ER at The Villages Hospital

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Old 06-10-2017, 09:27 AM
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I go to Leesburg ER and seen promptly- separate trips for TiA, trouble breathing and heart issues . Great service and caring staff
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Old 06-10-2017, 09:34 AM
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Originally Posted by Sky14 View Post
A few weeks ago, I submitted a Letter to the Editor, Daily Sun, but I have given up hope that it will ever be printed, so I'll share it here...

How is it that in The Villages, where everything is so wonderful, the ER service at its hospital, The Villages Regional Hospital, is so poor? Recently, my daughter was quite ill and waited four hours until the stress of sitting in the waiting room became worse than the stress of being sick at home. We left without having been seen. So did a man and woman sitting across from us. They were in their 80s and had been waiting six hours. And this was when the seasonal residents were gone! Since then, in telling our story, I have come across Villagers who said they spent eight hours or longer in the waiting room. This is appalling. If a business operated like that, it would have no customers. But The Villages Hospital has no competitors, so it does not have to care how long the ill and injured have to wait. With large parcels of land being purchased by The Villages, and the subsequent increase in population, the ability to obtain emergency care in a timely manner should be a huge concern for residents. This is about providing more than just amenities and shopping. This is about meeting life’s emergency needs.
A lot of this has been posted before, but I guess it is time to write another novel in response.

It seems the main thrust of your post is the waiting time, no mention regarding quality of care, so let's focus on that. Also, it would be nice if DB, a retired hospital administrator and frequent poster on TOTV would weigh in as well

ER waiting times are determined by many factors:
The number of beds in the ER
Staffing
Speed at which ER staff works
Bed availability for admissions
Number of patients that show up
Also, keep in mind, it is not a "first come, first serve" endeavor. I'm truly sorry your daughter was quite ill, but that means different things to patients than it does to healthcare professionals, hence the triage process.

My wife was quite ill last year, probably within hours of leaving us, and was admitted for 2 weeks after coming in through the ER and then spent another month in rehab, so I have first hand experience with TVRH. I also have 30+ years of experience as a board certified internist, professor of medicine at State University of New York, Chairman of our Quality Assurance Committee, and Chief of Staff at our community hospital, so I do have some "vague" idea of what I'm talking about.

At the time my wife was brought to the ER, all the ER beds were occupied and there were about 10 patients in the waiting room. Despite that, it took less than 5 hours from the time she arrived until she was in a bed on the floor, so no complaints from me as to time. Many others have been satisfied with waiting times, many others completely dissatisfied. And then there are the ludicrous posts about 90 year olds waiting 22 hours in pain to be seen by a doctor---you decide if that is credible.

I thought the number of beds in the ER were adequate, and the NUMBER of physicians and extended providers could handle the workload if the were diligent. Unfortunately, ERs tend to get bogged down by the "walking wounded"----patients who would be better served for their minor complaints in an urgent care setting or their doctor's office, but we all know THAT doesn't happen. As I looked around at the 10 patients in the waiting room, 8 of them could obviously be handled elsewhere, so triage was probably appropriate.

So far, so good, but now for the bad news:

From what I observed, the PACE at which work was being done seemed to be pretty slow. There did not appear to be any great rush to get admissions to the floor or get the remainder treated and released. My impression was that myself and one of my ER friends could clear that place out pretty quickly. Apparently the ER is staffed by a sub-contracted group out of the Miami area, and many of their ER docs are locum tenens---temporary employees that travel and generally work 3 months at a given location. My opinion of this situation is pretty low---they have no vested interest in our community, they are essentially nameless, faceless individuals who will soon be moving on, don't have a strong desire to work hard, and in general are just punching a time clock (My apologies to those dedicated locum tenens physicians out there) As a result, the ER tends to back up. Believe me, a stable group of ER docs who live in the community and are treating their friends and neighbors makes a WORLD of difference.

But they are not the sole reason. Getting admissions out of the ER depends on bed availability on the floors, which is not a monolithic problem either. The attending physicians need to discharge patients as early in the day as possible and in a timely manner. The nurses need to do their discharge paperwork and review it with the patient. The discharge planners need to finalize their plan and explain it. And housekeeping needs to clean the room after the patient leaves. Some of these groups are more motivated than others as well.

Here's how we fixed the problem in NY:
First we asked all attending physicians and hospitalists to do as much discharge paperwork as possible the evening before. Then we had them write a simple order: "Plan for AM discharge". This triggered the evening and night shift nurses to do as much discharge work as possible as well, and the discharge planners to get their ducks in a row.
We also spoke with the nursing homes, rehab facilities, home care agencies and medical transport companies and asked them to help by staggering shifts in such a way that more planning could be done the day and evening before discharge. We were able to get the medical community on the same page and work together to get more beds available earlier so the ER could get their patients to the floor. Believe it or not, the main resistance came from housekeeping. In general these are less educated minimum wage employees, many of whom had the job as a requirement of continued public assistance, with less motivation to put out extra effort.

So, a few final thoughts:

The one thing the hospital cannot control is how many patients show up at a given time. No restaurant, no retailer can staff for peak volume all the time, so sometimes the wait will be longer than others.

I think the ER wait issues are completely fixable, although it could be difficult. If I were in charge I'd be looking at a different ER group. It is probably not possible to build our own ER group with a top notch director and physicians who live here, due to recruiting difficulties. However, I would have the QA committee sitting on the ER and monitoring both wait times and quality issues. Probably 30-40% of the staff in that ER needs to experience "alternative career opportunity enhancement" . I would then try to address the issues surrounding discharges.

Lastly, to the individual who drives 30-70 miles to go elsewhere, even if sick, be careful---your luck may eventually run out.
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Old 06-10-2017, 09:43 AM
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Good post.
  #19  
Old 06-10-2017, 10:04 AM
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Once again Golfing Eagle writes a great post, as he should because it is his business. Unfortunately, the people that need to read his post and to digest the contents will not do so, they will keep right on complaining.
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Old 06-10-2017, 10:24 AM
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I will not go through the details but I have been a care taker for 3 cancers with my wives. One was sucessfully cured the other after 2 cancers was not fortunate and passed away. In the process of these I have been to a number of famous cancer treatment centers: Lahey Clinic, Mass, MD Anderson, Huston Texas, Mayo Clinic, Jacksonville Florida Westchester Medical Center, NY,
Cleveland Clinic, Fl.,Moffit, Tampa Florida, Etc. In rating I would give Mayo, Jacksonville as #1, Lahey #2, Moffit#3. and so on.Now to the originial subject. I would guess the Physician that wrote in probably gained some advantages by the sheer fact he was a Dr. That does not distract from his assessments just adds some balance to the input. In one case I had a relative who was held in the Ft Lauderdale Hospital ER for 18 hours in terrible pain. I ordered an ambulance, had her discharged and drove about 2-3 to Stuart Florida Hospital who said she had about 24 hours to live if she was not operated on immediately. She was and she is fine today. The bottom
line is that you are responsible for your care and taking action in the case of neglect. Mayo at Jacksonville is 2 1/2 hours away and has an ER. Rather then tolerate such terrible treatment go to a teaching hospital. I believe Sand's is one although never been there. I have heard some terrible things about the Villages ER and am at a loss why, if someone has 3 hours does not go to Sands or Mayo and get the best treatment?? It is not just the ER but the support team these locations have to ensure more than just bascic treatment. In closing I will add that I just don't understand why the Developer who may not be the final authority but carries a lot of weight in this area does not have a team to study the problems and ensure we have the best medical policies and practices and doctors to treat or to refer difficult cases to the best for treatment. Just some thoughts on a subject that I have spent many years involved in.
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Old 06-10-2017, 10:31 AM
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Originally Posted by PennBF View Post
I will not go through the details but I have been a care taker for 3 cancers with both wives. One was sucessfully cured the other after 2 cancers was not fortunate and passed away. In the process of these I have been to a number of famous cancer treatment centers: Lahey Clinic, Mass, MD Anderson, Huston Texas, Mayo Clinic, Jacksonville Florida Westchester Medical Center, NY,
Cleveland Clinic, Fl.,Moffit, Tampa Florida, Etc. In rating I would give Mayo, Jacksonville as #1, Lahey #2, Moffit#3. and so on.Now to the originial subject. I would guess the Physician that wrote in probably gained some advantages by the sheer fact he was a Dr. That does not distract from his assessments just adds some balance to the input. In one case I had a relative who was held in the Ft Lauderdale Hospital ER for 18 hours in terrible pain. I ordered an ambulance, had her discharged and drove about 2-3 to Stuart Florida Hospital who said she
had about 24 hours to live if she was not operated on nimmediately. She was and she is fine today. The bottom
line is that you are responsible for your care and taking action in the case of neglect. Mayo at Jacksonville is 2 1/2 hours away and has an ER. Rather then tolerate such terrible treatment go to a teaching hospital. I believe Sand's is one although never been there. I have heard some terrible things about the Villages ER and am at a loss why, if someone has 3 hours does not go to Sands or Mayo and get the best treatment?? It is not just the ER but the support team these locations have to ensure more than just bacic treatment. In closing I will add that I just don't understand why the Developer who may not be the final authority but carries a lot of weight in this area does not have a team to study the problems and ensure we have the best medical policies and practices and doctors to treat or to refer difficult cases to the best for treatment. Just some thoughts on a subject that I have spent many years involved in.
1) Not at all, I never tell anyone there who I am, I prefer to stand back and observe their normal functioning. Only if I spot an impending error do I have a "discussion" with the doctor.

2) I agree----it probably falls to the corporation that runs TVRH as well as Leesburg rather than the developer. This is what QA committees and hospital administrators SHOULD be doing.
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Old 06-10-2017, 11:14 AM
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Quote:
Originally Posted by golfing eagles View Post
A lot of this has been posted before, but I guess it is time to write another novel in response.

It seems the main thrust of your post is the waiting time, no mention regarding quality of care, so let's focus on that. Also, it would be nice if DB, a retired hospital administrator and frequent poster on TOTV would weigh in as well

ER waiting times are determined by many factors:
The number of beds in the ER
Staffing
Speed at which ER staff works
Bed availability for admissions
Number of patients that show up
Also, keep in mind, it is not a "first come, first serve" endeavor. I'm truly sorry your daughter was quite ill, but that means different things to patients than it does to healthcare professionals, hence the triage process.

My wife was quite ill last year, probably within hours of leaving us, and was admitted for 2 weeks after coming in through the ER and then spent another month in rehab, so I have first hand experience with TVRH. I also have 30+ years of experience as a board certified internist, professor of medicine at State University of New York, Chairman of our Quality Assurance Committee, and Chief of Staff at our community hospital, so I do have some "vague" idea of what I'm talking about.

At the time my wife was brought to the ER, all the ER beds were occupied and there were about 10 patients in the waiting room. Despite that, it took less than 5 hours from the time she arrived until she was in a bed on the floor, so no complaints from me as to time. Many others have been satisfied with waiting times, many others completely dissatisfied. And then there are the ludicrous posts about 90 year olds waiting 22 hours in pain to be seen by a doctor---you decide if that is credible.

I thought the number of beds in the ER were adequate, and the NUMBER of physicians and extended providers could handle the workload if the were diligent. Unfortunately, ERs tend to get bogged down by the "walking wounded"----patients who would be better served for their minor complaints in an urgent care setting or their doctor's office, but we all know THAT doesn't happen. As I looked around at the 10 patients in the waiting room, 8 of them could obviously be handled elsewhere, so triage was probably appropriate.

So far, so good, but now for the bad news:

From what I observed, the PACE at which work was being done seemed to be pretty slow. There did not appear to be any great rush to get admissions to the floor or get the remainder treated and released. My impression was that myself and one of my ER friends could clear that place out pretty quickly. Apparently the ER is staffed by a sub-contracted group out of the Miami area, and many of their ER docs are locum tenens---temporary employees that travel and generally work 3 months at a given location. My opinion of this situation is pretty low---they have no vested interest in our community, they are essentially nameless, faceless individuals who will soon be moving on, don't have a strong desire to work hard, and in general are just punching a time clock (My apologies to those dedicated locum tenens physicians out there) As a result, the ER tends to back up. Believe me, a stable group of ER docs who live in the community and are treating their friends and neighbors makes a WORLD of difference.

But they are not the sole reason. Getting admissions out of the ER depends on bed availability on the floors, which is not a monolithic problem either. The attending physicians need to discharge patients as early in the day as possible and in a timely manner. The nurses need to do their discharge paperwork and review it with the patient. The discharge planners need to finalize their plan and explain it. And housekeeping needs to clean the room after the patient leaves. Some of these groups are more motivated than others as well.

Here's how we fixed the problem in NY:
First we asked all attending physicians and hospitalists to do as much discharge paperwork as possible the evening before. Then we had them write a simple order: "Plan for AM discharge". This triggered the evening and night shift nurses to do as much discharge work as possible as well, and the discharge planners to get their ducks in a row.
We also spoke with the nursing homes, rehab facilities, home care agencies and medical transport companies and asked them to help by staggering shifts in such a way that more planning could be done the day and evening before discharge. We were able to get the medical community on the same page and work together to get more beds available earlier so the ER could get their patients to the floor. Believe it or not, the main resistance came from housekeeping. In general these are less educated minimum wage employees, many of whom had the job as a requirement of continued public assistance, with less motivation to put out extra effort.

So, a few final thoughts:

The one thing the hospital cannot control is how many patients show up at a given time. No restaurant, no retailer can staff for peak volume all the time, so sometimes the wait will be longer than others.

I think the ER wait issues are completely fixable, although it could be difficult. If I were in charge I'd be looking at a different ER group. It is probably not possible to build our own ER group with a top notch director and physicians who live here, due to recruiting difficulties. However, I would have the QA committee sitting on the ER and monitoring both wait times and quality issues. Probably 30-40% of the staff in that ER needs to experience "alternative career opportunity enhancement" . I would then try to address the issues surrounding discharges.

Lastly, to the individual who drives 30-70 miles to go elsewhere, even if sick, be careful---your luck may eventually run out.
Great post from someone who is more experienced (being a former health-care provider) than most of us who post here. Thank you Golfing Eagles!!!! Gracie also made some great points!!!

I wonder how many folks actually contact the "powers that be" at TVRH to complain of their experiences??? We've had several stops to the ER since moving here---all were different. Only one was, should I say, not the best? BUT I made it known both to the staff AND later in an e-mail to the director. I've heard 2 times that "they are working on it"...meaning trying to make it better. The hospitals here are like small-town hospitals but with LARGE city needs. I have to wonder if there aren't people in management who read these posts. I still say though...folks need to talk to the source and not keep complaining on social media!
  #23  
Old 06-10-2017, 11:24 AM
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Quote:
Originally Posted by golfing eagles View Post
A lot of this has been posted before, but I guess it is time to write another novel in response.

It seems the main thrust of your post is the waiting time, no mention regarding quality of care, so let's focus on that. Also, it would be nice if DB, a retired hospital administrator and frequent poster on TOTV would weigh in as well

ER waiting times are determined by many factors:
The number of beds in the ER
Staffing
Speed at which ER staff works
Bed availability for admissions
Number of patients that show up
Also, keep in mind, it is not a "first come, first serve" endeavor. I'm truly sorry your daughter was quite ill, but that means different things to patients than it does to healthcare professionals, hence the triage process.

My wife was quite ill last year, probably within hours of leaving us, and was admitted for 2 weeks after coming in through the ER and then spent another month in rehab, so I have first hand experience with TVRH. I also have 30+ years of experience as a board certified internist, professor of medicine at State University of New York, Chairman of our Quality Assurance Committee, and Chief of Staff at our community hospital, so I do have some "vague" idea of what I'm talking about.

At the time my wife was brought to the ER, all the ER beds were occupied and there were about 10 patients in the waiting room. Despite that, it took less than 5 hours from the time she arrived until she was in a bed on the floor, so no complaints from me as to time. Many others have been satisfied with waiting times, many others completely dissatisfied. And then there are the ludicrous posts about 90 year olds waiting 22 hours in pain to be seen by a doctor---you decide if that is credible.

I thought the number of beds in the ER were adequate, and the NUMBER of physicians and extended providers could handle the workload if the were diligent. Unfortunately, ERs tend to get bogged down by the "walking wounded"----patients who would be better served for their minor complaints in an urgent care setting or their doctor's office, but we all know THAT doesn't happen. As I looked around at the 10 patients in the waiting room, 8 of them could obviously be handled elsewhere, so triage was probably appropriate.

So far, so good, but now for the bad news:

From what I observed, the PACE at which work was being done seemed to be pretty slow. There did not appear to be any great rush to get admissions to the floor or get the remainder treated and released. My impression was that myself and one of my ER friends could clear that place out pretty quickly. Apparently the ER is staffed by a sub-contracted group out of the Miami area, and many of their ER docs are locum tenens---temporary employees that travel and generally work 3 months at a given location. My opinion of this situation is pretty low---they have no vested interest in our community, they are essentially nameless, faceless individuals who will soon be moving on, don't have a strong desire to work hard, and in general are just punching a time clock (My apologies to those dedicated locum tenens physicians out there) As a result, the ER tends to back up. Believe me, a stable group of ER docs who live in the community and are treating their friends and neighbors makes a WORLD of difference.

But they are not the sole reason. Getting admissions out of the ER depends on bed availability on the floors, which is not a monolithic problem either. The attending physicians need to discharge patients as early in the day as possible and in a timely manner. The nurses need to do their discharge paperwork and review it with the patient. The discharge planners need to finalize their plan and explain it. And housekeeping needs to clean the room after the patient leaves. Some of these groups are more motivated than others as well.

Here's how we fixed the problem in NY:
First we asked all attending physicians and hospitalists to do as much discharge paperwork as possible the evening before. Then we had them write a simple order: "Plan for AM discharge". This triggered the evening and night shift nurses to do as much discharge work as possible as well, and the discharge planners to get their ducks in a row.
We also spoke with the nursing homes, rehab facilities, home care agencies and medical transport companies and asked them to help by staggering shifts in such a way that more planning could be done the day and evening before discharge. We were able to get the medical community on the same page and work together to get more beds available earlier so the ER could get their patients to the floor. Believe it or not, the main resistance came from housekeeping. In general these are less educated minimum wage employees, many of whom had the job as a requirement of continued public assistance, with less motivation to put out extra effort.

So, a few final thoughts:

The one thing the hospital cannot control is how many patients show up at a given time. No restaurant, no retailer can staff for peak volume all the time, so sometimes the wait will be longer than others.

I think the ER wait issues are completely fixable, although it could be difficult. If I were in charge I'd be looking at a different ER group. It is probably not possible to build our own ER group with a top notch director and physicians who live here, due to recruiting difficulties. However, I would have the QA committee sitting on the ER and monitoring both wait times and quality issues. Probably 30-40% of the staff in that ER needs to experience "alternative career opportunity enhancement" . I would then try to address the issues surrounding discharges.

Lastly, to the individual who drives 30-70 miles to go elsewhere, even if sick, be careful---your luck may eventually run out.
I so agree with this. My husband went to the ER in an ambulance for chest pain and was seen right away. He was admitted and had a stent put in the next day. The following day he was cleared to leave by the Cardiologist in the AM and had to wait until 6PM to be discharged by the admitting physician so he occupied a bed all day for nothing.
  #24  
Old 06-10-2017, 12:18 PM
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Is there not some kind of Villager Survey going on now? We should bring this all up. Survey Login

Last edited by Taltarzac725; 06-10-2017 at 12:49 PM.
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Old 06-10-2017, 01:02 PM
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Is there not some kind of Villager Survey going on now? We should bring this all up. Survey Login
I agree. Maybe we can contact "Powers that be" and ask about that!!!!
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Old 06-10-2017, 01:11 PM
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I agree that all these good posts need to go to several departments and several different people at the hospital; remember about the squeeky wheel. Generally only by many squeeks will the wheel get better. Don't rely on the hospital to read and act upon this.
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Old 06-10-2017, 01:56 PM
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I think the ER wait issues are completely fixable, although it could be difficult. If I were in charge I'd be looking at a different ER group. It is probably not possible to build our own ER group with a top notch director and physicians who live here, due to recruiting difficulties. However, I would have the QA committee sitting on the ER and monitoring both wait times and quality issues. Probably 30-40% of the staff in that ER needs to experience "alternative career opportunity enhancement" . I would then try to address the issues surrounding discharges.
Absolutely agree, Doc. Well put. Hope someone from TVRH monitors this site.
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Old 06-10-2017, 01:59 PM
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Last week I went to the new free standing ER (it is not a Urgent Care) on 441 next to Spruce Creek - across from Camping World.
From the moment I walked in until discharge, I was treated promptly and with great courtesy by all the staff members. The doctor explained everything and spent quite a bit of time with me reviewing the results of the tests.
It is owned by Ocala Regional Hospital and is an extension of the ER on the main campus. Ocala Regional is the level two trauma hospital for our area. If you have to be admitted, if possible they will send you to your hospital of choice although they generally admit to their hospital. Again, it is not an Urgent Care but an actually well staffed and equipped ER with scanning capacity, etc.
I asked if they were busy when I walked in and it was affirmative with apologies because I waited about five minutes to be taken to a bed. Within ten minutes I was hooked up for an EKG, Dr in the room, chest X-ray and labs drawn even tho my main complaint was not chest pain.
I am a retired RN and have never seen a unit run as efficiently as this ER. I didn't count them, but it looked like they had at least 10-12 private rooms. It is a large building. Highly recommend.
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Old 06-10-2017, 02:23 PM
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Originally Posted by Sky14 View Post
A few weeks ago, I submitted a Letter to the Editor, Daily Sun, but I have given up hope that it will ever be printed, so I'll share it here...

How is it that in The Villages, where everything is so wonderful, the ER service at its hospital, The Villages Regional Hospital, is so poor? Recently, my daughter was quite ill and waited four hours until the stress of sitting in the waiting room became worse than the stress of being sick at home. We left without having been seen. So did a man and woman sitting across from us. They were in their 80s and had been waiting six hours. And this was when the seasonal residents were gone! Since then, in telling our story, I have come across Villagers who said they spent eight hours or longer in the waiting room. This is appalling. If a business operated like that, it would have no customers. But The Villages Hospital has no competitors, so it does not have to care how long the ill and injured have to wait. With large parcels of land being purchased by The Villages, and the subsequent increase in population, the ability to obtain emergency care in a timely manner should be a huge concern for residents. This is about providing more than just amenities and shopping. This is about meeting life’s emergency needs.
Poster: It takes better than 3-4 weeks after you are contacted by the Daily Sun before a letter is published, if it is published at all. The Daily Sun mimics much of what goes on in TV meaning the powers want tight control.

The frustration you express as to the TVRH emergency room has been expressed ad nauseam for the 11 years I have lived here.

I can't speak for others but in my humble opinion if the ER was any other business it would have gone out of business long ago.

Personal Best Regards:
  #30  
Old 06-10-2017, 02:35 PM
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Some folks may remember that The Villages wanted to build a second hospital near Brownwood on CR 44 but were denied a permit. They tried to fix the problem. Give them some ctredit for building the hospital in the first place !!!!!
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