Another Patient Dies Unattended in an ER

http://www.sacbee.com/101/story/1167483.html

Roland Banaga, 51, of Richmond, had come into the emergency room around noon Friday, two hours before he collapsed there

"If you're in an emergency room, you're there to be treated. You can't just sit and be neglected."

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One of our local ERs regularly has waits of 12 hours -- 24 hours on weekends when there are more DUIs and bar fight stabbings. 

When I called wanting someone to just look at something extremely painful that might have been nothing or might have been a major problem about to happen, my doctor's office gave me the usual "we're setting appointments 6-10 weeks from now, or go to the ER if you can't wait that long."  So I called the ER and was told "bring a book".  No, the triage nurse would not take 2 seconds to look at it and tell me "looks fine, go home" ... I was going to have to wait 12-24 hours before anyone would spare me that 2 seconds to tell me if I'd wasted my time sitting there. 

And, since my insurance thought this was something that could be dealt with in a doctor's office, they wouldn't authorize an ER visit, so I was going to have to pay $1000 out of my own pocket for the privilege of being ignored for a full day! 

Thankfully, my boss's wife was a nurse.  I called their house, and she just asked me a few questions to save me the trip over to show it to her -- I could describe what I was seeing, and she could easily describe what she was looking for.  At that moment, it was nothing to worry about, just ice and aspirin for the pain unless/until I saw the symptom she'd described; I would've been really peeved to spend 24 hours and $1000 for that information.  (Not to mention, ERs are hotbeds of airborne germs -- not a good place for those of us with fragile immune systems! -- and I would have been extra peeved if sitting there for 24 hours resulted in picking up a bug that cost me additional time off work.)

Someone I know online had a similar problem with the same ER.  She was vomiting frequently (eventually diagnosed as food poisoning) and was told to take a seat.  After waiting five hours -- FIVE HOURS! -- and throwing up the whole time, she was too weak to walk to the ladies room again, and threw up on the floor.  The nurse didn't offer her an emesis basin, or a glass of water, just cussed her out for making a mess on the floor so the nurse had to call someone to mop it up.  Telling the nurse that she was now too weak to stand didn't get her moved up the priority list, she was brusquely informed that the estimated waiting time from check-in to seeing a doctor was still the 12 hours she'd been told when she first came in.

At that point, her companion picked her up, carried her out, drove her to a different ER, and as soon as he said she was too weak to walk, they hustled her in ahead of the patients who'd been waiting.  She was so dehydrated that if they'd waited any longer, she definitely would have been hospitalized and might have died.  But she simply was not a priority at the other ER, even when she reached the danger stage.  If you thought doctors and nurses will bend over backward to care for patients, there's your proof that empathy and preventing further deterioration are not always a high priority.

If it were a one-time thing, a long delay because they were overloaded from a 50-passenger bus accident, there would be nothing to complain about.  But this was a chronic understaffing problem, 24/7, 365 days a year, made worse by the insistence of every doctor at that medical center that anything that couldn't wait 6-10 weeks for a regular appointment should be seen in the ER (including the request that the doctor call in a different prescription due to extreme side effects from the one he just gave you a few hours before).  After all, why should they take $50 for seeing a nurse practitioner when they could get $1000+ for sending you to the ER?  And why should they take $1000 for seeing you in the ER if they can ignore you long enough to get $10,000 for hospitalizing you? 

One of the best-kept secrets is that the medical center actually does have an Urgent Care where you could be seen a lot cheaper than the ER; but neither the phone line nor the ER tells you about it unless you specifically ask, and there are no signs along the drive pointing you toward it (it's halfway across the campus from the ER, and well-hidden to make sure you don't find it by accident) -- again, why should they run you through the Urgent Care for $100 if they can make $1000 by leaving you in the ER, or $10,000 if they ignore you long enough to require hospitalization?

Fortunately, one of the bosses had to deal with the same thing, waiting 24 hours for a worryingly sick child to be seen, and that experience convinced him to change our insurance so that we would not be required to use that ER.  The new medical group had an Urgent Care Center where you never waited more than an hour, and the new insurance had an Ask-a-Nurse telephone line that would, like my boss's wife, ask questions on the phone that might save you a trip to Urgent Care if the most worrisome symptoms were absent.

My new doctor is even better.  He reserves about a quarter of his appointments for emergencies; I can always be seen the same day or the next day, in his office.  Instead of having to explain my complex medical history to an ER nurse, I'm treated by someone who already knows what we have to be extra-careful about.  If I'm not sure if I need to actually see him, he'll personally return my call and ask the triage questions to determine if it's something serious or most likely nothing to worry about.

Hospitals need to be held accountable for patients who die in the ER, or whose condition gets worse while they are kept waiting for hours.  There's already a move afoot in several countries that insurance will not pay for treating hospital-acquired infections -- the hospital whose shoddy sanitation caused the problem has to pay the price for their failings; perhaps they should add that insurance also will not pay for hospitalization resulting from conditions that could have been headed off at the pass with prompt treatment.  If, like the gal from my online group, the patient gets tired of waiting and goes to a different ER, and is then hospitalized there because the delay caused her to get worse, the hospital bill should be sent to the ER that ignored her for hours on end.  Eventually, enough of these bills for extra treatment required due to excessive waits may convince them that it's more cost-effective to fully staff the ER than to let patients wait, untreated, until the situation becomes dire or even fatal.