Death after two-hour ER wait ruled homicide - page 13

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   scooterRN52
    Quote from Sylv
    Exactly!

    These are classic signs of an MI, that nurse should have made the pt a priority and she should have been listed emergent!
    Last edit by scooterRN52 on Oct 1, '06
  2. by   PANurseRN1
    Quote from scooterRN52
    These are classic signs of an MI, that nurse should have made the pt a priority and she should have been listed emergent!
    You were there? You have all the facts surrounding this case? You've worked as a triage nurse in a busy ED?
  3. by   Medic/Nurse
    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!
    Just wanted to bring my humble ideas to the front again - I remain stunned by the #'s who would have without question, regardless just rushed this patient back as the "sickest". Take it easy folks - lets see how this plays out. Sure, it's tragic. But, hindsight is 20/20. Until you are the one with the same set of cuircumstances/challenges it is really NOT POSSIBLE to predict an absolute behavior.


    Also, I still cannot find where ANYONE has been charged criminally - so see the coroner statement above. There is so much more to this that what we KNOW. I am waiting for disclosure before I form an absolute opinion. I encourage others to do the same.

    But for the grace of God go I...


    Stay Safe!
    Practice Safe!
  4. by   Cheyenne RN,BSHS
    Quote from nremt-p/rn
    just wanted to bring my humble ideas to the front again - i remain stunned by the #'s who would have without question, regardless just rushed this patient back as the "sickest". take it easy folks - lets see how this plays out. sure, it's tragic. but, hindsight is 20/20. until you are the one with the same set of cuircumstances/challenges it is really not possible to predict an absolute behavior.


    also, i still cannot find where anyone has been charged criminally - so see the coroner statement above. there is so much more to this that what we know. i am waiting for disclosure before i form an absolute opinion. i encourage others to do the same.

    but for the grace of god go i...


    stay safe!
    practice safe!
    wow, your input was well balanced, thought out, and fair. one does have to look at all the aspects of the case and i have personally known people who will c/o chest pain for the very reason "it will get me back there and seen faster."

    when it comes to placing blame, the general public has a large portion of that load to carry. er's are filled with non-emergent cases such as: abdominal pain's of "3 weeks duration", sinus headaches "for the last three days" , and c/o "no bowel movement for a week" in a twenty year old.

    imho, if society would use er's for what they are designed for, real life and death emergencies and not an after hours handy clinic, then there would be not be long waiting periods to begin with. we have all seen abusive uses of the er.






  5. by   BSNtobe2009
    I had cut my hand once accidently with a butcher knife (don't substitute a butcher knife for a job designed for a utility knife), I must have hit a vein because I was bleeding profusely.

    I went to the emergency room and held up my bloody hand covered by the other one and said, "I cut my hand really bad".

    You know what the snippy attendent said? "Sign in here" and then WALKED OFF.

    I stood there yelling for her through the window...finally I got sick and tired of waiting and picked up the pen, signed myself in, and pushed the now, blood-drenched clipboard back to her just as she was returning back to her seat.

    Yeah....it was the wrong thing to do...but the look on her face was priceless.
  6. by   UM Review RN
    Quote from fire wolf
    ...
    when it comes to placing blame, the general public has a large portion of that load to carry. er's are filled with non-emergent cases such as: abdominal pain's of "3 weeks duration", sinus headaches "for the last three days" , and c/o "no bowel movement for a week" in a twenty year old.

    imho, if society would use er's for what they are designed for, real life and death emergencies and not an after hours handy clinic, then there would be not be long waiting periods to begin with. we have all seen abusive uses of the er.
    true, but we all also forget something--non-medical people have no clue as to what exactly constitutes an emergency.
  7. by   CHATSDALE
    our hospitals have lpn work admitting, they as for sx, take vs and do a primary triage..doesn't solve the whole problem but is a start

    another thing i have noticed in reading this thread is that if you are in er as a pt or fly member with what you believe to be a serious condition, don't fall through the cracks make noise, if this annoys the personnel maybe they will assess the problem this is what has made the difference in a lot of cases
    once when i was on coumadin i had to have a vit k injection..the md's nurse called me and told me to go to the ed..i had to wait over two hours for a simple shot in the hinney . this could have been done by any nurse in the doctors office but the value of my time and the time of er personnel was a low priority
  8. by   navynurse06
    I don't know if this has already been said or not but....The ER I worked in if a pt came in c/o chest pain that was an automatic ticket to the back. Then O2, IV, Monitor. Some of the frequent flyers knew this so they would say they had CP to get to be seen faster.
  9. by   RNKay31
    OMG! so sad to hear.
  10. by   BSNtobe2009
    Quote from navynurse06
    I don't know if this has already been said or not but....The ER I worked in if a pt came in c/o chest pain that was an automatic ticket to the back. Then O2, IV, Monitor. Some of the frequent flyers knew this so they would say they had CP to get to be seen faster.
    That is how they do it where I used to live. I am only 37, but went to the ER thinking I had chest pains, and my nose actually started to bleed as I pulled into the parking lot. Scared the **** out of me. I had a BP of 160 over something (probably b/c I was so feaked out), but normal EKG.

    Found out later it was a horrible, inner ear infection that was pulling tension on the muscles on the side of my neck that went down to my chest. The pain was unbelievable. I couldn't beleive an ear infection could cause that much pain.
  11. by   jack8592
    This is so sad. I am not sure this is homicide, but definitely negligence. ER waiting rooms are always a nightmare, but when a client presents with CP or symptoms of any cardiac problem, they are triaged quickly to prevent this sort of thing. The triage nurse who had the labs & EKG done should have immediately brought the results to the MD. ????
  12. by   imenid37
    Quote from MilitaryMedtoRN
    What was this nurse thinking??? Nausea, SOB and CP. This is ridiculous.
    I work OB and have for the past 16 years. I was pulled to the ED several months ago and they wanted ME to be the triage nurse. I told them to forget it. I happily went around and had a great shift working with two other nurses who had pts. who need VS, to be tranported, etc. My point is that someone actually thought it would be okay for me to be the triage nurse. Who knows, this nurse could have been from another floor, etc. Something doesn't add up. The daughter was so concerned she asked when her mother would be seen, but yet left her alone to do whatever when they found her mom arrested. I would think if she was w/ her when she slumped over, she would have gotten help. This is either gross understaffing, gross incompetence or a good bit of both. There has got to be more to the story. You would think her sx's were an automatic ticket, but who knows perhaps she was known to the staff for some reason and they didn't take her seriously. Very sad though.
  13. by   EDValerieRN
    http://cbs2chicago.com/northsuburban...258112521.html

    A little more to the story:

    "According to his investigation there were no signs of disease or trauma and a five panel drug screen all came back negative. The autopsy revealed that she had a heart attack and had severe blockage of the left main coronary artery.

    At various times Beatrice Vance complained of chest pain, pains in her legs, feeling cold, shortness of breath and sweating. At one point Vance's daughter asked for a doctor to look at her mom and she was told she would have to wait because two ambulances had just arrived.

    At that point Monique Vance inquired about other hospitals in the area, even thinking at one point that she might call 9-1-1 to have her mother transported to another hospital."

close