I found this article "interesting" and it made me made....can someone tell my why the nurse "couldn't find help" and the MD blamed the death on her "guess". (Since I'm not certain of copywrite laws, I edited and took out names...to read the entire article go to
www.latimes.com)
From the Los Angeles Times
August 28, 2002
Hospital Error Cited in Man's Death
Stabbing: Coroner says victim of an alleged hate crime by gang members was given massive dose of an anticoagulant.
By TINA DIRMANN, TIMES STAFF WRITER
A new report on the death of a man stabbed outside a Riverside gay bar in an alleged hate crime reveals that the man may have bled to death because of hospital error.
A nurse accidentally gave Jeffery Owens 100,000 units of an anticoagulant drug--100 times the recommended dose--according to a report this week by the Riverside County coroner's office. With his blood unable to clot, Owens bled to death at Riverside County Regional Medical Center in Moreno Valley, the report said.
The coroner's report paints a picture of a confused emergency room, where the nurse was unsure of the proper dosage of the medication and couldn't find help from colleagues.
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The coroner's report lists the "inadvertent administration of excessive heparin," the anticoagulant, as a "significant condition" in Owens' death.
On June 5, the 40-year-old Owens and friends were leaving the Menagerie, a gay nightclub in downtown Riverside. The Moreno Valley man was stabbed five times and a friend, Michael Bussee, 48, was punched in the face and stabbed.
Police called the attack a hate crime and later arrested five alleged gang members
Owens, unaware of how badly he was injured, drove himself to the hospital emergency room. According to the coroner's report, doctors there considered his wounds moderately serious.
As Owens continued to bleed. Dr. ------- decided to give Owens a transfusion with his own blood. Dr. ------ a surgical resident, ordered a nurse to administer the anticoagulant heparin in preparation for the transfusion. The nursesaid she asked Dr. -----how much heparin she should use but the doctor did not know, according to the coroner's report.
The nurse told investigators she then called the hospital's blood bank and pharmacy for guidance. Neither department knew the proper dosage.
(the nurse) said she couldn't remember what happened next, but ultimately she began administering 100,000 units of the drug, the report said.
"Nobody ever gave me any direction," (the nurse) told coroner's investigators. "I thought I was giving him 1,000 units, that's what the protocol is."
The hospital's medical director said in an interview Tuesday that "the nurse guessed and she made a bad guess."
(the nurse) has been placed on administrative leave pending an internal hospital investigation.
Owens survived the surgery and seemed to stabilize, the report said. But as morning approached, he was bleeding profusely. Surgeons thought he still had an open wound and rushed him back into surgery. He died in the operating room.
"There was just generalized oozing [of blood] from everywhere," according to the report. "There was not one place that was bleeding."
Doctors at first thought Owens suffered from a condition that prevents the blood from clotting.
It wasn't until two weeks later, when Dr. ---- overheard nurses talking about the possibility of a heparin overdose, that hospital administrators became aware of what had happened.
"Accidents happen all the time in medicine," Dr. --- said. "But usually there aren't such big repercussions."
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