Death after two-hour ER wait ruled homicide - page 3

Death after two-hour ER wait ruled homicide "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... Read More

  1. by   jonear2
    Not to transfer any blame here, but did the daughter who was with her noice that she was unresponsive or slumped over??? That might have changed the situation.

    Also, every hour in our ED a tech comes out to take vitals on the triaged patients, at least there would have been some human contact if that were to have occured.

    No homicide, criminal negligence, definitely.
  2. by   casi
    This article doesn't paint the whole story and I'm not yet a nurse so I really can't make to great of a speculation.

    I do know that we don't know what happened in triage. We don't know what was exchanged between nurse and patient or if an EKG was done. I do know from personal experience that people who are having heart attacks can be in complete denial. Recently my father had a heart attack with the classical symptom. He didn't believe he was having a heart attack until they got him out of the Cath Lab and the Dr. who put did the angioplasty told him he had a heart attack. I don't know how normal this is but I also know that the EKG didn't appear to be abnormal until the third time they did it (just before they were going to discharge him to home) and even then it was barely abnormal. The doctor who performed the angioplasty told us that he completely expected to find no blockages; they were just taking him into the Cath Lab as a precaution.

    I guess what my story is trying to illustrate is that this article is rather vague and we don't know the whole story. Either way I don't think anyone should be charged with homicide.
  3. by   UM Review RN
    I'll be watching the outcome of this.

    Just reading the story makes me think that no matter how it turns out for this nurse, worrying about outcomes like this will only push potential nurses into safer fields.
  4. by   mercyteapot
    The article may have been vague, but the coroner has already ruled this death a homicide. I am sure s/he had the facts we're short on or wouldn't have made such a finding.
  5. by   MilitaryMedtoRN
    Quote from clee1
    This is going to happen more and more in the coming years.... until the ptb and the medical establishment get the guts to say "No, Mr./Mrs. Whinybutt. Your sinus infection is NOT an emergency - call your PCP in the morning. Oh, you don't have a PCP? Find one.... in the morning. Good bye."

    Also, the rash of Un/under-insured people using the ER as a PCP HAS to stop - like right now!

    It is unconscionable that people with emergent conditions like MI, SOB, or even a serious lac requiring sutures have to wait for hours for treatment because our ER's are crammed full of the slightly sick, chronically lame, or the insufferably lazy. Oops! I almost forgot: the severe LBP x 3 months that HAS to have some IV narcs RIGHT NOW!

    Gimme a break.

    Clee1, that reminds me of the night we got a call from the paramedics, they were bringing in a 40y/o F who went into cardiac arrest while swimming in a pool with her 3 daughters. Two minutes later we had a call that we had MVA vicitms coming in. As a courtesy someone would go out to the waiting area and inform the patients that we had emrgencies coming in. On this particular night there was a woman in the ER witha yeast infection, she had experienced for two days ( gyn had set aside appointments each day for problems like this, but I guess this woman did not like to go onhold until her call was answered). She started screaming at the charge nurse that she ahd been waiting a whole hour..................bo thought to the woman that was being brought in, in the back of an ambulance crashing. It is never going to change Clee. The ER is being used with the mindset "oh I dont need to wait to make an appointment with the Doc, I will just go to the ER
  6. by   amygooch
    Quote from MilitaryMedtoRN
    Clee1, that reminds me of the night we got a call from the paramedics, they were bringing in a 40y/o F who went into cardiac arrest while swimming in a pool with her 3 daughters. Two minutes later we had a call that we had MVA vicitms coming in. As a courtesy someone would go out to the waiting area and inform the patients that we had emrgencies coming in. On this particular night there was a woman in the ER witha yeast infection, she had experienced for two days ( gyn had set aside appointments each day for problems like this, but I guess this woman did not like to go onhold until her call was answered). She started screaming at the charge nurse that she ahd been waiting a whole hour..................bo thought to the woman that was being brought in, in the back of an ambulance crashing. It is never going to change Clee. The ER is being used with the mindset "oh I dont need to wait to make an appointment with the Doc, I will just go to the ER
    She came to the ER with a Yeast Infection????!!!!! UNREAL!!! Absolutely UNBelievable!!! WOW!!!
  7. by   911fltrn
    Triage is a difficult job. I have done alot of it. I have Icu and flights experience. I presently work agency and do triage at a facility in Illinois at times. I would suggest that if you havent done triage before you have no idea of how hard it is. The decision making process is made more difficult by the abusive patients at an inner city hospital.

    It is sad that this patient died. Negligent possibly. Criminal now that is b.s.

    I will no longer do triage in Illinois. I will go home before accepting triage as my slot. I hope the people who are making this a crime to hang on some nurse enjoy being triaged by a nurse less experienced than I am.

    I suspect that if this nurse is charged you will not be able to find any nurses to do triage. Bad blow for the family of this poor lady. Very bad for the thousands of patients needing triage in the future.
  8. by   Medic/Nurse
    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!
  9. by   Sheri257
    Quote from clee1
    This is going to happen more and more in the coming years.... until the ptb and the medical establishment get the guts to say "No, Mr./Mrs. Whinybutt. Your sinus infection is NOT an emergency - call your PCP in the morning. Oh, you don't have a PCP? Find one.... in the morning. Good bye."
    Last semester our teacher really hammered on this point during our ER lecture ... that people need to go to doctor's offices, urgent care, etc. instead for minor ailments.

    Nevertheless, while I'm doing my ER rotation ... there's one of our nursing students bringing her kid into the ER for a minor ear infection. I was stunned ... did she listen to the lecture at all?

    She's a nursing student ... and she should know better. It just goes to show how bad it is. People will continue to abuse the ER as long as you let them.

    :typing
    Last edit by Sheri257 on Sep 17, '06
  10. by   ironica01
    that's why in my hospital (RWJ, unfortunately the nurses are on strike) we have a Code MI on patients who come in with classic AMI symptoms. they are brought to the cath lab within an hour of triage. whether positive or not, the patients are take care of.
  11. by   PANurseRN1
    Quote from NREMT-P/RN
    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!
    Excellent post! Part of the time I work in the ED and do triage; it's an incredibly difficult job. Anyone who has not had the special privilege of working triage should sit down and shut up on this one. You cannot possibly know how you would have responded. Anyone can spout the textbook answer or cite "standard of care." Try doing that when you have a pt. giving you a vague, ever-evolving story and a packed ED with every critical care room filled and no monitors left.
    Last edit by PANurseRN1 on Sep 17, '06
  12. by   CseMgr1
    Quote from NREMT-P/RN
    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.
    Bingo. And if these lawyers really want to accomplish something, then they need to file a Class Action lawsuit against this country's health care system, which has been allowed to sink by self-serving politicians and greedy corporations...which should be considered a criminal act in itself.
    Last edit by CseMgr1 on Sep 17, '06
  13. by   michele08540
    TOO MANY NON- EMERGENCIES In the ER, (sore throat, splinters, scrapes etc) they need to have a Urgent Care and a ER and both properly staffed.
    That's really sad :-(

Must Read Topics


close