Missing a Heart Attack in LA: How Much to Prevent One Death?
So there was this horrendous story out of Olive View-UCLA where a young gentleman died after spending three hours waiting in an ER. His presenting complaint was chest pain and he died of a heart attack. He was 33.
An interesting, and well-written addition to our previous post about a death in (or, outside) an ED.
Hi grunt Doc-I hope it is alright that I linked you to my recent coffee post so people could see your coffee idea. I’m using it now to try to use up my 4 cans of opened coffee that I don’t seem to like anymore.
Thanks for the tip! :)
it’s nice that you will just blindly listen to the media and help spread false news as to what really happened to this young man. the real “horrendous” tragedy in this case is the horrible miss management in the way county hospitals are run under Antonovich’s jurisdiction. this poor nurse is being made a scapegoat for an understaffed overbooked hospital. if it was something as simple as chest pain the proper protocol would have been followed but it wasnt. the triage nurses credibility is being ruined and people like you and the media who dont care enough to investigate whats really going on are to blame for all that will happen to this nurse and those that work at ovmc. as a doctor its apparent this would have happened to anyone. this is an isolated case that couldnt have been treated right due to understaffing and missleading comments being made during the triage. those of you in the county medical community that care at all about how things are run need to submit their concern to Antonovich’s office to try to save the triage nurses reputation and help make county hospitals a better place to work and to be seen as a patient.
I read a news article and commented on it. If there’s more to the story, from a credible witness, we’d all love to hear about it. However, the story told in the news looks very bad for the triage nurse, and frankly is a LOT worse for the dead person. Before you snark at me, re-read your comment and find the compassion for someone who went for help and didn’t get it.
As a doctor it’s NOT apparent ‘this would happen to anyone’. Not at all. From here it looks like a pretty egregious miss.
It’s not clear your role, if any, in any of this. What is your level of knowledge that wasn’t reported?
for starters the autopsy report has yet to be completed and no one knows if this man has even died of a heart attack. “information” was leaked to the media and they chose to run a story about a horrible negligent nurse that let a man sit for three hours to die. i am a credible witness so im not at liberty to get into the specifics because the nurse in question is still fighting for her reputation and job. when i said “it would happen to anyone” yes in this particular case where a 33yo with normal vitals and blood pressure complaining of symptoms of gastritis after returning from a weekend bender in vegas can be kept to wait in a flooded er with no staffing or beds. any nurse seeing that patient that day would have chose what the triage nurse did. its horrible that something like this can happen to a patient but his unfortunate death should show just how miss managed the county system of los angeles is. staking his life on a simple ekg test (wich isnt normal practice in this county hospital it is to give a rythm strip once the patient has been brought back to a bed) is proof that something far worse was not easily seen. now you have and er of doctors and nurses afraid to do their jobs. you have a nurse who has all the blame put on her and now has to defend her decisions and medical liscence in the face of the media calling her a killer. the media is making it seem like the patient walked in began to say obvious sign of an oncoming heart attack but was told to sit down and shut up by some nurse ratchet. sorry to be snarky i know this is a horrible tragedy but if you read the article you pulled a line from you would see that it depicts a picture of what really happened from an unbiased point of view. an ekg would not have saved this mans life wich is their sole basis for ousting a nurse with almost 20 years experience. instead you chose to focus only on what every newspaper article has copied and pasted all over the la times and local news.
Very interesting comments.
Before we all jump on the “expert witness for the plaintiff” bandwagon, perhaps an examination of the source of the story is in order. I ask all ER Docs: When has the newspaper ever got it right? I find that in general, in their reporting they almost always have an agenda for the story, and pick the facts that support their agenda. The only truth we have here is we don’t know what happened. “Dr” seems to know what really happened, but we can’t verify the source. Personally, I would believe “Dr” more than I would believe a newspaper story.
The question (after examining the source of the story) we should ask is “is there a situation in my ER where this could have happened, and could I have arrived at the same conclusion as the Dr/Rn?”. The answer to this question should be defined as “standard of care”, not hauling out the retrospectoscope and stating “this would not happen in my ER”. Retrospectoscope thinking is what lawyers thrive on. And, situations like this occur in all ERs. Then the next question should be “how do we reasonably prevent it in the future?” I use the word reasonably because I don’t think doing EKG’s on 10 yr olds with chest pain, or screening abdominal CT scans for belly pain is the answer.
Sadly I have worked in many hospitals that were understaffed, lacked empty ER beds and defined medical practice as “trying to organize chaos with a pencil”. I think it is high time that we stop prostituting ourselves to the lawyers and collectively point the finger at administrators, insurers, lawyers and government and say “we did our best, now it it time for you to accept responsibility”. But, as usual, there will be a scapegoat and a settlement for millions. And the system will progress to a death of a thousand cuts.
Dear “Dr.”,
the ‘one sentence pulled from an article’ is part of a link to a full blog post by another blogger, who has linked the entire news article in his blog post.
I blogged on this independently a day or two before, and also linked to the entire news article. This isn’t selective quote pulling to disparage any particular person, it’s focusing on the meat of the reported event.
You system’s broken? Fix It. It takes little manpower and investment to do an EKG at triage. None of us work in a perfect place with everything we need; the focus has to be doing the best with what you’ve got.
Best for the patients, by the way, and nobody else.
thank you igloo for your comment. what needs to be done in this case to help this nurse and help put a better system in motion so a patient like this isnt overlooked again is to write or call your cities board of supervisors. in ovmcs case im asking all staff and all concerned citizens to write or call mike antovich’s office directly. its clear that this was leaked to the media and he is trying to throw this poor nurse out on the street, problem solved. people need to understand these are elected officials and we should not be content to sit around and let them maintain a horrible system getting rich of our tax dollars and doing nothing to show care or concern for patients and our staff. previously at olive view a homeless man taking up residence at ovmc (which is tolerated for some crazy reason) was found dead in a wheelchair after a few hours in front of a drinking fountain. no policy was changed no one was reprimanded because on paper he was never signed in. all the board of supervisors did was put a mirror next to the fountain and call it at that. its frightening to know that what goes on is less important than what is written on paper and those that know that can cover themselves anytime. the only thing this nurse did wrong was chose to hold off on her paperwork and continue to see patients that were flooding in and breaking into the triage room. this is all i have to say because things are still being investigated and the service union is still working with the triage nurse who wasnt supposed to be in triage. please take five minutes of your time to express your concerns in writing. you can find all antonovich’s contacts on his site or the la board of supervisors site as well. we have to try hard as citizens and medical staff to not let this happen to our patients or our nurses.
grunt doc its obvious you dont know this hospitals policies but are content to say this is what i would have have done with a holier than though attitude. “You system’s broken? Fix It.” this will never happen unless people do what i suggest and contact the board of supervisors immediately. then again i guess its easy to give an opinion resolved from little facts from a thousand miles away. i would appreciate it if you would leave this article alone until all the real facts have been released to the media. so until then just tell people better ways to use coffee and leave this article alone until the real news has been given.
I can and will comment on anything public I choose to. It’s a public news report, which I wrote about once, linked to another blogger once, and to which you’ve commented four times.
I’ve worked in crappy county facilities in California. I’ve been on teams that worked together to fix problems. It can, and does happen. That doesn’t make me holier than though, it makes me experienced (and not a whiner, but a doer).
What the heck do you need the board of supervisors for, anyway? If you think something needs to get fixed, walk into the administrators office, say “this needs to get fixed, here’s what I propose, let’s work together to prevent another tragedy” and go from there. Asking for the government to fix any aspect of healthcare is a losing proposition.
So, make yourself some coffee (there are directions on this site), screw up your courage and go work on the problem. Or, keep writing comments on a virtually unknown blog that I’m the problem and other people need to fix your hospitals’ problems.
Your actions will be illuminating.
youre equating what administrators do for private hospitals. this is a la county hospital and all decision and policies are implemented by the board of supervisors. ive talked to many administrators many blogs and many malpractice lawyers. ive commented here because your comments are the most infuriating. anyway im done now. enjoy your little site.
Well, now we know. Thanks for responding!
GruntDoc
Forgive my tone, but throwing Dr/Rn under a bus is not going to fix the problem. You are right, it is about the patients. But if we are continually sniping at each other, then the lawyers win big settlements, administration gets to hide behind policy and procedure manuals, and politicians will skewer us for poor medical care.
Is it reasonable to assume that a vomiting/epigastric pain is cardiac? In a 33yr old after a bender gastritis seems more likely, and an EKG would be reasonable as part of the workup. How about in a triage situation where you have a GI bleed with no BP showing up a triage simultaneously with an unconscious bradycardic OD, no staff, no beds, patients flooding in the front door and the only empty bed is the triage bed. I would say you provided a reasonable standard of care if you played the odds and went for the likely diagnosis so you can deal with the critically ill. I would suggest that to delay care to the OD and GI bleed to do an ekg in a low yield situation would be unreasonable, and therefore malpractice.
And what if an ekg was done (because we really don’t know), showed nonspecific changes? No beds and no staff, and he would have been triaged to the waiting room in most of the hospitals I have worked at. Would the death be less tragic?
As I have said, we do not know what the situation was at the hospital. But would it be too cynical to suggest that the story was leaked to taint the jury pool?
Dr. Igloo,
Again, all I have available is what the news report said. Yes, those are universally one-sided in cases like this. That doesn’t make them wrong, but we need to wait for the whole story to come out before any kind of punishments get started. That doesn’t mean practices improvements should wait.
I have said that a patient who presents with the complaints in the news report (chest pain radiating to the shoulder) should have an EKG if they cannot be seen immediately. Although it does reference this report it’s not specific to it.
You’ve included a lot of details not in the news: do you have personal knowledge, or is your scenario (and changed CC) hypothetical?
And, I haven’t thrown anyone under the bus. I have said the processes there need to be looked at and fixed. That’s just common sense.
No, the situations are entirely hypothetical.
I didn’t mean to imply you will throw anyone under the bus, but rather we, in the profession, are just going to watch it happen by the system in place. Maybe a mistake was made, but certainly a patient died and career(s) will end. A nurse will have to carry this burden around for the rest of her(his) life. And Drs and Nurses will undergo the torture of a lawsuit. Lawyers will get rich, a family will mourn and get rich, a hospital administrator may lose 30 seconds of rem sleep, and thankful politicians will have political meat for the grist. An ekg machine with suitable policy directives will be put in the ER triage.
But the culpable will not be held accountable. How did the ER get to the condition described by “Dr”? A homeless man takes up residence in the ER, dies and the administration puts up a mirror by the fountain? I have worked at a hospital where this could happen (and something like this did happen). When we took it to administration, they pulled our contract.
We work in a profession where there is no shortage of people who will throw us under a bus to save themselves. We will always be remembered for that last bad outcome, never for the thousands of good outcomes. I wonder if this is the case here?
Gruntdoc – great website. We don’t always agree, but I am a fan!
I am the person who took chris jones to olive view hospital..and I am outraged at this “Dr” comments above about comming back from a week end bender from vegas! Who in the hell do you think you are saying this you where not with us, you have no idea what we where doing in Vegas! The night before we drove home he was in his room asleep by 10pm, that doesn’t sound like a bender to me. If you where with me when we arrived at the hospital and he gave all the info which are deffinate signs of a heart attack. Chest pain Numbness and pain in the arm shortness of breath…How do I know this I watched my father have two seperate heart attacks and die of heart desease. The eyes in the nurse who took down his infor told the intire story she couldn’t wait to get off of work and couldn’t be bothered to save his life. Human error? Most definately! from someone that was there in person. Over crowded ER? yes with a bunch of people with no health insurance that had the flu and colds and sprained ankles, cloging up the EMERGENCY ROOM so that someone who was in need couldn’t receive the care that I hope someday god forbid if you need you receive. I don’t need the autopsy report findings to know that Chris did not do drugs did not have a siezure…that infact did die of a heart attack and only after not receiving the correct care from the hospital..NO DOUBT IN MY MIND THAT THIS IS THE CASE AND SOON YOU WILL KNOW THE TRUTH ALSO!
This sounds like the worst friend in the world. I’m outraged at your lies. I live in the area in fact I live right next to the hospital and I have read statements from you and your friend in the papers. I’ve never heard of anyone not over indulging themselves in Las Vegas. Also right here in the la times and daily newspaper your friend stated to the hospital that he had been drinking and was intoxicated at the time. If you’ve seen this happen to your father why in the world would you not take him to a local hospital in Vegas? How did he end up at a my county hospital in Sylmar hours and hours away? “the eyes of the nurse said she couldn’t wait to go home and couldn’t be bothered to save his life” how dare you!!?? I’m retired and chose to live next to Olive View hospital because of the excellent treatment I have received from their e.r. over these last 4 hard years. The nurses I’ve met don’t get into this business for money and I’m sure as hell mad that you would infer a nurse not caring for a patient in this situation. How dare you say that all the people in that hospital without insurance didn’t deserve attention over your friend. You make it sound as if he has insurance so why in the world would you go to a hospital full of people who don’t. What kind of person would wish that someone else would get the same treatment your friend did? Why don’t you call up the coroners office and tell them to stop looking into your friends death cause you know exactly what happened. You are the worlds worst friend.
I don’t think it is productive to blame the family, friends or the victim. A similar post on my blog made some valid points. I have edited it for offensive content (which is echoed by some of the more insensitive and brutish statements made here) and reposted with additional thoughts of my own…
http://executivephysician.blogspot.com/2007/11/follow-up-on-la-heart-attack.html
I’ve worked in an ED in Boston where they implemented a policy that any patient that has pain from the neck to the umbilicus automatically recieved an EKG in triage. This is shown to the Attending physician who signs it and decides if the patient can wait in the waiting room or needs to be brought back, without setting eyes on the patient or their chart. As Igloodoc stated, perhaps this person had non-specific ST changes, does this change anything? Or, is this new standard of care causing an increased liability on physicians?
My joint has sort of the same policy, but it’s up to whichever doc the EKG is shown to to decide on a ‘can-wait’ vs. ‘see now’ disposition. In my general experience, only completley normal EKG’s gett o wait, all others are seen Now.
An L.A. County coroner’s spokesman confirmed Tuesday that a 33-year-old man who collapsed and died last month after waiting more than three hours at Olive View-UCLA Medical Center to be treated for chest pains had had a heart attack.
The county-run hospital in Sylmar had failed to administer a simple test to check whether Christopher Jones was having a heart attack when he walked into the emergency room Oct. 28.
Within days of Jones’ death, the county Department of Health Services announced that it was taking steps to fire the triage nurse responsible for evaluating Jones. State investigators are continuing to review the case to determine whether the hospital provided adequate treatment.
Craig Harvey, operations chief for the county coroner’s office, said Jones died from a blood clot and coronary heart disease. Pathologists also found that he had an enlarged heart.
Medical records show that Jones told a triage nurse that he had arm pain, chest pain and chills. His vital signs were taken but he was never given an electrocardiogram, a test used to diagnose heart attacks.
The American College of Cardiology strongly advises hospitals to administer an EKG within 10 minutes of a patient’s arrival at an emergency department if he or she complains of chest pain or has other symptoms associated with a heart attack. If an EKG does not diagnose a heart attack but the symptoms continue, the college advises hospitals to continue administering the test every 15 to 30 minutes.
“They could have helped him,” said Jones’ sister, Sheryl. “We’re upset. He died for nothing because they didn’t want to help him. And this shouldn’t happen to anyone.”
Dr. Robert Splawn, the county’s senior medical director of health services, said the death has prompted Olive View to launch an extensive retraining of nurses and doctors on triage policy. He said the hospital also is revamping the way it assesses ER patients with chest pain.
“It’s very unfortunate that this happened to the patient and to the family,” Splawn said.
Dr. Susan Wiegers, director of the clinical echocardiography lab at the Hospital of the University of Pennsylvania, said Olive View’s staff could have given Jones clot-busting drugs or performed a procedure to unblock the artery had they known he had a blood clot. But she cautioned that EKGs do not always identify a heart attack even if a patient is experiencing one.
“It’s hard to know if they did the EKG whether it would have looked normal or not,” she said. “The difficulty is that there are a thousand things that cause chest pains, particularly in people that young.”
Wiegers, a member of Physicians for a National Health Program, said mistakes are all but inevitable as emergency departments continue to become more crowded with uninsured patients seeking treatment.
This truley sad case does not surprise me. I simply raised my voice on my phone one morning while taking a bath. My high pitched voice reached my neighbors adjoining room and a few minutes later 9 police cars pulled up, broke through my front door. They dragged me half naked and police battered to Olive View Psych. like an emergency case (which I was not). I was a healthy young woman taking up a much needed bed for three weeks. They had no problem lying about my condition and ignoring those who needed medical attention! I have suffered for years from the forced and inappropriiate medicine shoved down my throat, but the people that really needed the treatment were denied. (Ihappened to have EXCELLENT INSURANCE). This hospital has used poor judgement when it comes to addmitting truley ill people. And there biggest mistake is their affiliation with the San Fernando Valley Police Departments. Especially Devonshire Division. (Woman Abusers)
The nurses at Olive View Medical Center/UCLA in the 1990’s were definetly lacking in good training. They strapped me to a gurney for hours while injecting me with medicine I could have been allergic to. I did in fact have a terrible reaction to their drugs. They even tested someone elses urine with my name on it. I am sure as hell they are cruel and responsible for this young man’s death.