Man Dies in ER after 19hour Wait

[Medman7]

ER Death Points to Growing Wait-Time Problem

Family, Doctors Say Deadly 19-hour Wait Is an Example of a Nationwide Problem

By LAUREN COX

ABC News Medical Unit

Sept. 25, 2008 —

 

 

With notoriously crowded U.S. emergency rooms, chances are most American families have a story of someone waiting. It could have been half a day for a sore throat or perhaps hours for stitches or a sprained ankle.

 

But for 58-year-old Michael Herrara of Dallas help never came. He died of a heart attack last week an estimated 19 hours after he arrived at Parkland Memorial Hospital's emergency room waiting room complaining of severe stomach pains, according to reports from WFAA News in Dallas.

 

Members of the Herrera family said they know they aren't alone in facing dangerously long emergency room waiting times in this country.

 

 

Emergency physicians say the problem is getting worse.

 

"He's not here because they let him die, pretty much," Edward Marquez, Herrara's nephew, told WFAA.

 

"That's awful to know that people are treated that way," he said. "If someone can be helped by this, I think he would be happy."

 

Representatives of Parkland Health & Hospital System said they are reviewing the case.

 

"It's important to also understand that, as with all emergency rooms, patients in Parkland's ER are treated based on the severity of their medical condition rather than the length of time they've waited to ensure that the most urgent cases receive proper attention," Dr. Ron J. Anderson, president and chief executive officer of Parkland Health & Hospital System wrote in a prepared press statement.

 

Anderson told WFAA he knew the medical team marked Herrara's symptoms as a "level 5" case, rather than the most urgent "level 1."

 

"This incident is a tragedy and our hearts are with the family," Anderson said. "We always strive to deliver the best care to all our patients."

 

Members of the American College of Emergency Physicians have long said emergency rooms across the country face a difficult problem: They want to provide the best care, but everybody is swamped.

 

 

Doctors Upset About ER Wait Time, Too

"Emergency physicians have been sounding the alarm for years that ER waiting times have been growing," said Dr. Richard O'Brien, spokesman for American College of Emergency Physicians (ACEP) and a doctor at the Moses Taylor Hospital in Scranton, Pa.

 

In 2006, the Institute of Medicine released a report that approximately 120 million Americans -- roughly one in three Americans -- sought care in an emergency room each year.

 

According to a U.S. Centers for Disease Control and Prevention report, the number of emergency patient visits rose 32 percent from 1996 to 2006, but the number of hospital emergency departments decreased by 7 percent in that same time.

 

O'Brien said both trends -- fewer emergency rooms and more patients -- skyrocket wait times.

 

In 2004, the CDC reported that the average patient spent 3.3 hours in emergency department. Almost 400,000 patients waited 24 hours or more.

 

"Can you imagine if there was another Katrina or, God forbid, a terrorist action around the time of extraordinary hospital overcrowding," said O'Brien. "They're crowded all the time. If a building goes down, what are they going to do?"

 

O'Brien said in response to the growing problem, ACEP introduced a bill in both houses of Congress called The Access to Emergency Medical Services Act.

 

"It forces the government to study the problem ? so that we, as a country, can come to grips with it and deal with it as a country," said O'Brien.

 

In the meantime, many emergency room physicians are trying to stem the problem.

 

 

What Can Be Done for ER Wait Times?

"Anecdotally, there's no question that it's getting worse," said Dr. Sandra Schneider, secretary treasurer for ACEP and professor of emergency medicine at the University of Rochester in New York.

 

Schneider said out of 1,500 emergency physicians recently surveyed by ACEP, 200 personally knew of a person who had died because of the practice of "boarding."

 

Boarding means keeping patients in an emergency room bed when they should be in a regular hospital bed. Schneider said the practice eventually creates a backup in the emergency room.

 

 

Crowded Emergency Rooms

"If you sort of think of an emergency room as a restaurant where you're waiting to eat, and people sit down at breakfast time and they never leave? Then the line goes out the door," said Schneider. "The inpatients get put into the beds and they never leave."

 

Schneider said the emergency room is just the start of the clogged "assembly line" of patients in an entirely crowded hospital. But she thinks three solutions may at least help.

 

First, Schneider said make patients wait on the hospital floors where they need to be admitted rather than in the emergency room, thus spreading the workload among nurses in the whole hospital. Second, speed up the paperwork during hospital discharge to open up beds sooner.

 

"Many hospitals have such complex procedures that patients don't leave at noon, they're leaving at 5 or 6 o'clock at night," said Schneider.

 

Finally, Schneider said surgeons and follow-up care providers such as physical or occupational therapists should spread out their work, instead of crunching it in Mondays through Fridays.

 

Yet, these well-known ideas are easier said than done. Schneider said she knows some of the doctors where Herrera died, and knows them to be dedicated workers.

 

"I just wanted to say all of us in the emergency medicine community are very concerned and upset and our sympathies go out to the family of Mr. Herrera."

 

Dr. Corey Slovis, chairman of the Department of Emergency Medicine at Vanderbilt University Medical Center in Nashville, Tenn., said he has only found one way to help emergency room waits: assign a doctor to treat patients in the waiting room before they're technically admitted to the emergency room.

 

Slovis said the doctor visits people, runs lab tests and checks symptoms like sore throats, abdominal pain or weakness. Should any of this raise concerns, the patient would be sent straight ahead to an emergency room bed.

 

"Not only have we avoided seeing sick patients still in the waiting room," said Slovis. "We've even begun to be able to [treat and] discharge patients without even admitting them to the emergency room."

 

"We believe at the present time in this health crisis -- and I know we've got a financial crisis, and an Iraq War crisis -- but in this health crisis, I don't see a simpler, easier or better way to avoid having a mishap in the waiting room," said Slovis.

 

 

 

 

[jayde]

well. those lawyers that the hospital has on retainer better be good because here comes a lawsuit!

[jasonattsu]

Isn't this why most hospitals have a Triage room, to catch things like this? I know that I wasn't there and I am not familiar with this hospitals policies and methods of operation, but IF they had a Triage room wouldn't the person who initially saw the victim to determine what level of importance they were have noticed when they did the routine heart check that something was really wrong????

 

What are some other member's ideas on this? I know the local hospital where I live they check you out first in the Triage room, then send you back into the waiting room until you are called back. Presumably this is to determine your level of importance, and while you are in there they hook you up to a monitor to check your heart rate, etc. and ask you about your medical history, why you are here, etc. etc.

[Medman7]

THere is no excuse. THis man was flat out neglected for reasons that none of us will know anytime soon. Standard protocol is to never overlook anyone with chest pain. Knowing Parkland though, he was probably taking 2nd seat to some sort of massive trauma or gun shot wound. If that was the case then it could have happened to him in any hospital in America bacause like it or not care has to be prioritized. That is the whole purpose of triage! Parkland is a nightmare and one of the scariest hospitals that I have ever stepped foot in. There is absolutely no down time in that ER. It stays packed all of the time. If you have ever been there you could possibly understand how someone could be looked over whether it be right or wrong! ANother factor may include the nationwide shortage of medical staff. This shortage is extremely real and if really starting to show it's effects on the healthcare industry. Everyone one the staff that night may have already had their hands full.

[panther55dad]

:rolleyes: That figures!!! I have been in and around Er's a lot. I have seen this happen. NOW THIS WILL SOUND BAD. What peeve's me off is some gang banger or criminal without insurance gets shot and they get pushed to the front of the line, while the law abiding citizen with insurance gets stashed somewhere in the corner with not as much as a band-aid and maybe dies. With all that said my rant isn't about who has insurance or not. I understand this is a supply and demand issue.

[BluePirate]

Hospitals don't (and shouldn't) consider social status or thugness when deciding who's going to be treated. Patients arriving by ambulance are treated before patients arriving by personal vehicle in every ER I've been in. With that said, triage is supposed to be an ongoing function. Was this man ever reassessed?

[flukeshot]

:rolleyes: That figures!!! I have been in and around Er's a lot. I have seen this happen. NOW THIS WILL SOUND BAD. What peeve's me off is some gang banger or criminal without insurance gets shot and they get pushed to the front of the line, while the law abiding citizen with insurance gets stashed somewhere in the corner with not as much as a band-aid and maybe dies.

 

What if the gang-banger has insurance and the law-abider doesn't? Who goes first?

[OBTS]

well. those lawyers that the hospital has on retainer better be good because here comes a lawsuit!

 

I'm sure that there is documentation in this case that justifies how this patient was triaged. They triaged him at a level 5 for stomach pain.

 

It's possible that this case involved an error in judgment, but it is also completely possible that the medical symptoms didn't show up upon the patient's arrival.

 

The media always needs a victim for the story to be sensational. They might have missed the mark on this one.

[Guest bleeds]

I'm sure that there is documentation in this case that justifies how this patient was triaged. They triaged him at a level 5 for stomach pain.

 

It's possible that this case involved an error in judgment, but it is also completely possible that the medical symptoms didn't show up upon the patient's arrival.

 

The media always needs a victim for the story to be sensational. They might have missed the mark on this one.

 

If the pain was not there upon the patient's arrival, why was he there in the first place? As BluePirate said, anyone who knows anything about triage knows it entails regular re-assessment. If that had happened, they would have known this guy was serious.

 

How can you let a guy sit in an ER for 19 hours and die of his symptoms, and the story not be sensational based solely on the facts?

[chase.colston]

I don't know how anyone could ever sit in an ER for 19 hours.

 

After about four hours, I would have gone home and called an ambulance if I knew something bad was going on. Or might have even gone to another hospital.

[OBTS]

If the pain was not there upon the patient's arrival, why was he there in the first place? As BluePirate said, anyone who knows anything about triage knows it entails regular re-assessment. If that had happened, they would have known this guy was serious.

 

How can you let a guy sit in an ER for 19 hours and die of his symptoms, and the story not be sensational based solely on the facts?

 

What are the facts? Nobody knows if they just read the story posted above. Maybe he was reassessed...what was his BP...pulse...what was his self assessed pain level on a 1-10 scale...what did he eat in the past 12 hours, etc?

 

I am not in any way discounting that Parkland is somewhat to blame. It is Parkland we are talking about!!! But I'm not going to be so quick to judge and place all of the blame on one person (triage nurse) without facts.

 

The message from the media here says that nobody should die once they get to the hospital. That's baloney and we all know it. Great doctors and surgeons lose patients every day because of unexpected events. We should give the benefit of the doubt to the medical professionals before we run a story that sensationalizes and politicizes long wait times in hospital emergency rooms.

 

 

 

 

 

I agree that this is an epidemic in America that needs research and a better solution. But the free market is working and adjusting to fix the problem--government needs to stay out of the way! There are more and more urgent care clinics popping up on main street. If I am not in need of a surgeon, I'm going there with my BCBS card and getting taken care of in 1/3 the time. The extra $30 co-pay is worth it to me. But at Parkland, there aren't many people running around with BCBS cards so you get in line. That's life. Maybe Dallas County needs to step up and build a new hospital because Parkland has been inadequate since about 1980. And once again, the middle class taxpayer will foot the majority of the bill and the irresponsible and unemployed will benefit. This patient died because Parkland has become a socialized hospital. People that want government health care need to see exactly what happens at Parkland--because that is what most hospitals in America will look like if Obama is elected with a democratic congress. Stories like the one above won't even be news!

[Guest bleeds]

Was the message from the media that a person should not die after they get to the hospital or that they should not die in an ER waiting room waiting to see a doctor?

 

I don't have all the facts either. But I do know if a person is regularly and properly reassessed, his chances of survival go up exponentially, because changes are noted, one assessment to the next. Trends in condition are revealed. This guy didn't just come in, was assessed, then reassessed every 15 minutes to half hour for 18 hours and 45 minutes with no change, then all of the sudden his condition deteriorate which led to his death.

 

As I said, I don't have all the facts. But his guy believed he was in bad enough shape to stay at the hospital and wait for 19 hours hoping to see a doctor.

 

Someone dropped the ball.

 

[Guest bleeds]

BTW, obviously people do die in the hospital. Happens all the time. ER's are design to prevent that from happening to people in their waiting room. That's why they are call "Emergency" rooms. People who come into them have medical or traumatic emergencies.

 

Most people who die in hospitals either do so "IN" the ER (while being examined/treated) or on the operating table or in their room. It is generally considered poor form to allow one to die in an ER waiting room waiting to be seen.

[OBTS]

Was the message from the media that a person should not die after they get to the hospital or that they should not die in an ER waiting room waiting to see a doctor?

 

I don't have all the facts either. But I do know if a person is regularly and properly reassessed, his chances of survival go up exponentially, because changes are noted, one assessment to the next. Trends in condition are revealed. This guy didn't just come in, was assessed, then reassessed every 15 minutes to half hour for 18 hours and 45 minutes with no change, then all of the sudden his condition deteriorate which led to his death.

 

As I said, I don't have all the facts. But his guy believed he was in bad enough shape to stay at the hospital and wait for 19 hours hoping to see a doctor.

 

Someone dropped the ball.

 

Would ETMC or TMFHS reassess every 15 minutes? In my experience there, that is not the case. I'm concerned that Americans consider the ER to be drive-thru service. In and out in 15 minutes with a miracle cure/pill?

 

I agree that 19 hours is nuts. I'd love to be a juror in this civil case--Parkland definitely has some splanin' to do. I'd love to hear their side of it.

 

[c-train]

Emergency rooms have become a lot of peoples doctors visits. I've seen too many times where people take family members to the emergency room because they can't afford a trip to the doctor with just common problems. This in turn causes major "log jams" for the emergency room staff. How do you fix this problem?????? If you show up to the emergency room, you're gonna get treated. Lots and lots of immagrants have figured this one out!!!!!!!!!!

[Guest bleeds]

Would ETMC or TMFHS reassess every 15 minutes?

 

I don't know. I don't live in Tyler. Fact is, I don't even know if Paris Regional would. But the basis for the decision of whether a patient is in immediate need of medical attention is obviously his condition. If initial assessment indicates he can wait, he is not seen immediately. However, that condition must (or at least should) be reassessed regularly so as to be able to make a determination as to whether the patient's condition has improved, deteriorated, or stayed the same. That way, he is seen as his condition warrants. Obviously that did not happen in this case. Rarely does a patient go from not needing to be seen, to dead without something either being overlooked or a failure to reassess.

 

[BluePirate]

Emergency rooms have become a lot of peoples doctors visits. I've seen too many times where people take family members to the emergency room because they can't afford a trip to the doctor with just common problems. This in turn causes major "log jams" for the emergency room staff. How do you fix this problem?????? If you show up to the emergency room, you're gonna get treated. Lots and lots of immagrants have figured this one out!!!!!!!!!!

 

Perhaps emergency rooms should utilize the "right to refuse" like many ambulance services do. What that means is if the patient assessment finds that no emergency exists then patient transport is denied. I believe the same should take place in ER triage... if there isn't an emergency, send them to minor care facilities.