Survivors of medical error need crisis intervention

Survivors of medical error need crisis intervention

When health journalist Cheryl Clark wrote about the need for crisis intervention for “second victims” of medical error, defining “second victims” as medical caretakers, she struck a nerve.  Recommending crisis intervention for staff, highlights the absence of meaningful help for injured patients and their families.

In Clark’s article, a hospital patient safety officer notes that medical error trauma is worse when hospital staff  have a personal relationship with the injured or deceased patient, e.g. if the deceased is a colleague.

But the obvious conclusion is not drawn:  Survivors need more assistance than they currently receive.   Isolating patients and their families from circumstances surrounding medical errors does not promote healing of patients or their families any more than it helps traumatized medical staff.

Recognition of the needs of caregivers should trigger awareness that patients and their families deserve more effective care as well. Too often, when medical errors occur, patients and families may not even learn that the mistake happened.

Crisis intervention for medically-harmed patients and their families is virtually nonexistent.  Yet, bullet-proofing communications between staff and patients fuels both grief and anger.

As the parent of a patient, I have personally encountered crisis responses which appeared to be designed for our benefit as harmed patient and family member.  However, my daughter’s medical records suggest that interventions might have been self-serving, business-based efforts designed to minimize the hospital’s liability and to protect its reputation rather than genuine efforts to help.

After a mistake on the telemetry unit resulted in respiratory arrest, rescue, and transfer to the ICU, a telemetry nurse visited my daughter in the ICU and exchanged emails with her.   We never questioned whether the nurse’s outreach was genuine.

But when the nurse broke off  communication after asking me to let her know about a time to meet, I wondered if her assistance was an effort to deflect a possible complaint to the state health department.  Because the error was serious and at least indirectly led to my daughter’s death, I did file a complaint, and the state health department issued a statement of deficiency and ordered a plan of correction.

In the notes of the meeting that followed, I found the following:

“It is well known that this patient was a very difficult patient and frequently refused to comply with the physician prescribed pulmonary treatments.”

My daughter was intubated, but alert.  Everything she “said” is preserved in the notebooks she filled and sent home from the hospital.  A typical note:

I am very motivated to do as much as possible to get better!

At this point, when I try to inhale sometimes I exhale instead and it is very hard, but I am not       giving up.

I want to do as much as I can to get better!

When it doesn’t work, when someone tells me “take a deep breath” and I instead take a shallow   breath or even exhale I am TRYING to take a deep breath and the wrong thing happens.  Just let me keep trying until I get it right (if possible)

Duplicity is never a good idea in personal or business relationships.  It is particularly difficult in the context of a parent watching her only child die in the ICU.

Martha Deed is a retired psychologist and author of The Last Collaboration.

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  • riotofcolor

    Not only is crisis intervention for an injured patient virtually nonexistent, but patients are re-victimized with subjective, emotionally charged, derogatory comments intended to justify errors on the part of medical staff, as you have well illustrated.

    Being a victim isn’t an honor. While I agree that medical staff can be considered another victim of medical errors, it is not a personal victimization. They are victims of a system that places medical staff at the center, a system designed to serve the interests of the medical staff first. Defensive documentation is a good example.

    • Martha Deed

      Very well put. Thanks for posting.

  • PJT27

    The trauma I experienced in the aftermath of a medical error far exceeded the actual physical harm caused by the error. In truth, I probably would have been fine if I didn’t have to then deal with derogatory and outright erroneous comments on my medical records. Then I faced a war with the insurance company to pay for my care because the physician had coded the “complications” in such a way that they refused payment.

    Had my physician been a decent human being I wouldn’t have seen any reason to change physicians. Once I realized my physician’s priority was to save face rather than care for me, I left and never went back. Unfortunately, I think physicians like her are anything but rare.

    • Martha Deed

      I’m sorry for what you have endured. Your story is familiar to me. Re the paperwork nightmare: My daughter’s medical paperwork took up more inches in my files than my entire psychology practice (admittedly, not a huge practice, but sufficient). I handled her paperwork, and it was a nightmare despite the fact that I always handled my own paperwork as a provider — didn’t hire a secretary to do it.

  • Docbart

    I am sorry for your loss.

    Physicians and hospitals are very afraid of lawsuits and regulatory actions. There is definitely a culture of cover-up and concealment.

    I have been told by the administration at my hospital not to document in charts or inform patients or their families of errors that affect their care. The preferred procedure is to “go through internal channels” to have the problems corrected, but in a manner that is not readily discoverable by legal or regulatory inquiry.

    That being said, there are times when physicians become convinced, rightly or not, that patients are not complying with their treatment regimens, thus contributing to a suboptimal outcome. Obviously, the physician should try to remedy that problem, but it is appropriate to record that concern in the patient’s chart. The aim should not be to punish that patient, but to help evaluate why a treatment may have failed and to determine what treatment is likely to succeed in the future.

    • Martha Deed

      I’m sure there is frustration on both sides. I think it is important to look for points where our interests coincide so we can work together on a solution. E.g. nursing staff shortages may impair patient care and they also put nurses at risk.

      • Docbart

        I’m not sure where frustration comes into this. I also don’t see any real solution. Hospitals are financially squeezed- everyone wants to pay less for healthcare. They want to get the most possible work from the fewest possible staff. Errors will happen and patients will be harmed. It’s a cost of “doing business.” We can try to minimize that, but it will always happen. Hospitals are desperate not to be held accountable, though, and the culture of cover-up and concealment only makes it harder to eliminate errors, since errors are not acknowledged.

        • Martha Deed

          Thank you for your comments. They are truly helpful and go straight to the point.

  • Tara McMan

    I totally agree with PJT27. The event is so traumatizing, you want to run and hide from it all. Then the people that CAUSE the nightmare DO NOT listen, and they continue to rub salt in the wounds, no one can say “We are sorry, we are human, with humanity comes human error.”

    It would have meant so much to us had one person said “Sorry” and not treat US as if we slipped with the needle, that caused a MASSIVE drug overdose, and it was worse when the ICU nurses had no idea why they were treating him. Then the bills came, The bills I went to everyone and said how very cruel it would be to send me, came days following discharge.

    Then the months of fighting for “how could you let this happen?” “What will you do to prevent this happening to anyone ever again?:” and “We dont want to sue, we have no intention of it, but why must we threaten that action to get someone to talk to us?” Fighting with medicare who was billed “creatively” to get the thousands of dollars the hospital would get, and telling them the TRUTH of what transpired so that they suffered some sort of repercussion for their mistreatment before, during, and after our issue. But no one, not the medicare hmo, not the office of OIG, no one cared that they were clearly being defrauded.

    Our incident involved a medical device, and by state and federal laws incidents involving such devices must be reported to the FDA. The hospital, doctor, and even the manufacturer assured me that they had done the reporting, they had not after months of the incident.

    I did. I reported it to the FDA. Our primary goal was so that many learned a lesson from our experience. It was clear all throughout that no one had learned. Not one thing.

    My screams saw to it that a protocol to handle such events was put in place, how there wasn’t one I do not know. The offending personnel has since been terminated from the employ of the facility. She just showed her incompetence and inability to even care about her patient, when five days post ICU discharge, she had to attempt the exact same procedure again, she had betadine ready to cleanse his skin. Betadine is one of two things in the world that had it been used, probably would have put him back in the ICU bed.

    Ironically, about 6 months prior to this event, I began my first position as a Nurse. Guess where I had my clinical training? The very same hospital.

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