Tuesday, June 26, 2007

MLK

A woman died waiting in the ER at the troubled MLK hospital in LA. One particularly shocking element to the story is that the woman called 911 from the ER itself, and was not helped.
LOS ANGELES - A woman who lay bleeding on the emergency room floor of a troubled inner-city hospital died after 911 dispatchers refused to contact paramedics or an ambulance to take her to another facility, newly released tapes of the emergency calls reveal.

Relatives said Rodriguez was bleeding from the mouth and writhing in pain for 45 minutes while she was at a hospital waiting area. Experts have said she could have survived had she been treated early enough.

Relatives reported she died as police were wheeling her out of the hospital after the officers they had asked to help Rodriguez arrested her instead on a parole violation. Sheriff’s Department spokesman Duane Allen said Wednesday that the investigation is ongoing.
The MLK ER was almost shut down a month or so ago, and the California Emergency Physician's ER group (where my wife works) picked up the contract at the last minute, keeping the ER open. After the lady died, the ER, and the whole hospital, may be closed down.

ERs are heavily regulated. They have to admit and treat all patients who walk in, regardless of ability or willingness to pay. Most ERs only have a small (~30%) successful bill rate. Triage in the ER is focused on people who have potentially life threatening conditions -- such as strokes and heart attacks. Non-lethal, but unpleasant conditions like broken arms wait. ERs cannot transfer patients to other hospitals. A recent law passed in California has made it illegal to discharge people to the street, even if they are homeless.

The consequence of all these regulations is that ERs become choked with "frequent fliers" -- who are often drug users who live on the street, and come into the ER repeatedly for more drugs, warmth, food, company, etc. If they are admitted to a bed, which they must be if they complain of "shooting pains in the left arm", they stay in the bed until the ER finds a shelter that will admit them that they can discharge them to, since they can no longer be discharged to the street. While they are in the waiting room, they take up attention and resources from other patients. While they are in a bed, no other patients can be admitted. While a nurse is trying to find a shelter for them, she cannot be treating patients. Frequent fliers tend not to stay in shelters. The only way and ER can deal with these regulations is to exist somewhere too far for high frequent flier populations to get to.

It's also extremely common for patients to call 911 from ER waiting rooms, and even when they are admitted and are in a bed. While the newspapers have played up this angle as if it's shocking and highlights the awfulness of this case, the truth is that patients call 911 all the time asking to be sent to a different hospital for a whole variety of reasons ("tired of waiting", "won't give me drugs", "don't like it here", etc.) They are routinely turned down as ambulances are for taking people to hospital, not shuttling people from hospital to hospital until they find one they like.

The case of Rodriguez is tragic, but it's also not surprising that someone coming in with nausea would be triaged down in a busy ER. It's also not surprising that a busy ER, filled with frequent fliers, would move through patients slowly. The call to 911 from the ER waiting room is common enough to not be worth mentioning at all.

From news reports, it sounds like the MLK ER, and maybe MLK itself, will be closed down. The consequence of this is that patients will have to be sent to hospitals further away. They are therefore more likely to die en-route, because they could not get care in time, or they will simply die at home (after deciding that the hospital was too far to get to). These events will probably not make the news, nor will MLK's population be better served.

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