A 12-Foot Fall, A Broken Workflow, And Why Patients Get Left Behind

A panicked shout from the other room, a young roofer on the ground, and a fogged-in helicopter set the stakes before coffee even kicks in. From there, we follow a second crisis that unfolded in silence: a wound vac doing its job on a fresh amputation, then a sudden insurance change that triggered a computer discharge with no warning. We walk through both moments—the immediate trauma response and the slow-burn administrative breakdown—to show how care holds together or slips apart based on clear protocols, consistent workflows, and basic human follow-through.

We break down what happens after a fall greater than ten feet and why spine precautions matter, then translate that urgency into home care logistics. You’ll hear how negative pressure wound therapy speeds healing and prevents infection, and why a missed dressing change can undo weeks of progress. The conversation pulls back the curtain on home health operations, prior authorizations, and the hidden handoffs that either protect patients or abandon them. We offer practical fixes anyone can use: requesting a warm transfer to an in-network agency, asking for a short-term cash pay bridge to prevent lapses, documenting timelines, and escalating to case management early.

Working from home as telehealth clinicians adds another layer. When your clinic is your living room, codes don’t page a team—they page you. We talk honestly about boundaries, backup coverage, and the systems that keep quality high even when life happens. And we propose something simple with outsized impact: an RN-led hotline for the gray areas—appeals, denials, transport barriers, DME hiccups—so people are not left guessing when the system shrugs.

If this conversation hits home, tap follow, share it with a friend who’s navigating care at home, and drop us a review with the one tool you wish you had when insurance changed mid-treatment. Your stories shape the fixes we build next.

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Transcript

Welcome And Disclaimers

Kelli 0:26

Hey guys, welcome back to another episode of Tattoos and Telehealth to edition 2026, where things are just a little bit different. But we do still have to say to make everybody happy that this does not constitute medical advice. And watching our podcast, listening to our podcast, and being a part of our podcast does not constitute a patient provider relationship. Nicole and I are just a couple of telemedicine practitioners who like to chat it up. And uh this year we're going to be talking about all the crazy things that we see in telemedicine and some of the stuff that we get to handle. Fun things, weird things, crazy things, wild things, changes in medicine, stuff as we go along. So Nicole and I had been chatting behind the scenes before we hit the record button and she wants to share some stuff with you guys.

The 12-Foot Fall On The Job

EMS Response And Trauma Protocol

Nicole 1:09

So a lot of times when we, Kelly and I connect, like we always do like this, like we like chat it up, like you know, how's your dad? How's your how's this? How's that? How's this? What how is your life a shit show? Because that's our common theme. Life is a fucking shit show. Okay. So real life, not even work, just real life. So so my dad, I think I've talked about it before. My dad is uh has been uh a right leg amputee now for about six months, and he just got his wound back off, but he's still in his wheelchair. And so the the little in-law suite that he's in, it has a door to outside with glass in it. So outside of that door, because then this house, the garage, well, before we bought it, was converted into a really cute in-law suite. We are building a two-car garage with an apartment up top. So it's it's like unattached, but it's like right out his door. So he's in his wheelchair yesterday. I'm still in bed, and he's looking out the door. They've built the cement floor, the cement walls up 10 feet, and now the apartment side of it is all is all wood. And so there's there's three guys up there that are putting the roof on the wood, right? Yeah. So they're working out there and hammering and huh? They're stick framing it. Yes. So so they're up there, and dad's just looking out, you know, just look looking and looking out the window. And I'm I'm in bed and I hear him yell for me. Like there's that yell. Like when your kids yell and you're like, What is what is happening? So he yells for me. So I think that he fell. And I jump out of bed, I run in there, and he's like, the guy fell, the guy fell. So I run outside. One of these poor guys that's working was so 10 feet concrete, and then there was two feet of wood. So he fell 12 feet on his back. Like on like his butt back, like, you know, like not like he didn't hit, he didn't hit his head, just from from what we could tell. So poor guy. So the the two other guys that are with him, they don't speak very much English. And I speak a little bit of Spanish, but the guy that fell, he's he's good. So he is laying on the ground. I go out there and he's moving his legs. Well, my dad said he tried to get up, but he couldn't. And I'm like, oh no. So I asked him what his name was. His name's Kevin. I call 911, get EMS on the way, the whole nine yards. So he's like, My back, my back. I'm like, you have to stop moving. Like this, like you have to stop moving. We have to protect your spine. You quit. Like he was kept pulling his knees up. I'm like, I'm like, stop it. Like, we have to protect your spine. We don't know if anything's broke. We I don't want you to get paralyzed. Like, just stop. He was in so much pain. So anytime I was a firefighter before I was um a nurse back in a previous lifetime. But anyway, anytime you fall greater than 10 feet or double your height, which would be more like for kids, you know, um, it's a trauma alert. So this poor guy, EMS, gets here and they're like, do we need to call it? And it was it was 12 feet. So they called a trauma alert. So they were gonna get the helicopter to come and it was too foggy. So the helicopter couldn't safely fly. So they grounded him to the nearest trauma center. And this poor guy, like, I he's 25. He's 25. And once EMS got here, I was still in my pajamas. I said, Are are you you guys okay? You got it. I gave them kind of a quick scenario. I came inside and I went in my daughter's room and I'm like, I'm like, hey, there's you know, EMS is outside. She's going to school for for nursing. And I was like, hey, you know, EMS is outside. I had to call. There's a trauma alert out there. And so she jumps up and she goes out there and she is she is such my kid. She's like, let me know, let me know. Let me see. Yeah, yeah, yeah, yeah. Yeah, right away. So she's like, Oh my gosh, does he have a family? Oh my gosh, oh my gosh, is he okay? Well, oh my gosh, does he speak English? What is his name? He's lost one of his shoes. What are we gonna do with the shoe? She's over by him, like getting the sawdust off his head. EMS is like, you have to stay, you have to stand back, right? So then she's like, so she stands back and she's like watching. And so she goes to talk to the other people. She's like, Where's his his family, his family? So they the family, they call his, his, his mom, and he's they're putting him on the stretcher. They get him on the stretcher and they're strapping him in. So they're not they're in the driveway now, but they're he's on the stretcher. And so she takes the phone and she's like, Here, here's your mom, here's your mom. Like, she wants to see you. Like, she was the mom was so scared, you know? And so I'm like, that she is such my kid. Like, she just jumps into action. Like, she and she hasn't even taken a nursing class. Like, she's she's just I mean, her mom's a nurse, right? That's it. But she jumps into action to what she knows. She was telling the mom he fell, he's okay, he's alert, he's he's he's moving, they're gonna take him just to make sure his spine's okay. Like, she that's awesome. It was the cutest thing. So there's always adventures here every day because my dad is wild, he's he's just stubborn. He's a he's a farmer, so that says it all. He's a farmer. Okay, so he whatever. His wheelchair broke and he zip tied it. You know, I'm like, you're uh you're you know, my dad's six, seven, you're 300 pounds. You're is okay, okay look.

Kelli 6:22

At least there's zip ties now because back in the day when I was growing up, it was it was hay baling wire. Oh yeah, oh yeah, it was baling wire. There were no zip ties, it was zip wire. 100%, and that's what he would have used. Cheap ass duct tape, not the stuff they have now, not the black gorilla tape, cheap ass duct tape, and hay baling wire.

Daughter’s Quick Thinking And Family Support

Nicole 6:43

Listen, you could fix a car with a bobby pin and a stick of gum. Okay, that's that's just the way that it the way that it was. But yes, yes, nonetheless, they took him to and I I I I called the builder because they're the framing company. So I called our my um like the you know the builder, and um I said, Hey, you know, this guy fell, whatever. I'm just letting you know because you probably need to let his company know I don't know. And he's like, Oh my gosh, that's so anyway. So he led them, but I checked in last night and they said that by the grace of God, nothing was fractured. I'm like, he's 25, so that's amazing. Because if he'd have been 40, oh my gosh, it'd have been different. So he's gonna be sore AF for DS for a long time, for a long time. So anyway, so it was just it started out my day. And then my dad's wound vac, he's had it on for like how many months now? Probably four, Cal? Like four months. It was like three or four months at least. Yeah. Was like this nine-inch wound on his stump because he he was doing shenanigans and fell and busted open his nice amputated suture line. So he had this wound vac and it was getting smaller, getting smaller, and now it's you know, it's pretty small, but the wound vacc do great for healing and they promote faster healing. But not only that, they for him, it protects it from infection, right? Because it's a tagoderm, it's like a sealed, it's a it's a sealed, like you can't get no germs in there. Closed system. So I'm like, as long as you can keep the wound back on, the nurses were coming out Monday, Wednesday, Friday. Keep it on. Okay, so he's had the wound back since last year. Love his nurse that was coming out. She's from uh one of the home health care companies. Great. Anyway, all of a sudden I get a call before the wound back goes off. This was earlier this week. I get a call. They wanted to know an update on his insurance because January, his insurance, we we changed it. He's gonna need a prosthesis and all the all these things. We wanted to make sure he had the right insurance and his doctors were covered because things were changing that were out of our control for insurance coverage.

SPEAKER_00 8:42

Yeah.

Nicole 8:43

And they call to get his update insurance. So I give it to him. His nurse texts me on Tuesday and said, Hey, the other nurse will be out today. I'm gonna be doing education. And I'm like, Okay. So I usually get a text that says, Hey, can I come see dad? I didn't get anything. He waited here all day. Nobody came. So I text the nurse that night and I go, Hey, nobody came. Do you want? Should I change it? Because I mean I have changed it before. And so she's like, call me. So this is like eight o'clock at night. He's like, Is my is my is my nurse coming? And so I call her and she said they realized that under his new insurance this the company's not covered, so they discharged him. I'm sorry, what he has a wound vac that has to be changed every other day. So they just discharge him and they don't tell me anything.

Kelli 9:42

So now I'm going back to my previous statements. Insurance companies and big pharma who are in bed together run the nation. It is not about easy care, it is not about what's best for anybody, it is about getting paid, and if you won't pay them, they're out the door.

Nicole 10:00

So I had if I wasn't able to do the wound back change, you tell me what a 76-year-old man would have done with this one back.

Kelli 10:17

He would have gone to the ED and incurred another$10,000 worth of charges that wouldn't have been covered because the insurance says they're not gonna pay for it, and the ED would have had to have they would have actually taken it off and put a wet to dry dressing on it and sent him home, and now he's at risk for infection.

Wound Vac Basics And Protection

Nicole 10:33

So hello patient abandonment. Yeah. Anyway, so I was pissed about that. Their service, nurses, wonderful, but I was pissed about that. Administrative breakdown, which is the problem. There is a wound vac on his leg working in in action. Therapy is going. And we go, whoop, you're discharged. We're out of here. Sorry, we're done. I don't know how people so anyway, so I'm like, I, you know, I can't believe they didn't tell you. I can't believe what you know. I'm like, well, okay, so what should have happened is they should have told me he's not covered under our insurance. So we're going to or even tell me, call his the company that is covered, and once we'll hand over care to them. Yeah. So there's no lapse in therapy. Nobody did that. I didn't even know. Until eight o'clock at night. And I wouldn't have known had I not reached out to the nurse, to the very sweet nurse. I would not have known. So luckily, it had been on three to four months. It was supposed to come off Friday. So this was Wednesday night.

Kelli 12:06

So for those of you that are just listening, this was two nights ago.

Insurance Change And Sudden Discharge

Nicole 12:10

Two nights ago. So long story short, I ended up just taking it off. Yeah. I did, I did change it initially the one time, but then yesterday I I just I'm I'm like, it's I'm I'm gonna take it off. This this this poor guy. I mean it it it was ready to come off. At this point, thank God. Thank God it was ready to come off. And thank God I knew how to take it off. Because what do people do? I honestly I feel like we should have a business, and I've always thought this for people who just don't know what to do because they're left in the dark. Yes, for somebody to just call and say, I don't know what to do. This is what happened. I feel like we should have like a 1-800 number of exactly I've been screwed.

Kelli 12:55

Yes. 1-800 help me. Somebody please create that phone number. Tell me what to do. Yeah. Because, you know, consistency matters, especially in telehealth. But and this is where our nation is breaking down. And this is where I think that, you know, people like Nicole and I and providers that are getting lost in the cycle of insurance won't pay, pharma won't pay, they're they're they're denying this medication, blah, blah, blah. You know, when teams follow, teams like teams like we've put together follow clear, consistent workflows, communication standards. Patients feel supported, they feel informed, they are confident in their care, even from a distance, even from that telemedicine distance. You have reliable processes, you reduce errors, you improve efficiency, you help ensure that patients receive the same high quality, same experience every single time. And that's what helps not only your patient, but your team that you have on the backside. Like those nurses, I promise you, those nurses feel just as dumped on as your dad does because they are like you and I. They have the need to help. So they are probably stressed out. They feel like nobody's listening to them, they don't feel like they are respected or that their opinion matters, and they can't provide the patient-centered care that is compassionate that they're that they feel strongly about.

Nicole 14:13

It's a problem. 100% correct. So even when I was a bedside nurse, an ICU nurse, I have always said, like, what do these people do?

unknown 14:22

Yeah.

Nicole 14:23

What do these people do? I would be advocating for the patient on a level that I don't have to, but I'm like, wait a minute, this patient is a snowbird and they need to get home. Like they need to get home. Like, we need to facilitate this. Like, we need to figure this out. They're dying. Yeah. And, you know, I mean, I don't have to facilitate a transport, but I'm like, okay, let's let's get case manager. Let's talk to the family. Let's see what resources they have. What does insurance cover? Like, come on, people. Like, let's let's let's just get on it. I feel like we need a hotline. 1-800 help me. Yeah. Like that's this. Just tell me what to do.

Kelli 14:57

Just tell me what to do. Yeah. Not it needs to be it needs to be staffed by an RN case managers, absolutely. Case managers, a social worker, like that. It needs to be somebody that does it. And somebody that is that is briefed in the language of insurance bullshit.

Patient Abandonment And System Failure

Nicole 15:16

Because that's what it usually falls on, truth be told. Is it the bottom line is insurance? They had been coming out for 10 days without coverage. And all of a sudden, no computer discharged with no with no communication. Again, with no communication and therapy, going. Not okay. Again, patient abandonment. Patient abandonment. Patient abandonment. So what they wanted to happen, I'm sure, and they didn't tell me this, but I would hope to think that they would call the patients, tell the patient that they're going to be discharged, that they need to call their their new whoever, whatever insurance covers their home health, and have them come out as soon as possible, and they will come out until then.

unknown 16:12

Yep.

Nicole 16:12

Here's your question.

Kelli 16:13

I may not be able to get them out for a week and his back needs to be changed every two days. Yep. And they should have said, Nicole, here's how much we will charge you cash pay to come out and keep changing it until you can get somebody to come out and do it. And work it out. Work it out. You know, sometimes you have people like Nicole and I who would say, We're not going to charge you for that. This is not your problem. You know what I mean? But then you have companies that we get it. They have to make money. Okay, fine. We'll give you a cash price. Whatever. But you figure it out and you work together. It's it's called, you know, it's called patient care.

Nicole 16:46

It was coming off Friday. This was like in the middle of the week. You you've been coming for 10 days. You couldn't come for two more times. Two more times you couldn't come to take it off to discharge them for real.

Kelli 16:59

Yeah. So these are some of the things that and and I'm gonna back this up just a minute, guys, so y'all can hear me say this. I know that working from home sounds glamorous, but we have talked about this before. Nicole and I have talked, we have a whole episode over your your office at home. This is what happens when you work from home. You live at work. You live at work. You can't separate, like she could have very well been working when her dad yelled at her to come out. She could have well very well been in the middle of seeing a patient virtually when whatever happened and she had to go take care of it. Like we live where we work, and so that's like I may have to time out and tell a patient, I'll be right back because someone's knocking at the door and the dogs are going nuts. And I'm like, if I were in an office, this wouldn't happen. It's great until it's not it's great until it's not. It's great until it's not. Yeah, you become the house manager, you become the keeper of all things, you become the one that deals with all the crap that happens. You but you become everything.

Nicole 18:00

Because we're under the same roof. Because we're under the same roof.

Kelli 18:03

Yeah, it's great till it's not.

Cash Pay Bridge And Practical Fixes

Nicole 18:05

It's great till it's not. In a hospital setting, what pulls you away is somebody more sick, a code blue, a trauma, things like that. But you have a team. You have a team. Right. Right. Right at home, you don't have a team. The morning that the morning that he fell, Buck was here and he, I mean, he was helping him to the bathroom because it was very early. Like it was 10 days. No, it was two weeks post-op. He had an incision on his stump, and the it the the sutures had just come out.

Kelli 18:34

Guys, I wish I wish we could link pictures in the show notes of her dad's stump. I wish we could show you guys if it was if it was not too obscene for for internet, it was just, it wasn't gross. It was just for me fascinating because you know those things fascinate me. But how quickly this wound that was beautifully stitched together just went whoop and just opened right up. It was just like yeah, it dehissed. It was just like whoop. I was like, oh, she sent me a little bit. There was the muscle and there was the meat. It was like, there's the meat of them of the human that is not supposed to be on B seen. You should not be able to see that.

Nicole 19:17

That's not by the grace of God. I had held his blood thinner for two weeks because that would have been awful.

Kelli 19:24

He would have been, he would have lost a pint of blood before you could have got in the hospital.

Nicole 19:29

He would have been he probably would have been, he would have been a trauma alert. He was bleeding like a stuck pig already.

unknown 19:33

Yeah.

Nicole 19:34

Anyway, it's just this, it's our anyway. So today it was more about personal stuff. Today it was more about how we are super sorry that health care kids are left the way that they're left, and they're left in our families, they are left. We're not special, we are not special, nobody cares. I mean, the nurses care, let's be real. She was like, Oh my, she was mortified. She was mortified. But it happens, it happens, and I think we need a number for people to call to say, I don't, I don't know what to do.

Kelli 20:09

So if any of our listeners have the ability, the funding. The technology, the willingness, the desire, the love, the hope, all the words to do that. Nicole and I would gladly help you staff it. Yeah, we would staff it. 800 something, just a place where people can pick up the phone and go, help. What do I do for X? What do I do for not if you're having a heart attack?

Working From Home Reality In Telehealth

Nicole 20:33

Yeah, not if you're having a stroke. It's I'm stuck and I don't know what to do with this. Something that's can be answered in yeah.

Kelli 20:42

How do I how do I file an appeal with my insurance? Help. How do I get my migraine medicine paid for? Help. My loved one is stuck in Abilene, Texas, and we live in Kansas and we can't get there. They won't pay for the ambulance ride. He can't get in a car. What do I do? You know, what do I do next?

SPEAKER_00 21:01

What do I do next?

Kelli 21:02

So yeah, we'll help you if anybody feels so inclined.

Nicole 21:07

All right. Well, I have a pharmacy calling that needs clarification on an order. So I say we're gonna we're gonna go ahead and wrap this up next week. And Kelly, have you been watching The Pit?

Kelli 21:19

I have not, but I'm going to because so I've been putting it off for no other reason than I've been busy at night. I want to watch it, but a friend of mine messaged me a couple of nights ago.

Nicole 21:29

I need to watch it. Okay. So next week I want to talk about the pit because I watched it. I watched last season. I'm with I'm gonna watch episode two of season two as soon as I can. And I have homework. It is real MF life.

Kelli 21:46

It is Did you know? Did you know that who is what is the name of the actor? Umiley. Noah Wiley, his mom is really a nurse. Yes, yes, his mom is really a nurse. So I love that. Shout out Noah Wiley. If you are listening to this, give your mama kisses and hugs from Nicole and I, please love that woman.

Nicole 22:06

Yes, and he does an amazing job. And I love that he was on the show, ER back in the day, like before. Yes. I love that. So we will talk about the pit okay next week and see about what Kelly thinks about it. So she has homework. So all right, guys, we'll see you next week and hope you guys have a wonderful weekend, and we will talk to you soon.

SPEAKER_00 22:27

Great. Bye guys.