Julie McDonald: A tale of two emergency rooms


A year ago, the day after attending a memorial service for our good friend Ed Fund, I experienced unexplained pain in my left arm, so I called the nurse line on my insurance card. She recommended I visit the emergency room, so my husband and I drove to Providence Centralia Hospital on a Sunday evening.

I checked in at the front desk, where a woman wrapped a band onto my wrist and told us to take a seat. We sat. And sat. And sat some more.

An hour later, around 10:30 p.m., I was chatting with a woman across from us who said she’d been at the ER since 11:30 in the morning. What? I looked at my husband.

“Well, they must not think I’m having a heart attack, so we should probably go home,” I said. “I’ll call my regular doctor in the morning and ask for an appointment.”

I walked to the front desk, told the clerk I was leaving, and let her clip off the wrist band.

First thing the next morning, I called Hawk’s Prairie Medical Clinic for an appointment. As I drove north to Lacey, I received a call from that office. A woman was checking to see if I should go to the clinic or the hospital. She told me the records showed I was still sitting in the ER at Centralia.

After an electrocardiogram (EKG) to evaluate my heart, the doctor said he thought I was fine but could order a stress test. I felt a bit like a hypochondriac, so when they called about the stress test, I told them I didn’t need it after all.

Then, the week before her wedding in early August, my daughter was convinced I had a blood clot in my cramping leg after driving a lot. Finally, to set her mind at ease, I agreed to visit a walk-in clinic at Hawk’s Prairie. After an EKG, which they said differed from the one I’d had in April, they sent me to Providence St. Peter Emergency Center. Like I had in Centralia, I checked in and found a seat. Before long, someone from the main desk took my blood pressure and oxygen level. I was soon taken back for a chest X-ray and then later an ultrasound.

Although admittedly scared, I felt reassured by the quick care. Perhaps it was better because I’d been sent to the ER by a clinic. But the difference I experienced between the ERs at Centralia and St. Peter couldn’t be more pronounced.

I didn’t have a blood clot. And following the wedding — after my husband and I recovered from COVID — I visited Hawk’s Prairie for a follow-up on Aug. 17. Although the doctor there said my two EKGs didn’t look that different, I could do a stress test. After two visits to the ER in a year, I decided to go ahead with it.

They scheduled the test for Jan. 2 in Olympia, saying I could call Providence Centralia Cardiology Associates to see if perhaps they could fit me in sooner, but I received no response after two calls.

The long and short of it is that I flunked the treadmill test, and two months later, a cardiologist inserted a stent into my main artery to fix a blockage of 95 percent. I’m so grateful to God — and the cardiologist — for a second chance.

Needless to say, I’ve changed my ways. After all, as Ed used to say, you reap what you sow. After stepping off that treadmill, I gave up red meat and fast food — other than grilled chicken and salads. I’m trying to eat less and exercise more. Fear is a great motivator.

But I’ve been concerned about my Centralia emergency room experience, a worry exacerbated by a recent visit with a friend. I hesitated to write anything because someday I may need emergency care in Centralia. Would criticism of the ER influence any care my husband or I might receive? I hope not.

Then another friend posted a meme on Facebook showing a half-filled bucket of coins above the words: “I decided to put a coin in a bucket every time I got irritated. I started an hour ago.”

The conversation quickly veered into frustration over visits to ERs, and Doris Wood Brumsickle shared her recent experience at the Centralia ER with her husband, Bill, who was short of breath after suffering from long COVID since 2022.

In February, she and Bill spent a long day at the Providence Centralia ER — from morning until after midnight while waiting for test results — that ended with Bill admitted to the hospital for three nights after suffering pneumonia and a slight heart attack. His blood pressure was over 230, Wood Brumsickle said. He was cared for professionally, recuperated nicely, and returned home Feb. 24.

But a March 20 visit left both Bill and Doris frustrated. He woke up short of breath and, because of his recent heart attack, was transported to the Providence Centralia ER.

“The day was unbelievable,” she said. “A dementia patient screaming all day, a patient’s IV alarm constantly ringing. When I asked why, I was told by staff, ‘That’s some other nurse’s patient, and she’s off the floor.’ ”

Wood Brumsickle asked four times for a nurse to bring Bill water before he finally received a glass in the mid-afternoon.

In her Facebook post, she wrote, “Between the lab and the ER, the second Troponin test got wasted, and four hours later, they drew more blood for it.

“I don’t know how anyone could stand to work there, but when you’re a patient, and there is just flub after flub, you just want to scream ‘help,’ too.”

After Bill finally received an IV dose of Lasix, he released fluids, and the doctor said they could go home, but it took another two hours for them to receive the paperwork to leave. A nurse treating a patient in critical condition dropped by the paperwork and a wheelchair.

“It was a remarkably unnecessarily long day because of understaffing and underprepared staff to work in chaos,” she wrote in a letter to Providence Centralia Hospital leadership. “That’s what the ER is: Chaos! Why anyone would agree to work in an ER is not clear to me. My heavens, someone who can provide an unjaundiced eye at the situation and who has a skill in teaching people to work smarter not harder is a primary need in this ER.”

Some employees tuned out the drama, perhaps to survive the chaos, she said.

“The work habits I observed in the ER last Wednesday will lead to worker burnout, mistakes that could be deadly, and a total lack of trust from community members,” Wood Brumsickle wrote.

She asked why the hospital hasn’t grown along with the community, why the ER is so understaffed, and whether Providence is hiring graduates of the outstanding Centralia College nursing program.

“There are so many people who should be stepping up and saying, ‘WE HAVE TO FIX THIS!’ ” Wood Brumsickle said. “Because Providence Centralia, YOU DO!”

She ended her note saying, “I dread the next occurrence when one of us or anyone I know has to go to the ER. And I pity anyone who doesn’t have or can’t be their own advocate!”

She said it’s tough to dread visiting the ER “because of what’s now apparently normal.”

She’s not alone. A look at nearly 300 Google reviews of Centralia Providence Hospital, which averages 2.2 out of 5 stars, indicated 10-hour visits to the ER aren’t abnormal. Many said they’d give a zero instead of one star if they had that option. Most complaints focused on the ER while many five-star reviewers raved about the great care they received on the hospital wards.

I know the hospital staff works hard, but I have to wonder why so many patients reported negative experiences in the ER.

Last Friday morning, I posed that question in a call with three hospital officials: Cindy Sidley, site administrator at Providence Centralia and executive director of nursing; Angela Maki, communications director for the South Puget Sound region; and Chris Thomas, communication senior manager.

“We’ve worked really, really diligently to make sure that our whole hospital, including the emergency room, is staffed based upon the volume of patients that come in throughout the day,” said Sidley, a nurse for 44 years.

Providence employs the ER staff, although the physicians are independent providers. She said Centralia Providence works closely in partnership with Centralia College’s nursing program, with students doing clinical rotations at the hospital. The past couple of years, the hospital also has employed student nurses through its nurse tech program. It also has nurse residency programs.

“It’s provided a very nice pipeline for us once they graduate and are licensed to come on board and be licensed nurses here at the hospital,” Sidley said. “We’ve seen the staffing in the emergency department here at Centralia improve dramatically from what it was during the COVID era, if you will, and so we do have staff to meet the needs of our community.”

Providence has ongoing recruitment efforts and a residency program at its Chehalis clinic to train and retain providers in Lewis County, Maki said.

While ER visits can take 10 hours, other times patients don’t need to wait long.

“It just depends on who’s coming in at that moment,” Sidley said.

To make patients more comfortable, the hospital purchased additional recliner chairs for the ER waiting room and offers blankets to keep people warm. It might want to make water available, too.

“We are trying to make the time that you’re waiting a little bit more comfortable,” Sidley said. “Because we do know that there are times when there is a longer wait time.”

“We really urge the community to use the emergency room for true emergencies and then seek health care with their primary care provider or urgent care, or we even have online and express care options available where you can see a provider online,” Maki said. “That will help out the entire community.”

During the past six months to a year, Sidley said, the hospital has added a nurse in the lobby from 9 a.m. to 11 p.m. and a provider from 11 a.m. to 11 p.m. to assist in triage, reviewing symptoms to determine which patients need treatment first based on their medical needs.

“Some of the challenges that we have is a lot of folks come into the emergency room that might be better served at a clinic locally,” she said. “We have a fair number of behavioral health patients.”

Each of those 60 to 80 patients a month — five to eight patients every day — must be given a medical screening before they can be cleared for discharge, which takes time. The number of behavioral health patients visiting the ER has increased 40 percent in the past five years, Thomas said.

Some patients suffering from behavioral disorders also require more one-on-one attention, which takes away from care provided to other patients.

Why wouldn’t they be seen at Cascade Community Healthcare, formerly Cascade Mental Healthcare, in Chehalis?

Cascade, a great partner for the hospital, is a voluntary program, Sidley said.

“Many in a crisis don’t know where to go. They don’t know what to do, and so they come to the hospital, and then we’re obligated to have to see them,” Sidley said. “They’re not always interested in voluntary assistance and support. So that can be a challenge.”

Often, they can be treated better in clinics with integrated behavioral health counselors, Maki said.

Centralia Providence Hospital is licensed for 128 beds, and Sidley said the number of beds filled by patients fluctuates between 80 and 100.

“While the community is growing, I believe we have the beds we need to safely care (for) and provide quality care for our community,” Sidley said. “Of course, that’s always re-evaluated.”

But, she added, “We do have more beds available to us than what we’re currently using.”

Another problem hospital staff face is the 15 percent to 20 percent of their patients who no longer require medical attention but have nowhere safe to go. They are referred to as length-of-stay patients.

“Many of these length-of-stay patients have behavioral health issues, so they’re not easily placed,” Sidley said, adding that the community doesn’t have enough skilled nursing beds or adult family homes, and sometimes patients pose too many challenges for family members to care for them. Western State Hospital in Lakewood, a psychiatric hospital with 806 beds, often has a wait time of a month or two. At times, hospital staff need to find a guardian for patients to make care decisions.

But all that takes time.

“This is an issue, not just at Providence, but all hospitals in the state of Washington and throughout the country, the backlog that creates,” Thomas said.

Maki compared it to a conveyor belt with one end stuck, creating an inability to remove stuff, so everything backs up behind it.

“That’s exactly what’s happening in the hospital,” she said. “These long length-of-stay patients are taking these beds in the hospital when they don’t have a medical necessity to be there, and then that backs up the whole system, all the way back through the emergency department.”

ER experiences vary depending on the time of day, the day of the week and, simply, how busy it is.

“When people come into the emergency room, it’s usually one of their worst days,” Maki said. “We want the community to have good experiences, even if it is their worst day. We want them to walk away thinking that they were cared for.”

Despite negative reviews, many people share positive letters thanking hospital staff for lifesaving measures and excellent care. Maki said those kind words are published in the hospital’s internal newsletter to encourage hard-working staff members.

Joanne Schwartz, who served on the Providence Chehalis Community Board for 22 years, commented on Wood Brumsickle’s Facebook post.

“The original mission of the Sisters of Providence has been totally compromised,” she wrote. “I feel sorry for the staff trying to do their best. They are as much victims as the patients. Providence has become a behemoth, and it’s all about the bottom line.

“By the time I left, I could see things were disintegrating. I believe the local board is now combined with Providence St. Peter’s. I am beyond disappointed.”

Negative experiences sadden her, Sidley said.

“We always want to provide the best quality and the best experience for all of our patients,” she said. “And we know that sometimes we’re not meeting expectations, and we want to hear and learn from the community.”

All patients are encouraged to fill out surveys after their hospital visits. Thomas said every single survey is read by hospital staff members who may not see Facebook posts or Google reviews.

“The ER is the entry point, and that’s where we need to greet our community and put our best foot forward,” Thomas said.


Julie McDonald, a personal historian from Toledo, may be reached at memoirs@chaptersoflife.com.