Three ED visits in six months. The fourth would have cost her job.

The situation

Lupita is 38, a social worker in Phoenix, mother of two. Her dad Carlos is 72, retired, lives ten blocks from her. Carlos has heart failure following a heart attack two years ago. By the time Lupita reached out to Pinnie, Carlos had been to the emergency department three times in six months for fluid overload. Each time Lupita had left work mid-shift to meet him there. Her supervisor was patient. Her supervisor was also done being patient. Lupita could not afford to leave a fourth shift.

How Pinnie stepped in

The advocate, Elena, started by getting a copy of Carlos's full medication list. She found three duplicate prescriptions written by two different doctors, including a beta blocker Carlos was taking at twice the prescribed dose. She set up a three-way call with the cardiologist and primary care provider to consolidate everything onto one prescribing physician. She arranged for a visiting nurse to come every Wednesday morning to fill the weekly pill organizer and do a quick weight check. She set up a daily symptom check-in with Carlos and built him a simple paper log to track weight, swelling, and shortness of breath. When numbers drifted, the nurse adjusted diuretics by protocol within hours, not days.

Where things are now

Eight months into the new plan, Carlos has not been back to the emergency department. His weight is stable within a two-pound range. Lupita has not left a single shift. She checks in with Elena every two weeks, mostly because she likes hearing her dad is okay from someone other than her dad.