Audit Findings -- TB testing at San Mateo County Health Center
Based on my recent experience at San Mateo County Health Center attempting to get a clean TB Health Certificate, I have found:
Excellent procedures if you test negative. An appointment is made the day of the test for a reading 48-72 hours after the injection.
Poor scheduling if you test positive. Since procedures call for an Primary Care M.D. to read the X-ray, the Primary Care M.D. appointment becomes the critical path. An X-ray was taken on 08/23/02 as a result of a positive reading of the injection.. My Appointment to see an M.D., made on that same date, was for 10/18/02.
Appointments are cancelled without notification to the patient..When I arrived on 10/18/02 to see Dr. Ashe, I was advised that my appointment had been cancelled and not rescheduled. The hospital computer showed that I was allegedly notified of the cancellation by phone in September. After searching for evidence of who at my home was notified, the staff was unable to find a log entry of the cancellation. I heard the staff person tell another person words to the effect that Dr. Ashe doesn't follow the procedures of cancellation notification.
An R. N. with authority apparently can review the X-ray report and sign the health certificate for the Reading M.D. Only after complaining about the cancelled appointment and the realization by staff that I was only after T.B. test results was I promptly seen by an R.N. I gave the R.N. the dates of the test and X-ray reading posted on my  Immunization Certificate  -  - did the best I could from memory, they are not exact.
Reception staff at the out-patient window are polite, courteous, and responsive. Immediately upon recognition that I had a complaint, the staff reacted to get me to see an R.N. I saw the R.N. and she completed a TB ImmunizationCertificate (see "Immunization Certificate" above) for me.
There is no comprehensive, coordinated Alpha to Omega program for TB testing. Assuming an R.N. can review X-ray findings and sign a health certificate for the Reading M.D., patients should be given an appointment within days of their X-ray to see an R.N. Appointments to see said R. N. should be made by the patient following the X-ray, not en-route to the X-ray lab as in my case. (Of course my appointment making for an M.D., but nonetheless the X-ray should be completed before the appointment is made for obvious reasons)
I interupt here to state that I went to see Administration with a complaint after  receiving my Health Certificate. I not only wanted to report the two month delay in getting a reading, but the fact that the narrative X-Ray findings other than being negative for TB, were not explained to me and I wanted to see an M.D.  I am happy to report that I was promptly and courteously received in Administration and was in the presence of Rob Fleming and the Chief Nurse within minutes!  The Chief Nurse escorted me personally to see a doctor who explained the narrative  X-Ray findings.  Her nurse had done an intake and the doctor and I had a comprehensive discussion of my health.  She offered the hospital services to do a complete physical exam which I don't need since I have my personal physician at Seton Medical Center and a solid Health Insurance Program.
Charges for care totalled only $10.00 and I assume that if I went back for the complete physical exam, I would incur no charges since my  County Health Center ID Card  is encoded 01.  I see no expiration date on my card.  This is an area which should be looked into.  I have health insurance coverage for life through the Department of Defense and should not be tapping into the County for care.
County Health Care Center cards show an individual's Social Security Number and Date of Birth. This is an area which should be looked into. What a find for a thief who steals a purse or wallet and gets a credit card, driver's license, and San Mateo County Medical Center identification card!
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