Monday, May 17, 2010

Responsibility, Revised

I had written a post earlier today but it was brought o my attention (once again by my voice of reason a.k.a. my sister) that I had potentially repeated too much sensitive information. In an effort to not violate HIPPA (and be fined and spend the rest of my life in jail), I deleted that post and am starting over.

I will not tell you where I work. I will tell you that it is a wonderful place despite what I am about to tell you. The thing is, I am pretty sure what happened at my hospital can and does happen in all hospitals across the country. It has really made an impression on me and bothered me in ways I cannot explain. I do not know the solution or the answer but I know that ignoring the problem will not make it go away. I think the responsibility of health care providers to tell the truth to their patients will do more to fix doctor-patient relationships than any other single thing. Sometimes it is not all about the litigation or what someone can do with the truth. It is more about people just needing closure and deserving to know what really happened.

I believe in telling people the truth. I am honest sometimes to a fault. I do not hold much back (as you might have gathered if you read much of this blog). I think others should be honest as well. Sometimes being honest is like handing someone a loaded weapon in that the potential really exists for someone to get hurt. Even with that in mind I think the truth should be told without exception.

I am an ICU nurse. Our nurse patient ratio is 1:2. I am expected to think critically and really understand what is going on with my patient. As an ICU nurse you know everything about your patient without even having to go back and look at the chart. Out on the medical/surgical floors it is so much different. Those nurses have a 1:7 nurse to patient ratio. They are expected to work like a machine. They have little time to really stop and consider the implications of what they are doing. They just quite frankly don't have time.

An order was written by a doctor and it was written incorrectly. It was written so that a patient would get 15 more doses of a medication than they needed and it is a dangerous drug. It is a drug that when levels in the body get high enough can cause a lethal arrhythmia and a patient will die. Because the doctor wrote the order incorrectly and the pharmacy didn't question it and neither did the nurse who had 6 other patients on the med/surg floor, the patient went into cardiac arrest. He was coded, revived, and then brought to the ICU where I work and was placed on a ventilator barely alive. He suffered a series of other health crises and eventually his family withdrew care and he died. Although he suffered from multiple medical problems prior to this, you could have given that medication in that dose to a healthy person and it would have likely had the same effect. The patient died as a result of an error made by a doctor contracted by the hospital, and a pharmacy run by the hospital, and by multiple nurses employed by the hospital.

Here is where the problem is. The family was never told what happened. They were never told that the hospital's error caused his death. Instead, they will be sent a bill for hundreds of thousands of dollars they cannot afford for care they only received as a direct result of something done in error in the hospital. I do not think for even a moment that any of this was done with malice. It just so happened that all of the holes in the swiss cheese lined up just right and all of the safety checks in place fell through. Asked directly I would have told the truth, but the family was not very educated and didn't even know to ask or what to ask. So who does the responsibility to tell the family the truth belong to? The hospital, the doctor, the nurse? Who is going to own the fact that this man is dead because of a mistake?


  1. ugh.. this just really stinks.. I have always wondered about things like this. I believe it would need to be taken to administration and that the hospital should be required to tell the family. The only thing is, if you bring it up then are they going to look at you as a liability?

  2. Risk management is aware and it is in their hands now. The sad thing is that we will have all of this root cause analysis crap and policy changes and whatever and that is great but the family will STILL not know the truth!