Death after two-hour ER wait ruled homicide - page 17

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   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!
    i have followed this case and remain committed to my original post. the entire situation remains pretty scary and i think we all should look at our practice and ask:

    [font="georgia"]"could this happen to me?"

    i have been this triage nurse. how about you?
  2. by   theofficegirl
    Quote from MilitaryMedtoRN
    What was this nurse thinking??? Nausea, SOB and CP. This is ridiculous.
    Ditto! This is an ER Triage Nurse????

    I'll stop now so I don't get mean.
  3. by   charebec65
    I went into the ER the other night. I was feeling vertigo, nausea, chest tightness, sob on exertion and my b/p was in the 170's/130's just before my hubby took me in. I gave the nurse at reception my this information and told her of my hx of Mitral Valve Prolapse and Wolff Parkinson White Syndrome. She gave me a number and sent me to the waiting room. About 40 minutes later, after pts like a child who had been hoarse since 3am the previous day, I was finally taken back for 'triage'. At that point my b/p was 209/136 or 138. After that nurse was done with me I was sent over to the registration desk to register before I was taken back for an EKG, CXR, etc., almost an hour after I arrived. Once back in the ER, everything was done quickly. Fortunately my cardiac enzymes were okay and with different meds my b/p went down nearly to normal but who knows how it could have been.
  4. by   burn out
    This is a systems problem not one that any one person did anything "wrong". You can not blame one person but the system as a whole. I doubt if this particular hospitals ER functions that much differently than any other ER, therefore, it is not just a system problem at one facility but more a matter of how care is delivered across the health care industry. I don't now how you could sue a system , maybe hold the hospital accountable for this particular delivery of care system but them all hospitals will need to make changes too.
  5. by   Medic/Nurse
    Hey there theofficegirl -

    You can get mean if you want. Not too sure what it will accomplish - or where it comes from?

    I am having a hard time figuring out if you are a REGISTERED NURSE or not. I note that your profile lists "other" as nursing education, so...

    I see additional degrees, but...

    Until YOU are the one on the LINE - and actual practice considerations that place YOU as the licensed REGISTERED NURSE, I think it is a bit heady and reckless to sit in judgement of a REGISTERED NURSE. It is so easy for other REGISTERED NURSES to be a armchair quarterbacks as it relates to another REGISTERED NURSE in many situations - still this is not a good practice. Now add the ancillary staff that sits in judgement and the issue gets murky at best! Until you are the one that "has it on the line" you opinion does not have the relevance of a peer! Is "this opinion" any more relevant than the opinion of a layperson?

    I encourage all to list your credentials with your opinions! That way it is easy to see what "Practice Reality" you come from - and we all come from different practice realities. Also, our experience will dictate our understanding!

    Practice SAFE!

    RN, CEN, CCRN, NREMT-P, BA

    Additional coursework:
    ACLS, PALS, NRP, TNCC, ENPC, PHTLS and 16 YEARS OF EXPERIENCE IN EMERGENCY/ACUTE/CRITICAL CARE! Also instructor in many of the courses above! Also undergraduate instructor (didactic and clinical) in emergency care and nursing disciplines! Also, I have extensive experience as a subject matter expert in medical-legal matters that relate to nursing/medical practices!

    I'm not trying to be mean either! Nothing is accomplished with mean! I just think it is important to be clear!

    Last edit by Medic/Nurse on Feb 13, '07
  6. by   PANurseRN1
    Quote from theofficegirl
    Ditto! This is an ER Triage Nurse????

    I'll stop now so I don't get mean.
    Excuse me, but it's bad enough that people who have never worked as ED triage nurses are passing judgement, let alone people who aren't even nurses period.

    Now I'll stop before I get mean.
  7. by   PANurseRN1
    Quote from NREMT-P/RN
    Hey there theofficegirl -

    You can get mean if you want. Not too sure what it will accomplish - or where it comes from?

    I am having a hard time figuring out if you are a REGISTERED NURSE or not. I note that your profile lists "other" as nursing education, so...

    I see additional degrees, but...

    Until YOU are the one on the LINE - and actual practice considerations that place YOU as the licensed REGISTERED NURSE, I think it is a bit heady and reckless to sit in judgement of a REGISTERED NURSE. It is so easy for other REGISTERED NURSES to be a armchair quarterbacks as it relates to another REGISTERED NURSE in many situations - still this is not a good practice. Now add the ancillary staff that sits in judgement and the issue gets murky at best! Until you are the one that "has it on the line" you opinion does not have the relevance of a peer! Is "this opinion" any more relevant than the opinion of a layperson?

    I encourage all to list your credentials with your opinions! That way it is easy to see what "Practice Reality" you come from - and we all come from different practice realities. Also, our experience will dictate our understanding!

    Practice SAFE!

    RN, CEN, CCRN, NREMT-P, BA

    Additional coursework:
    ACLS, PALS, NRP, TNCC, ENPC, PHTLS and 16 YEARS OF EXPERIENCE IN EMERGENCY/ACUTE/CRITICAL CARE! Also instructor in many of the courses above! Also undergraduate instructor (didactic and clinical) in emergency care and nursing disciplines! Also, I have extensive experience as a subject matter expert in medical-legal matters that relate to nursing/medical practices!

    I'm not trying to be mean either! Nothing is accomplished with mean! I just think it is important to be clear!

    Ditto, ditto, ditto!

    RN x 22y including ED (just spent part of last Sat. "in the cage," as a matter of fact).
    Last edit by PANurseRN1 on Feb 13, '07
  8. by   walk6miles
    This ridiculous and disgusting breach of every first year of nursing school basic cardiac guidelines reminds me of two situations. The first, involved my sister. After a half day spent at Kennedy Space Center, she began to complain of SOB; one look at her gray, pasty skin had me sitting her down and calling for an ambulance (her chest pain did not come into play until after she was in the nearest hospital's ER). My brother-in-law and I followed the ambulance and we sat quietly in the waiting room (based on experience, I felt it would be polite to wait at least 45 minutes before approaching the ER staff). Bear in mind, the ER was a small one (8 beds) and as I counted later, only three were filled, including my sister. We were allowed to see my sister, who at that point in time was seated upright on the stretcher with EKG monitoring (however, all the alarms were OFF on her monitor)and as we stood there, the physician FINALLY came in to assess her! Now where in the h..ll was he when the ambulance came in?!!! The initial labs weren't drawn until my sister had been there for over an hour!! Needless to say, my sister was transported to the hospital where I worked in Open Heart Recovery. She was cath'd, placed on a balloon pump and rushed into emergency open heart. She is doing quite well at this time!
    Now for the second "incident": during my time as an ER nurse, I got a great deal of experience. At the time I worked either Fast Track, Med. Obs., Trauma, or Medical, Triage was frequently handled by "techs". (A policy which has since been changed). This particular night, a tech came into one of the rooms I had in Fast Track and asked me if I would take a look at a patient out at the Triage desk. I walked out to find an elderly man with his left foot in a black plastic trash bag; a piece of rope was tied around his ankle on the outside of the bag. I asked the tech if he had seen the man's foot (NO), so I knelt down and undid the rope and the plastic bag. To my utter HORROR, blood was oozing rapidly from the dirty dish towel he had hastily wrapped around the ARTERIAL cut !!!! We rushed the man via wheelchair to the TRAUMA room! The tech was not to blame - no one had really trained him for something like the man with his foot in a plastic bag; indeed, I was very relieved he had the sense to find a nurse to assess the situation instead of having the patient sit in the waiting room until the "suture room" became available!
  9. by   GLORIAmunchkin72
    "Excuse me, but she died of a HEART ATTACK, right? Them there's what we call 'natural causes' in these here parts. Failure to appropriately assist might be negligence, but it isn't and wasn't the primary cause of death.

    A multi-million dollar judgment? Probably."

    The question is, would the outcome been different if the heart attack victim would have received emergency care much sooner...
  10. by   Draken
    Quote from NREMT-P/RN

    RN, CEN, CCRN, NREMT-P, BA


    not to start a fight but

    /cheer I love it when people think more education is directly related to patient care. A NREMT-B can see this patient is having a heart attack and they get paid minimum wage here.

    Thats why we have those wonderful doctors who will not listen to an rn who says my PT has an infection and the doctor says "ill make that decision" turns around and doesnt look at the PT until hell freezes over.


    Post more credentials because it sure impressed me.

    Oh i have BLS, ACLS, PHTLS, PART, NREMT-B, (was a grader for NREMT practicals)91W, combat life saver, expert medic badge, and now im in a BSN program but guess what as a RN I can do less then I could in the military as a 91W.

    Education credentials are linked but not directly to experience and knowledge
  11. by   CritterLover
    i've followed this thread pretty much from the begining, but haven't posted on it until now.

    there are a large number of posters who keep commenting on how neglectful the triage nurse was.

    it realy isn't that simple. at least, not with the info that has been provided. (or will likely ever be provided).

    though not as experienced as many of the nurses that have posted before me, and not a full-time er nurse, i have done triage.

    you know what? it would be so wonderful if everyone that came to the er gave a complete/accurate answer to the question "what brings you here tonight?"

    it would be great if your patient actually let you get out the statement "on a scale from 0 to 10, with 0 being no pain and 10 being the most pain you could possibly imagine, where would you rate your pain?" before abruptly cutting you off and barking "10, it is a 10." (now, again, i don't triage daily, or even weekly, but i can count on one hand the number of patients who have given a number less than 10 when answering this quesiton. makes it difficult to prioritize patients based on their perception of pain when everyone gives the same answer.)

    it would be nice if the patients who are dragged in by their families didn't try to down-play their very serious signs and symptoms because: they don't want to be admitted; they are scared and in denial; they don't want to be a bother; "you need to attend to that young lady crying in the waiting room;" whatever.

    it would be a flat-out relief if every patient who was sick of waiting didn't suddenly come start having chest pain/shortness of breath/"the worst headache of my life" when it becomes evident that the wait is going to be a long one.

    and, it would be really, really great if everyone who was having an acute mi had predictable signs/symptoms, ones that screamed "i'm the big one."

    the bottom line is that we don't know the true story. we don't know what the patient told the triage nurse. we don't know what the patient's vital signs were. and unless i've missed something, we don't even know if they didn't do an ekg upon presentation. ekgs can be normal even during an mi, depending on the timing. we don't know what the patient load was like that day. we don't know how many other patient's with c/o chest pain there were that day/that hour. (or major trauma. or severe ha with elevated bp. or outrageously elevated blood sugar. or severe sob with crappy sats......) we just don't know, and probably never will.

  12. by   bluiis923
    Quote from ERTRAVELER
    The criminal issures here are all the sore throats and belly aches that take up precious time and rooms in the ER because that's where their FREE access card covers them 100% coverage. People who come in and demand we give them Tylenol because they can't "afford" to buy it, but they can afford that $5.00 pack of cigarettes in their pockets
    Preach on it sister !!!
  13. by   CyndieRN2007
    Quote from critterlover
    i've followed this thread pretty much from the begining, but haven't posted on it until now.

    there are a large number of posters who keep commenting on how neglectful the triage nurse was.

    it realy isn't that simple. at least, not with the info that has been provided. (or will likely ever be provided).

    though not as experienced as many of the nurses that have posted before me, and not a full-time er nurse, i have done triage.

    you know what? it would be so wonderful if everyone that came to the er gave a complete/accurate answer to the question "what brings you here tonight?"

    it would be great if your patient actually let you get out the statement "on a scale from 0 to 10, with 0 being no pain and 10 being the most pain you could possibly imagine, where would you rate your pain?" before abruptly cutting you off and barking "10, it is a 10." (now, again, i don't triage daily, or even weekly, but i can count on one hand the number of patients who have given a number less than 10 when answering this quesiton. makes it difficult to prioritize patients based on their perception of pain when everyone gives the same answer.)

    it would be nice if the patients who are dragged in by their families didn't try to down-play their very serious signs and symptoms because: they don't want to be admitted; they are scared and in denial; they don't want to be a bother; "you need to attend to that young lady crying in the waiting room;" whatever.

    it would be a flat-out relief if every patient who was sick of waiting didn't suddenly come start having chest pain/shortness of breath/"the worst headache of my life" when it becomes evident that the wait is going to be a long one.

    and, it would be really, really great if everyone who was having an acute mi had predictable signs/symptoms, ones that screamed "i'm the big one."

    the bottom line is that we don't know the true story. we don't know what the patient told the triage nurse. we don't know what the patient's vital signs were. and unless i've missed something, we don't even know if they didn't do an ekg upon presentation. ekgs can be normal even during an mi, depending on the timing. we don't know what the patient load was like that day. we don't know how many other patient's with c/o chest pain there were that day/that hour. (or major trauma. or severe ha with elevated bp. or outrageously elevated blood sugar. or severe sob with crappy sats......) we just don't know, and probably never will.
    well said, critterlover! until you posted, i just imagined an almost empty er, with the patient slumped over in the chair, and the nurses doing nothing. not a jam packed, overload er with various trauma situations coming in. we do not know the other circumstances, and we probably never will.

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