate or blood pressure until approximately 4:00AM. When finally treated by staff, I still did not improve. My anxiety and related conditions had, by this time, been sustained for too long of a time period and did not respond to medications that were given. (Hint: optimally medication should be administered at onset of symptoms or as close to onset as possible). Additionally, I was not offered medication to control blood pressure and/or rapid heart rate. No lab work was ordered. Before I knew it, I was in the process of being discharged and expressed concern to my doctor that I did not feel stabilized. The doctor responded that time was up, and that nothing else could be done. I was instructed to go home and add Benadryl to my existing medications and wait until Monday for a follow up with my primary care doctor. I requested to speak with COPE; however, about 20 minutes later the treating doctor appeared and asked, “What’s up?” Again, I expressed that I was not feeling stabilized and requested to speak with COPE. The doctor repeated earlier instructions.
After expressing my concerns again, I was handed a document with discharge instructions which included inaccuracies and unclear information concerning my ER visit, diagnosis and aftercare.
The discharge document contained information that I was anxious due to “Xanax withdrawal.” I am not prescribed nor do I take the drug Xanax-this is a complete falsehood. It further recommended that I replace Xanax (which I do not have access to) with clonazepam, which I’ve never heard of, did not get a prescription for or received information about what it is. Then, ER “doctor’s orders” was to treat my future panic attacks with a single antidepressant (unspecified). And added that upon this discharge I should take Benadryl.
I could not figure out if he was recommending me to override my established psychiatrist’s program of treatment by adding clonazepam, or if he would consult my own established doctor to coordinate a plan with him or if this discharge paper of instructions was possibly for another patient.
Labwork such as blood and/or urine were never gathered or requested from me, which again confused me as to the arrived assumption of “Xanax withdrawal.”
With premature discharge and unclear after care instructions from the ER, my legitimate concern for myself at that time, was I would go home, my symptoms would be on- going or possibly escalate and I would be alone. In a state of heightened agitation and anxiety, and being alone, my judgement would likely not function as normal.
The result of my early ER discharge, while still experiencing mental instability with no clear aftercare instructions, has a higher rate of unhealthy outcomes than if I would have been stabilized and given a clear and well thought out after care plan.
It is my respectful opinion that early on, medical staff determined I was a patient experiencing mental health problems and I was not treated comparably to patients being treated for other “non-mental health” concerns.
Roma Zerangue
would this be considered negligence?
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.


I am sorry that you had this bad experience. I will go through some of the details that you lay out and discuss what i think was happening and try to give you better understanding of the decisions that had taken place...

The pulse of 104 is common with anxiety.. normal resting is typically 60 to 100 so 104 does not require treatment. Also in the ER setting it is extremely common to see high numbers for pulse and blood pressure. These transient changes do not require treatment.

Similarly the blood pressure was high at 171/85 but it would not be at an emergent level. It is understood that the ER setting and the usual anxiety that people come in with we usually do see very frequent elevated numbers. Yes , you should follow up on your blood pressure. It should be measured by you I advise in seated position , after 10 minutes rest about 10 or 15 times >> you add the numbers and look at the AVERAGE of these as the more important number. Record your readings and review with your regular doctor. Your average should be in range of 100-135/60-85 ON AVERAGE. If your average should run at level of 171/85 then you would need treatment. Chances are that your average will prove closer to normal at least. We don't base treatment decisions that are long term on a single or couple of high readings in a high stress situation though...

What happened to you with the initial fast evaluation and then the delay was that you were placed through a triage protocol >> this is a quick evaluation to determine how severe your emergency status is.. the ER treats based on the severity of the emergency and not with regard to whom is next ...

You had a panic attack it sounds and you would have benefited from more timely treatment. I agree with you on this. The problem that you ran into is that you went to the ER and were determined to not be an emergency. Dozens of patients went ahead of you that were thought to be in more danger.

You would have been better served to have had faster treatment I think such as a dose of Ativan for example...

When a person has a panic attack they may indeed FEEL AS THOUGH THEY ARE ABOUT TO DIE .. I have heard this description many times.. The ER doctor pushed you aside and diminished your needs...

No to the question of the ER doctor's orders over-riding your psychiatrist's orders and treatment plan!!! NOT AT ALL! Your psychiatrist is the specialist in the area of your need and this doctor KNOWS YOU!! The psychiatrist remains in charge of your care!! Disregard the ER doctors orders in comparison to your own treating psychiatrist.

Benedryl is of course an antihistamine with mild sedating effect. It is of course over the counter and for anxiety it may be described I think as perhaps better than nothing .. but it is not the treatment of choice ...

The inaccuracies of your discharge notes and instructions sound to me that a busy ER doctor was busy and rushed and perhaps careless >> these factors lead to errors...

You may complain as to your experience to the hospital administration. I think that would be appropriate to your case. Things should have been handled better for you, I agree...

It is also I am afraid a bit of a precautionary tale in that you are in general best to avoid the ER for non-emergent problems. Panic attacks you are much better to have medicine with you at all times that may be helpful to add on an as needed basis. There are strategies to help PREVENT most panic attacks.

ER doctors are not the best option at all to address this issue. (Psychiatric issues tend to be if anything the OPPOSITE of what they are best at >>>)

I hope that this helps to put this bad experience into perspective. I would encourage to to file a complaint with the hospital administration this along with other complaints may help to improve this aspect of care in the long run.

I hope that this information is helpful for you. Let me know if you have further questions or discussion. I will be happy to get back with you. If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. Thank You and Best Regards,

Anthony Bray MD