Thursday, June 14, 2007

Emergency Bleeding

This is terrible. We will never hear the whole story. A "Los Angeles Hospital" is in huge shit trouble now and this poor woman is dead. The story is a bit confusing because she is placed both in "the hospital lobby" (in which case a "Code Blue" should have been called and doctors and nurses should have run to the lobby) or she was the E.D. lobby in which case the triage system failed miserably.

A million dollars says that there is much more to this story that, if told, would make this less shocking. As the lawyers on both sides are already flexing though we will never hear it. This kind of publicity will generate a settlement, and soon.

And hey, which presidential candidate from will be the first to cite this case and bend it to their agenda? Odds?


  1. Apparently, according to the news I heard tonight, she had been "discharged" according to her boyfriend person. Ugh, what a mess.

    Wonder what rules JCAHO will make up for this one.

  2. While "bouncebacks" should always raise a red flag, especially for abdominal pain, I would be interested in hearing the mitigating circumstances too. But I bet we never will.

    Had she gotten a CT scan on her previous visit? Was this her 20th visit for abdominal pain with several negative workups? Had she been a histrionic screamer on previous visits? Was she thought to be a drug seeker? Otherwise, I can't conceive how this might have happened.

    It's a tragic story for all sides.

  3. Those who would blame the local EMS or 911 operators are ridiculously deluded, btw. There is nothing that EMS could have or should have been expected to do in this case.

    Many of these commenters on the ABC site are sadly misinformed as well.

  4. There is no doubt much more to this story. But it could also shed light on how the symstem is filled to the max with illegals,(I don't know if she was one, but at this Harbor hospital they serve a bundle) as is the school system in LA county. There will be no "fixing" of the system, and the only winner will be some John Edwards type scumbag lawyer.

  5. 'cat et al.,
    in residency i had a patient who called 911 five times from a bed in the ED. she was coming down off crack and was paranoid. finally the police called our CLERK who put them in touch with me and the officer asked me if i would take the phone away from the patient as they were sick of getting calls from her and was diverting resources. i then went into the patient's room and she looked like i was an avenging angel. i calmed her down and took the phone away assuring her that she was safe and would be cared for well. i couldn't do anything about the bugs under her skin though because i couldn't see them.

  6. Wow, it is a wild story. I'm curious as heck about the particulars. Hard to know from the media because there are so many details that are obviously left out---the story seemed disjointed. But 'cat is probably right---the only winner will be a lawyer....

  7. here's some wild conjecture...

    1. the ED was full and the waits were in the multiples of hours
    2. the patient's presenting vital signs and complaint got her triaged as non-urgent
    3. the patient was a frequent-flier at that ED and had been admitted multiple times for various complaints including abdominal pain and chest paint and the workups had been negative
    4. she was an alcoholic
    5. she had been seen within a couple of days of her death at the same ED
    6. she was a drug seeker
    7. based on the above she moved herself off the nurses radar
    8. she was taking lots of aspirin or motrin for her 'pain'
    10. she had a bleeding ulcer or esophageal varix at presentation but appeared stable
    11. the doctors and nurses were wrong about her this one time

    if 80% of the above guesses are not correct then color me surprised. this patient IS THE EXACT EXAMPLE OF WHY PATIENTS IN THE EMERGENCY DEPARTMENT GET WORKED-UP EVERY TIME, REGARDLESS. it's also one of the many reasons why medicine in america is so costly.

  8. I bet it may be the frequent flyer theory, but normal vitals could also be thrown in there. Every now and then pts with 30 -40 visits to the ED will DIE, and it amazes me how everyone says "Oh my gosh, he/she died!". The key to the game is to not be the last one to see the patient in the ED. They usually die from something unrelated to the 40 visits.

  9. Autopsy report here.

    CT scan negative 3 days prior to death. Multiple ER visits for same pain, actually admitted the day before. History of narcotic abuse, with arrests. Methamphetamine on board at time of death.

  10. we will never know the whole story, but the Autopsy results from te LA Times sure help in hte speculation.

  11. 9-1-1 doc had it right on the money.

  12. LA Times 'story' here (sorry i don't know how to link in the comments yet):,1,633441.story?ctrack=1&cset=true.

    Maddening that the times poo-poos all that the patient did to get herself into her dire condition AND writes about medical care, and emergency care in particular, from the perspective that it is a cost-free RIGHT for every human in who happens to be in the United States. this without any regard for the fact that those of us on THIS side of the fence are at the breaking point.

    i will keep saying this because it is already happening, doctors will quit or will move themselves out of emergency care, nurses too, and we are not replaceable. medical care will then be unavailable to all but the rich, but it will at least be a right.


    will you lend your pathologic expertise to the autopsy scribbles? link above in comments.

  14. See new post...