No Criminal Charges In CA Waiting Room Death-Perforated Bowel - page 3

This is the case from last year. I'm sure they will win big in the civil case. They should. Read article in its entirety:... Read More

  1. by   Vito Andolini
    Quote from canoehead
    Actually, I am saying that it was her fault- although I know that is not the PC thing to say.

    The emergency room staff relies on indicators from the patient to evaluate illness. She had been to that ER many times in the past showing signs of illness, but not being ill. Lots of drama, and interventions, and referrals that were never used by the patient. Lots of faking for meds- she was known as a drug abuser. So knowing ALL THAT the triage nurse still takes her complaints seriously to err on the side of caution, and she is seen by a doc and discharged.

    After discharge she hasn't even left the hospital and continues with the same symptoms. OK, knowing her history, and knowing she was just seen by someone smarter than me and declared fine, I would retriage her ("patients have a right to a medical screening exam") and put her very near the bottom of the pile, and watch for new symptoms. If there has been a lot of drama in the past I would NOT count that as a new symptom. If the drama continued, and she was disrupting care of people that are ill in the waiting room I would have no problem calling the police to either remove her or put her in custody. I'm totally sure that if the police know she has just finished an ER visit they would remove her, rather than babysitting her for a few hours until she was seen again.

    So this woman had a known pattern of behavior, she had been seen by a doc and cleared for discharge. Anyone else would have been given another face to face with the doc, because we all know things can be missed, or get worse. Known drug abusers have long used up their second chances with most everyone they know. She burned her bridges long ago, so when she really needed the benefit of the doubt it wasn't there.

    Sadly, even after hearing the story, I'd still do the same thing, perhaps with a bit more caution, but the outcome would have been the same, dead patient.

    I'm not saying care would be denied, I'm saying that in the triage sorting process she would have been on the bottom of the pile after her first screening. In a busy ER that means hours and hours of waiting for the next screening. Clearly she would have died before being seen again, and most of the reason being that she had faked the same symptoms in the past, and had no pathology.
    She had pathology. It was missed. I'm glad you will be a bit more cautious in the future. I know it's tough and we can't catch perfectly all the time but perf in a known opiate addict? Isn't that pretty common? Why did it get missed? Docs erred big time, TN did, too. 20/20 looking back, of course, but let's all learn from this to look at and hear the patient, not dwell on their HX exclusively. Sometimes a fresh pair of eyes is needed - a different nurse, a different doctor.
  2. by   herring_RN

    You can hear the 911 tapes here.

    When it happened the video was on TV. She was on the floor vomiting blood while a man mopped up the bloody vomit without looking at her.
  3. by   TriageQueen
    All of our triage classes have taught us that bounce-backs within 72 hours should be strong candidates for level 2 (ESI 5 level triage system). Regardless of whether they are frequent fliers or not. A person complaining of 10/10 pain, is also a candidate to be a level 2... we can always add the objective information "pt c/o 10/10 toothache, drinking dr. pepper, and eating cheetos... etc" to justify not making them a level 2.

    I know it's frustrating that we have to take these people seriously every single time they walk through our doors... but the world (especially the legal system) doesn't care about the fact that they have visited our ED 4 times within the past 3 days, has also been seen at the other hospital in the county this week, pulls their regular routine of "seizing" in the parking lot, physically/verbally abuses staff, etc. They care about the end result: did this person die, become injured, or suffer some injustice. Therefore, to cover ourselves we need to err on the side of caution. Not that we need to be Miss Polly Polite the whole time (to h-e-double hockey sticks with press gainey, some of these people need a reality check!), but we still need to assess them for their complaints.

    It's a sad case whenever something like this happens, however I believe its an example of the understaffed, under-resourced (IDK if that's a word or not), and over-burdened ED's in this country. We don't have resources because, more often than not we are the only contact homeless people, those without insurance, and illegal immigrants have with medical staff. Even those with insurance may find it difficult to afford their medical bills, and put off payments. We get treated horribly by some patients, and the hospitals have castrated us, not even letting us respond to the abuse... we have to smile and be nice because they don't want bad press gainey scores. I'm sorry, when did ED's become about customer service, not treating patients.... but that's a whole other soapbox. So yes, its also understandable that the staff may have felt a certain level of anger with this patient, but we're all aware of how litigious this society is, and that sometimes diagnoses get missed, and patients die.
  4. by   BradleyRN
    Quote from vito andolini
    and the police are going to arrest her so she can get medical care at the jail?????
    indeed that is a lie. as far as i can tell, the whole thing is a lie. of course the county is not going to find a county facility or the county police guilty of anything. and what kind of treatment is pain-killers for gall stones??? that to me is negligence as well. if you arent going to remove them, then at least prescibe her actigall to dissolve them. but then how could they do that if they never performed the tests to prove it was gallstones in the first place? since it was not gallstones and rather a perforated bowel, then where are the test results for those gallstones? it isnt very expensive to do an ultrasound or check the blood for an elevated alp. unless there are tests that prove she actually had gallstones, then the death is not an accident, it is criminal medical negligence!!
  5. by   BradleyRN
    Quote from canoehead
    Actually, I am saying that it was her fault-She had been to that ER many times in the past showing signs of illness, but not being ill. Lots of drama, and interventions, and referrals that were never used by the patient. Lots of faking for meds she was known as a drug abuser.
    Another reviewer, lawyer and physician Dr. Mark Brown, noted that Rodriguez had a history of drug abuse and that hospital staff could "rationally conclude" that she was only trying to enter the hospital again to obtain "food, shelter and narcotics and was not in medical crisis."
    The report said she had been seen at the hospital at least six times in the month before her death and had spent 14 hours there a day earlier.

    How did you get all that information? She had been there and misdiagnosed, so she was still in pain. Of course if she had a history of drug abuse, now would be the time for the lawyer to bring that up. Nowhere in the article does it mention these "referrals" or "interventions" that you mention, nor does it say that her prior 6 visits were to obtain drugs. A lawyer said it could be "rationally concluded", but never tied those 6 visits to drug seeking. She was never correctly diagnosed, so that perforated bowel may have been her issue the whole time, led to peritonitis, and finally caused her death. Her pain could have been legitimate the whole time, and receiving the wrong diagnosis led to this misconception that she was simply drug seeking. Good grief! How is this woman to blame for that????
  6. by   ernrs2b
    As an ER nurse I can tell you that you have no idea what this nurse was going through on this particular day.. imagine being responsible for 20+ people that are sitting in the waiting room, imagine being lied to on a daily can you judge if you've never worked in such extreme you think this nurse was hiding a bed in her back pocket that the patient could have gone to, do you think she enjoyed having her in the waiting room in that about we fix the rest of the hospital so that we are not clogged up with HOLDS and patients waiting for YOU to come back from your smoke/lunch/bathroom break to take report so that we can see these critical people/maybe they should sue the floor nurses for not doing enough to make a bed, you forget that we dont have the choice to shut our doors when we get full, we have to care for every patient that walks in the door have no right to judge until you've been there!
  7. by   kimbernurse
    I think it is very difficult for us to speculate on this case without the full picture. Exactly what tests had been done on this women on her previous ER visits?
    BTW, pain killers,discharge, and surgeon referral are very appropriate when gallstones have been diagnosed and cholecystitis and common bile duct obstruction have been ruled out. Actigall can take up to 8 months to dissolve gallstones, and is also very expensive. Gallstones can often pass through the CBD and on into the duodenum, jejunum and can occasionally cause an ileus that may lead to a perforated bowel. Just a wild grasp here, but it could of happened. We don't have autopsy results, though.

    Anyways, if the patient was properly diagnosed with stones and given referral to follow up with surgeon and didn't, are we supposed to force these people to become accountable? It is very trying to see the same people come in over and over again complaining of the same things because they are noncompliant with the meds and follow up we gave them the week before. We are all human, and I challenge people to not become the slightest bit complacent if you were placed in a situation in which you saw some of the same "regulars" on at least a weekly basis for the same type of complaint.