Aug 9, 2016

Pouya Afshar--no phone number--odd and unusual--angry--UCSD hospitalist

The front of Center Hall in University Center ...
The front of Center Hall in University Center at UCSD. (Photo credit: Wikipedia)
Chloe Louise 

I would like to complain about Dr. Pouya Afshar, he is the physician taking care of my mother at the Balboa Nursing Home and Rehab Center on 4th Avenue in San Diego

Thank you for providing this forum for me to express my thoughts

What I am saying is my opinion and not necessarily fact as I am very afraid of Dr. Afshar as he threatened to report me. I do not know what he wanted to report me for as I was very concerned, alarmed actually about the position my mother was in as she was consuming her evening meal

By the way, I am using this site as Dr. Afshar is affiliated with UCSD as a hospitalist. 

My mother was in UCSD Hillcrest a little over one month ago after a fall and after repair of a femur fracture. 

she received excellent care at UCSD. The next day after the surgery everything was going along according to plan until she had a very serious aspiration incident. She choked, apparently turned blue and had a very difficult time breathing. I believe this happened as she was eating her meal and I was not there at the time. 

This resulted in a case of pneumonia. I do not know now the current status of the pneumonia but it seems like it is clearing up. That was one of my complaints.......I never know what is going on. 

I know my mother has had a lot of problems eating and does not like her pureed diet as a result of the incident. 

Right now, at the Balboa Nursing home I get most of my information from her room mate who is very nice. 

I am worried about my mother as she can be very obstinate and uncooperative and argumentative. 

In all honesty it is a confusing situation--I do not think she has ever liked me very much and has always resented my existence. I think we can draw the conclusion that she definitely does not think I know anything and does not want me to have any input in the situation. 

So here's the thing.......when I visited her she was in a position in her bed at about a 45 degree angle. she has been instructed many times to sit up in a chair to eat her meals in order to avoid another incident of aspiration. 

I did not say anything to her because the last time I asked her to sit in a chair she stated she liked to sit in her bed to eat because it is cozy. The speech therapist works with her on a regular basis to increase her muscle strength associated with eating and to instruct her on how to eat properly to avoid any kind of life threatening incident again. 

I reported her eating position to the nursing staff........the problem is that she often refuses to get in the chair as the patient has the right to refuse and my mother is quite skilled at having a reason not to do something. 

So in all honesty, now I am really confused as to what to do. 

We had a meeting the next day as a result of my complaint. I did not want to complain to my mother because she will say I am trying to tell her what to do and that I am balling her out. Those are her favorite words to say to me her whole life. I did not want her to eat in a dangerous position. The next day at the meeting with the Physical Therapist, the Case Manager, the Social Worker, the Dietician, The Assistant Director of Nursing and myself. It was good of them to have the meeting with me the next day. 

I am a nurse, myself, but my expertise is not geriatrics and I had consulted with someone I knew who is the Director of Nursing at a geriatric facility. I thought it was very bad that my mother was eating in that position but I did not know what to do. This director told me that for safety my mother had to eat in the proper position and it was up to the facility to make sure she is in a safe environment. 

I just thought it was odd because no one even came in the room and asked her to get up in a chair before the tray was brought in. On this particular evening is was not a matter of her refusing but she was never asked and then when the attendant adjusted the bed they put it at the 45 degree angle. 

I went to the desk right away and as I came back in the room my mother was making a very odd swallowing movement and had the pillow under her head so that even though she was at a 45 degree angle her head was almost 90 degrees. she did state that her head always has to be up when she was eating. 

The next day when I was there after the meeting she did indeed sit up to eat with the assistance of an aid and she stated she sits up to eat every evening and at every meal but I have been told she often refuses many times by the staff and I reminded her she did not sit up the evening before in the chair but remained in bed. 

At our meeting with the staff they suggested Dr. Pouya Afshar would call me and I am thinking now what they were trying to accomplish is that I could be more informed about what was going on as she had also lost quite a bit of weight which was infact, reported incorrectly by my mother and by the room mate. 

In the phone call, today, Dr. Afshar was very angry and said my mother was not incapable of making her own medical decisions and that many people are overweight and they eat anyway. 

I tried to explain to him she was forgetful and could no longer follow her favorite show or have the ability to pay bills. That is why I got involved--she was paying the wrong bill--she was paying bills that no longer existed, not to mention her checking account was overdrawn. 

When we first moved in together she could write a pretty good letter......that was about a year and a half ago but since then she has lost her ability to write a letter or make any decision about money. 

Dr. Afshar said she could be in charge of everything including her finances. I can honestly say her bills would not be paid. He became very angry and said he did not have time to listen to me and eventually hung up on me. I tried to explain the situation--the eating position and safety was the whole reason for the conversation. I really did not know what to do. 

I was so offended by the conversation of this individual. He suggested we iron out our differences--I am actually in agreement with that part of his statement but what should I do when I find her eating in what I think is a very bad and dangerous way. I guess, according to this very angry Dr. Afshar, he does not want me to mention it. Shall I not care about my mother. 

I tried to explain to him at the ST. Paul's Manor skilled nursing facility the same thing happened. They brought in a psychiatrist in to evaluate the situation. This individual also came to the same conclusion. But in fact, mother was paying her room bill at the independent living--but she no longer lived there and that had been explained to her many times. It was impossible to place her because she would not divulge any of her financial information because she did not think it was anyone's business. 

She became angry because everyone was trying to tell her what to do. She lost her medicare coverage because she would agree to physical therapy but when the time came she refused because she was eating her meal. Then when she saw her huge bill of private pay she could not believe it and if you ask her to this day she will say "Can you imagine, an 8,000 dollar bill being placed under my door." 

But in fact, that bill was never placed under her door. The bill went under her door when she was still in her room in independent living and the consequences of losing medicare coverage were explained to her many, many times. 

I had said lets get a place together, because she could walk well by then even though she refused the therapy, and we have lived together for approximately the past year and one half. 

I have gotten her hooked up with the VA as she was a WW2 WAVE and she also goes to the Glenner Memory Center 3 times a week. She loves it but she also did not want to go there as she does not like hanging out with old people but I said let's just try it. It is a wonderful place and I think it gave her a nice quality of life and they sing all of the old songs her family sang and she knows well. 

I will give an the VA medical office in Mission Valley the nurse is always telling me how to get her to drink more water and fluids and they also send out info from the Glenner on keeping the seniors hydrated in the hot weather. 

She often refuses the liquid and while they are making many nice suggestions as to how to get her to drink it is often an impossible situation as she refused saying she is not a water drinker. There are many different strategies such as lemonade and offering the water more frequently. 

To me her decision making ability is poor in this kind of situation--what should I do because if it was up to her she would not eat or drink anything at all. 

This is where I do not know what to say to Dr. Afshar and even what philosophy to take. What should I think? Shall I ignore everyone's suggestion as she can make all of her own medical decisions as Dr. Afshar insists. 

By the way, I do believe she does have the diagnosis of dementia and that is why she goes to the Glenner. 

On her own she is just sitting there--it is confusing because she does know the news yet she cannot follow her favorite Soap Opera or Doc Martin. One day she knows Marlon Brando and one day she has no idea in the world who he is. I explained to Dr. Afshar she forgot she had the surgery the day before and he insisted it was the anesthesia but this is common place for my mother. Sometimes she forgets what she is doing while she is doing it yet she will tell you about a wedding she went to in 1923. 

Now I am very sad. At our very nice meeting the staff said Dr. Afshar would call to reevaluate her cognitive ability. 

The man was quite enraged after his clock test--my mother has never not been able to tell time. 

I was confused to at first because she is actually pretty good at Wheel of Fortune but I think it may be because that is immediate but her memory is really not reliable, particularly her recent memory. Trust me on this one, I suffer this on a daily basis. Her ability to make a judgement or decision based on facts does not really add up. 

It is true--she does not ever want to listen to me but what am I suppose to do. 

Shall I let her choke and keep my mouth shut. Shall the staff offer her to get up for the meal or not offer at all because she often refuses. Why does she have physical therapy at all--she definitely does not want it. 

Last week she told my cousin, the food is horrible here--I don't know why I just can't have two poached eggs for breakfast and toast--again complaining about the pureed diet. He seriously asked me why she could not have that--she had him convinced. 

So apparently Dr. Afshar wants to operate in secret without any address or phone number. He will only talk if he feels it warrants his attention. I guess he is above reproach. I have never heard of the ghost physician before so I am glad you have allowed me to write my feelings. My phone number is 316*347*9710 and my name is Sherry McDowell. I am frustrated. My e-mail is 

I have never met a physician as boringly obtuse as Dr. Afshar or on such a high level he could not talk--he told me he did not have time to listen and he also did not believe what I said. Thank you again for your forum and I hope you will get back to me. 

And as far as the food--we go to McDonalds on Fri for the fish filet sandwich.

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