Death after two-hour ER wait ruled homicide

I'm not sure where to start on this one - but here goes...

1. You DO NOT KNOW what YOU DO NOT KNOW. I find a tragic set of circumstances that does raise questions. QUESTIONS we don't have all the answers to.

• 49 F patient with CP, SOB - sure at first glance "sounds like a classic MI to me". I'm a bit surprised at HOW FAST other nurses jumped on - "OH, I would have rushed the patient back, classic MI", "Did this triage nurse know how to do the job?" I challenge any triage RN that has NOT at some point had a "CP" that had to wait for a ED bed.

TIME OUT.

Sure it would be a perfect system where all CP's were rushed to a bed - but the reality is this - sometimes there is no bed to put someone in. Some places do 12 leads/labs at triage and then try to assign, but the fact is this:

MOST ER'S ARE NEAR THE BREAKING POINT. YOU HAVE FINITE # BEDS, FINITE # OF STAFF. UNTIL THERE IS A FUNDAMENTAL CHANGE IN THE WAY ED'S OPERATE - WE ARE PROBABLY JUST SEEING THE TIP OF AN ICEBERG SIZE PROBLEM - THAT MAY JUST SINK US ALL.

Yep, 2 hours does seems like a long wait - but I (and others) do not know the other circumstances. Maybe this was a 49 year old female frequent flier that had NO cardiac history (maybe she had a normal cardiac cath (or 2) - that was finally done because her 22 other ED visits in the past 6 months for CP - because that complaint gets me rushed right back- that were never ruled in as a cardiac cause) Maybe she had no family history. Maybe this CP had been going on for 4 days with a productive cough and her 2 pack a day smoking habit (with her last cigarette smoked just as she entered the ED waiting room doors). Maybe she did not look ill (no pallor, diaphoresis) Maybe the VS were normal. I am a fairly experienced triage nurse and I have had cases of CP that I either could/would/did not "Rush Right On Back". It really just depends on the patient/symptoms/available resources. I can say that regardless of the beds/staff - If I thought a patient was looking like an AMI - I made a spot for them (even if it was a radiology stretcher with a transport monitor and personally got the doc to the bedside now). But, I can say with 100% honesty that I have had a "CP" have to have a seat in the waiting room.

2. This Coroner that called the inquest - just what were their "qualifications"? In many states coroners do NOT have to be Medical Doctors or have ANY medical background for that matter. In many locales coroners are FUNERAL DIRECTORS that are elected to a political post. Most laws that deal with coroners in many states, require little training and give them broad legal authority. Pretty scary. (This is a whole other soapbox of mine, I'll stay off of it for this case) So depending on the circumstances surrounding this coroner and the "Patient/Victim" - I think the entire situation may need a closer review.
DEATHS can be ruled as to manner: NATURAL, HOMICIDE, SUICIDE, UNDETERMINED, ETC. AS to the cause of death there is the autopsy (with an MD, not necessarily the coroner) finding that will that detail the physical cause of death.

Also in some matters like this there could be some POLITICAL motivations.

KEEP IN MIND HERE - BECAUSE THE CORONER RULED "HOMICIDE" - Now means that the "case" will enter the CRIMINAL JUSTICE SYSTEM. Some prosecutor will now have to make a "case" against someone who is responsible for this death, err..HOMICIDE. This means that someone will be CRIMINALLY CHARGED and will be ARRESTED for a FELONY and may go to JAIL or ultimately PRISON.

Now???

WHO DO YOU CHARGE WITH THE CRIME?

The triage nurse?
The charge nurse?
The hospital administrator?
The ER physician?
EVERYBODY?

I urge all the awesome nurses and medical professionals to take a step back here - and consider the practice decisions that we must make on a daily basis. Given any number of variables -

Could I have been that triage nurse?

WE are ALL dealing with serious issues:
ED overcrowding in general, in- patient admission issues,
limited staff (and some inexperienced staff) with high patient loads/acuities, some ED cultural practices,
the droves of the non-emergenct patients that due to the nature of the "beast" often take up ED beds for prolonged times,
and administrations, that although aware, that are fully not supportive of the ED staff and are unwilling to make the necessary adjustments that will allow ED's to treat the emergent patients and refer the others to alternate sources of care.

Anyway, before we rush to judgement - I urge caution from other providers. This tragedy has left a patient dead, but will destroy other lives as well.

Practice SAFE!

What was this nurse thinking??? Nausea, SOB and CP. This is ridiculous.