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Tuesday, May 22nd 2007

Trusting Patients

Even I – in just the short steps I’ve taken towards joining the physician fraternity – have grown a bit cynical to some patients’ complaints. But this is an utter reminder of how much respect doctors need to treat each and every complaint. Even if some patients make such difficult.

This story from Drew/MLK in Los Angeles is tragic, disgusting, and, obviously unacceptable.

How [Edith] Rodriguez came to die at a public hospital, without help from the many people around her, is now the subject of much public hand-wringing. The county chief administrative office has launched an investigation, as has the Sheriff’s Department homicide division and state and federal health regulators.

The triage nurse involved has resigned, and the emergency room supervisor has been reassigned. Additional disciplinary actions could come this week.

Having recently been seen in the ER, Miss Rodriguez was found wallowing on the ground outside the hospital and taken back to the ER by the police.

“Thanks a lot, officers,” an emergency room nurse told Los Angeles County police who brought in Rodriguez early May 9 after finding her in front of the Willowbrook hospital yelling for help. “This is her third time here.”

The 43-year-old mother of three had been released from the emergency room hours earlier, her third visit in three days for abdominal pain. She’d been given prescription medication and a doctor’s appointment.

Turning to Rodriguez, the nurse said, “You have already been seen, and there is nothing we can do,” according to a report by the county office of public safety, which provides security at the hospital.

She falls out of her wheel chair in the waiting room where the police leave her, and writhes around on the floor without any help. Finally, her boyfriend shows up, and starts trying to find assistance for her.

Jose Prado, returned to the hospital after an errand and saw her on the floor, he alerted nurses and then called 911.

According to Sheriff’s Capt. Ray Peavy, the dispatcher said, “Look, sir, it indicates you’re already in a hospital setting. We cannot send emergency equipment out there to take you to a hospital you’re already at.”

Prado then knocked on the door of the county police, near the emergency room, and said, “My girlfriend needs help and they don’t want to help her,” according to the police report. A sergeant told him to consult the medical staff, the report said. Minutes later, Prado came back to the sergeant and said, “They don’t want to help her.” Again, he was told to see the medical staff.

Finally, the presumably annoyed police, run her name and find she has an outstanding warrant. They arrest her as she iscurled up on the linoleum floor of the waiting room. By the time they get her out to the police car she has no pulse.

The woman ended up having a perforated colon. Related to what it isn’t clear.

LA County’s Chief Administrative Officer, David Janssen, had this to say,

[H]e said, the preliminary investigation suggests that the fault primarily rests with the nurse who resigned. “I think it’s a tragic, tragic incident, but it’s not a systemic one.”

And listen to a county supervisor,

Supervisor Mike Antonovich said he believed care had improved at the hospital overall, but added, “It’s unconscionable that anyone would ignore a patient in obvious distress.”

What? Martin Luther King/Harbor has an absolutely abysmal record, no matter what name it is under. Read the LA Times series on the troubled hospital. And it has a history of being unable to fix its incredible lapses. This story is further proof of that.

I have no doubt Miss Rodriguez’s tragic death certainly does reflect something systemic, no matter what Mr. Janssen contends.

And, perhaps as importantly, it represents huge lapses in personal responsibility. I preach over and over not to jump to conclusions in med mal cases. Even so, how did Miss Rodriguez get out of the emergency room the first time, after being seen, with peritonitis like that? How did MLK/Harbor employ such a callous triage nurse? How did the police ignore Miss Rodriguez’s condition? What about physicians, nurses, or ancillary staff who might have passed Miss Rodriguez on the waiting room floor or might otherwise have known she was in there suffering and yet did nothing?

We should let the investigation play out, but with past history you’d think more heads need to role than merely this triage nurse’s.