Babies uneccessary death!!

SharonH, RN · Jul 18, 2004

This story was extremely disturbing for a lot of reasons the most obvious being that a child died. But there are other things:

If I was a layperson reading that story in the Baltimore Sun I would have come away with the following impressions:

Only physicians give meaningful "safe" care. Every bit of meaningful care this little girl received was performed by physicians(according to this story).

Only physicians have any significant interaction in the lives of the patients and their families.

Nurses are nameless, faceless insignificant drones whose only job is to record vital signs, I&Os and call the doctors when things go wrong and they can't even get that right.

Patients cannot get safe care unless their family members(even negligent ones who let their children fall into bathtubs full of scalding water) stand watch over them.

The story also states that a code had been called and when Doctor somebody arrived, several staff members were just standing there "shocked" apparently waiting on him to give orders which he then proceeded to do.

There is a lot more to this story than is being told and the one that has been told is clealy misleading. I am not convinced from what I have read that there was absolute negligence by the hospital staff. The doctor seemed to accept blame for what happened after first blaming the nurses(I&Os not recorded properly). But an autopsy and other investigations show that it isn't clear what led to Josie's quick deterioration. According to the story, several people were following her and trying to determine what was causing her lethargy or her fevers. They were not just "neglecting" her. People and medical personnel forget that a good outcome is not guaranteed and sometimes no matter what you do, there can be bad endings.

AlishaNHayzley · Jul 18, 2004

There is a video about this story with the momma making a speech. We are required to sit down and watch it at my school right before we start passing meds. So sad.

brain · Jul 20, 2004

Patients cannot get safe care unless their family members(even negligent ones who let their children fall into bathtubs full of scalding water) stand watch over them.

And who was supervising her when she got the burns????

There have been several insinuations here that the parents especially the mother of the child was "negligent", simply due to the mere fact the child had sustained the burn injury. I do not want to be rude, but my honest reaction to this sort of unbelievable holier than thou thinking is sheer disgust.

The child went into the bathroom unobserved and within minutes had scalded herself turning on the shower. It does not take a lot of time for hot water to scald the skin of an 18 month old. And any child who can walk can do what this girl did. The only way a parent can 100% prevent it is to keep the child imprisoned, totally, 100% of the time.

If you think you are so perfect, and the parent of any child who has any accident is "negligent", 1. there are a millions of negligent parents in America, hell, every parent in this country would be negligent, 2. why are you even nursing? Resign your job taking care of the children of negligent parents, and go home and watch your own kids, 360`, around the clock, 24 hours, 86,4000 seconds a day.

The mother here is clearly one who is incredibly devoted to her kids. her grief, even after so many years is palpable. Unlike people who post anonymously on internet boards, she has gone out and through tremendous effort is trying to improve our medical system, starting with the world's greatest hospital. And she is just a lay person, not a nurse or doctor or some powerful politician. Kudos to her.

RN92 · Jul 20, 2004

I tend to agree with BRAIN. It is totally irrelevant whether or not the mother was or wasnt responsible. We are supposed to be non-judgemental. Actually, the mother praised the Docs and Nurses in ICU. She had planned on throwing them a thank-you party once Josie was home. It was only the step-down unit staff that she had a problem with. Lets please focus on the moral of the story - "listen to your patients and their families" - dont be so defensive that we refuse to look at our own errors. Thats how we learn and make better nurses. Its been my experience that if there has been a mistake made - people can deal with it better if they dont think you are hiding something - if you're honest with them up front. One of the best pieces of advise I ever got was from a "legal" nurse - "its a lot harder for pts and family to sue you, if they have gotten to know you and like you"

wonderbee, BSN, RN · Jul 20, 2004

Such a tragedy to a beautiful little life. I'll be starting a peds rotation in August. I'll think of Josie and all that went wrong in her care when I learn. Thank you for sharing her story.

Pediatric Critical Care Columnist · Jul 20, 2004

there was clearly a problem with the charting.
i'm also a bit surprised there was absolutely no change in bp.

falling bp in a toddler is a very late and often unfixable sign of impending collapse. there are at least a dozen other signs that precede an event, such as tachycardia, tachypnea, dry mucous membranes, absent tears, sunken eyes, sunken fontanel (if still present), poor skin turgor, cool, dry skin, markedly decreased urine output and increasing lethargy. a marked rise in urea, creatinine and serum sodium would also be noted (if labs were done), in the case of hypovolemic shock as seen with josie. astute assessment should pick up enough of these red flags before collapse is imminent. none of these signs appear to be noted in the chart. accurate and timely charting is a nurse's best defense should a case ever go to court and should include the full name and title of all staff notified of a problem, when and how they were notified, and what the response was. for example, ")0500: dr. j. smith notified by writer at 0330 via telephone of patient a's hr 170, rr 40 and lack of u/o for more than four hours. dr. smith ordered stat cbc, electrolytes and fluid bolus 10 ml ns/ kg to be given over 15 minutes. dr. smith then attended bedside to assess patient. please see lab result sheet for details; fluid bolus given as ordered, with hr decreasing to 130, rr now 24 and patient voided 50 ml concentrated amber urine." none of us has a good enough memory to recall all the details of an event that happened several years before, never mind who said what and when. document, document, document!!

EarthAngel · Jul 21, 2004

As the mom of 5, I can say first hand that things can get hectic. NO matter how careful you are, someone will always be sticking a butter knife in the electric socket (so to speak-dont flame) Its a bit harsh to imply the parents were careless, especially after such a loss. I cant imagine them looking something up on the internet, and stumble across this board. My heart certainly goes out to them and theirs.

1BlessedRN · Jul 21, 2004

This is indeed a very sad tragedy that could have been avoided, this hit so close to home, I lost my father-in-law last year in a similar case, instead of pointing fingers this should be a WAKE-UP CALL for all healthcare members who play a important and vital role in our society, whether you are a doctor, nurse, cna, or therapist everyone is important...please remember that.

wv_nurse · Jul 21, 2004

I totally agree. I would have to see the entire chart before I could believe this incident happened the way it is being reported. Unbelievable--- I have been in multiple codes in the past 15 years and have NEVER seen a nurse or other personnel just stand there!! Obviously this is being exaggerated.

This story was extremely disturbing for a lot of reasons the most obvious being that a child died. But there are other things:
If I was a layperson reading that story in the Baltimore Sun I would have come away with the following impressions:
Only physicians give meaningful "safe" care. Every bit of meaningful care this little girl received was performed by physicians(according to this story).
Only physicians have any significant interaction in the lives of the patients and their families.
Nurses are nameless, faceless insignificant drones whose only job is to record vital signs, I&Os and call the doctors when things go wrong and they can't even get that right.
Patients cannot get safe care unless their family members(even negligent ones who let their children fall into bathtubs full of scalding water) stand watch over them.
The story also states that a code had been called and when Doctor somebody arrived, several staff members were just standing there "shocked" apparently waiting on him to give orders which he then proceeded to do.
There is a lot more to this story than is being told and the one that has been told is clealy misleading. I am not convinced from what I have read that there was absolute negligence by the hospital staff. The doctor seemed to accept blame for what happened after first blaming the nurses(I&Os not recorded properly). But an autopsy and other investigations show that it isn't clear what led to Josie's quick deterioration. According to the story, several people were following her and trying to determine what was causing her lethargy or her fevers. They were not just "neglecting" her. People and medical personnel forget that a good outcome is not guaranteed and sometimes no matter what you do, there can be bad endings.

RN92 · Jul 22, 2004

"Obviously this is being exaggerated."

Thats just it!! its not being exaggerated. Thats why John Hopkins took total responsibility for Josies death. Otherwise, no hospital or organization would even HINT that it was their fault. I know its hard to imagine that we, as nurses, could let something so bad happen.!! It does happen. It wasnt just nurses - but it was the WHOLE system..

A great psychiatrist told me once that, we as humans,have to believe that there is some "greater force" directing our lives - otherwise, we would have to accept responsibility on our own. For instance....so and so had a wreck - was it because he was speeding? was it because he was drinking? it couldnt possibly be that "it just happened"....We have a NEED to feel in control of our lives. Otherwise, we wouldnt be in "CONTROL" - and that is scary as hell to most people. . This little girl died because of errors made by the people that were there to save her. We have to accept responsibility for our errors - thats how we learn.

1BlessedRN · Jul 22, 2004

We have to accept responsibility for our errors - thats how we learn. I couldn't agree more ERslave:)

urbancowgirl · Jul 29, 2004

Obviously, you don't have any children, or only one? When kids are that age you CANNOT keep a constant eye on them even though you may try your DAMNDEST to do so!!! Try a home with 4 small children. For the record, accidents happen.

And who was supervising her when she got the burns????