Death After 2 Hour ER Wait Ruled a Homicide

This article (sent to me by my friend Tara) made nationwide headlines:

 

WAUKEGAN, Illinois (AP) -- A coroner's jury has declared the death of a heart attack victim who spent almost two hours in a hospital waiting room to be a homicide. 

 

Beatrice Vance, 49, died of a heart attack, but the jury at a coroner's inquest ruled Thursday that her death also was "a result of gross deviations from the standard of care that a reasonable person would have exercised in this situation."  A spokeswoman for Vista Medical Center in Waukegan, where Vance died July 29, declined to comment on the ruling. (Jury's findings)

 

Vance had waited almost two hours for a doctor to see her after complaining of classic heart attack symptoms -- nausea, shortness of breath and chest pains, Deputy Coroner Robert Barrett testified.  She was seen by a triage nurse about 15 minutes after she arrived, and the nurse classified her condition as "semi-emergent," Barrett said. He said Vance's daughter twice asked nurses after that when her mother would see a doctor.  When her name was finally called, a nurse found Vance slumped unconscious in a waiting room chair without a pulse. Barrett said. She was pronounced dead shortly afterward.  Barrett said he subpoenaed records after finding discrepancies in the hospital's version of events.

 

It wasn't immediately clear if the ruling would lead to criminal charges. Dan Shanes, a chief of felony review for the state attorney's office, said his division needed to review the case.  Vista Medical Center spokeswoman Cheryl Maynen said the hospital, just north of Chicago, cooperated with the coroner's investigation and had also investigated the incident. She declined to comment on the homicide ruling.  Copyright 2006 The Associated Press. All rights reserved.

 

As many of you know, I work as a Registered Nurse in the Emergency Department, so I have mixed feelings about this ruling.  I don’t know all the details presented at trial, but I can tell you firsthand how overcrowded ER waiting rooms have become in just the last ten years.  See there was this little law (EMTLA/COBRA) that passed and said that everyone who presents to an emergency room has the right to receive treatment regardless of ability to pay.  So forget waiting until morning to go see your doctor, or going to free clinics, the health department, etc., just show up at your local hospital for whatever ails you.

 

Now I’m for all equal healthcare, but emergency rooms were not designed to be urgent care clinics, and unfortunately that is what has happened.  And those who have really figured out the system come by ambulance regardless of urgency (I’ve checked in drunks, sinus headaches, rashes, flea bites, bumps, back pain, heavy menstruation, etc) so they can get “right back”, which is another abuse of the system.  And those who have government assistance (such as Medicaid or AHCCCS here in AZ) are the ones who utilize and abuse the ER most as they only have to pay either $1 or nothing at all for their visit.

 

So what does all this overuse/abuse of the system do for the patient who really needs urgent or emergent care?  The perfect example is the one presented in the article.  A woman with chest pain waits two hours to be brought back to see a physician.  Now in a perfect world someone presenting with chest pain and who meets certain criteria such as described above (chest pain and associated radiating pain – arm, neck, shoulder, back; nausea/vomiting; shortness of breath) would and should be brought back immediately.  But let’s say all your beds are taken up by non-urgent patients, one side-step could be to do an EKG in the triage area, but unfortunately EKGs are not the determining factor in all heart attacks and can appear “normal”.  You could also draw blood (a clearerpicture), but again not necessarily the determining factor.  It is more the whole picture, or everything totaled.  Also, given this woman’s age (medical history unknown) should have been something that would have gotten her to the back in a timelier manner.

 

Most emergency departments use the MONA system (morphine, oxygen, nitroglycerin, aspirin; along with an EKG) within 10minutes of arrival.  So to make a 49-year-old woman wait 2hours in a busy waiting room does go against the normal standard of care or protocol, but is it necessarily gross negligence or a homicide?  Some responsibility has to be placed on the patient and/or family members.  If the patient or their family member thought she was having a heart attack they should have activated the EMS system by calling 911, thereby providing immediate, and in this case, life-saving care within minutes of the onset of her systems.  The patient would have gone directly back to the emergency room and seen by either a doctor or nurse within minutes of arrival.

 

Unfortunately, as in this case, many people tend to deny their symptoms or to brush them off, or come by private car and wait in the lobby (again a denial of symptoms), and the result can often be fatal.  I can’t tell you the number of times I’ve pulled a patient out of a car who was dead or near death because they didn’t want to call an ambulance or were denying the seriousness of their symptoms.

 

PEOPLE PLEASE…CALL 911, IT COULD SAVE YOUR LIFE!

 

But also remember, the people who respond to "your emergency" are exactly that...people...human...meaning all are capable of mistakes.  As nurses and doctors we are held to a higher standard (and should be in our job setting), but we are capable of misjudgments.  So please be an active participant in your own healthcare.