When it comes to hospital food, some patients have greater concerns than how it tastes.
The last thing on Danielle Kichler’s mind when she went to the George Washington University Hospital emergency room for chest pains in August 2008 was her next meal.
But hours after checking in, the 43-year-old Florida native grew hungry and informed hospital staff that she would need a vegan meal – one with no meat, dairy or eggs. Then, and throughout the day, a nurse said the request had been noted.
When it was delivered, however, Kichler’s lunch consisted of a roast beef sandwich, chicken noodle soup and dessert. She ate the side salad and sent back the rest.
“I was really upset and a little annoyed,” Kichler, who has been a vegan for 10 years, said. “I think in my case there was either a breakdown in communication or the nursing staff blew me off.”
Despite several requests, she never received the vegan meal during her 26-hour hospital stay.
“Maybe I should have complained,” she said. “But at that point I just wanted to get out of there.”
The hospital eventually diagnosed her with acid reflux and released her from the hospital.
GW Hospital declined to be interviewed for this story. A spokeswoman said GW subcontracts dietary services to an outside company.
Kichler’s experience exemplifies the difficulties patients can face when they request hospital foods that meet their religious or lifestyle beliefs.
Patients with dietary preferences like Kichler’s are not alone. A 2008 poll by Vegetarian Times magazine found that more than 7 million people eat a vegetarian-based diet and 1 million of those are vegans. Nationally, 21 million people follow a gluten-free diet, reported Forbes magazine in May 2011.
The Physicians Committee for Responsible Medicine, a nonprofit organization that promotes vegetarianism, found that fewer than one-third of the 40 hospitals it surveyed in a 2005 study offered a daily salad bar or vegetarian entrée. At hospitals that offered vegetarian options, many meals were high in fat, sodium and cholesterol.
Susan Levin, director of nutrition education at the organization and a registered dietitian, said many hospitals don’t have an incentive to consistently serve healthy meals because it’s unlikely that a sick patient will leave their facility because of their diet.
“It’s disgraceful that every hospital isn’t serving food that we know is scientifically proven to be healthy,” Levin said. “There’s such a disconnect – it’s almost criminal.”
Little information is known about hospital food because privacy laws make it difficult to access patients’ menus, said Levin. In winter 2011, the organization published an updated hospital food analysis listing the five worst hospital cafeterias in the U.S. that host fast-food outlets and offer fried foods — none were in the D.C. metro area.
In Washington, home to both a large and ethnically diverse population, catering to every special dietary request can be a challenge. From kosher and halal to sulfite free and organic requests, it’s easy for a misunderstanding to occur between patients and hospital staff. And even if hospital food technically meets a certain dietary restriction, it could lack nutritional value.
Patients at Washington Hospital Center in Northwest D.C. who are not on special diets eat meals comparable to what the general public might eat — ones flavored with more fat and salt. The hospital’s food and nutrition director, Patrick McDonald, said these types of meals are some of the easiest to produce.
McDonald said the hospital receives few complaints about unmet dietary preferences because a nurse takes the patient’s meal order every day. Many of the complaints it does receive result from a patient’s high expectations.
“If someone comes in demanding filet mignon and lobster tail, that’s just not realistic from the beginning,” McDonald said.
The hospital gets about two kosher requests a week and 20 weekly requests for gluten-free and vegetarian meals, said McDonald. The hospital buys gluten-free pastas, cereals and snack bars to meet the increased number of gluten-free patients, who can’t eat anything that contains wheat, rye and barley. The hospital doesn’t have a kosher kitchen, which requires adherence to a strict set of food preparation rules, but it keeps frozen kosher meals on hand.
He said there are systems of hospital food management – similar to a hotel room service-style food ordering and delivery – that could improve how patients get their preferred meals, but these systems are expensive and difficult to implement.
In Baltimore, Johns Hopkins Hospital decides what patients will eat by inputting diet orders from their doctors into special nutrition software, which automatically filters what each patient should eat.
Johns Hopkins clinical nutrition manager Julie Branham said patients could also note allergies and preferences on their intake forms when they arrive at the hospital, and nurses ask again about their food restrictions and preferences during assessments.
Branham said because of its urban location, the hospital serves people from a wide variety of racial and socio-economic backgrounds, including about 400 patients who make special dietary requests a week.
“It’s a challenge to have healthful foods for one group when you have another group who wants comfort foods like macaroni and cheese or meat and potatoes,” Branham said.
If the hospital does not have a requested food in stock, staff has been known to travel to Whole Foods grocery store to find it.
“We never let cost get in the way,” Branham said. “If we can’t get it, it’s simply because no one can get it.”
At Sibley Memorial Hospital in Northwest D.C., clinical nutrition manager Christa Bowen said cost and availability drive the extent to which dietary preferences can be met.
She said individual requests, such as a certain brand of gluten-free crackers, are weighed against what other patients will eat, and the hospital encourages patients with very restrictive diets to bring their own food.
While the hospital does not get many vegan requests, it has seen an influx of “odd” requests, Bowen said, such as aversions to high-fructose corn syrup and the food additive maltodextrin, which is used to sweeten a number of foods, including canned fruits and dessert mixes.
Sibley recently overhauled its vegetarian menu to add more protein. The number of vegetarian requests by patients there has since increased, said Bowen.
The menu at Shady Grove Adventist Hospital in Rockville, Md., follows the Seventh-Day Adventists religious tradition, which calls for a vegetarian lifestyle. The hospital’s standard menu is lacto-ovo-vegetarian, which includes dairy and egg products, though a meat-based alternative is offered daily.
Ethnically diverse patients sometimes bring outside food into the hospital. A traditional Indian lentil dish was added to the main menu because so many patients request it.
Pamela Barainca, clinical nutrition manager at Shady Grove, said more patients are asking for healthier food and there has been a rise in patients choosing to eat gluten-free.
Hospitals are responding to calls to make healthier foods available to employees and visitors, but there is no consensus about what constitutes healthy hospital food, Nutrition Today found in a 2010 analysis.
Until hospitals figure that out, Kichler plans to pack her own food if she goes to the hospital again. She said that while the D.C. area is vegan friendly, she is not surprised that hospitals cannot always accommodate special diets or provide healthy food to patients because of high costs and staffing shortages.
“I think some vegetarians and vegans are reluctant to make a stink because there are people who perceive us as being annoying,” she said. “I hope next time I have the courage to speak up.”