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Edited on Sun Feb-15-09 11:08 PM by bluedawg12
There are two part to this case as I understand it:
1.) Patient care
2.) How the family of the patient was treated.
Let’s start with your first claim about the medical bay.
You are simply wrong.
Family members are brought into the ER bay, or the ER room to obtain a medical history especially if a patient is in critical condition, is anxious, in pain, medicated, in the midst of undergoing emergency studies, suffering from a ruptured cerebral aneurysm, or otherwise altered mentally or obtunded and cannot provide a thorough medical history.
“Working feverishly,” as you claim, means obtaining a thorough medical history from any and all available reliable sources. In the bay or in the hall, is immaterial, a history must be obtained and family members are the ones who most often assist.
Do you know the mental status of the patient at 3:25? At 4:15 PM?
Do you know her Glasgow Coma Scale score?
Do you have information that the patient, who was suffering from a cerebral bleed was in full possession of her mental capacity?
Do you know if she was given any pain medications?
Do you know if she was given any sedatives?
If you do not, then, you cannot state that the family’s additional medical history was not necessary.
Let’s assume that the records will show that the patient was able to provide what appeared to be a reasonable medical history, while suffering an acute cerebral bleed, and that alone strains credibility.
Even if the patient was able to provide some level of a medical history, it is customary, prudent and reasonable, to double check the medical history provided by a patient in an extremely critical condition and double check the facts against the medical history provided by capable and willing family members.
Elements of a complete medical history should include, past medical history, same or similar symptoms, medications, allergies, history of recent trauma, surgeries, family history, etc. etc.
It does not seem credible, that a patient who collapsed of a cerebral aneurysm had full mental capacity to provide such detail. The facts in the records will speak for themselves.
Next, let’s assume that the patient did give a through and complete detailed medical history and the records confirm that, unlikely as that seems, no additional past medical history was required.
Tell me, how would you know if the patient with an actively bleeding cerebral aneurysm omitted some part of that history, unless one checked it against another source, such as a family member?
Next, what about the scene of the incident? It is customary, prudent and reasonable and perhaps necessary, to obtain additional eyewitness history of the events at the time of the catastrophic collapse of the patient from family members who were eyewitness to the events and who are available to provide such a history.
The family, according to the complaint, were not contacted to obtain either a confirmatory medical history, nor to provide an eyewitness description of the incident, nor any of the events prior to the incident on the day of the acute event.
Had the patient complained of any head aches? Struck her head? Complained of nausea? Double vision?
That information, which may have yielded diagnostic clues to the nature of the condition were not obtained as the patient’s family was denied in-put about the patient’s health status prior to arrival.
That does not appear to coincide with prudent and customary medical care.
Would or could that have made a difference? That is what the records will show.
Regardless of the final outcome, one could argue, that, by not obtaining a thorough and timely medical history from family members, that a delay ensued in providing care, and, that the possibility exists, that a record reviewer of the facts of this case may find that even a quick 5 minute discussion with family members could have pointed to a clearer clinical picture. I do remind you, that while we have not had access to the full medical records, plaintiff’s counsel has.
As it stands it is a legitimate question and will be revealed at trial, if the family is allowed it’s day in court.
With regards to the staff being too busy to talk to the family and the concern about the ER bay being off limits while the health care team was “working feverishly.” Surely, you do not suppose that while the patient was undergoing a cerebral aniogram, or perhaps a MRA of the brain, or MRI of the brain, that the entire health care team was huddled on the MRI table or angio-room on the gurney, with the patient?
Moving beyond mental competence to provide a medical history, what about mental competence to provide an informed consent?
If the records show that the patient was in anyway obtunded or medicated, then, with a properly executed health care POA, any treatments, or invasive testing must be performed after obtaining an informed consent from the POA. An informed consent has several elements to it, among them a through discussion of indications, alternative options, risks and benefits.
I am only confining this discussion to the patient care situation and not how the family was treated, in the interest of time.
The patient had the right to see her family, her loved ones, which means not only her partner but her children.
The family arrived at 3:15 PM. A seemingly hurried consent for what appears to be the insertion of a ventricular monitor was obtained from the partner at 5:30 PM. This was not an attempt to repair the aneurysm, in case any one imagines it otherwise. No comment is made, what so ever, on the appropriateness of the probable monitor and care, as I don’t know the facts. However, according to the records, the patient was not allowed to see her family until three hours elapsed and until she went into surgery and not before, and the first time the family was allowed at beside was for the last rites being administered to the patient by a priest.
It appears, based solely on the facts provided in the complaint that the patient, allegedly, was deprived of the love and comfort of her family at beside for the first three hours after arrival, deprived of the love and comfort of her family even before, or while, she was being wheeled into the OR and that it is not in keeping with what is the customary practice in regards to compassionate care of patients who are customarily allowed to see their family prior to surgery and anesthesia.
According to the records the first time the family was allowed to be present and to comfort the patient was after it was too late for the patient to derive any comfort from their presence, at her own last rites.
She expired three hours later, as I recall, the facts.
According to the complaint, there was no medical justification for keeping the family from the patient’s bedside.
According to the complaint:
On page 10 of the complaint, it states that, upon arrival at Ryder, the partner/POA informed the admitting clerk that she was able to provide relevant history regarding the patient's condition.
The partner/POA also advised the admitting clerk (Jane Doe) that the patient's children were present at the time.
Subsequent to that, the partner/POA had a conversation with social worker Fredrick. Page 10 complaint.
Between 3:15 PM and 4:15 PM, the partner/POA had provided verbal information about her status as the POA, and while confirmation of documentation was pending, the staff was alerted and knew to anticipate the confirmatory POA.
At 4:15 PM, the POA arrived by facsimile.
It is my opinion, that the social worker and attending physicians had a duty to enquire about family members and about the presence of any POA, as the patient’s primary condition was an aneurysm of the brain and her mental function, regardless of how good it may have been initially, was subject to deterioration by virtue of the diagnosis.
Medicine was administered at 4:30 PM
The patient was taken to surgery at 5:20 PM
At 5:20 PM a consent was obtained for a “brain monitor,” from the POA.
At 6:20 PM two physicians brought the partner and family up to date, during which conversation, the patient’s condition deteriorated.
At 6:50 PM the family was first allowed at bedside, while a priest administered last rights.
............
I speculate that neither you nor I have reviewed the medical records. We don't have the chronology of events, or the facts, to form an opinion about standard of care. However, the legal complaint raises some serious questions. It is a little premature to speculate who would or would not win the case pertaining to a deviation from standard of care and without a thorough review of facts we cannot know. The complaint however, paints a picture that is horrific.
Disclaimer:
I relied on the legal complaint that is available on line for the sake of a forum discussion and have discussed my speculation of the allegations as they are found in the complaint available to the public on line and in various public lay sources from news outlets.
The case has not been tried in a Court, therefore, all comments are speculative and are based on the presumption of innocence until proven guilty in a Court of Law, and are all considered "allegations," in all of my posts by definition.
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