Homicide Verdict = EM Death Knell

The lead story for the December 2006 Emergency Medicine News (not avaialble online) is headlined: “Homicide Charges Against ED Stun EM”. It is a story based on the death of Beatrice Vance and our Coroner’s jury verdict of “homicide” (there are no “charges”). For the most part the article is fairly done (although a couple of my comments and my 17 years experience as an ER Doc is garbled). Two key points missing from the retelling of the story of this woman’s death is that her pain on presentation to the ER was “10 on a scale of 1 to 10” and that her daughter had pleaded with the triage nurse 5 times to get her mother the attention she deserved, allowing the American College of Emergency Physicians to comment that patients should “notify the triage nurse right away if medical conditions worsen in an emergency department waiting room” (is that before or after their cardiac arrest?)

I am clear in my quotes in the article that I see this as a system problem and the system needs to be changed to prevent this type of problem. Dr Blum (president of the American College of Emergency Physicians), quoted several times in the article, feels that this verdict will drive doctors away from the field of Emergency Medicine and feels the decision “criminaliz(es) a system problem”. The article also states that “the homicide charges filed in this case (none are filed) may have sounded the death knell (for the emergency care system). [I might also mention that I knew this article was out when I received some “hate” email from an ER doctor in North Carolina.] If only this verdict would have that much “power” and cause some improvement in the system. That is what I hope for. I don’t want Emergency Medicine to circle the wagons and protect itself from the “evil” Coroner’s Inquest verdict; our jury verdict demands improvement.

It is interesting that in the same edition there is a “Quality Matters” column (by Dr Shari Welch) on “Human Error in the Emergency Department”. The author says that errors happen but that it is time for “a new approach”…”we are all about designing an environment where mistakes are anticipated and mitigated, where we create a setting conducive to uninterrupted problem solving, and where we anticipate our own failures”…and….”build a health care system that is safe and reliable.” I and my jury ask for nothing more (or less).

Previous posts on this here, here and here