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I thought this story might be of interest to some people. The family in question has dropped the lawsuit - which they would almost certainly win - in return for aggressive reforms related to the death of the journalist in question. They reserve the right to resume the lawsuit if promises aren't fulfilled.
quote:The family of a slain New York Times journalist yesterday agreed to forgo the potential of millions of dollars in damages in exchange for something that might be harder for the D.C. government to deliver: an overhaul of the emergency medical response system that bungled his care at nearly every step.
David E. Rosenbaum's family said it will give up a $20 million lawsuit against the city -- but only if changes are made within one year.
Under a novel legal settlement, the city agreed to set up a task force to improve the troubled emergency response system and look at issues such as training, communication and supervision. A member of the family will be on the panel.
Although legal experts said the family could have won millions had it pursued the case, Rosenbaum's brother Marcus said he and other relatives were more interested in making sure that the city enacted measurable changes.
"As details of the case started to come out, we decided among ourselves to do something for all the citizens so that things would be improved," Marcus Rosenbaum said, standing next to a dogwood sapling planted near where his brother was mugged in January 2006. David Rosenbaum was pounded on the head with a metal pipe by robbers who accosted him during an evening walk. He then was mistakenly treated as a drunk by D.C. firefighters and other emergency workers, who failed to notice his severe head wound.
Rosenbaum, 63, died of a brain injury two days after the attack on Gramercy Street NW. He had recently retired after nearly four decades at the New York Times, where he covered economic policy and other issues, but continued to work in the Washington bureau on special assignments.
The D.C. inspector general's office issued a blistering report in June that faulted firefighters, emergency workers, police and hospital personnel for an "unacceptable chain of failure" and warned of broader problems with emergency care. The report called for stronger supervision and training, clearer communication and more internal controls for emergency workers and hospital personnel.
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This is fantastic. I think it's wonderful - it very closely ties lawsuits to what I think they should do: change the behavior that caused the problem in the first place.
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I'm with Katie-- this is exactly what lawsuits are for, to make a change in the system that let a wrong thing happen.
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In an ideal world, that's how it would work.
Unfortunately, I can think of plenty of organizations, entities and institutions that would prefer to fight and lose a case like this than invite a review of their procedures and introduce the concept that there is a place for openness and accountability in their operations.
To be honest, I believe most hospitals and nursing homes wouldn't readily participate in something like this.
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Wow. That's a powerful and admirable stance for the family to take.
Why didn't anyone do a blood alcohol level on him? That seems automatic at all the ERs I've been in. Or had he been drinking, then been assaulted, and then when his BAL was high, the mental status changes were only attributed to that (instead of looking for trauma causes)?
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quote:Originally posted by ClaudiaTherese: Wow. That's a powerful and admirable stance for the family to take.
Why didn't anyone do a blood alcohol level on him? That seems automatic at all the ERs I've been in. Or had he been drinking, then been assaulted, and then when his BAL was high, the mental status changes were only attributed to that (instead of looking for trauma causes)?
There isn't much of anything about this that points to the emergency workers doing their jobs well.
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quote:Rosenbaum, 63, a recently retired New York Times reporter and editor, was taking a walk near his home in upper Northwest Washington when he was apparently assaulted and robbed of his wallet, authorities said. Rosenbaum, who was not drunk, died Sunday at Howard University Hospital, authorities said. [italics added]
--- and more details, same article (Jan 11, 2006):
quote:Police officers, who arrived quickly after the emergency call, thought Rosenbaum had suffered a medical problem, such as a seizure, officials said. They did not realize he was a crime victim, because he was wearing his watch and wedding band, and a portable radio was resting nearby. ... Four firefighters on the firetruck and the two emergency medical workers on the ambulance thought that Rosenbaum was intoxicated, the sources said. Rosenbaum was disoriented and tried unsuccessfully to get up, police said. There were no apparent signs of major trauma to his head, police and fire officials said. One police official said that only a "small bump" was visible on his head.
Once they got to Howard University Hospital, the ambulance crew members told hospital workers they thought the man had been drinking, the sources said. Rosenbaum went through a triage area in the emergency room but did not appear to have been examined for at least an hour, the sources said. A hospital nurse did not begin to evaluate Rosenbaum until he began vomiting while on a stretcher in a hallway, the sources said.
Only after he was checked by doctors did authorities learn that Rosenbaum had suffered a massive head injury, either from being struck on the head or hitting the ground.
Wow. So horrifying.
This is a know problem for people with Type I diabetes, too. Extreme hypoglycemia can look like drunkeness, and there is often an off odor to the breath (ketone bodies) which could be mistaken for the odor of alcohol.
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In my limited experience with emergency medicine (as patient or friend of patient), the EMTs and ER nurses and doctors seemed particularly concerned about identifying the cause of altered mental states. None of my visits involved bleeding, breathing problems, or heart issues (the ABC we learned in life saving class in the scouts), and all my pop-culture experience suggests those would come first.
But the signs of mental alteration (alcohol once (not me), shock once, and (tiny little) bump on the head once) were the focus of almost everything they did until the had identified the cause.
All those stroke commercials ("time lost is brain lost") seem to suggest that's important, too.
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Excuse me, but isn't 'setting up a task force' roughly the equivalent of a Congressional Bill being set to committee? I've always taken this as a way of placating the public, filing the problem away, while the government goes on, business as usual.
I think the Families should have won the law suit, than said we will wave payment, if you will impliment changes to our satisfaction. Even still, it is possible the government would have preferred to pay the money rather than actually do their jobs. Likely the money would have been paid from some kind of insurances, so in reality, no money out of their pocket.
The way it is, you are asking politicians to spend money they clearly have been resisting spending. You are also trusting them to be as good as their word; which is a huge mistake by any measure.
I don't think they should drop the law suit that, limited as it may be, is the only leverage they have over the politicians. They should suspend the law suit pending a positive and satisfactory out come of their demands for reform.
In another law suit a family sued the city for not having adequate communications capability between police and dispatchers. Their son (or daughter) died because the city said it couldn't afford new equipment. So they sued and won, and took the millions they earned and used it to buy the city a new communications and dispatch system.
Trusting politicians to form a 'task force' that has any real intent to accomplish anything is right up there on par with pulling teeth from a chicken.
quote:Originally posted by Dagonee: In my limited experience with emergency medicine (as patient or friend of patient), the EMTs and ER nurses and doctors seemed particularly concerned about identifying the cause of altered mental states.
It seems from my brief read that the problem with no identification of a cause other than alcohol lasted until he was evaluated by an ER nurse (or physician -- the timing isn't quite clear). Not that it couldn't have been missed by those evaluators as well, just that there are pretty standard protocols in place to screen for this once you are in the ER system.
One huge problem is that he didn't get into that system (i.e., be evaluated by an ER triage nurse) for some time -- he waited for help, then waited through the drive, then waited in the waiting room unseen.
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quote: Trusting politicians to form a 'task force' that has any real intent to accomplish anything is right up there on par with pulling teeth from a chicken.
That may be, but this is "trust" with a both stick and carrot attached. There is a time limit to the process. According to the article, at least one family member will be involved. If the family isn't satisfied with the efforts, they go back to court (I suspect there is probably some kind of formal agreement defining "progress" or "success.").
And this one isn't a matter of cutting a check and buying equipment. It will involve a system of training and accountability.
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Oh my God! What were all these people thinking? Didn't anybody even notice that he didn't smell of alcohol?
I went to the ER one time after I got hit in the head by a raquetball traveling at high speeds. Hurt like heck but turned out no lasting damage. Still, they asked me a dozen questions to make sure I didn't have memory loss or anything. They did this BEFORE I even completed my registration and certainly before I waited an hour for my turn at a doctor.
How, then, can a man come into the ER, incoherent, and not be given some kind of initial screening to determine how bad things were?
I hate to say it, though, but I don't know what policies are going to make a difference. This case sounds like it was based largely in sheer human stupidity and prejudice. I admire the sentiment of giving up 20 million for changes, but I think the gesture will be largely for nothing in the end.
quote:This is a know problem for people with Type I diabetes, too. Extreme hypoglycemia can look like drunkeness, and there is often an off odor to the breath (ketone bodies) which could be mistaken for the odor of alcohol.
Yeah, this is why my diabetic friend wears a bracelet at all times.
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quote:I think the Families should have won the law suit, than said we will wave payment, if you will impliment changes to our satisfaction. Even still, it is possible the government would have preferred to pay the money rather than actually do their jobs. Likely the money would have been paid from some kind of insurances, so in reality, no money out of their pocket.
The way it is, you are asking politicians to spend money they clearly have been resisting spending. You are also trusting them to be as good as their word; which is a huge mistake by any measure.
That is not the way I understood the settlement. It says specifically they will give up the law suit if changes are made within one year. Of course I haven't seen the legal text of the document but it sounds as if the agreement allows the family to resume the lawsuit if changes are not made.
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quote:Originally posted by Altáriël of Dorthonion:
quote:One police official said that only a "small bump" was visible on his head.
So, only if he had seen a cartoon style ginormous bump would he have thought the injury was worse?
Yeah. When I was in elementary school even the school nurse (who wasn't really a nurse) knew that if there was ANY bump on a head after a fall or blow to the head, a parent had to come get us and take us to the doctor to get checked out.
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We (DC) have a new mayor, Adrian Fenty. He is extremely popular and energetic. (Case in point - he will almost certainly be successful in taking over the school system, which his predecessor failed to do a couple years ago.) I, personally, think he is a good guy - a real DC native who wants to make DC better. If real reforms are going to made, now is when it's going to happen.
quote:Oh my God! What were all these people thinking? Didn't anybody even notice that he didn't smell of alcohol?
You can get drunk w/out smelling like alcohol.
quote:I went to the ER one time after I got hit in the head by a raquetball traveling at high speeds. Hurt like heck but turned out no lasting damage. Still, they asked me a dozen questions to make sure I didn't have memory loss or anything. They did this BEFORE I even completed my registration and certainly before I waited an hour for my turn at a doctor.
How, then, can a man come into the ER, incoherent, and not be given some kind of initial screening to determine how bad things were?
The difference between your situation and Mr Rosenbaum's is that the method of injury in your case was known. Since you had an obvious case of potential head trauma, you were seen w/out delay.
In Mr Rosenbaum's case, the mistake was made by the responding EMTs. By incorrectly identifying his problem, he was placed at a low priority*. The fault really lays w/the EMTs. There is no reason why they should have failed to do a more thorough examination.
*So many of the calls that EMS runs are drunks in varying stages of lucidity. So it's understandable that once the ambulance arrived at the ER, the 'drunk' patient was a low priority and wasn't seen for some time.
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quote:Originally posted by Dagonee: In my limited experience with emergency medicine (as patient or friend of patient), the EMTs and ER nurses and doctors seemed particularly concerned about identifying the cause of altered mental states. None of my visits involved bleeding, breathing problems, or heart issues (the ABC we learned in life saving class in the scouts), and all my pop-culture experience suggests those would come first.
When my father had his aneurisms (4 in 1980), the first doc he saw said he was drunk and sent him home. This, despite total amnesia. A couple of days later, after he complained of migraines, another doc gave him pain killers and sent home. My father wasn't properly diagnosed until 10 days later at another hospital with a head swelled up and black and blue and purple from the bleeding.
I've had severe asthma attacks that resulted in me nearly passing out, and yet I still waited in the ER for 4-6 hours before seeing a doc or a nurse. People with cut fingers got in before me, since they were bleeding, after all. I couldn't even speak, so I couldn't actually say anything to the lady at the registration desk, not that she would have cared.
Throwing up from a gall bladder attack got me in straight past the registration lady though. Go figure. I guess the next time I have an asthma attack at a Canadian hospital, I'll have to make sure to throw up as soon as I get there. [/sarcasm]
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It shouldn't happen. It can't be the norm, though, or the morbidity and mortality rates would be worse. Most of the care given both in Canada and the US is fantastic.
The times when it isn't still shouldn't happen.
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What if the family went after the violent attackers instead of the EMTs--as in lobbying for a crackdown on poverty in the D.C. area?
Not that I don't think it's a great move to forgo the lawsuit in favor of government enacting change (seriously, what a cool move), but the first thing that popped into my head was that the real problem was that he was attacked--probably by impoverished inner-city thugs. The bigger problem I see is socio-economic inequality.
The fact is, doctors and EMTs do make mistakes, but it's very rarely big mistakes like this one. By forcing the government to spend money on this, it's taking money away from other things that might need it more. I also imagine that more regulations for the hospitals are going to somehow drive prices higher, making health care even more difficult.
Anyone see where I'm coming from?
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I think that when there are bad medical outcomes that could have been prevented, pressure has to be put on the system. The standards have to be kept excruciatingly high.
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