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As patients die waiting in emergency rooms, as they lay neglected in hospitals beds, as they struggle to find proper care for injuries and illness, a new first commandment has emerged for anyone forced to seek medical care:

Never, ever go alone.

Do not enter a hospital, an emergency room, or any other medical facility without competent, assertive help by your side at all times. To do so puts your very life at risk. Even doctors and nurses on the front lines of the system will tell you that today.

As hospital care grows increasingly complex and medical errors kill some 100,000 Americans every year, a whole new industry is forming to deal with this disaster — offering hired help to get you through your hospital stay alive.

It is a trend emerging here and across the country, though it's not without controversy — and a hefty price tag. But it may be offering a vital, even lifesaving service in a severely overburdened medical system plagued by a shortage of nurses, doctors and hospital beds.

Arizona — with the nation's longest ER wait time and an extreme shortage of doctors and nurses — should prove fertile for the fledgling business.

"We have seen so many patients — including my own father and mother — nearly die in the hospital because of mistakes or neglect, we realized somebody had to do something," said Alice Milton, a Tucson attorney now working for Patient Care Advocates, a company launched two years ago in Tucson — first to provide home care services, expanding to hospital patient advocacy in recent months.

"This idea was born of personal trauma, of seeing firsthand what kind of fight you have to wage to get decent care for someone you love. And of seeing patients who are absolutely terrified to go to the hospital, because they are certain they will die there," Milton said.

"The need for this is huge — great enough to actually earn a living doing it."

As University of Arizona neurosurgeon Dr. Allan Hamilton said in his just-published book, "The Scalpel and the Soul":

"Having a guardian angel to watch over you is critical if you are the patient and want to get out of the hospital alive. Most folks have no idea how prone the medical field is to mistakes."

You don't always have to pay for your patient advocate.

Many people have family members or friends who have the time and savvy to shepherd them safely through their hospital trip — monitor their medications, review their treatment plan, know their detailed medical history, alert overworked nurses when vital signs go bad, battle for timely attention in a jammed ER, coordinate care as nurses and doctors change shifts, and look out for their comfort, hygiene and mobility.

But many of us don't have that kind of help when crises strike.

Norma Jean French's son is a UA-trained doctor. But when she had to go into the hospital twice last year for surgery and heart problems (once to St. Joseph's Hospital and once to University Medical Center), he immediately put the team at Patient Care Advocates — a nurse practitioner, a registered nurse, a physical therapist, an attorney and a physician medical director — on her case.

It may have saved her life.

At one point, French, 82, developed atrial fibrillation — an abnormal heart rhythm that can prove fatal if undetected — on an early morning in the hospital. She was not on a monitor, so no warning sounded. But her advocate at that hour, physical therapist Josie Gorman, noticed her client "did not look right."

"When the heart goes into flutter, the blood pressure drops, and if you have experience with this, you can see changes in the patient when that happens," Gorman said.

She immediately summoned nurses and a cardiologist, who stabilized French.

"They were so surprised this had happened. The medications she was on had thrown her system off," Gorman said.

What almost happened to French — known as "failure to rescue" — is the leading cause of preventable hospital deaths. More than 188,000 patients died from 2004 to 2006 when hospital staff failed to notice or respond to fatal complications that could have been prevented, according to the most recent report from HealthGrades, a national health-care ratings group.

"I was so impressed with these girls — I cannot tell you how grateful I was for the care they gave me. They are outstanding," French said.

"My son knew the hospital was short of nurses, and he wanted them to stay with me. He called them in. I was very sick, and he knew I would not get the care I needed.

"Sometimes when you're in the hospital, you're not really with it. And certain patients need more care than a short nursing staff can give."

French said she noticed no conflict or resentment from hospital staff toward her outside advocates — though that has been a reported push-back to this new industry, and a source of controversy around it.

"The nurses seemed very happy to have them there; they seemed to appreciate the extra help," she said.

But some physicians have complained that this extra layer of people around a patient actually can complicate care, create conflict and interfere with communication and treatment.

"I guess the professional attitude should be, if someone is asking questions or trying to advocate for a patient, we should accept that," said Dr. Michael Hamant, a Tucson primary care physician and president of the Pima County Medical Society.

"But when it is a business relationship — someone is trying to justify a fee — there's a risk they will be showing off, interfering, asking inappropriate questions, to earn their pay. That is a concern."

But Hamant admitted a medically educated advocate with good social skills — paid or not — indeed could be useful in today's hospitals, where the care is extremely complex and dangerously fragmented, with the patient passed off from the family doctor to a hospitalist or a subspecialist as shifts change.

"There is a communication breakdown that occurs. I always ask the hospitalist to call me when one of my patients is admitted to their care, but they often choose to be too busy to do that," Hamant said. "That can really cause problems for the patient, with the medications, the medical history.

"When a knowledgeable, professional advocate, whoever it is, can bridge that breakdown for the patient, then it is very helpful."

But the services of paid advocates are automatically exclusive — available only to those who can afford them. That troubles many in this new business, and sets the stage for scams and frauds targeting vulnerable, often elderly patients.

Patient Care Advocates charges an upfront fee of $1,895 for two years of patient advocate service, available whenever it's needed. They say that does not cover their actual expense of performing the service, which is supported by the other part of their business, home health-care services.

It may indeed be a "bare-bones" fee, as Chris Simon, a registered nurse at the company, puts it, compared to a Baltimore-based company that charges a $15,000 initiation fee, then $10,000 a year for similar services for a family.

Offering a different fee structure is Heartfelt Senior Homecare, based on Tucson's Northwest Side, which offers in-hospital patient advocacy service for $35 an hour. That compares to reported hourly fees of $100 or more elsewhere in the country.

"Some charges for this are outrageous," said Susan Coopman, owner and geriatric-care manager for Heartfelt.

"This is a very new service nationwide, with little oversight, so people must be vigilant that whoever is advocating for you does have the training and resources to do what they promise. You must get references. You must check their credentials."

And with so much personal information — medical and financial — available to the advocate, fraud and scams are a real threat, she warned.

"There are scary things happening out there with this very new industry. Make absolutely sure whoever you hire is trustworthy."

But it may not be long before this advocacy is covered by insurance, some in the business say.

"The costs for medical care go way up when patients are neglected," said Kathy Andrea, nurse practitioner at Patient Care Advocates. "Once insurance companies realize this saves money, they'll cover it."

She's right. Already, several large U.S. corporations have added this service to their employee health plans, for a small extra monthly fee, ranging from $1 to $4 on employee premiums.

But the very fact that there is a growing market for the service "is a bad sign," said Sean Clarke, associate director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

"It signals that people are losing faith that hospitals can provide safe care," he said. "It's a clear statement that the system is broken, and instead of fixing it, you have to hire someone to get you through it safely.

"If this industry really takes off, this is not where we want to be."

On StarNet: Find links to recent articles about health care in Tucson at azstarnet.com/health.