Friday, March 20, 2009

Natasha Richardson R.I.P.

EDITOR'S NOTE: OLDFART POSTED BELOW A FEW HOURS AGO AND SITTING HERE IN BED WITH THE WIFE I LEARNED, IN THAT REPUTABLE MEDICAL JOURNAL 'PEOPLE MAGAZINE', THAT MRS. RICHARDSON HAD INDEED REFUSED TRANSPORT AND MEDICAL CARE AFTER WHAT WAS A MINOR FALL ON A 'BUNNY SLOPE' (ON WHICH SHE WAS NOT WEARING A HELMET).

THOUGH I TOO WONDERED IF THE 'QUEUE UP' PROBLEM WAS AT PLAY HERE IT EVIDENTLY WAS NOT, AND SO WHILE WE WILL NO DOUBT HAVE OTHER OPPORTUNITY TO COMPARE THE ACCESS TO EMERGENCY CARE IN SOCIALIZED COUNTRIES TO THE ACCESS TO EMERGENCY CARE HERE, THIS IS NOT THE CASE TO DO IT WITH.

I WILL ASK THIS QUESTION OF ANY CANADIAN PHYSICIANS WHO HAPPEN BY HOWEVER. HOW QUICKLY CAN ONE GET A CT OF THE BRAIN IN A CASE SUCH AS THIS WHERE THERE APPARENTLY WAS NO OBVIOUS TRAUMA AND THE ONLY COMPLAINT ONE HOUR AFTER THE FACT WAS A WORSENING HEADACHE? HOW ABOUT FOR A INTERNATIONAL CELEBRITY?

911doc


How do you think Natasha Richardson's family likes that socialized medicine in Canada??

Any 3rd year med student or an EMT worth his salt would know she was a set-up for an epidural hematoma. It is an incredibly classic story for it. And so easy to diagnose with an 8 second CT of the brain.

But in Canada I bet she was "put in queue" for a CT scan next week and had to fly to the US in order to get one in a real hospital's ED. But by then she was brain dead.

Still want Hussein's version of medicine here you fuckin' brain dead liberals?? Could save a lot of tax payor's dollars, huh? Everybody could get the "same access" to health care huh?

Just not when it's your family..

My prayers to Ms Richardson's family..

37 comments:

  1. Oldfart from three point land!

    some questions about this tragedy...

    1. did she refuse to be taken to the hospital?
    2. was she actually knocked unconscious in the fall?
    3. was she wearing a ski helmet?

    i would bet that if details emerge that tend to exculpate the medical treatment she received that she probably shrugged it off and told the ski patrol and medics to go away. however, if details do not emerge my suspicion would be that there is fault here and that a nice, quiet, under the table settlement between the Canadian government and the Richardson family will be agreed upon.

    had this happened at, say, Aspen, you could bet that a line of plaintiff's attorneys would be jetting over to visit with the aggrieved and pointing out the possibility of malpractice. keeps one honest to be sure. but, if i am not mistaken, liability is capped in Canada and jury trials for alleged malpractice are simply not done.

    interesting comparison. i doubt we will ever know the details. and yes, tragically, very textbook.

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  2. I agree with Kevin's take on this. Initial treatment declined, coupled by not flying her out to a tertiary hospital contributed to her death.

    http://www.kevinmd.com/blog/2009/03/did-canadian-health-system-fail-natasha.html

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  3. According to this article a shortage of medical helicopters in Quebec might have played a part in Richardson's outcome.

    http://jam.canoe.ca/Movies/2009/03/17/8774516-cp.html

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  4. She refused treatment initially, even signed a document; paramedics were turned away initially as well according to initial reports. She did not complain of HA, 'tumbled' but did not lose consciousness, no NV, GCS 15 initially, non-focal. No helmet, obviously.

    You can point the finger at Canada but I don't think it's warranted here. She doesn't even rule in to New Orleans Head CT rules, Canadian Head CT rules say no imaging, only clinical suspicion to go on. The one wierd thing is the ski instructor stopped the lesson, tabogganed her to the bottom, and then stayed with her...obviously not a run-of-the-mill fall, in which case someone at the resort should've said, sorry, ma'am, you get taken to the ED. But there was no initial ED or EMS eval of this woman.

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  5. I like also to add that the quality of health care various from province to province and even with in a province and it is not fair to judge all of the Canadian health care system based on what has happened in one geographical location. Just something to keep in mind the next time you would like to bash the Canada's health care system based on a medical case you have read in a newspaper.

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  6. We'll be hearing from more anonymous Canadian docs defending the system.

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  7. Having worked up there for a while, I can tell you that CT would probably not be done until signs warrant... ie changing level of consciousness, persistent vomiting, etc. This may be why she sat in the ER for a couple of hours before being scanned, or the local ER may have been swamped.
    The only way there would be a lawsuit is on celebrity. The standard of care is quite acceptable, for Canadian ERs. And the payout, even if the case were really, really, really compelling might be $100K (CDN). There just are no jackpots up there, and for the most part, lawyers don't even try.
    Helicopter transports are used, rarely, and would have to come out of Montreal, so the ambulance transport was probably faster.
    It is true that quality of care is different in different provinces, and Quebec had a reputation of having very poor care. I understand for a while that the there were so few Docs in the province that Quebec government mandated any Doc that had hospital privileges had to staff the ER... so you had surgeons doing ER cardiology and psychiatrists running traumas. I believe that has stopped, so perhaps our current Canadian friends can confirm if this was indeed the case.

    In Canada, you have to get used to the words "no" and "get in line".

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  8. Found the link from Canadian Emergency Physician Association

    http://www.caep.ca/template.asp?id=C215DF90A43649F496D6515A468FDE34

    Scary, Scary stuff. Are you ready, america?

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  9. 911
    "I doubt we will ever know the details. and yes, tragically, very textbook."

    Not sure how you are calling this "textbook" from the lack of detail I have seen in the lay news media. Let's see what comes in future reprts on the subject before jumping to ideological conclusions...shall we?

    A sad situation.

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  10. My wife went to the hospital 3 days postpartum for abd pain. ER found a low blood count (due to large clots she'd been passing) and gallstones. Arrived on Sat afternoon, so she was going to be held on the floor until Mon for observation, more blood, and pain management until the gallbladder removal on Mon. All day sunday she had a headache that increased throughout the day despite Tylenol. She started seizing about midnight sunday, which prompted the CT that found her cerebral bleed. Surgery was performed the next afternoon and she was about 95% recovered in a year afterward. It's been almost 12 years and she's good now.
    So, in a US health system, presented with a patient with a massive, worsening headache for 12 hours, my wife didn't get a CT until she exhibited a significant symptom of something else, ie the seizures. I can understand that. Later, due to her hx, she had about 5-6 CTs to rule out another bleed just because migraines.
    My point-we are all so opposed to socialized medicine that some folks jumped to conclusions that were not justified. Better to wait and jump when it's proven, or else we sound like the boy who cried wolf.

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  11. I'm no Doc, but your wife didn't have a known head-trauma -- at least not from your description. She had an obvious diagnosis which explained her known symptoms. When her symptoms changed -- seizures -- she got a head CT.

    The Richardson case is totally different. She went into a tree head-first.

    Apples and oranges!

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  12. What is it with Celebrities and skiing??? Motorcycles are much safer...Gary Busey's still goin strong..and and least it wasn't Natasha LYONNE... "Freeway 2, Confessions of a Trickbaby" just came out on Blue Ray...SWEET!!!

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  13. I was in a head-on, unrestrained, doing about 45 mph. LOC at the scene. I had a massive headache and a bruise. They took me to the ER where I declinded the CT scan because I was uninsured. The dr was like "okay" -- I didn't even have to sign out AMA.

    My reasoning was that if I died or became a veg, at least I wouldn't have to worry about paying off the costs incurred.

    /wears her seatbelt now

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  14. Disgruntled Internist7:26 AM, March 23, 2009

    Ha, this thread makes me laugh. You boys are so worried about health care reform you'll distort the truth any way you see fit in order to scare people. Just another example of Republican fear-mongering.

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  15. Go ahead, Laugh, Flea-boy... I'd be disgruntled too if I wasted 3 years in a specialty even Tubercular Haitian Immigrants turn their nose up at... Only attractive thing about IM is the lucrative sub-specialties, and if you're disgruntled in one of those...oh yeah, you're an Internist,

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  16. I have nothing of import to say other than it's really cool to see Farty posting again. I've missed you, big guy!

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  17. ahh frankie passing gas out of his anus again.

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  18. If Frank can pass gas from another orifice then he fucking rocks.
    911doc

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  19. I think we can all agree on who is to blame for this tragedy.

    And this video sums it up nicely:

    http://www.youtube.com/watch?v=nYSYipouABI

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  20. Hrrrrm...

    A few things on this one, first, it does seem like a bit of a stretch as it'd seem to me, at least by the news reports, she would of probably died no matter where she was. However, I have no doubt that access to medical helicopters is probably restricted in Canada(the only way one can run a socialist healthcare system is by rationing care).

    As for the lovely internist, he's just one of these people who yells Republican fear-mongering and fails to see that Obama himself is the fear-monger-in-chief. Both sides fear-monger to some degree. This, fear-mongering? Maybe. The president opening his trap at all on the economy? Hell yeah. Reason the Dow drops everytime.

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  21. In a nutshell, this is my argument against socialized medicine: everyone is happy with it....as long as THEY don't have to wait. or it's not THERI family being denied treatment.

    If those assholes in Congress had to adhere tot eh exact same plan that we had -- right down to wait times and denial of services -- I might be more satisfied.

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  22. I'm not sure that blame lies with any one thing or another. Surely Ms. Richardson and her family didn't know about the possibility of an acutely life-threatening condition presenting almost no symptoms.

    I know that y'all have the experience of being ER docs where everybody comes in with every stubbed toe and paper cut, but from an outside point of view, I can bring to mind many people who DON'T get medical attention when they really should, or who delay it because they feel silly going to the ER for "a little gas pain", myself included (turned out needing emergency surgery for that "gas pain" which was NOT gas pain!).

    A lot of people don't want to feel silly getting a bunch of tests, scans, and x-rays for something that turns out to be nothing, and it's also a huge hassle.

    However, after this high profile incident, people will be much more aware of what can happen in those particular circumstances, and perhaps lives will be saved by this awareness--people will get the MRI or whatever in time instead of refusing transport.

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  23. Hey Docs,

    Completely off topic but one of my wisdom teeth broke on me. So instead of exploring John Milton's work and the lovely world of linguistics tomorrow, I'll have to try to get a Dentist appointment and chances are have the tooth removed. Wish me luck and keep me in your prayers.

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  24. Can't you get one of your 42 wives to do it??

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  25. Living in Toronto my family and I have had nothing but exceptional healthcare, from immediate and expert treatment of breast cancer at Sunnybrook to open heart surgery for my mom at TGH with one of the world's top surgeons Dr. Tirone David, thank God for great Canadian doctors like him who are interested in something other than just making as much cash as possible.

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  26. You will pray for the family? You believe in a personal, loving god but use the word "fuck" in regards to liberals? Strange god that you have. This was my first, and last visit to this blog.

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  27. I think God has more to worry about than the word fuck used as adjective. Sticks and stones and all that.

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  28. Anon sure as fucking hell wouldn't want to visit my fucking blog, then.

    Good fucking riddance, thinks I.

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  29. Hey! The resort she was at is over 2 HOURS away from Montreal, which has quite a few big trauma centres. Plus the area does not, for whatever reason (which has nothing to do with social medicine) have helicopter transport to the city.

    So you have someone who falls, refuses medical attention, then has to be driven 2+ hours to the nearest trauma centre. You want a medical miracle?

    I'm currently preggo for the first time, and my Montreal doctor is nothing short of amazing. I can pay for extra services if I wish, and faster blood tests, but visiting him goes on Medicare and it's quick and efficient and I have no complaints. Plus I don't have to sell my house to pop out a few kids. Amen, sez I.

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  30. Oh, and it's illegal to sue for such things in Canada, so I doubt the Canadian Government will be settling anything with the Richardson family.

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  31. I have a house in one of the poorest counties in missouri....1 doc for every 3,120 people...if they can afford it, people buy helicopter insurance....anything other than a broken bone gets flown off to St.Louis, an hour away.

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  32. Ms. Richardson's death was tragic, my deepest sympathies go to her family.

    I simply do not understand how you can blame the Canadian health care system for this tragic accident.

    According to the reports I have heard, the resort was two hours away from a major trauma centre and the first ambulance on the scene was sent away.

    I understand that it is a natural impulse to want to find someone to blame, but sometimes there is no one at fault. Sometimes awful things just happen.

    Where do you get the idea that Canadians are put on a waiting list in the case of an emergency? That is simply not true.

    The Canadian system isn't perfect; I would be the first to acknowledge its faults. But I would take it ANY day over the US model of care.

    It is regrettable that you dismiss a system that provides excellent care and doesn't discriminate on one's ability to pay, as you clearly are misinformed about how it operates.

    Again, my thoughts and condolences are with Ms. Richardson's family.

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  33. dear penelope,
    i agree. i think this was the wrong case to make a point. our sympathies to the family. this probably would have happened anywhere in the world, it only looks bad in the 'retrospectoscope', which is a term we use when speaking about second guessing other physicians, usually in court. i think it would have been particularly hard to 'lean on' a celebrity to come to the hospital against her will.

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  34. Midwest woman we must live near each other! I also live in rural Misery and have seen those helicopter insurance thingies...Do I really need one????? I thought...I though heli flights were part of that whole ambulance thing that comes out of my taxes?

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  35. BTW, just for arguments sake, I knew a 5 foot tall gal pregnant and about to explode with triplets. She lived in Canada, and they made her go overdue because they kept canceling her scheduled c-sec. They didn't have enough room.

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  36. dear amy,
    now that's a good example of a common occurence in a rationed care system. there's nothing deleterious about going a little post dates in delivery other than discomfort to the mom. sorry.

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  37. Well, I was more surprised because I thought it was risky to go overdue with multiples like triplets, not that going overdue in general is the end of the world, although it might feel like it at the time.

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