A two-hour ER wait is ruled a homicide

A patient presented with chest pains and is incorrectly triaged:

Vance had waited almost two hours for a doctor to see her after complaining of classic heart attack symptoms — nausea, shortness of breath and chest pains, Deputy Coroner Robert Barrett testified.

She was seen by a triage nurse about 15 minutes after she arrived, and the nurse classified her condition as “semi-emergent,” Barrett said. He said Vance’s daughter twice asked nurses after that when her mother would see a doctor.

When her name was finally called, a nurse found Vance slumped unconscious in a waiting room chair without a pulse. Barrett said. She was pronounced dead shortly afterward.

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  • Greg P

    A typical eventual outcome of this will be that, aside from what happens to the triage nurse, the hospital will pay massive damages, and this family and their lawyer become rich.

    So satisfying. So American.

  • scalpel

    I’m not sure it’s true that the patient was incorrectly triaged given the information we have.

    “Emergent” suggests that without immediate attention, the patient is likely to expire. Penetrating chest trauma, acute neurological changes, airway obstruction, anaphylaxis, or uncontrolled active bleeding are some examples.

    “Semi-emergent” suggests that urgent attention is needed to prevent death or complications. Many presentations of chest pain fall into this category. An ECG is used to help triage patients with chest pain, but even that is not always definitive.

    The fact that the patient died is not proof that the patient was incorrectly triaged. The reported delay in obtaining an ECG signifies insufficient triage, however.

    I also have a post on this topic.

  • Cathy

    “Emergent” suggests that without immediate attention, the patient is likely to expire.”

    “Semi-emergent” suggests that urgent attention is needed to prevent death”

    Is there a difference in those two quotes?

  • scalpel

    urgent < emergent.

    Emergent means NOW.

    Urgent means as soon as possible.

  • scalpel

    It still may not be clear to those who don’t work in an ER, so I’ll try to explain further.

    Level 1, emergent: comes back to a room right now (knife in chest, chest pain with abnormal ECG or low blood pressure)

    Level 2, urgent: comes back to a room now if possible, but if all rooms are full, comes back when a room opens up. (chest pain with no ST elevation on ECG and stable vital signs, most abdominal pain)

    Level 3, nonurgent: doesn’t really matter how long you wait (sprained ankle, sore throat, cough)

    Some places have another one or two designations interspersed, but this is the basic one.

  • Cathy

    I got it now. Thanks Scalpel!

  • lawyersux

    Homicide? Does that mean they’ll now put us in jail because we happen to work in an ER with a full waiting room? How are they going to get our money if we’re rotting away in jail?

  • CJD

    Greg,

    Do you think they’d rather be rich or have had the healthcare professionals do their jobs correctly?

    Or do you think we ought to jail those responsible?

    If you can think of some other way of punishing negligent behavior or compensating the loss, please let us know.

  • Okulus

    Deficit of information. Was the two hour wait because there was no available space in the E.D. for this patient to be seen straight away, or was there some failure to appreciate the urgency of the patient’s complaint when space was available? Was the triage nursing staff overtaken by an inflow of new patients and did not re-assess the chest pain patient as they ordinarily would have, or did they go and take a coffee break? People wait in E.D.s all the time with their emergencies, and they wait with symptoms. It would be reassuring to believe that anyone with complaints of chest pain would get first priority for at least an ECG, but someone has to interpret that study and is that person available if the E.D. is jammed?

    To call this homicide (I’m guessing manslaughter or negligent homicide) presupposes that with some form of earlier evaluation and treatment, –again, assuming the E.D. could deliver that care right away– the patient would have with certainty survived whatever event immediately led to her death (arrythmia, probably).
    I just can’t see how they can make that case. People who are seen in E.D.s having MIs without delay and who are given thrombolytics, oxygen, antiarrythymics and analgesics still sometimes develop lethal arrythmias and die.

  • lawyersux

    CJD doesn’t get it. We do make mistakes. I have made mistakes. But we don’t get sued for our mistakes. I have royally fucked up, spent months worrying about getting sued for a fuck-up, and nothing comes of it. Then the phone rings, and you find out you’re getting sued for a patient you did NOTHING wrong on. Or NEVER EVEN SAW. All my colleagues say the same thing. In residency they told us this would happen: “YOU NEVER KNOW which ones will come back and bite you”. The “healthcare professionals doing their job correctly” is the Bullshit the CJDS of the world, who have never so much as gotten a needlestick, promulgate as the reason they deserve to earn big bucks. But we work our Butts off, freak out when a patient dies because of a choice we made, but never hear a word about those cases. Then some drunk or Coked-up asshole walks out of the ER, drinks more or does more cocaine and drops dead, and you have to go to this Lawyers office and explain how you fucked up. Maybe the ER had 50 patients waiting. Maybe some Lawyer’s son had an ingrown toenail and the Lawyer was pushing his weight around. Does it matter? Can you really charge a doctor with “Homicide”, no different then if he stabbed someone in the chest?

  • CJD

    Yes. Particularly a physician like you.

  • veman

    cjd-it’s sad that even on this site you seem to be accusatory. While this case does illustrate much about the crisis in our ED’s, the other contributors bring up great points. It is the fear of litigation that drives many of our practice habits with in turn lead to delays/backups, which lead to these instances. For example the millions of patients with belly pain seen in the nation each day. 10 years ago, many of these patients would undergo exams, a few directed lab tests then either imaged, consulted by surgery, or sent home with good instructions on reasons to return. Today, the latter is done less and less. Now there is a palpable fear that the 1 in 100 you send home with explicit instructions on why to seek medical care has a bad outcome. You have the fear of litigation. So, now you CT more than before. You tie up the bed, you back up the waiting room and still send the patient home 99% of the time. You could take any chief complaint and find similar instances. The fear of litigation has driven many MD’s out of practice secondary to malpractice insuranace inavailability/cost. I’m not saying the missed MI death is not tragic, but charging a busy EM physician with homicide is a slippery slope and if successful, you may find longer wait in ER because you will have less docs taking the risk. The machine of litigation needs serious repair.