Death after two-hour ER wait ruled homicide - page 12

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   mynika
    After triaging for years the stories I could tell. There was 1 case when the woman came in complaining of choking on a piece of chicken while eating a chicken sandwich. She was monitored for a time and after stating the object went down and after swallowing water was allowed to go home. She later returned to our ER as a code due to a massive MI. Due to sympathy factors this was settled with the family out of court. The Standard of Care was met but did not matter. The s/s were presented by the patient in an unusual manner. Our patient with CP, SOB, and nausea could have also told the triage nurse that they were running a fever, coughing up green luges, etc... You get the picture. I find it hard to believe that any triage nurse, experienced or new, would allow a patient with the straight forward c/o's of Nausea, SOB, CP (with no extentuating circumstances) to sit in an ED with no CP protocols started. Was it flu season?
    I will join the many in here that said there go I....

    By the way, I left ER after 15 years because of the whining inconsiderate people who abuse ER's and ER Staff. I also left because I felt the care I was giving was not adequate. It was rushed and minimal so we could move more patients through the system. I expect those ER nurses that care about patients will be harder and harder to find. It is really really hard to be caring toward a person with a smart mouth that you seen 4 times that month wanting Percocet for a toothache. And my boss wants me to make him "100% satisfied with his care". UGH.
  2. by   superh13
    ]As an ER nurse who has had the unfortunate assignment of being the triage queen, I will not even speculate on the circumstances surrounding the assessment or judgement of this nurse. Hindsight is always 20/20. Triaging in an busy ER is stressful at best. (Reality - it sucks on a good day)

    There are many questions that may or may not ever be answered. What was the true presenting symptoms of the patient? Underlying history? Current medications? What resources were available? What were the conditions of the patient's already in the department that prohibited more urgent intervention for this particular patient? What was the experience of the nurse? Was the nurse experienced enough to be at triage or placed in a position that was isolated with minimal resources? What was the patient flow coming in to the ER? How many ambulances were arriving while this patient was being triaged? What were the priorities of other patient's in the waiting room?

    Triage is a very difficult position. Using a PA or NP at triage is an inappropriate use of a mid-level provider. The triage desk in the waiting room is not an environment to adequagely assess, diagnose and treat appropriately. Fast tracks in ER's are designed to specifically address the non-urgent cases to free up the physician's time for the more urgent patients.

    This unfortunate incident identifies the limited number of providers who accept Medicaid/uninsured patients. Since these patient's who are unable to access health care will utilize the ER since EMTALA requires a screening exam and possible treatment prior to being discharged. They need care, and they can't get help.

    ]Yes, it's unfortunate that a death occurred in the waiting room. Homicide? Doubtful. Possibly negligent; who knows? My prayers are with the family and with the nurse. Being off-site and making judgements from limited media-released information is always easier then working in the trenches. ]May we, as professionals, learn from this tragedy and don't pre-judge one of our own until the ALL of the facts have been presented.
  3. by   BabyRN2Be
    Quote from hogan4736
    It's not just the medicaid pts that fill our ERs...It's everyone not knowing any better, or more likely, just not wanting to wait...It's the affluent to the homeless abusing the ER...
    I have to add here that some of it is due to the doctor's offices themselves. For a while I did not have "good insurance." Before that, I had very good insurance. During that time, every time I called my primary care doctor for things that could have been seen through the clinic (sore throat, sinusitis, etc.), her nurse told me "Just go to the emergency room." This drove me nuts to no end. I told her I can wait for a day or two, or three, this is not something that warrants the ED. She said, "You have insurance, just go to the ER!." I should say that this nurse (maybe she was an MA) could have used a little education about who should and shouldn't go to the ED.

    For a while, Medicaid pts in my state had to obtain permission from their PCP to go to the ED (during normal business hours). If they went to the ED on their own and were not admitted to the hospital, the PTS had to foot the entire ED bill. If something happened outside of business hours, they had to use the state's "Call a Nurse" line to obtain permission to go to the ED.

    I don't know if that's the case anymore. I'm wondering if it cut down on those non-emergent complaints? I imagine it would if someone got a $600 bill for a pg test or hangnail.
  4. by   twotrees2
    Quote from BabyRN2Be
    I have to add here that some of it is due to the doctor's offices themselves. For a while I did not have "good insurance." Before that, I had very good insurance. During that time, every time I called my primary care doctor for things that could have been seen through the clinic (sore throat, sinusitis, etc.), her nurse told me "Just go to the emergency room." This drove me nuts to no end. I told her I can wait for a day or two, or three, this is not something that warrants the ED. She said, "You have insurance, just go to the ER!." I should say that this nurse (maybe she was an MA) could have used a little education about who should and shouldn't go to the ED.

    For a while, Medicaid pts in my state had to obtain permission from their PCP to go to the ED (during normal business hours). If they went to the ED on their own and were not admitted to the hospital, the PTS had to foot the entire ED bill. If something happened outside of business hours, they had to use the state's "Call a Nurse" line to obtain permission to go to the ED.

    I don't know if that's the case anymore. I'm wondering if it cut down on those non-emergent complaints? I imagine it would if someone got a $600 bill for a pg test or hangnail.

    off topic a bit but speaking of high cost pregnancy tests - another peeve i have is tests when they are not needed - this surgery is the first one that let me actually sign a waver that i sad i wasn't pregnant ( and we dont need to ask how i know i wasn't i just know lol) and forgo the test - any other time they did it unnecessarily and was a waste of money for the ins co and me.
  5. by   clee1
    Quote from teeituptom
    1. So you are making your harsh criticisms on what you heard. Not what you can see and measure with your own eyes. How come the worst criticisms are always from young military medics who are in nursing schools. and think they know everything.
    That's because we are trained to use our heads and get the job done, regardless of the circumstances or load. A military medic IS the Doc 99% of the time! The vast majority of the cases seen in the ER (or Urgent Care) would never get anywhere near an MD in the military. Also, we had all the authority to we needed to provide care to the limits of our training and experience (but God help you if you screwed up!) Also, there is none of this chicken-shizzle bickering about what task is in someone's "scope of practice" like there is in the civilian world.

    So, your average military medic sees and does more in a 4 year hitch than your average ADN or BSN does for several years after NS.

    Not better or worse, just different. Military medicine has, for decades, done more with less - and the "medic" is the tip of that particular spear.
  6. by   OC_An Khe
    clee1
    Totally agree with the above post. Double if the medic served in war time and in the zone.
  7. by   schoona
    Quote from rjflyn
    My question is where was the EKG on this patient. The national standard of care is that a patient having an MI have one within 15 mins of arrival. Hence at my facility even when full up and overflowing we have one done on every patient presenting with chest pain in the triage area if need be. I would find it extremely hard to believe that this patients EKG did not have changes consistent with MI or at the very least abnormal to the point of she would not of waited in triage long enough to move some BS pt out in to the hall.

    So yes something criminal did take place. As to what I will not say as I dont know that hospital system or their protocols.

    With out all the informatin ie the chart specifically its hard to know what the triage nurse was presented with or saw. But since a jury determined a gross deviation from standards I would bet something pretty glaring occurred.



    Rj

    Have to agree, where was the ECG? It is expected that all chest pains irrespective of age get one down here. We usually have a senior dr look at it and sign off as to where they want the pt ie/ resus or general monitor or unmonitored etc.
  8. by   JessicRN
    Not sure about your hospitals but our hospital has an express it is open 1100am to 1100pm people do not care they come at 0600 and after 1100 even for a chronic non emergency. Also the express in most places is usually only a few beds and if your doctors are like mine. I can triage a pt who comes in with a sore throat but then has a multitude of complaints that they only want to talk to a doctor about then the next thing you know the pt is getting Lab xray ivf etc and takes a bed. (they do not transfer them to the main ER either) so what normally would take 15 minutes at most now takes hours. Why because our doctors are afraid to be sued so now they cover every tiny complaint of a patient with a complete workup. Used to be if a pt came to the ED with multiple nonemergent complaints the MD would say this is not one stop shopping treat the critical complaints and sent the pt home to F/U with own MD. Not anymore. In the main ED they used to only treat life and death illness now every minor headache gets a CT, we have actually done Breast ultrasounds at 0200 in the morning for a breast lump for 2 months. In the ED drunks usually were not taken to the ED they were taken to jaill,now they come to us and get direct admit to the main ED to be worked up and get xrays and CT's IVF labs and stay until they are sobrer. Mental health has cut sevices so now the patient are seen in the ED suicidal pt get immediate admit to the main ED. (we have 5 pts who come every single night sometimes 2-3 times in the 24hrs who stay until they are sober then leave to got out and get drunk then come back to get sober again. Why is it like this now, LAWSUITS who does them THE PUBLIC. So why are ER's so Busy this is why. Welcome to nursing in the ED in 2006.
  9. by   caroladybelle
    Quote from twotrees2
    off topic a bit but speaking of high cost pregnancy tests - another peeve i have is tests when they are not needed - this surgery is the first one that let me actually sign a waver that i sad i wasn't pregnant ( and we dont need to ask how i know i wasn't i just know lol) and forgo the test - any other time they did it unnecessarily and was a waste of money for the ins co and me.
    I also am frequently annoyed at the pregnancy test administered for every single female complaint...especially the times when I know positively that I am not pregnant (Can't have the disease if you haven't been "exposed").

    Unfortunately, we can blame ER abusers for that. The teens that "haven't been even kissed" with abdominal pain....the female abdominal painer that hasn't had sex w/ her spouse in years...or even better, the woman in a relationship with a man that swears that he had a vasectomy and was tested sterile, admitted with nausea and vomiting - liars of both genders abound.

    You also have to consider the lawsuits from people that "swore" they were not pregnant and on birth control, that were started on accutane or had medical tests, and "immaculate conception baby" has medical problems.

    It annoys the heck out of me to have to pee in the cup (Hello!, I've been NPO for the last 12 hours and without an IV) at every turn around, before any tests can be done and how the heck do I know when my last period was (No reason to keep track) , but I just have deal with it.

    I have had insurance refuse to pay for the test upon occasions when Ireally felt it was out of line and had it knocked off the bill....but you know we still pay for eventially.
  10. by   nfahren05
    Have to agree, where was the ECG? It is expected that all chest pains irrespective of age ...

    Definitely agree, although the issue here is gender, not age. Had this patient, presenting with these s/sx's been male, it would have been extremely unlikely that she (or he, in that case) would have been returned to the waiting room. It's unfortunate that women who present to the ER with cardiac problems are simply not treated with the same urgency as their male counterparts...and this was with the "classic" presentation of infarction, one which is not always seen in women. Too often, women show up c/o symptoms that can be dismissed as anxiety or "gas." While I don't think this case should be regarded as homocide--that would present a totally inappropriate penalty for the clinical staff involved--I would hope that it would provide a "wake up call" to ER's whose chest pain protocols do not address the female patient adequately.
  11. by   ManEnough
    When I read this story, my first thought was "wow.. that could have been *me* working triage that night."

    I work in an extremely busy, inner-city ED seeing at least 300 patients a day. I have had nights where every bed is filled with 30 patients signed in waiting to be triaged. Yes, in a perfect world, the chest pains and SOBs and strokes are spotted immediately by an experienced RN, taken straight back into a clean bed with pressed white sheets as the entire ED team jumps on them to save their life. Life is not an ABC drama.

    More likely, the first person to see the patient is a registration clerk, who may or may not have been trained to notify the RN of potentially critical signs/symptoms. The single RN at triage is probably busy triaging a smiling, happy toddler with a fever of 99.8 whose parents have never heard of Tylenol. If and when the nurse does become aware that a patient is potentially critical, they then have to sift through the 30+ people who are already signed in and make sure none of them take precedence. And, natch, when the door is opened to let in this critical patient, the nurse is no doubt deluged by angry patients and families demanding to know why someone else is being taken first. I can think of few jobs in the universe more stressful than a being a triage nurse in a busy ED. Working security for a mosque in Baghdad, perhaps?

    I'm glad this story made the press. Not because of the sensational aspect of the "Killer Nurse", but because it exposes the complex problems plaguing EDs across the country. These problems are not going away. They require national attention and legislation. It's sad that people have to die in order for people to wake up and take notice.

    My heart goes out to the nurse involved in this incident, incompetent or otherwise. I think we should all refrain from judging until all of the facts surface.
  12. by   PANurseRN1
    They don't call it "the shark cage" for nothing. :uhoh21:

    Excellent post, ManEnough.
  13. by   hogan4736
    Quote from ManEnough
    ...More likely, the first person to see the patient is a registration clerk, who may or may not have been trained to notify the RN of potentially critical signs/symptoms. The single RN at triage is probably busy triaging a smiling, happy toddler with a fever of 99.8 whose parents have never heard of Tylenol. If and when the nurse does become aware that a patient is potentially critical, they then have to sift through the 30+ people who are already signed in and make sure none of them take precedence. And, natch, when the door is opened to let in this critical patient, the nurse is no doubt deluged by angry patients and families demanding to know why someone else is being taken first. I can think of few jobs in the universe more stressful than a being a triage nurse in a busy ED. Working security for a mosque in Baghdad, perhaps?
    We have a greeter nurse...Gets made fun of (by co-workers), but it combats the very situation you describe...

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